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Older People’s Needs Assessment of 129 30 August 2013

AN ASSESSMENT OF THE

HEALTH AND SOCIAL CARE NEEDS OF

OLDER PEOPLE

Version

Final Prepared by Marlene McMillan, Andrew Pulford,

Zhan McIntyre, Lynda Hamilton, Maggie Watts Effective from 10/09/2012 Review Date 30/08/2014

Lead reviewer Carol Davidson

Executive Director of Public Health Dissemination Arrangements

Joint Strategy Group for Older People East, North and South Ayrshire Council websites

NHS Public Health Athena website Officer Locality Groups (adults and older people)


Executive summary

Chapter 1 of this joint services needs assessment provides an introduction and overview of the current policy context, both national and local including legislation that are of relevance to older adults.

Chapter 2 focuses on the demography with prospective commentary on what has been described as “the demographic challenge” - rapid ageing of our population and its consequences for population health in the future. Future projections for changes to the population profiles for Ayrshire and Arran and East, North and South Ayrshire are provided (where possible and useful) up to 2035.

Demographic changes in the Scottish and local populations are highly complex. The exact nature of them relies on the success of policy responses in relation to the ageing population, which in turn is dependent on policies relating to the working age population and of young families.

For example, Chapter 2 presents data to show that the ageing population will have implications not only in relation to demands on health and public services but also on potential labour shortages in the future for staffing these services. Understanding the demographic challenge allows agencies to plan for the future impact on services and respond proactively with appropriate policies and service developments. The health service needs to work together with its social, cultural and economic partners who can influence population retention locally and where young people can live, work and raise a family in environments that allows this to be balanced and achievable.

The fact that people are living longer is in itself a major achievement. However, this needs to be achieved for everyone. Mortality, life expectancy and healthy life expectancy are all improving but there are significant variations in health status across Ayrshire and Arran as there are in Scotland, and the key determining factor is deprivation1.

Life circumstances, including a range of cross-cutting factors that have a material impact on the health and well-being of individuals are discussed in Chapter 3. In particular, information on income, housing circumstances, housing options for older people, marital status, household composition, free personal nursing care, supported and sheltered accommodation, care at home clients, fuel poverty, fear of crime and internet use are covered.

Chapter 4 examines lifestyle factors that are known to affect the chances of having the best possible health. This section examines levels of smoking, alcohol misuse, healthy weight, diet and nutrition and physical activity and exercise.

Health Status is explored in Chapter 5 and in particular the issues of life expectancy and healthy life expectancy, all cause mortality, specific morbidities common in older age such as coronary heart disease and stroke, winter mortality, self-reported health status, long term conditions, visual and hearing impairment, oral health, mental health, sexual health and bone health are all included.

Chapter 6 presents information on the use of health and social services. Within this chapter is information on emergency hospital admissions, the use of primary care, models of supply and demand for informal care, estimates of households requiring regular help and care, profile of unpaid carers, the percentage of people spending the last 6 months of life at home or in a community setting and the impact polypharmacy has on admission rates.

Chapter 7 raises a number of important issues, where little local data relating to needs are available. These include poverty, social exclusion, multiple deprivation, gender and ethnicity and health inequalities.

N.B. This needs assessment can be used as a reference document by clicking on the links to access the information required to underpin and inform planning and commissioning of services for older people.


Contents

Chapter 1: Introduction and overview 1.1 The policy context 1.2 Health and social care specific legislation 1.3 National policy 1.4 Local frameworks and policies

Chapter 2: Demography 2.1 Ayrshire and Arran population 2.2 Population projections for Ayrshire and Arran 2.3 Demographic change 2.4 Population projections for Scotland 2.5 Projected population changes for Ayrshire and Arran

2.5.1 Projected population changes for East Ayrshire, 2010 to 2035

2.5.2 Projected population changes for North Ayrshire, 2010 to 2035

2.5.3 Projected population changes for South Ayrshire, 2010 to 2035

2.6 Population ageing in Ayrshire and Arran 2.7 Dependency ratios 2.8 Older people and deprivation

Chapter 3: Life circumstances 3.1 Income 3.2 Housing 3.3 Marital status

3.3.1 Housing quality 3.3.2 Housing options for older people – equipment and

adaptations

3.3.3 Housing options for older people – sheltered housing 3.3.4 Housing options for older people - care homes

3.3.5 Housing options for older people – home care 3.3.6 Free personal and nursing care

3.4 Societal and environmental factors 3.4.1 Internet use 3.4.2 Crime and fear of crime 3.4.3 Fuel poverty 3.4.4 Climate change

Chapter 4: Lifestyle factors 4.1 Smoking

4.1.1 Smoking prevalence 4.1.2 Smoking-related mortality 4.1.3 Smoking cessation services

4.2 Alcohol and drugs misuse 4.2.1 Alcohol

4.2.1.1. Alcohol consumption 4.2.1.2 Primary care 4.2.1.3 Acute care 4.2.1.4 Specialist addiction services 4.2.1.5 Alcohol-related brain damage

4.2.2 Drugs 4.3 Healthy weight 4.4 Diet and nutrition 4.5 Physical activity and exercise


Chapter 5: Health status 5.1 Life expectancy 5.2 Mortality 5.3 Self-reported health status 5.4 Long-term conditions 5.5 The occurrence of specific health problems common in older age 5.6 Sensory impairment 5.7 Oral health 5.8 Sexual health and blood-borne viruses 5.9 Bone health 5.10 Screening and immunisation 5.11 Mental health and wellbeing

Chapter 6: Use of health and social services 6.1 Primary care consultation rates in Scotland 6.2 Emergency hospital admissions

6.2.1 Multiple emergency admissions 6.2.2 Risk of emergency admission to hospital in the following

year 6.3 Older adults with high support needs

6.3.1 Supply and demand of informal care 6.3.2 Older adults with learning disability 6.3.3 Potential supply and demand for informal care

6.4 Carers 6.5 Palliative care and end of life care

6.5.1 Choosing place of death - spending last months at home 6.6 Polypharmacy - pharmacy needs of older people

Chapter 7: Equity and healthy ageing 7.1 Poverty, social exclusion and multiple deprivation 7.2 Impact of health inequalities

7.2.1 Healthy life expectancy 7.2.2 Premature mortality 7.2.3 First hospital admission for coronary heart disease

7.2.4 Cancer incidence and mortality 7.2.5 First hospital admission for alcohol and alcohol

mortality 7.2.6 Mental wellbeing 7.2.7 Incidence and mortality of falls amongst older people

7.3 Ethnic background and equality 7.4 Gender inequality 7.5 Rural inequality 7.6 Expenditure-poor older adults 7.7 Sensory impairment and older adults 7.8 Early intervention and prevention


List of figures

Figure 1: Estimated population by age group and gender in Ayrshire and Arran, 2010

Figure 2: Estimated population by local authority and age group, 2010

Figure 3: Projected population by age group in Ayrshire and Arran, 2010-2035

Figure 4: Percentage of population over state pension age, 2010 to 2035

Figure 5: Five-year average number of birth and death registrations in Ayrshire and Arran, 1991-2010

Figure 5a: Five-year average ratio of deaths to births by NHS Board and Local Authority area, 1991-2010

Figure 6: Population pyramid of Scotland, 2010

Figure 7: Population pyramid of Scotland, 2035

Figure 8: Age and gender composition 2010 for Ayrshire and Arran

Figure 9: Age and gender composition 2035 for Ayrshire and Arran

Figure 10: Age and gender composition 2010 of East Ayrshire

Figures 11: Age and gender composition 2035 of East Ayrshire

Figure 12: Age and gender composition 2010 of North Ayrshire

Figures 13: Age and gender composition 2035 of North Ayrshire

Figure 14: Age and gender composition 2010 of South Ayrshire

Figure 15: Age and gender composition 2035 of South Ayrshire

Figure 16: Projected population by older groups in Ayrshire and Arran, 2010, 2020 and 2030

Figure 17: Projected median age of population; East, North and South Ayrshire and Ayrshire and Arran, 2000 to 2035

Figure 18: Projected dependency ratios for East, North and South Ayrshire and Scotland, 2010 – 2035

Figure 19: Projected old age dependency ratios for East, North and South Ayrshire and Scotland, 2010 - 2035

Figure 20: Projected female population by broad age group in Ayrshire and Arran, 2010-2035

Figure 21: Projected male population by broad age group in Ayrshire and Arran, 2010-2035

Figure 22: Number of people over 65 years of age living in Ayrshire and Arran by deprivation quintile, 2010

Figure 23: Number of people aged over 65 years living in East Ayrshire by deprivation quintile, 2010

Figures 24: Number of people aged over 65 years living in North Ayrshire by deprivation quintile, 2010

Figure 25: Number of people aged over 65 years living in South Ayrshire by deprivation quintile, 2010

Figure 26: Rate of Pension Credit claimants, 2008 and 2011

Figure 27: Rate of Attendance Allowance claimants, 2008 and 2011

Figure 28: DLA claimants by older age bands in East Ayrshire, 2008-11

Figure 29: DLA claimants by older age bands in North Ayrshire, 2008-11

Figure 30: DLA claimants by older age bands in South Ayrshire, 2008-11

Figure 31: Single pensioner household by tenure, 2009-10

Figure 32: Marital status in East Ayrshire of adults aged 35 years and over, 2009-10

Figure 33: Marital status in North Ayrshire of adults aged 35 years and over, 2009-10

Figure 34: Marital status in South Ayrshire for adults aged 35 years and over, 2009-10

Figure 35: Trends in care home places for older people, 1999-00 to 2010-11

Figure 36: Home care clients by age group, 2011

Figure 37: Breakdown of hours of home care for clients aged 65 years and over, 2009-2011

Figure 38: Percentage of households in fuel poverty in East, North and South Ayrshire by age, 2004-07 to 2008-10

Figure 39: Estimated percentage of smokers in the adult population of Ayrshire and Arran by age and sex, 2003-04

Figure 40: Percentage of adults in Scotland that smoke by age group, 2009

Figure 41: Smoking status of patients in Ayrshire and Arran at 1 Jan 2009 as a % of all patients with smoking status recorded by GPs, by age group


Figure 42: Age of clients using local smoking cessation services in Ayrshire and Arran, 2009

Figure 43: Crude rates of all alcohol-related acute hospital discharges (SMR01) for all persons aged 30 years or over by 5-year age band in Ayrshire and Arran (2000, 2004, 2008)

Figure 44: Alcohol assessments by specialist addictions services (2005-06 to 2008-09); age at referral (banded)

Figure 45: General acute inpatient and day case discharges with a diagnosis of alcohol-related brain damage in any position: five-year average age standardised rate per 100,000 population, by health board 2001-02 to 2010-11

Figure 46: Crude rates of all drug-related acute hospital discharges (SMR01) for all persons aged 10 years or over by 5-year age band in Ayrshire and Arran (2000, 2004, 2008)

Figure 47: Expectation of life at birth (LE), by sex for East, North and South Ayrshire, split by level of deprivation, 2006-2010

Figure 48: Male life expectancy and healthy life expectancy at birth in years for East, North and South Ayrshire CHPs, 1999-2003

Figure 49: Female life expectancy and healthy life expectancy at birth in years for East, North and South Ayrshire CHPs, 1999-2003

Figure 50: Age-standardised death rates for all causes, NHS Ayrshire & Arran and Scotland, 2006 to 2010

Figure 51: Age-standardised death rates for all causes, East Ayrshire and Scotland, 2006-2010

Figure 52: Age-standardised death rates for all causes, North Ayrshire and Scotland, 2006-2010

Figure 53: Age-standardised death rates for all causes, South Ayrshire and Scotland, 2006-2010

