Central issues in future research and policy for chronic diseases

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Abstract
In our ageing societies, with effective health care systems, more and more people will live till old age. It is an achievement of which we can be proud. However, it has implications for the future demand for health care services and financial consequences that need the attention of policy makers. It also has consequences for the main health care problems in future populations that will need the attention of the medical profession. These central issues for future policy at the level of the individual patient and of the population raise questions that need to be addressed in research today. Using a computer simulation model, PREVENT, some of these issues are examined. It is shown that even with extensive preventive interventions absolute numbers of elderly patients with chronic diseases will increase. In fact, effective prevention of mortality in middle-age will exacerbate this effect. Most of the current research on risk factors or clinical trials do not include elderly patients which greatly complicates cost-effectiveness analyses or guidelines for both preventive and curative services. Policy measures will need to take into account the rise in demand and the shift towards more elderly patients. Research needs to shift attention to avoiding or averting disabilities and increasing the quality of life.

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