At the last census in 1966 there were nearly 12 million people aged between 45 and 64 in England and Wales. This age group, which for convenience will be termed 'middle age' throughout this paper, covers the second part of economically active life. It is a time during which, while many careers are still reaching a peak, a decline in physical and mental powers has already begun to set in. As middle age is entered, a new phase of life begins. Patterns of morbidity and mortality rapidly alter as degenerative diseases become increasingly more significant. Socially, middle age is associated with a change in the organisation of family life. For women, the menopause generally occurs during the mid-forties. For both men and women, as children grow up and leave home, middle age brings declining parental responsibilities. In this sense the quotation, 'life begins at forty', may seem appropriate, but despite the great advances made during the last century, it is still too often the period in which life prematurely ends.