Figure 54: Seasonal increase in mortality in the winter, by age-group and NHS Board area of usual residence, 2001-02 to 2010-11; Ayrshire and Arran; 5 year average

Figure 55: Increased Winter Mortality index, by age-group and NHS Board area of usual residence, 2001-02 to 2010-11; Ayrshire and Arran; 5 year average

Figure 56: Self-assessed general health, 2008, 2009 and 2010 combined, by age, Scotland

Figure 57: Prevalence of long-term conditions, 2008, 2009 and 2010 combined, by age, Scotland

Figure 58: Heart disease deaths in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band and year of death registration

Figure 59: Heart disease deaths in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age 65-74 years and year of death registration

Figure 60: Heart disease deaths in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age 75 years and over and year of death registration

Figure 61: Heart disease deaths in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band, local authority of residence and year of death registration

Figure 62: Incidence of coronary heart disease; Ayrshire & Arran and Scotland, <75 years

Figure 63: Coronary heart disease estimated prevalence by age and sex for Ayrshire & Arran and Scotland, 2010

Figure 64: Coronary heart disease estimated prevalence for males by CHP, 2010

Figure 65: Coronary heart disease estimated prevalence for females by CHP, 2010

Figure 66: Cerebrovascular disease deaths in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band and year of death registration

Figure 67: Cerebrovascular disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population, (age 65-74 years) and year of death registration

Figure 68: Cerebrovascular disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age (75 years and over) and year of death registration

Figure 69: Cerebrovascular disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band, local authority of residence and year of death registration

Figure 70: Incidence of cerebrovascular disease; Ayrshire & Arran and Scotland, <75 years


Figure 71: Age-specific incidence rates of cancer (all types) registrations in Scotland, by five year age band between 1986 and 2010

Figure 71(a): Age-specific incidence rates of cancer (all types) registrations in Ayrshire and Arran, by five year age band between 2006 and 2010

Figure 72: Age-specific incidence rates of cancer (all types) registrations in Ayrshire and Arran, by five year age band between 2006 and 2010

Figure 73: Number of cancer (all types) deaths in Ayrshire and Arran, by five year age band between 2006 and 2010

Figure 74: Age-specific incidence rates of cancer (all types) deaths in Ayrshire and Arran, by five year age band between 2006 and 2010

Figure 75: Age-specific rate per 10,000 population of COPD admissions by sex and age group for Ayrshire and Arran; for 1997-98 to 2006-07

Figure 76: Percentage with 20 or more natural teeth, and percentage with no natural teeth, 2008, 2009, 2010, by age band

Figure 77: The number of fall related hospital discharges by gender, age group and year, 1997-2009, in Ayrshire and Arran

Figure 78: The crude rate per 100,000 population of fall related hospital discharges by gender, age group and year, 1997-2009, in Ayrshire and Arran

Figure 79: Number of hospital discharges with fracture of the neck of femur as a result of a fall by gender, age group and single year (1997-2009) in Ayrshire and Arran

Figure 80: The crude rate per 100,000 population of hospital discharges with fracture of the neck of femur as a result of a fall by gender, age group and single year (1997-2009) in Ayrshire and Arran

Figure 81: Breast screening uptake by NHS Board of residence: Scotland, 1st April 2004 to 31st March 2011; Percentage uptake (three year rolling periods), females aged 50-70 years

Figure 82: Seasonal influenza immunisation uptake among people aged 65 years and over, 2004-05 to 2010-11

Figure 83: Mean WEMWBS scores, 2008, 2009 and 2010 combined, by age and sex; Scotland

Figure 84: Good, average and poor WEMWBS scores, 2008, 2009 and 2010 combined, by age and sex; Scotland

Figure 85: GHQ12 scores for men, 2008, 2009 and 2010 combined, by age

Figure 86: GHQ12 scores for women, 2008, 2009 and 2010 combined, by age

Figure 87: Discharge from mental health units, by age on discharge, males; rate per 100,000 population; Scotland

Figure 88: Discharge from mental health units, by age on discharge, females; rate per 100,000 population; Scotland

Figure 89: Mental illness specialties in Scottish hospitals: percentage of male discharges by age and length of stay: year ending 31 March 2011; Scotland

Figure 90: Mental illness specialties in Scottish hospitals: percentage of female discharges by age and length of stay: year ending 31 March 2011

Figure 91: Mental illness specialties in Scottish hospitals: percentage of male residents by age and length of stay: year ending 31 March 2011

Figure 92: Mental illness specialties in Scottish hospitals: percentage of female residents by age and length of stay: year ending 31 March 2011

Figure 93: Percentage of those over 65 with dementia, 2007 and 2021 in East, North and South Ayrshire

Figure 94: Percentage of all males and females with dementia, 2007 and 2021 in East, North and South Ayrshire

Figure 95: Estimated number of consultations, for financial year 2003-04 by gender and age group, Scotland

Figure 96: Estimated number of consultations, for financial year 2010-11; by gender and age group, Scotland

Figure 97: Admission rates per 100,000 population of all emergency admissions, all Ayrshire & Arran residents 2006-07 to 2010-11 by age group.

Figure 98: Admission rates per 100,000 population of all emergency admissions for Ayrshire & Arran residents aged 65 years and over, 2006-07 to 2010-11 by age and deprivation category

Figure 99: Admission rates per 100,000 population for patients with 3 or more emergency admissions for all Ayrshire & Arran residents, 2006-07 to 2010-11 by age group

Figure 100: Patient rates per 100,000 population for patients with one or more emergency admissions per year for Ayrshire & Arran residents aged 65 years and over, 2006-07 to 2010-11


Figure 101: Patient rates per 100,000 population for patients with 3+ emergency admissions for Ayrshire & Arran residents aged 65 years and over, by deprivation category, 2006-07 to 2010-11

Figure 102: Number of patients (65 years and over) at risk of emergency admission to hospital in the following year; by risk category; Ayrshire and Arran

Figure 103: Percentage of patients (65 years and over) at risk of emergency admission to hospital in the following year; by risk category; selected areas, 2012

Figure 104: Percentage of patients (65 years and over) classed as being at “high risk” of emergency admission to hospital in the following year; for selected areas, 2012

Figure 105: Projected potential informal care to people aged 75years and older by people aged 50-64 years in Ayrshire & Arran

Figure 106: Projected potential informal care to people aged 75years and older by people aged 50-64 years in East Ayrshire

Figure 107: Projected potential informal care to people aged 75years and older by people aged 50-64 years in North Ayrshire

Figure 108: Projected potential informal care to people aged 75years and older by people aged 50-64 years in South Ayrshire

Figure 109: Percentage of people spending last 6 months of life spent at home or in a community setting

Figure 110: Proportion of individuals in relative poverty before housing costs by area of residence: Scotland 2008-09 to 2009-10

Figure 111: Percentage of people in relative poverty (before housing costs) by ethnic group: Scotland 2007-08 to 2010-11

Figure 112: Percentage of adults in relative poverty (before housing costs) by gender and by single-adult household composition, Scotland 2010-11

List of tables

Table 1: Number of births and deaths registered in East, North and South Ayrshire, 2009 & 2010

Table 2: Average numbers of migrants (in and out), East, North and South Ayrshire, 2008-10

Table 3: Housing tenure for pensioner households

Table 4: Profile of disrepair and average cost of works of pensioner properties

Table 5: Households that have or require adaptation to dwelling (2008-10) and projections (2033)

Table 6: Profile of aids and adaptations in East Ayrshire for all tenures, 2009-10 to 2011-12

Table 7: Average number and expenditure on equipment and adaptations, 2009-10 to 2011-12

Table 8: Profile of expenditure of private sector housing grant, 2007-08 to 2009-10

Table 9: Profile of expenditure in mainstream South Ayrshire Council properties, 2008 - 2010

Table 10: Supported accommodation schemes in East Ayrshire

Table 11: Sheltered accommodation complexes in North Ayrshire

Table 12: Sheltered housing complexes in South Ayrshire

Table 13: Older people supported in care homes, 2010-11

Table 14: East Ayrshire care homes inspection grades (latest inspection)

Table 15: North Ayrshire care homes inspection grades (latest inspection)

Table 16: South Ayrshire care homes Inspection rates (latest inspection)

Table 17: Home care client age groups

Table 18: Older people receiving intensive home care (10+ hours per week)

Table 19: Free personal and nursing care (FPNC) provided to clients

Table 20: Internet use by people aged 60 years and over, 2007-08

Table 21: Perceptions of safety when walking alone in the neighbourhood and in own home at night


Table 22: Proportion of pensioner households living in ‘poor’ NHER rated housing and in fuel poverty

Table 23: Smoking status of patients in Ayrshire and Arran at 1 Jan 2009 as a % of all patients with smoking status recorded by GPs, by age group and CHP area

Table 24: Estimated smoking-attributable mortality by age and sex, NHS board, 2000–2004

Table 25: Estimated usual weekly alcohol consumption in Scotland, 2008, 2009 and 2010 combined, by age

Table 26: Estimated alcohol consumption on heaviest drinking day in last week, 2008, 2009 and 2010 combined, by age, Scotland

Table 27: Adherence to weekly and daily drinking advice, 2008, 2009 and 2010 combined, by age and sex, Scotland

Table 28: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of alcohol abuse or alcohol dependency – diagnosis appearing first on GP record, by age group and deprivation category

Table 29: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of drug abuse or drug dependency – appearing anywhere on GP record, by age group and deprivation category

Table 30: Adult body mass index (BMI), 2008, 2009 and 2010 combined, by age and sex, Scotland

Table 31: Body Mass Index (BMI) of patients in Ayrshire and Arran at 1 Jan 1999, 2004, 2009 – counts of all patients with BMI recorded by GPs, by age group and CHP area

Table 32: Prevalence of fruit and vegetable consumption, 2008, 2009 and 2010 combined, by age and sex, Scotland

Table 33: Summary physical activity levels, 2008, 2009 and 2010 combined, by age and sex, Scotland

Table 34: Participation in different activities in the past 4 weeks, 2008, 2009 and 2010 combined, by age and sex, Scotland

Table 35: Expectation of life at birth (LE), by sex in East, North and South Ayrshire, 2006-2010

Table 36: Life expectancy at age 65, in East, North and South Ayrshire, Ayrshire & Arran and Scotland, 2008-2010

Table 37: Rate of reported long term conditions per 1000 adults, 2008, 2009 and 2010 combined, by age and sex, Scotland

Table 38: Counts and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of coronary heart disease (CHD)

Table 39: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of stroke by age group and deprivation category

Table 40: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of cancer by age group and deprivation category

Table 41: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of maturity onset of diabetes type 2 by age group and deprivation category

Table 42: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of COPD by age group and deprivation category

Table 43: Number and approximate rates per 100,000 population of patients with Parkinson's disease in Ayrshire and Arran GP practice survey by age, gender and location (June 2006)

Table 44: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of hearing impairment or visual impairment by gender, age group, and deprivation category

Table 45: Number of natural teeth, and percentage with no natural teeth, 2008, 2009, 2010, by age and sex, Scotland

Table 46: Average length of stay for fractures of the neck of femur by age group in Ayrshire and Arran in 2009

Table 47: Average length of stay for fractures of the neck of femur by age group in Ayrshire and Arran in 2009

Table 48: Mental illness discharges of male by age and main diagnosis on discharge; rate per 100,000 population: year ending 31 March 2011; Scotland

Table 49: Mental illness discharges of female by age and main diagnosis on discharge; rate per 100,000 population: year ending 31 March 2011; Scotland

Table 50: Estimates of households with someone requiring regular help and care, 2009

Table 51: Profile of unpaid carers in Ayrshire and Arran, 2009


Chapter 1: Introduction and Overview

A range of national policies has been developed to address the rapid changes in age composition of our population, its consequences for public health in the future, the likely increases in demand for public services and the consequent pressure on public spending. Across the UK, public expenditure related to older people has been estimated to rise from 20.1% of GDP in 2007-08 to 26.6% in 20571. The Office for Budget Responsibility2 stated that: “the public finances are likely to come under pressure over the longer term, primarily as a result of an ageing population.” The demographic dividend of the last six decades has begun to diminish as the large cohorts of baby boomers have started to retire in 2010 and policies to maintain independence and quality of life are essential. However, the future health status of the population will depend on policies to tackle current health, social, economic and educational inequalities3. The policy response by the Scottish Government is a programme of change with the publication of Reshaping Care for Older People 4. The NHS and local authorities need to work together to make sure that they can provide services that work for older people, that are affordable and that encourage older adults to lead healthy, active independent lives. The Ayrshire and Arran Joint Strategy for Older People group have requested an Assessment of older people’s needs to inform the Older People’s Strategy. It is intended that this Needs Assessment provides a comprehensive profile of the health and social needs of older people now and projected into the future.

