I read Nicky Hayes and Jonathan Webster's article 'Give old people a seat at the modernisation table', having just given a presentation at the Royal College of Physicians on 'the role of the nurse in musculoskeletal services - care for the older person'.

The special needs of the older person in healthcare delivery are poorly recognised and, as the authors of the feature state, two-thirds of inpatient care is now delivered to a population over the age of 65.

Either we must all become specialists in the care of the older person, with no need for the specialty, or we have to vastly increase this specialism.

But there is another option: should we "raise the bar" on the "older person" criteria, to perhaps above 75 years of age, or base them on other factors such as social/psychological need? In my experience, most patients with osteoarthritis who are over 65 have low expectations of healthcare yet there are many approaches that can help the individual cope.

However, actually getting community services commissioned to deliver this sort of approach has always been a challenge, despite such documents as the Department of Health musculoskeletal strategy framework.

Data capture on this patient group is poor and the cycle of disability, lack of access to practical support and low self-esteem should be addressed.

With the growing elderly and chronic disease populations set to double by 2020, it is time for a strategic approach to enhancing the quality of life of the older person, however that is defined.

Susan M Oliver, chief nurse adviser, National Rheumatoid Arthritis Society