Health Care Quality for an Active Later Life

How successful have we been in England at preventing disease and disability in later life? How well are we delivering high quality medical treatments for the common disabling diseases of later life? How effective are these treatments, given that many have not been tested in randomised trials in older people? These were the questions underlying a programme of work at UEMS on the treatment of older people.

Reports from this research:

2012 report: Health Care Quality for an Active Later Life

Project 1: Age UK programme on health care quality

The University of Exeter Medical School (UEMS) Ageing Research Group was funded by Age UK to bring together recent health data from diverse sources to shed light on the first two questions posed above.

The aim for the initial phase (2011/2012) was to examine the current state of health of the older population, explore the evidence on how the NHS was meeting the needs of the older population and examine whether the current healthcare reforms improved health outcomes for older people. We published a ‘chartbook’ of key information on the health and medical treatment of older people (Health Care Quality for an Active Later Life). This was very well received, with the Department of Health’s then clinical lead for older people using this report widely, including in evidence to a House of Lords committee.

The second phase (2012/2013) aimed to utilise the Clinical Practice Research Datalink (CPRD) and hospital episode statistics (HES) datasets in order to explore the potentially inappropriate prescribing and polypharmacy in older people. We used the American Geriatrics Society prescribing standards and comparing them to the prescriptions actually received by a sample of 50,000 older people in England.

Project 2: NIHR study of quality of treatment for diabetes, cardiovascular disease and osteoarthritis in older people

In a sister project funded by the NIHR, we explored the quality of care received in the English Longitudinal Study of Ageing. Using the Assessing the Care of the Vulnerable Elderly (ACOVE) evidence and consensus based treatment standards1, we estimated achievement of indicators of quality healthcare for diabetes, cardio-vascular disease, depression and osteoarthritis. Additionally, we examined correlates of receiving indicated care, to help guide efforts to improve treatment quality for older people.

Additional projects:

In collaboration with the Henley group, we examined quasi-experimental approaches to estimate the impact of interventions in the elderly, using CPRD general practice and hospital electronic records. Professor Melzer was the national co-lead for the ageing theme in the NIHR National School for Public Health Research, which enabled further development of this programme of work.

Research Team

Principal Investigator:

  • Prof David Melzer Professor of Epidemiology and Public Health, University of Exeter Medical School (UEMS), University of Exeter

Joint PI:

  • Dr Suzanne Richards Senior Lecturer Primary Care, UEMS


  • Prof Paul Dieppe Professor of Medical Education & Consultant Rheumatologist, UEMS
  • Prof William Henley Professor of Medical Statistics, UEMS
  • Dr Iain Lang Senior Lecturer and Consultant in Public Health, UEMS & PenCLAHRC (supported by PenCLAHRC)


  • Dr Behrooz Tavakoly Research Fellow in Health Services Research, Epidemiology and Public Health Group, UEMS, University of Exeter, BSc, MSc, PhD
  • Ms Rachel Winder Research Fellow in Health Services Research, Epidemiology and Public Health Group, UEMS, University of Exeter, BSc, RGN
  • Dr Luke Mounce Associate Research Fellow in Health Services Research, Epidemiology and Public Health Group, UEMS, University of Exeter, BSc, MSc, PhD
  • Mr Adam Streeter PhD student, Medical Statistics, UEMS, University of Exeter, MSc
  • Dr Jane Foster NIHR Academic Clinical Fellow and Specialist Registrar in Geriatric Medicine, Peninsula Deanery & UEMS, MBChB, MRCP

Grant Funding:

  1. Health Care Quality in Later Life: Trends for the UK 2011 to 2014. Programme grant: Melzer D (PI), Suzanne Richards, Paul Dieppe, William Henley and Iain Lang. Age UK, 2011 to 2014
  2. Quality of Healthcare in the English Longitudinal Study of Ageing. Project grant: Steel N, Bachmann M, Clarke A, Campbell J, Henley W, Richards S and Melzer D (Melzer PI of Exeter half of study). UK National Institute for Health Research, July 2012 to June 2014
  3. Fair Comparisons of Interventions: Extending the Prior Event Rate Ratio method (EPERR study). Methodology project grant: William Henley (PI), Chris Hyde, Iain Lang, Dave Wright and David Melzer. (UK) Medical Research Council, October 2010 to Sept 2013
  4. National School of Public Health Research. Programme / infrastructure funding: Melzer D (PI), Charles Abraham, Ken Stein, Lora Fleming. UK National Institute for Health Research, 2011 to 2016


  • Steel N, Bachmann M, Maisey S, Shekelle P, Breeze E, Marmot M, Melzer D. Self reported receipt of care consistent with 32 quality indicators: National population survey of adults aged 50 or more in England. BMJ. 2008 Aug 13;337:a957. doi: 10.1136/bmj.a957. PMID: 18703659