1.1 The policy context

Whilst many older people continue to live active lives without recourse to care and assistance from local authorities and health agencies, there will always be some who need help to live fulfilling lives. The Scottish Government has a longstanding policy of ‘shifting the balance of care’. This means supporting people to remain at home independently for as long as possible rather than in care homes and hospitals5. This was set out in the Scottish Government’s Reshaping Care for Older People Programme for Change4. This chapter sets out the context for the needs assessment by outlining the range of national and local policy documents, agreements and structures already in place across Ayrshire.

1.2 Health and social care specific legislation

Social Work (Scotland) Act 19686 This is the primary Act detailing the general social work function of the local authority. A number of subsequent Acts have inserted amendments in respect of revised or additional duties.

Chronically Sick and Disabled Persons (Scotland) Act 19726 This Act requires local authorities to assess the needs of disabled persons and to provide assistance and services.

Disabled Persons (Services, Consultation and Representatives) Act 19866 This Act permits authorised representatives to be appointed for a disabled person. It also requires that, for a person with a mental disorder who has been in hospital for a continuous period of at least six months, both the health and local authority should be notified and carry out an assessment of the individual’s needs.


NHS and Community Care Act 19906 The 1990 Act led to the insertion of s12A into the Social Work (Scotland) Act 1968 creating a duty to assess the needs of any individual who it appears may require community care services that the local authority has a duty or power to provide or secure. Carers (Recognition of Services) Act 19956 This places a duty on local authorities to consider the needs of unpaid carers.

Community Care (Direct Payments) Act 19966 This created the opportunity for a local authority, as an alternative to the provision of care, to make a direct payment to an individual to enable them to arrange their own support for assessed needs.

Adults with Incapacity (Scotland) Act 20006 This allows for support and intervention for individuals who are deemed to have incapacity. It sets out the provisions for intervention orders and guardianship orders.

Community Care and Health (Scotland) Act 20026 This Act details a range of provisions in respect of community care services.

Mental Health (Care and Treatment) (Scotland) Act 20036 This replaces the Mental Health Act 1984. It places a duty on local authorities to meet the needs of ‘mentally disordered’ individuals as well as including the provision of care in the community and aftercare services. It provides for the detention of individuals in hospital where this is defined as necessary. The Act also sets out the requirement to appoint mental health officers to discharge the duties required by the Act.

Adult Support and Protection (Scotland) Act 20076 This Act provides greater protection to those thought or known to be at risk of harm through new powers to investigate and intervene in situations where concern exists. Social Care (Self-directed Support) (Scotland) Bill http://www.scottish.parliament.uk/parliamentarybusiness/Bills/48001.aspx

If enacted, the Bill will:

Introduce the language and terminology of self-directed support into statute

Provide a consistent, clear framework in law

Impose firm duties on local authorities to provide the various options available to citizens – making it clear that it is the citizen’s choice as to how much choice and control they want to have

Widen eligibility to those who have been excluded up to this point, such as carers

Consolidate, modernise and clarify existing laws on direct payments Personalisation The personalisation agenda of self directed support is linked closely with the British Association of Social Workers code of ethics that demonstrates the commitment to five basic values:

Human dignity and worth

Social justice

Service to humanity

Integrity

Competence The principles underpinning ‘Personalisation’ are outlined in a discussion paper by Chetty et al., 20127.

http://www.legislation.gov.uk/asp/2003/13/contents

http://www.legislation.gov.uk/asp/2007/10/pdfs/asp_20070010_en.pdf

http://www.scottish.parliament.uk/S4_Bills/Social%20Care%20(Self%20directed%20Support)%20(Scotland)%20Bill/Bill_as_introduced.pdf

http://www.scottish.parliament.uk/parliamentarybusiness/Bills/48001.aspx


1.3 National policy

The strategic direction of travel in Ayrshire and Arran is driven by a number of key national and local policies.

Community Care: A Joint Future (2000) http://www.scotland.gov.uk/Resource/Doc/1095/0013865.pdf

This report outlined recommendations to secure better outcomes for people through improved joint working between health and social care, including developing arrangements for managing and financing joint services.

Partnership for Care (2003) http://www.scotland.gov.uk/Publications/2003/02/16476/18730

This white paper included proposals to increase patient-centred care and established the mandate to create the Community Health Partnerships to bridge the gap between primary and secondary healthcare and between health and social care. Reshaping Care for Older People: A Programme for Change (2011)4 The Scottish Government vision that ‘Older people are valued as an asset, their voices are heard and they are supported to enjoy full and positive lives in their own home or in a homely setting’ was a key driver of the re-shaping care agenda.

The Programme for Change, published in 2011 set out the reasons for change in the approach to care for older people and what has been seen as the key actions required to achieve this change. Some of the key messages which need to frame the development and delivery of the Reshaping Care programme include:

1. Older people are an asset not a burden 2. We need a shift on philosophy, attitudes and approaches 3. We are adding healthy years to life

4. Supporting and caring for older people is not just a health or social work responsibility

5. Services should be outcome focussed 6. We need to accelerate the pace of sharing good practice 7. It is important to align partnership resources to achieve our goals 8. Additional funding is needed for care.

The Programme for Change also outlined the main messages from stakeholders about the preferences of older people:

1. People want to stay in their own homes for as long as possible 2. People want a greater degree of personalisation and choice 3. People want more joined up working – less needless bureaucracy 4. People want to avoid prolonged hospital stays 5. People want greater support for unpaid carers 6. People want funding and support for pensioner networks of

community groups 7. People want a consistency of paid workers 8. People want regular health and well being check ups 9. People want more specialist services for people with dementia 10. People want appropriate housing and timely installation of

equipment and adaptations 11. People want information.

The Programme for Change also outlined a commitment to continue Change Funding of £70 million for 2012/13 and in the region of £300 million over the period 2011/12 to 2014/15 to stimulate shifts in the totality of the budget from institutional care to home and community based care and enable subsequent de-commissioning of acute sector provision.

Commissioning Social Care www.audit-scotland.gov.uk/docs/health/2012/nr_120301_social_care.pdf

After a substantial review of how effectively the public sector commissions social care services, Audit Scotland made several

http://www.scotland.gov.uk/Resource/Doc/1095/0013865.pdf



http://www.scotland.gov.uk/Publications/2003/02/16476/18730

http://www.jitscotland.org.uk/action-areas/reshaping-care-for-older-people/

http://www.audit-scotland.gov.uk/docs/health/2012/nr_120301_social_care.pdf

http://www.audit-scotland.gov.uk/docs/health/2012/nr_120301_social_care.pdf


recommendations for Councils along with NHS boards and other relevant commissioning partners:

The need to develop commissioning strategies

The need to manage the risks of contracting services from voluntary and private providers

Implement self-directed support in a way that service-users will get information, advice and support and processes are in place to monitor the outcomes of the support

The need to work very closely together.

The Healthcare Quality Strategy for NHS Scotland (2010)


The quality strategy was developed following the progress made with the implementation of Better Health Better Care (Scottish Government, 2007). Implementation of the Quality Strategy will enhance the integrated approach to service planning and delivery. It sets out the commitment of the NHS in Scotland to ensure all patients are at the centre of their care, and that the care is clinically effective, safe and timely. Patients will be encouraged to be partners in their own care and when consulted on what they wanted and needed from health services they indicated:

Caring and compassionate staff and services

Clear communication and explanation about conditions and treatment

Effective collaboration between clinicians, patients and others

A clean and safe care environment

Continuity of care and clinical excellence.

Age, Home and Community: A Strategy for Housing for Scotland’s Older

People: 2012 - 20215

The Age, Home and Community document published by the Scottish Government sets out the vision for housing services for older people in terms of the shifting the balance of care agenda.

The strategy highlights the importance of and support for:

Advice and information for older people about the housing options and support available to them

Piloting a housing options approach for older people

Encouraging accreditation under the Scottish National Standards for Information and Advice Providers

Delivering adaptations in a efficient and effective way

Developing a national register of accessible housing

Establishing and promoting ‘Trusted Trader’ schemes

Encouraging ‘downsizing schemes’

New guidance for the redevelopment of sheltered and very sheltered housing

Making it easier for older people to access equity in their home

Mainstreaming telecare

Reviewing building and design standards to meet the needs of older people.

Intermediate Care Framework (Consultation document)

http://www.scotland.gov.uk/Publications/2012/07/1181

Maximising Recovery and Promoting Independence: Intermediate Care’s contribution to Reshaping Care. Scottish Government, April 2012. Intermediate care encompasses a range of functions that focus on prevention, rehabilitation, enablement and recovery. This is one core element of reshaping health care and support services for older people and will be developed by the (yet to be established) Health and Social Care Partnerships. The framework outlines the need for multi-professional, multi-agency coordination to prevent unnecessary acute hospital admission, premature admission to long term care, support with timely discharge from hospital, promotion of faster recovery from illness, support of anticipatory care planning and self management of long term conditions. This is in line with expressed needs from



http://www.scotland.gov.uk/Resource/0038/00386925.pdf

http://www.scotland.gov.uk/Publications/2012/07/1181


consultation where older people stated that they want to stay in their own homes as long as possible. Generic legislation

Human Rights Act 1998 This set out the rights everyone can expect to have protected by law including:

The right to life

The right to freedom from torture, inhuman and degrading treatment

The right to liberty

The right to a fair trial

The right to privacy

The right to freedom of conscience

The right to freedom of expression

The right to freedom of assembly

The right to marriage and the family

The right to enjoy the previous rights and freedoms without discrimination.

Equality Act 20106 This Act consolidates a range of laws that protected and enhanced the rights of people from minority groups as well as placing a duty on public authorities to promote equality of opportunity.

1.4 Local frameworks and policies NHS Ayrshire and Arran

Carer Information Strategy 2008 – 2011 A Carer Information Strategy was prepared by NHS Ayrshire and Arran that complies with legislative requirements set out in the Community Care and Health (Scotland) Act 2002.

Research carried out for the Carer Information Strategy suggested that there are around 37,318 carers in Ayrshire:

East Ayrshire – 12,454

North Ayrshire – 13,479

South Ayrshire – 11,385 The purpose of the Carer Information Strategy was to ensure that:

Carers are given the support and information they require to carry out their caring role

Carers are given the opportunity to be actively involved in the development, implementation and evaluation of the Strategy and related services.

Getting Better...Together - Care Counts The Care Counts document explains NHS Ayrshire and Arran’s vision for the future of the local health service over a ten year period from 2012. It sets down the notion that a ‘hospital’ based model of care is no longer sustainable or appropriate to meet the health needs of the population, and advocates the adoption of a community-focused health and social care service.

This document explains that the public health priorities across Ayrshire and Arran are:

Alcohol

Tobacco

Obesity

Mental Health

These priorities are still current in relation to improving the health of older people across the area.

http://www.legislation.gov.uk/ukpga/1998/42/contents

http://www.legislation.gov.uk/ukpga/2010/15/contents

http://www.nhsaaa.net/media/83201/cis09.pdf

http://www.nhsaaa.net/media/78403/ccbooklet.pdf


East Ayrshire

East Ayrshire Single Outcome Agreement The Single Outcome Agreement 2011 - 2014 in East Ayrshire is recognised by the local Community Planning Partnership (CPP) as a management tool to:

Further improve the quality of life across our communities

Deliver better outcomes for local people

Secure opportunities for reducing bureaucracy

Make more efficient use of resources

Make a difference by removing barriers to improved service delivery

Identify areas for improvement.

Included in East Ayrshire’s Single Outcome Agreement is a commitment to shifting the balance of care, illustrated by the Local Outcome:

That ‘Older people, vulnerable adults and their carers are supported, included and empowered to live the healthiest life possible’ East Ayrshire Change Plan 2012/13 The indicative Change Fund allocation for East Ayrshire in 2012/13 is £1.887M.

East Ayrshire’s Change Plan for 2012/13 focused on the following areas:

Falls prevention and management

Community based clinical pharmacy

Voluntary sector

Primary care

Dementia

Out of hours services.

Supported Accommodation Strategy for Older People in East Ayrshire (2006)

This strategy sets out the way in which supported accommodation is operated. Access to supported accommodation is based on an assessment of the level of dependency of the individual as well as how urgently they need the support.

North Ayrshire

North Ayrshire - A Better Life A Single Outcome Agreement for North Ayrshire 2009 - 2012 The Single Outcome Agreement 2009 – 2012 replaced the Community Plan 2006 – 2016 and the North Ayrshire Community Plan 2008 – 11. Although the agreement slightly pre-dates the mainstreaming of the language of ‘shifting the balance of care’, there is a clear commitment to helping people to be supported in their own home.

‘North Ayrshire Outcome 6d – more vulnerable people are supported within their own community’

North Ayrshire’s SOA will be reviewed and updated in 2013 and will include direct references to the rebalancing care agenda.

North Ayrshire Change Plan 2012/13 The indicative Change Fund allocation for North Ayrshire in 2012/13 is £2.240M.

North Ayrshire’s Change Plan for 2012/13 focuses on the following areas:

Supporting people with dementia

Care homes

Anticipatory care and end of life care

Care at Home – including out of hours

Intermediate care and enablement

Community ward

Older People Review Team

Local Operational Teams (LOTs)

Older people’s housing strategy.

http://www.eastayrshirecommunityplan.org/portal.asp?P_ID=32&URL=/cats/Single%20Outcome%20Agreement/SOA%20Introductory%20TextFINAL.pdf

http://www.north-ayrshire.gov.uk/Documents/CorporateServices/ChiefExecutive/CommunityPlanning/SOA%20-%20Part%202%20-OutcomesandIndicators.pdf

http://www.north-ayrshire.gov.uk/Documents/CorporateServices/ChiefExecutive/CommunityPlanning/SOA%20-%20Part%202%20-OutcomesandIndicators.pdf


North Ayrshire Joint Commissioning Strategy for Older People 2009 - 2012

The Joint Commissioning Strategy for Older People 2009 – 2012 was developed by the North Ayrshire Community Health Partnership. The main vision outlined in the strategy was to:

‘Enable older people to remain at home for as long as it is practical and safe, give person centred care and provide a range of services and support appropriate to meeting their needs and achieving good outcomes’. Key proposals within the strategy include:

Need for joint needs assessment, and partnership working

Refocus care in the community rather than relying on hospital beds or care home placements

Agree level of in-patient care to be retained

Consider number and use of assessment and rehabilitation beds

Agree amount of resource release for investing in community health and care infrastructure

Consider short to medium term purchase of care home places to reduce number of delayed discharges

Agree joint investment strategies

Link more closely with Rapid Response Team

Develop respite facility for people with dementia

Increase use of assistive technology

Introduce closer liaison between community based social care and health and hospital services to reduce numbers admitted inappropriately to hospital by accessing joint provision and out of hours services

Increase range and type of community rehabilitation, anticipatory and preventative care.

North Ayrshire Local Housing Strategy 2011 - 2016

The North Ayrshire Local Housing Strategy 2011 – 2016 provides a strategic vision for housing. In relation to meeting the needs of older people, the strategy provides commitments of:

Ensuring all new homes are built to a standard that allows households to remain living in them throughout their lives

Working with local Registered Social Landlords (RSLs) to ensure equality of opportunity in terms of accessing equipment and adaptations as well as matching adapted empty rental properties to people with similar needs

Ensuring there are housing support measures available that promote independent living through development of a Housing Support Strategy. The North Ayrshire Local Housing Strategy 2011 – 2016 was approved through the Scottish Government Peer Review process.

South Ayrshire

South Ayrshire Single Outcome Agreement 2009 - 12

The Single Outcome Agreement 2009 – 2012 replaced the Community Plan ‘A Better Future Together 2006 – 2010’. As with North Ayrshire, although the SOA document predates the ‘re-balancing care’ policy drive, there is a clear commitment to helping older people remain as independent as possible within their own homes:

‘South Ayrshire Strategic Objective 9c’ – increase and maintain the independence of older people and people with long-term conditions and disabilities. South Ayrshire’s SOA will be reviewed and updated in 2013 and will include direct references to the rebalancing care agenda.

http://www.north-ayrshire.gov.uk/Documents/PropertyServices/HousingBuilding/LHSVision.pdf

http://www.south-ayrshire.gov.uk/documents/singleoutcomeagreement2009-12.pdf


South Ayrshire Council Change Plan 2012/13

The indicative Change Fund allocation for South Ayrshire in 2012/13 is £2.210M.

South Ayrshire’s Change Plan focused on the following areas:

Community capacity building

Targeted housing adaptations

Dementia related activity

Telehealthcare development and capital

Mobile attendants

Enablement

Community wards.

South Ayrshire Local Housing Strategy 2011 - 2016 The South Ayrshire Local Housing Strategy 2011 – 2016 provides a strategic vision for housing. In relation to meeting the needs of older people, the strategy provides a clear commitment to:

A strategy for housing options for older people

Improved access to advice and information for older people

Agreeing a South Ayrshire amenity standard.

The South Ayrshire Local Housing Strategy was approved through the Scottish Government Peer Review Process in September 2011.

Housing Options for Older People – Re-ablement The re-ablement model of care has been introduced across Ayrshire in various ways. Re-ablement represents a significant departure from the existing ‘care at home’ model. Rather than providing a home-carer to undertake the various tasks that a client may not be able to do because of an injury or illness, help and support are provided to that client to help them regain confidence and skills to undertake the tasks for themselves.

In East Ayrshire the Transformation Plan developed in 2012 included proposals within the work streams to integrate rehabilitation and enablement services. Community-based integrated health and social care service models with a focus on re-ablement, alternatives to hospital admission and accelerated discharge teams have been proposed to deliver this change. In North Ayrshire, re-ablement is offered to clients for up to 12 weeks. This involves agreeing a support plan to help learn or relearn skills and also provide support to help the client achieve their desired outcome. If, after the 12 week period is over, more support or care is required, this will be arranged. In South Ayrshire, the re-ablement model has been piloted in several areas and has proved very successful in producing positive outcomes for clients and reducing costs for the community care team. Due to the success of the pilot schemes, re-ablement is being rolled out across the whole area over 2012-13.


Chapter 2: Demography 2.1 Ayrshire and Arran population

The most recent population estimates available at the time of writing the joint needs assessment are for 2010. These estimate a slight decline in the Ayrshire and Arran population from 368,149 at the time of the 2001 National Census to 366,860 in 2010. The estimates use the census figures and make calculations allowing for major population changes such as births, deaths, inward and outward migration from geographic areas. Figure 1 provides a profile of the age and gender distribution, in broad age bands, of the estimated Ayrshire and Arran population in 2010. The gender balance shifts from a higher proportion of males in the youngest age group (in the majority of years there are slightly more boys born than girls), to a higher proportion of women in the older age groups. These population changes are due predominantly to differences in male and female mortality rather than to migration factors. In the 75 years and over age group, 37.5 percent of the population are male with females accounting for 62.5 percent. These gender imbalances are not new and reflect the national picture. Those persons aged 65 years and over account for 19% of the Ayrshire and Arran population. East, North and South Ayrshire Populations

The population estimates in Figure 2 for 2010 indicate that North Ayrshire is the most populated locality with 135,180 people residing there; this represents 37 percent of the Ayrshire and Arran population, the East Ayrshire population of 120,240 accounts for 33 percent and South Ayrshire, with the smallest population of 111,520, accounting for 30 percent.

Figure 1: Estimated population by age group and gender in Ayrshire and Arran, 2010

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/estimates/mid-year/2010/tables.html

Between 2009 and 2010 the population of East Ayrshire and South Ayrshire changed little; North Ayrshire saw a decrease of 0.2 percent. The total population in all three localities has fallen overall since 1984. In Scotland 23.1 percent of the population are aged 60 years and over. In East Ayrshire the figure is 24.5 percent (29,495 people), in North Ayrshire 25.9 percent (34,995) and in South Ayrshire those aged over 60 years account for 28.7 per cent of the population (31,998).

0

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http://www.gro-scotland.gov.uk/statistics/theme/population/estimates/mid-year/2010/tables.html



Figure 2: Estimated population by local authority and age group, 2010

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/estimates/mid-year/2010/tables.html

2.2 Population Projections for Ayrshire and Arran

Population projections are calculations based on trends of four demographic variables - the fertility (births) rate, the mortality (deaths) rate, immigration and emigration. Projections are reasonably accurate and reliable given that the cohorts are already born. Projections have limitations and tend to be less reliable for areas with small populations; local and regional population projections are set in a national context. The key demographic trends in Scotland are a result of many years of high fertility rates (‘baby booms’) followed by low fertility rates and sustained increases in life expectancy that are rising at a faster rate than healthy life expectancy. There is little that changes the predicted population trends other than extraordinary migration or mortality3.

However, it is argued that extraordinary migration in Scotland may not change the current projected balance between young and old because migrants often adopt the fertility pattern of their country of residence8. Population projections are therefore important in understanding the

likely future impacts of these demographic changes for the public sector and how they will affect demand on services. As a result these data are valuable for informing a whole range of policies that contribute directly and indirectly to securing the population’s health.

It is clear from Figure 3 that the population structure of Ayrshire and Arran is projected to change quite markedly over the period from 2010 to 2035. Whilst the overall population is projected to decline (to just under 356,000 in 2035), this is not evenly distributed across age groups. The 16 years and under population group will decline by 7.8 percent, 16 to 29 years old group by 13.1 percent, 30 to 49 years old group by 14.8 percent and 50 to 64 years old group by 23 percent. Conversely, the 65 to 79 years old population group will increase by 33 percent and the 80 years and over group by 105 percent accounting for 10 percent of the total population.

Figure 3: Projected population by age group in Ayrshire and Arran, 2010-2035

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/projections/sub-national/2010-based/index.html

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http://www.gro-scotland.gov.uk/statistics/theme/population/projections/sub-national/2010-based/index.html




The 65 years and over population group accounted for 19 percent of the total Ayrshire and Arran population in 2010 and is projected to account for 30 percent of the total population by 2035. This translates into an increase in the number of people aged over 65 from the current 69,720 to 106,800, a rise of just over 37,000 individuals. The rise in the number of ‘older old’ i.e. those over the age of 80 is anticipated to rise from 17,598 in 2010 to 36,070 in 2035, a rise of 18,472. It is known that the age of retirement will increase over coming years and this will require a focus on workplace policies to maintain the health and wellbeing of an ageing workforce. Pensionable age is 65 years of age for men, 60 for women until 2010; between 2016 and 2018 pensionable age for women increases to 65. Between 2018 and 2020, State Pension age will increase to 66 years for both sexes, rising to 67 by 20269. Figure 4 shows that the largest increase of people over the state pension age between 2010 and 2035 is projected to be 17 percent in North Ayrshire, almost doubling the percentage of pensioners in the population. In East Ayrshire projected to increase by 15 percent and in South Ayrshire by 16 percent.

Figure 4: Percentage of population over state pension age, 2010 to 2035

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/index.html

21

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43

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http://www.gro-scotland.gov.uk/statistics/theme/population/index.html


2.3 Demographic change The population changes outlined above will have a profound impact on the demand for health, social and long-term care services. It is likely that this will increase substantially over the next few decades. The geographic distribution of this change in terms of urban and rural living may add complexity to meeting demand; Scottish projections show that there will be a higher percentage (21%) of people aged over 60 living in rural areas compared to the percentage (17%) living in urban areas1. Reasons for population change

Population change is determined by the interaction of four demographic variables as outlined in section 2.2. Natural change is the difference between the number of births and deaths. There has been a long-term linear decline in mortality as is shown for Ayrshire and Arran in Figure 5 and for each local authority in Table 1. Meanwhile, births have also decreased, although this trend has levelled off in recent years. Figure 5a provides further detail of this relationship as a ratio of deaths to births at NHS Board and Local Authority level. It should be noted that the ratio of deaths to births can be observed to have reduced in recent years, in line with the national trend. However, while nationally births currently outnumber deaths (indicating a natural growth in population); locally, deaths continue to outnumber births (indicating a natural decrease in population). This is particularly evident in South Ayrshire where there are currently about 1.34 deaths for every birth. East and North Ayrshire remain above the Scottish average but are both approaching a ratio of one death to every birth.

Figure 5: Five-year average number of birth and death registrations in Ayrshire and Arran, 1991-2010

Source: National Records for Scotland

Table 1: Number of births and deaths registered in East, North and South Ayrshire, 2009 & 2010

Births % change 2009-2010

Deaths % change 2009-2010 Year 2009 2010 2009 2010

East Ayrshire 1,362 1,334 -2.1% 1,328 1,270 -4.3%

North Ayrshire 1,498 1,450 -3.2% 1,608 1,484 -7.7%

South Ayrshire 1,054 1,035 -1.8% 1,379 1,439 4.1%

Ayrshire and Arran

3,914 3,819 -2.4% 4,315 4,193 -2.8%

Scotland 59,046 58,719 -0.4% 53,856 53,967 0.2%

Source: www.gro-scotland.gov.uk/statistics/at-a-glance/council-areas-map.html

0

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http://www.nrscotland.gov.uk/

http://www.gro-scotland.gov.uk/statistics/at-a-glance/council-areas-map.html


Figure 5a: Five-year average ratio of deaths to births by NHS Board and Local Authority area, 1991-2010

Source: National Records for Scotland

Fertility

The fertility rate is a key driver to demographic change, along with migration (in- and out-) and life expectancy. These variables impact on the size of the population and the dependency ratio. The dependency ratio measures the number of dependent people (above and below working age) compared to the number of people of working age.

Of the four demographic variables it is fertility that has the biggest impact on the ageing of the population8. The birth rate has increased in Scotland since 1995, peaking in 2008 with 60,000 births. This dropped by 2.1 percent in 2010 and currently Scotland has the lowest birth rate of the UK countries1. There have been two large ‘baby boom’ cohorts that increased the number of people of working age for the labour market. The first was in 1946-1950, peaking in 1947 at 110,000 births and the second in the 1960s10. This ‘demographic dividend’ is now beginning to diminish as the baby boomer generations start to retire from 2010 onwards. This will result in a substantial decrease in the size of the working age population3. Scotland’s fertility rate is now below the level required to replace its population1. The replacement level of fertility is approximately 2.1 live births per woman with a level above 1.5 considered to be in the ‘safety zone’ (net immigration can still compensate for lower fertility)11. The Total Fertility Rate (TFR) per 1000 women of reproductive age for East, North and South Ayrshire in 2010 is 1.90, 1.88 and 1.78 respectively, placing a reliance on in-migration to compensate. Migration

Net migration is the balance between immigration and emigration and it is projected that, without net immigration, Scotland’s population will decrease over the longer term12. Migration flows are difficult to predict as they are influenced by social, cultural and economic factors that are not accounted for in the assumptions. An out-migration of young people from Scotland due to the current economic downturn is possible but difficult to predict or project.

0.4

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http://www.nrscotland.gov.uk/


Table 2 indicates in-and out-migration for East, North and South Ayrshire. In-migration exceeded out-migration in East and South Ayrshire. North Ayrshire experienced more out-migration than in-migration. However, in all three areas the 16 to 29 year olds age group accounted for the largest in-migrants and out-migrants (National Records for Scotland, 2011). Long term migration assumptions predict that East, North and South Ayrshire will experience more out-migration than in-migration over the medium to long term, contributing to the fall in population seen in the projections13.

Table 2: Average numbers of migrants (in and out), East, North and South Ayrshire, 2008-10

All Ages In Out Net

East Ayrshire 3,439 3,215 224

North Ayrshire 3,787 3,852 -65

South Ayrshire 3,659 3,403 256

Ayrshire and Arran

10,885 10,470 415

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/index.html Demographic data are essential in determining current and future public health needs. These also assist in highlighting the differences shown at local authority level and can be utilised in joint service planning between NHS Ayrshire & Arran and each local authority and, in particular, for the health and social care of older people in our communities.

http://www.gro-scotland.gov.uk/statistics/theme/population/index.html


2.4 Population projections for Scotland

Population pyramids provide a quick reference profile of the population structure; the bars to the left of the central axis shows populations for males in ten year age bands, the bars to the right are female populations. The population pyramids for Scotland summarise the anticipated changes in the population structure between 2010 and 2035 (Figures 6 and 7). Figure 6: Population Pyramid of Scotland, 2010

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/projections/scotland/population-pyramids.html

As can be seen, the shape of the ‘pyramid’ changes in a number of ways over the twenty five year period. There are fewer people aged between 0 to 20 in 2035, the high numbers of people aged 20-30 in 2010 are reflected in the bulge in the numbers aged 45-55 in 2035 and the high number of those in the mid 40s in 2010 become the increased number of people aged around 70 in 2035. There is a much less steep gradient in older age in 2035 with higher numbers extending into later years. Figure 7: Population Pyramid of Scotland, 2035

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/projections/scotland/population-pyramids.html

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http://www.gro-scotland.gov.uk/statistics/theme/population/projections/scotland/population-pyramids.html







2.5 Projected population changes for Ayrshire and Arran, 2010 to 2035

Figures 8 and 9 compare the age and gender structure of Ayrshire and Arran in 2010 with the projected changes estimated for 2035. The difference between the figures indicates slow population growth with low birth rates and declining mortality. The 50 to 59 year olds in 2010 are the 75 to 84 year olds in 2035. Figure 8: Age and gender composition 2010 for Ayrshire and Arran

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/projections/index.html

Figure 9 shows substantial change to a more rectangular shape with a shift from those aged 40-49 constituting the largest proportion of the population, to those aged 60-69 years. Figure 9: Age and gender composition 2035 for Ayrshire and Arran


20 15 10 5 0 5 10 15 20

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http://www.gro-scotland.gov.uk/statistics/theme/population/projections/index.html





2.5.1 Projected population changes for East Ayrshire, 2010 to 2035

Figures 10 and 11 compare the age and gender structure of East Ayrshire in 2010 with the projected changes estimated for 2035. The differences between these figures show an ageing population with a slight increase in the gender imbalance towards females in the older age groups by 2035. Figure 10: Age and gender composition 2010 of East Ayrshire


The projections indicate that male life expectancy is increasing. For example all males aged 80 to over 90 years old make up three percent

of the population in East Ayrshire in 2010 and in 2035 it is estimated that this will increase to eight percent of the total male population. The population pyramid for East Ayrshire 2035 shows a similar pattern to the pyramid for Ayrshire and Arran 2035. The largest population are aged 60 to 69 years - those born between 1966 and 1975. Figures 11: Age and gender composition 2035 of East Ayrshire


Females aged 80 to over 90 years old currently account for five percent of the East Ayrshire population and this is projected to double by 2035.

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50 - 59

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90 +

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n y

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2.5.2 Projected population changes for North Ayrshire, 2010 to 2035

Figures 12 and 13 compare the age and gender structure of North Ayrshire in 2010 with the projected changes estimated for 2035. The differences between these figures show an ageing population with more females in the 60 to 79 year age group by 2035. Figure 12: Age and gender composition 2010 of North Ayrshire


Figure 12 shows the rectangular profile indicating the low birth rates, ageing population and increased life expectancy, although the excess of females over males appears more clearly in those aged over 60. Figures 13: Age and gender composition 2035 of North Ayrshire


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2.5.3 Projected population changes for South Ayrshire, 2010 to 2035 Figures 14 and 15 compare the age and gender structure of South Ayrshire in 2010 with the projected changes estimated for 2035. The differences between these figures show an ageing population with lower birth rates over the period than in East or North Ayrshire. In Figure 14 the male and female populations aged 40 to 49 is the largest and the 1960s baby boom has contributed to a proportion of this. The large male and female populations aged 60 to 69 years old are a result of the post war baby boom. Figure 14: Age and gender composition 2010 of South Ayrshire


Figure 15 shows large male and female populations aged 70 to 79 which are a result of the 1960s baby boom. Those aged 60 to 69 were born during the last baby boom of the 1980s. The pyramid is ‘top heavy’ demonstrating the higher proportion of people in the older age groups compared to those in the younger age groups in the future in South Ayrshire. Figure 15: Age and gender composition 2035 of South Ayrshire


20 15 10 5 0 5 10 15 20

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2.6 Population ageing in Ayrshire and Arran Ageing of the population includes an increasing number of older adults as well as increases in the median age of the population. Figure 16 has projections for the older adult age groups. It is estimated that between 2010 to 2030 there will be significant percentage increases in these population age groups: 21 percent in the 65 – 69 year age group, 22 percent in the 70-74 year age group, 24 percent in the 75-79 year age group, 43 percent in the 80-84 year age group and 61 percent increase in the over 90 year age group. Figure 16: Projected population by older groups in Ayrshire and Arran, 2010, 2020 and 2030


Figure 17 shows a clear trend in an increasing median age in East, North and South Ayrshire. This is due to reduction in mortality rates combined with low fertility rates. The largest projected increase in median age is in North Ayrshire; in 2000 it was 38 years and in 2035 it is projected to be 46 years, an increase of 8 years. The median age in South Ayrshire is estimated to be 48 years in 2035 however it was 41 years in 2000. In East Ayrshire the median age is 38 and this is projected to rise to 45 years by 2035. Figure 17: Projected median age of population; East, North and South Ayrshire and Ayrshire and Arran, 2000 to 2035

Source: GROS Bespoke Mid year population estimates and Population Projections for Scottish Areas combined, 2000 to 2035

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2.7 Dependency Ratios Age-dependency ratios are a measure of the age structure of the population and the projections of the ratios into the future is a function of the mortality, fertility and net migration. Dependency ratios summarise how many young people (under 16 years of age) and older people (over the state retirement age) depend on people of working age (16 to state retirement age). Areas that have a high dependency ratio have more people who are not of working age and therefore fewer who are working and paying taxes to sustain public services. The higher the number then the greater the level of dependent people 14, 15. For example, a dependency ratio of 50% equates to one dependent person for every two people of working age, a dependency ratio of 75% equates to three dependent people for every four people of working age. For example, a dependency ratio of 50% equates to one dependent person for every two people of working age, a dependency ratio of 75% equates to three dependent people for every four people of working age. Solutions to higher dependency ratios include raising the retirement age in line with increasing life expectancy, encouraging in-migration and discouraging out-migration of people aged 20 to 30 years old (OECD 2007). Figure 18 demonstrates that the dependency ratios are predicted to rise across Ayrshire and Arran between 2010 and 2035.

Figure 18: Projected dependency ratios for East, North and South Ayrshire and Scotland, 2010 - 2035


Old Age Dependency Ratio

The projected old age dependency ratios (the number of people over retirement age divided by the working age population only) for East, North and South Ayrshire and Scotland are presented in Figure 19. These demonstrate that the population structure in Ayrshire and Arran is ageing faster than that of Scotland. Between 2010 and 2035 there will be an increase in the dependency ratio of 17 percent in Scotland. However, in East, North and South Ayrshire this increase is projected to be 26, 30 and 28 percent respectively. Taking the 0 to 15 year olds out of the calculation reduces the ratio.

0.0

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Figure 19: Projected old age dependency ratios for East, North and South Ayrshire and Scotland, 2010 - 2035


It is therefore vitally important that planning for health improvement, health and health and social care services in the future addresses the demographic changes that are predicted for the population in NHS Ayrshire and Arran over the coming 20 years.

Policy Responses to the Dependency Ratio

Figures 20 and 21 demonstrate the projected structural changes in the Ayrshire and Arran population between 2010 and 2035. In Figure 20, females aged 0 to 15 years make up 16 percent of the population in 2010 and this is estimated to decrease slightly to 15.5 percent by 2035. The female working age population, i.e. those aged 16 to 60 years old, account for 56 percent in 2010 and this is estimated to decrease to 46.5 percent by 2035. The largest change is in the older female age groups with the over 60 year olds making up 28 percent in 2010, this being estimated to increase to 38 percent by 2035. It also demonstrates that the policy solution to decreasing the dependency ratio by increasing the State Pension age to 66 years increases the female working age population by 8 percent compared with the situation without Pension Reform. Figure 20: Projected female population by broad age group in Ayrshire and Arran, 2010-2035


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Figure 21 shows that males aged 0 to 15 years make up 18.5 percent of the population in 2010 and this is estimated to decrease slightly to 18 percent by 2035. The male working age population, those aged 16 to 65 years old, account for 64.5 percent in 2010 and this is estimated to decrease to 55 percent by 2035. The largest change is in the older male age groups with the over 65 year olds making up 17 percent in 2010, this being estimated to increase to 27 percent by 2035. It also demonstrates that the policy solution to decreasing dependency ratio by increasing the State Pension age to 66 years has less effect on the male working age population as it will only increase by 1 percent. Figure 21: Projected male population by broad age group in Ayrshire and Arran, 2010-2035


The predicted changes in the population of Ayrshire and Arran as highlighted above will impact on the proportion of people of working age compared to those who are of non-working age. This information

assists in determining the current and future needs of the population, in service planning and in focusing on upstream policies aimed towards keeping people well so that the quality of life in older age is optimised and people can live as independently as possible.

2.8 Older people and deprivation

The Scottish Index of Multiple Deprivation 2009 allows for mapping of areas into populations living in the most and least deprived geographic areas. SIMD quintiles provide an estimate of the deprivation experienced by the population living in any defined geographic area. This means that the 20% most deprived areas are geographically identifiable and service providers can look at ways to improve access and encourage uptake and use of local services that contribute to improving health and reducing health inequalities.

Figure 22: Number of people over 65 years of age living in Ayrshire and Arran by deprivation quintile, 2010

Source: GRO Scotland 2010 and SIMD 2009

0%

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Figure 23 indicates that almost 60 percent of those over 65 years of age live in quintiles 1 and 2 in East Ayrshire. Twenty-nine percent of those over 65 years of age live in the most deprived quintile with 12 percent living in the least deprived quintile. Figure 23: Number of people aged over 65 years living in East Ayrshire by deprivation quintile, 2010


Figure 24 presents the data for North Ayrshire indicating that 54 percent of those over 65 years of age live in quintiles 1 and 2. Twenty-eight percent live in the most deprived quintile with only 10 percent of those aged over 65 living in the least deprived quintile. Figures 24: Number of people aged over 65 years living in North Ayrshire by deprivation quintile, 2010


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The profile for older people and deprivation in South Ayrshire shown in Figure 25 is markedly different to that of East and North with only 40 percent of the population aged over 65 living in quintiles 1 and 2. Twelve percent of those over 65 years of age live in the most deprived quintile whereas 27 percent are living in the least deprived quintile. Figure 25: Number of people aged over 65 years living in South Ayrshire by deprivation quintile, 2010


Chapter 3: Life Circumstances

3.1 Income

Household income and expenditure

The Department of Work & Pensions (DWP) reports that the proportion of pensioners living in low income households has fallen in recent years with the introduction of the minimum income guarantee although the risk of low income rises with age. Single female pensioners are more likely to have a lower income than single male pensioners or pensioner couples. Once people are over the age of 75 they are more likely to live in a low income household than younger pensioners. This is partly explained by the fact that the proportion of pensioners living alone rises with age (http://www.dwp.gov.uk/research-and-statistics/). Pension Credits

Pension Credits are a means tested welfare benefit for people over the state retirement age designed to guarantee those qualifying with a minimum level of income. Pension Credits are therefore an indicator of low income in older people. Figure 26 presents the rate per 1000 population over pensionable age of Pension Credit claimants for East, North and South Ayrshire in two separate years, 2008 and 2011. These data are collected quarterly with little variation across the year so it is the third quarter of each year for each age band that is presented. East Ayrshire has the highest rate of claimants in most of the age bands. The Poverty Site estimates that around a third of pensioner households entitled to claim the credit do not. It is highlighted that take up of Pension Credits is much higher in those who live in social rented

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housing and are more likely to be in contact with advice and rights services (http://www.poverty.org.uk/66/index.shtml). Figure 26: Rate of Pension Credit claimants, 2008 and 2011

Source: www.sns.gov.uk

Attendance Allowance

Attendance Allowance is a tax-free non-means tested benefit for people over the age of 65 who require personal care because they are physically or mentally disabled. It could be argued that it is a proxy indicator of a higher dependency level of care needs within the community. However not all people apply for or have equal access to benefits so it could underestimate need.

Figure 27 presents the rate per 1000 of Attendance Allowance claimants for East, North and South Ayrshire in two separate years, 2008 and 2011. These data are collected quarterly with little variation across the year so it is the third quarter of each year for each age band that is presented. East Ayrshire has the highest rate of claimants in almost all the age bands. Figure 27: Rate of Attendance Allowance claimants, 2008 and 2011


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Age 65-69 - 2008

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Age 75-79 - 2011

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Rate per 1000 by age band

East Ayrshire North Ayrshire South Ayrshire

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Age 90 plus - 2011



http://www.poverty.org.uk/66/index.shtml

http://www.sns.gov.uk/



Disability–related benefits Figures 28, 29 and 30 present the rates per 1000 by age band of Disability Living Allowance (DLA) claimants for 2008 and 2011 from 65 to over 90 years of age in East, North and South Ayrshire. These data provide some indication of the levels of dependency within the population and show that for the vast majority of age bands, the level of claimants has increased over a short time period. The highest claimant count in all three areas is among those aged between 65 to 69 years. The smallest claimant count is amongst those aged 90 plus however this has increased from zero to around 20 per 1000 in two years and is likely to continue to increase as the population ages. Figure 28: DLA claimants by older age bands in East Ayrshire, 2008-11


Figure 29: DLA claimants by older age bands in North Ayrshire, 2008-11

Source: www.sns.gov.uk The prevalence of disability increases with age and is significantly higher in those aged over 74 years old. Disability related benefits provide an indicator of dependency amongst older people; however not all older people who are entitled to these benefits apply for them. People aged less than 65 years with care and/or mobility needs are entitled to DLA; this continues into retirement if the needs continue, so more is paid to the ‘younger old’. Attendance Allowance is a similar benefit and paid to those aged over 65 years and is highest in those aged 75 years (the ‘old old’). Payment of these benefits decrease in the ‘oldest old’ population (those aged 85 years and above) and are low in the ‘very old’ population (those aged over 90)16.

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Age 65-69 - 2008

Age 65-69 - 2011

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Figure 30: DLA claimants by older age bands in South Ayrshire, 2008-11


These national patterns of benefit uptake are reflected in East, North and South Ayrshire. What is not clear from the data is the extent to which the benefits offset the additional costs of disability for older people and whether they actually prevent them moving into poverty, therefore impacting on health, wellbeing and independent living16.

3.2 Housing

This section explores issues relating to housing options and housing quality across Ayrshire. It covers a wide range of issues including:

Housing tenure

Household characteristics

Housing quality

Housing options

Equipment and adaptations

Sheltered and supported accommodation

Care homes

Home care

Housing options suitable for older people are vital to achieve the wider agenda to shift the balance of care. There is a strong relationship between housing and health since housing in a poor state of repair can increase the risk of accidents, serious injury and death amongst its occupants. Poor energy-efficiency and thermal conditions can impact on health status in relation to a range of conditions such as influenza, heart disease, stroke and respiratory illness; and a lack of modern facilities can impact on living conditions, physical and mental health. Housing tenure Housing tenure refers to the ownership of the housing in which people live. In Scotland, there are two main tenure types:

Private

Ownership – either outright or with a mortgage

Renting – from a private landlord

Social

Renting – from a Local Authority or other Registered Social Landlord (RSL)

0 50 100 150

Age 65-69 - 2008

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Age 85-89 - 2011

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Age 90+ - 2011




The key point to highlight, in terms of tenure and health and wellbeing implications for older people, is the household expenditure associated with paying for and maintaining a home. The Scottish House Condition Survey (SHCS) provides information relating to housing issues for older people across Ayrshire. It uses the term ‘pensioner household’ for those households where there are two adults, at least one of whom is of pensionable age and no children, or one adult of pensionable age and no children. The private sector is the predominant tenure for pensioners across all areas. However, a higher proportion of pensioner households live in the private sector in South Ayrshire compared to East and North Ayrshire (Table 3 and Figure 31). Table 3: Housing tenure for pensioner households

East Ayrshire

North Ayrshire

South Ayrshire

Ayrshire and Arran

Pensioner households as a proportion of all households (%)

30% 30% 38% 32%

Pensioner households (Estimated number)

16,117 18,602 19,580 54,299

Pensioner households in ‘Private’ tenure (%)

63% 63% 79% 69%

Pensioner households in ‘Private’ tenure (Estimated number)

10,207 11,781 15,458 37,446

Pensioner households in ‘Social’ tenure (%)

37% 37% 21% 31%

Pensioner households in ‘Social’ tenure (Estimated number)

5,909 6,821 4,122 16,852

Source: SHCS (2008-10) (Table 2.9)

Household characteristics Figure 31 shows that there are very few single pensioners live in the private rented sector. Fifty nine percent of single pensioner households in East and South Ayrshire are owner occupied - below the Scottish figure of 61 percent with North Ayrshire above this at 66 percent. This may reflect the high level of social housing transferred into the private market via the right-to-buy policy of the recent past. Social rented housing by single pensioner is higher than the Scottish figure of 33 percent in East and South Ayrshire where it is 36 percent whereas North Ayrshire is lower at 25 percent. The percentage of single pensioner households in East, North and South Ayrshire is 14, 16 and 18 respectively. Figure 31: Single pensioner household by tenure, 2009-10

Source: http://www.scotland.gov.uk/Publications/2011/08/17093111/23

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NorthAyrshire

SouthAyrshire

Percentage

Other

Private rented

Social rented

Owner occupied



3.3 Marital Status

Marital status in older adults provides an indication of whether or not people are likely to be living alone and what type of support may be available to them. Figures 32, 33 and 34 all present a fairly similar pattern with the greatest likelihood of being widowed/bereaved civil partner in the over 75 year age groups. Figure 32: Marital status in East Ayrshire of adults aged 35 years and over, 2009-10

Source: www.scotland.gov.uk/Topics/Statistics/16002/LA0910Excel

Figure 33: Marital status in North Ayrshire for adults aged 35 years and over, 2009-10


Figure 34: Marital status in South Ayrshire for adults aged 35 years and over, 2009-10


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http://www.scotland.gov.uk/Topics/Statistics/16002/LA0910Excel




3.3.1 Housing quality

Housing quality can have a significant impact on health and well-being. Analysis of the SHCS (2008-10) shows that housing quality is closely related to housing tenure; people living in the private rented sector are at a higher risk of living in poor quality housing (Woods and Bain 2001). Table 4 shows the proportion of pensioner households who live in a dwelling that has some element of disrepair. This category ranges from very minor and trivial disrepair such as the need for new paint on the window sills to more serious problems such as major repair works to the roof. However it provides a high level overview of the level and challenge of constantly repairing and maintaining housing stock over time – which can be applied to the whole population and the totality of the housing. The majority of pensioners live in a dwelling that has at least some level of disrepair which may require a considerable amount of resources to maintain and improve their properties. Table 4: Profile of disrepair and average cost of works of pensioner properties East

Ayrshire North Ayrshire

South Ayrshire

Ayrshire and Arran

/ total

Pensioner households who living in a dwelling with any disrepair (%)

90% 90% 82% 87%

Pensioner households who living in a dwelling with any disrepair (estimate)

14,505 16,742 15,973 47,220

Annual spend on work to dwellings by pensioner households (total)

£11M £9M £24M £44M

Spend on work to dwellings by pensioner households (median)

£2,200 £2,500 £3,500 -

Source: SHCS (2008-10) Table 2.9 and 7.7

3.3.2 Housing options for older people – equipment and adaptations The majority of older people live in their own homes. As such, the provision of equipment and adaptations has been, and will continue to be, a vital part of helping older people remain in their own homes as they age. There is a wide range of options that can help transform a home that has become inaccessible and dangerous because of changes in the resident’s health and mobility, into a safe and independent living space. Guidance produced by the Scottish Government (2009) reiterates that Local Authorities have a duty to provide equipment and adaptations to people if an Occupational Therapist (OT) determines they have an ‘assessed need’. Equipment and adaptations are provided when a person’s house no longer meets their physical needs, and are installed to enable the individual to remain in their own home for as long as possible. Private sector aids and adaptations are funded from the Scheme of Assistance (formerly Private Sector Housing Grant) which is administered by the Local Authority. The Housing (Scotland) Act 2006 placed a statutory duty on Local Authorities to fund 80% (rising to 100% if in receipt of qualifying benefits) of grants for disabled adaptations. Table 5 indicates that 10 – 20 percent of households across Ayrshire had one or more adaptations, and a further 5 – 7 percent still require an adaptation in their dwelling. The bottom two rows of Table 5 show the estimated number of households that will require adaptations in 2033 if current conditions remain unchanged. This figure does not take into account the ageing of the population – which will almost certainly increase the requirement for adaptations.


Table 5: Households that have or require adaptation to dwelling (2008-10) and projections (2033) East

Ayrshire North

Ayrshire South

Ayrshire Ayrshire

and Arran

Households where one or more adaption is present in dwelling (%)

19% 11% 20% 16%

Households where one or more adaption is present in dwelling (Estimates)

10,207 6,821 10,305 27,333

Households where an adaptation is required to the dwelling (%)

5% 7% 6% 6%

Households where an adaptation is required to the dwelling (Estimate)

2,686 4,340 3,092 10,118

Estimate of households requiring adaptations at 2033

2,950 4,677 3,323 10,950

% Increase in households requiring adaptions 2010-2033

10% 8% 8% 8%

Source: Scottish House Condition Survey (2008-10) Tables 5.11 and 5.15 and GRO(S) Household Projections for Scotland 2008 based Tables 5 and 11

Each local authority has a slightly different approach to the provision and recording of aids and adaptations. As a result, information for each of the local authorities is given separately.

In East Ayrshire, the average annual expenditure on aids and adaptations over the period 2009-10 to 2011-12 was £507,683, with the total spend reaching £1,523,049 over that period. The highest level of funding has been for the provision of showers, which accounted for around 62% (£950,502) of the total spend over that three year period (Table 6).

The next highest grant allocation was used for the provision of stair lifts, which accounted for around 23% (£353,908) of the total expenditure over that same three year period.

Table 6: Profile of aids and adaptations in East Ayrshire for all tenures, 2009-10 to 2011-12 Number

2009/10 Number 2010/11

Number 2011/12

Average

Shower 107 102 207 139

External Handrails 144 124 69 112

Stair lift 43 19 62 41

Door Adaptations 16 22 15 18

Ramps 14 8 13 12

Source: East Ayrshire Council Housing Spending Figures

In North Ayrshire, the average annual expenditure on aids and adaptations was just under £1.5M a year. The highest amount of funding has been for the provision of shower/wet rooms. Table 7: Average number and expenditure on equipment and adaptations, 2009-10 to 2011-12


Year No Costs No Costs No Costs

2009/10 324 £474,290 924 £1,482,530 - £1,160,287

2010/11 102 £325,806 767 £1,285,885 - £1,118,581

2011/12 366 £722,951 1,135 £1,107,601 216

£687,841 (private sector only)

Average 322 £507,683 942 £1,292,006 - £988,903

Source – Adaptation Information from each Local Authority

In South Ayrshire, as with East and North Ayrshire, the highest level of funding in the private sector has been used for the provision of showers which accounted for 48% of total grant funding in 2009 or £416,849 (Table 8). The second highest grant allocation is used for the provision


of stair-lifts, which accounted for 17% of total grant funding in 2009 at £148,461. Improving access through the provision of external ramps accounted for the third highest level of expenditure across all three years and totalled £45,356 in 2009-10 or 5% of total funding. Table 8: Profile of expenditure of private sector housing grant, 2007-08 to 2009-10

2007/08 2008/09 2009/10 Average

Access improvement £5,950.00 £1,808.60 £15,994.95 £7,917.85

Auto WC £3,245.00 £1,753.38 £11,817.40 £5,605.26

Dampness £1,891.75 £11,020.47 - £6,456.11

Extension £77,837.96 £114,281.79 £81,017.02 £91,045.59

External steps - £1,035.18 - £1,035.18

Formation of bathroom £23,464.93 £10,261.5 £31,722.40 £21,816.28

Formation of bedroom £15,500 £15,500 £20,000.00 £17,000.00

Formation of shower room

- £9,094.47 £20,468.5 £14,781.49

Provision of bathroom £3,328.40 - £6775.00 £5,051.70

Provision of various rooms

£20,000.0 - - £20,000.00

Ramp £33,313.89 £33,789.79 £45,356.95 £37,486.88

Shower £219,560.94 £413,857.35 £416,849.50 £350,089.26

Shower & access steps - £3,963.78 £3,963.78 £3,963.78

Shower & platform lift £14,574.00 £14,574.00 - £14,574.00

Stair lift £152,353.71 £136,985.37 £14,8461.30 £145,933.46

Stair lift & shower £37,015.17 £77,032.97 £35,839.19 £49,962.44

Stair lift & WC - £13,112.51 £5,318.00 £9,215.26

Stair lift & wetroom - - £7,475.00 £7,475.00

Tracking hoist £17,430.98 £25,344.80 £2,545.61 £15,107.13

Wet room £9,894 - £5,739.00 £7,816.50

Windows - - £2,039.18 £2,039.18

Total £629,410.73 £881,607.36 £845,387.83 -

Source: Information provided by SAC Building Standards Section: December 2010

Table 9 provides a breakdown of all adaptations carried out to mainstream (rather than sheltered) South Ayrshire Council properties over the past three years (2008 - 2010). This table does not include the costs for stair-lift installation or costs relating to the provision of equipment. This information is held and recorded separately by Social Work and cannot be broken down by housing tenure. The total cost of stair-lift provision from 2008-2010 amounted to £205,940. Table 9: Profile of expenditure in mainstream South Ayrshire Council properties, 2008 – 2010 2008 2009 2010 Average

Automatic WC £3,498.60 - £400.49 £1,949.55

Banisters £18,067.78 £8,632.44 £7,365.74 £11,355.32

Door alterations £3,037.37 £1,575.81 £3,045.28 £2,552.82

Intercoms - - £160.01 £160.01

General £5,820.96 £769.06 £890.30 £2,493.44

Handrails £24,601.87 £24,956.80 £14,515.54 £21,358.07

Lever taps £1,907.06 £927.51 £387.23 £1,073.93

Ramps £30,211.25 £41,160.63 £15,854.22 £29,075.37

Sensory adaptations £2,197.29 £663.06 £325.64 £1,062.00

Showers £97,231.79 £94,138.50 £28,517.23 £73,295.84

Steps £282.23 £86.24 £2,997.79 £1,122.09

Wash hand basin £162.86 - £271.39 £217.13

Wet floor shower £160,578.10 £142,653.20 £187,302.80 £163,511.37

Total £347,597.16 £314,900.19 £262,033.66 £308,177.00

Source: Information provided by Housing Occupational Therapists: December 2010 The level and allocation of funding follows a similar pattern to private sector adaptations. The provision of wet floor showers accounts for the total highest level of funding across the three years at £490,534, followed by showers at £219,887, ramps at £87,226 and handrails at £64,074.


3.3.3 Housing options for older people – sheltered housing

North Ayrshire Council has undertaken a considerable amount of research and strategy development in relation to housing options for older people in recent months. This has resulted in the development of the ‘North Ayrshire Older Persons Housing Strategy’, which was submitted for partner approval in the summer of 2012. It offers considerable insight into the housing needs and aspirations of older people in the area. The key ‘wants’ in terms of service improvement that older people identified as part of this research included:

More involvement in strategic decisions and the development of the services that affect them

Improved communication between the local authority, NHS and partners

Improved information and advice on the housing and care options available to them

Localised care and support to help them remain independent and in their own home

Increased low level preventative support to reduce the risks of falls and injury in the home

Improved social events and activities within sheltered housing complexes.

East Ayrshire has 40 supported accommodation schemes throughout the area, 30 of which are linked to the East Ayrshire Risk Management Centre (RMC) and the remaining 10 not linked to this facility, (Table 10). Out of the 40 supported accommodation schemes, East Ayrshire Council operates 21, Hanover Housing operates eight, Bield operates six, Trust operates three and Atrium and West of Scotland Housing operates one each. East Ayrshire Council is in the process of reviewing their approach to supported accommodation for older people to ensure that it is providing the best possible service. In the meantime,

supported accommodation applicants to Council schemes are asked to complete a questionnaire that is assessed by the social work team. Applicants are categorised into requiring low, medium or high needs accommodation as well as the priority that should be awarded to the application. Bield, Hanover and Trust operate their own common housing register for the supported accommodation schemes. Table 10: Supported accommodation schemes in East Ayrshire

Local Sub-Area Number of support accommodation schemes

Number of units

Cumnock 13 303

Doon Valley 3 56

Kilmarnock and Loudon 24 444 Town

Auchinleck 2 53

Catrine 1 21

Crookedholm 1 10

Crosshouse 1 23

Cumnock 7 160

Dalmellington 2 37

Darvel 1 8

Drongan 1 33

Galston 3 68

Kilmarnock 13 264

Kilmaurs 2 24

Mauchline 1 22

Muirkirk 1 14

Newmilns 1 10

Patna 1 19

Stewarton 2 37

East Ayrshire total 40 803

Ratio of 65+ population (20,852) to units available (803) 2012 1:26

Ratio of 65+ (30,328) to units available (803) 2030 1:38

Source: East Ayrshire Council Housing Team


The two bottom rows in Table 10 shows the ratio of the population aged over 65 to number of units currently available in 2012 and in 2030 – if provision were to remain exactly the same. If the provision of units remains the same into the future, the pressure on supported accommodation will increase significantly. If no change is made to the level of provision of supported units, the ratio would increase from 1 unit for every 26 people aged over 65 to 1 unit for every 38 people aged over 65. As part of the overall review of sheltered housing in North Ayrshire, the complexes were categorised into four categories from 1 – High Demand to 4 – Very Low Demand. North Ayrshire Council have proposed to invest around £800,000 per year for the next five years (around £4M) in improving selected complexes to meet the needs and aspirations of older people in the 21st century. There are 43 sheltered housing complexes across North Ayrshire, (Table 11). Out of the 43 complexes, North Ayrshire Council operates 28, Isle of Arran Homes operates six, Hanover operates three, Blackwood Homes and Irvine Housing Association operate two each, and Bield, McCarthy and Stone and Peverel Retirement operate one each.

Table 11: Sheltered accommodation complexes in North Ayrshire

Sub Housing Market Area

Number of Sheltered Housing Complexes

Number of Units

Arran 6 63

Garnock Valley 8 148

Irvine/Kilwinning 14 276

North Coast 7 221

The Three Towns 8 203

Local area

Ardrossan 3 55

Arran 6 63

Beith 2 41

Dalry 2 59

Irvine 8 192

Kilbirnie 3 48

Kilwinning 5 84

Largs 4 189

Saltcoats 4 97

Stevenston 3 51

West Kilbride 3 32

North Ayrshire total 43 911

Ratio of 65+ population (25,275 )to units available (911) 2012 1:27

Ratio of 65+ population (37,130) to units available (911) 2030 1:41

Source: North Ayrshire Council and Older People’s Housing Strategy 2012


The last two rows in Table 11 above show the ratio of the population aged over 65 to number of units available in 2012 and in 2030 – if provision were to remain exactly the same. With the same proviso in place about the limitations of this figure, it shows that if the level of provision were to remain the same, the ratio would increase from 1 unit for every 27 people aged over 65, to 1 unit for every 41 people aged over 65. South Ayrshire Council has also recently undertaken a review of housing options for older people across the area, which identified a range of units suitable for further investment to establish a range of ‘extra-care’ housing options. There are 46 sheltered housing units, as shown in Table 12. In total there are 1,471 units of sheltered housing (Council, RSL and privately owned), which includes 234 amenity standard flats located in Riverside Place in Ayr. Out of the 46 complexes, South Ayrshire Council operate 21, Hanover Housing Association operate 8, Peveral Retirement and Trust Housing Association operate 5 each, West of Scotland Housing operate 3, Blackwood Homes operate 2, while Bield Housing Association and Sandfirs Investment Ltd operate one each. Out of these complexes, one has been specifically designed for people with dementia.

Table 12: Sheltered housing complexes in South Ayrshire

Local Area Number of sheltered housing complexes

Number of sheltered housing units

Ayr 18 747

Prestwick 5 166

Troon 14 377

Maybole 1 24

Girvan 3 84

Rural North 5 73

Rural South - 0

South Ayrshire Total 46 1471

Ratio of 65+ population (24,059 )to units available (1,471) 2012

1:16

Ratio of 65+ population (33,528) to units available (1,471) 2030

1:22

Source:-South Ayrshire Council Internal Systems and RSL stock returns: January 2011 (please note these figures contain Riverside Flats in Ayr).

3.3.4 Housing options for older people - care homes A care home is a residential setting where a number of older people live usually in individual rooms, and have access to on-site care services. A home registered simply as a care home will provide personal care only - that is help with washing, dressing and giving medication. Some care homes are registered to meet a specific care need, for example dementia or terminal illness. Table 13 shows the number of people and rate per 1,000 population who were supported in care homes in 2010/11. The rate is similar across each of the Ayrshires.


Table 13: Older people supported in care homes, 2010-11

East Ayrshire

North Ayrshire

South Ayrshire

Clients aged 65+ 735.5 883.5 833

Total population aged 65+

21,157 25,314 23,787

Rate per 1,000 population

34.8 34.9 35

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Health/Data/CareData The number of places has changed in recent years (Figure 35). In all cases, the number of care home places has decreased, although this change has been sporadic rather than demonstrating any trend. Figure 35: Trends in care home places for older people, 1999-00 to 2010-11

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Health/Data/CareData

Care homes are regulated by the Care Inspectorate, with a focus on four areas:

Quality of care Quality of staffing

Quality of environment Quality of management and leadership

Scores can range from 1 – 6:

1=Unsatisfactory 2= Weak 3 = Adequate

4 = Good 5 = Very good 6 = Excellent http://www.scswis.com/

In East Ayrshire, there are around 21 care homes, offering around 914 beds. The smallest care home has 10 spaces and the largest has 80 spaces. The rates charged at the time of writing range from £435 per week to £1,000 per week. Table 14 shows the grades reported for East Ayrshire’s care homes at the latest inspections. The majority of care homes have an adequate grading or higher. An interdisciplinary team from the Council and NHS has been established to work with care homes that are underperforming.

Table 14: East Ayrshire care homes inspection grades (latest inspection)

Grade Quality of Care

Quality of Environment

Quality of Staffing

Quality of Management and Leadership

1 1 - - -

2 2 1 2 3

3 8 8 4 4

4 2 1 3 -

5 4 4 3 3

6 1 - - - Source: East Ayrshire Council

60%

65%

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85%

90%

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105%

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East Ayrshire

North Ayrshire

South Ayrshire

SCOTLAND

http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/Data/CareData


http://www.scswis.com/


In North Ayrshire, there are 21 care homes, offering 906 spaces. The smallest care homes have 15 spaces and the largest has 92 spaces. The rates charged at the time of writing range from £487.20 per week for residential care to £568.96 for nursing and residential care. Table 15 shows the grades reported for North Ayrshire’s care homes at the latest inspections. The majority of care homes have an adequate grading or higher. However, due to concerns about quality of some care home services, North Ayrshire Council and NHS have invested in Care Home Support Team, made up of CPNs, District Nurses, Social Workers, and a Clinical Improvement Practitioner. Table 15: North Ayrshire care homes inspection grades (latest inspection)



Quality of Staffing


1 1 - -

2 2 1 2 3

3 11 11 6 7

4 2 2 8 6

5 4 7 5 4

6 1 - - 1 Source: North Ayrshire Performance Information

In South Ayrshire, there are 26 care homes offering just over 1,000 spaces. The smallest care homes have 14 spaces and the largest has 80 spaces. One property offers specialist care for people with dementia. The rates charged at the time of writing range from £462.20 to £639.75 for the specialist dementia room.

At the last inspections returned for South Ayrshire’s care homes the majority of care homes received an adequate grading or higher (Table 16).

Table 16: South Ayrshire care homes inspection grades (latest inspection)



Quality of Staffing


1 1 - - 1

2 - 1 1 -

3 5 4 3 4

4 8 5 2 2

5 12 3 1 -

6 - 1 - Source: South Ayrshire Council Performance Information

3.3.5 Housing options for older people – home care Home care is care provided for an individual in their home to enable them to maintain their independence. It involves regular visits from a home care worker and may include:

Personal care

Shopping

Meals on wheels/frozen meals delivery

Collecting pensions and prescriptions/paying bills

Laundry – washing and ironing in home or laundrette

General cleaning.


Access to home care is not restricted by age, as shown in Table 17, however, the data does show that the highest proportion of those who utilise the service are over the age 65, with a more than 50 percent increase between the ages of 65 to 74 and 75 to 84 reducing slightly after the age of 85. Table 17: Home care client by age group and geography, 2009-2011

East Ayrshire

North Ayrshire

South Ayrshire

Ayrshire and Arran

2009

0-64 471 162 527 1,160

65 - 74 294 262 295 851

75-84 714 628 627 1,969

85+ 580 602 724 1,906

2010

0-64 423 117 551 1,091

65 - 74 268 249 306 823

75-84 700 537 650 1,887

85+ 527 517 709 1,753

2011

0-64 350 101 665 1,116

65 - 74 261 243 323 827

75-84 661 552 693 1,906

85+ 562 531 756 1,849

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Health/Data/CareData Figure 36 shows the age profile of home care clients in 2011 alone. It shows that South Ayrshire had the largest amount of clients across all age groups.

Figure 36: Home care clients by age group, 2011

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Health/Data/CareData However, it is important to highlight that not every service user needs the same level of care. Figure 37 shows the breakdown of the number of hours each client received between 2009 and 2011. Although there is a little year on year and geographical differentiation, around a third of clients receive less than 4 hours per week, around a third between 4 and 10 hours and around a third receive over 10 hours. Table 18 shows the number of people aged 65 and over and the rate per 1,000 people receiving more than 10 hours a week of support. South Ayrshire has the highest rate of people with intensive care.

350 101

665 261

243

323 661

552

693

562

531

756

0

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1000

1500

2000

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65 - 74

0-64




Figure 37: Breakdown of hours of home care for clients aged 65 years and over, 2009-2011

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Health/Data/CareData Table 18: Older people receiving intensive home care (10+ hours per week), 2009-2011

East Ayrshire

North Ayrshire

South Ayrshire

Ayrshire and Arran

Clients aged 65+

302 412 622 1,336

Rate per 1,000 population

14.3 16.3 26.1


3.3.6 Free personal and nursing care

Free personal and nursing care (FPNC) was introduced in Scotland on 1 July 2002. Prior to 1 July 2002, people could be charged for personal care services provided in their own home and many residents in care homes had to fully fund their care from their own income and savings. Now people in care homes aged 65years and over and assessed as self-funders can receive a weekly payment towards their personal care. This weekly FPNC payment was set at £153 from April 2009. Furthermore, people aged 65years and over can no longer be charged for personal care services provided in their own home due to the introduction of Free Personal Care (FPC).

Table 19 shows the number of FPNC for people in care homes and FPC for people receiving care at home from 2007-08 to 2010-11. South Ayrshire has the highest level of clients across Ayrshire. The number of clients has increased more or less consistently over the past three years.

Local data show that free personal nursing care for Care home clients between 2007-08 and 2010-11 is lowest in East Ayrshire and has remained constant over the time period; that North Ayrshire was higher and increased over the period and South Ayrshire was highest and also increased over the period. The expenditure for this reflects the pattern. The number of clients receiving FPNC at home was lowest in North Ayrshire followed by East and South Ayrshire, and the expenditure reflected the same pattern. South Ayrshire’s spend per person was £2,259 more than East Ayrshire and £404 per person more than North Ayrshire for Care at home. This may be an indicator of higher dependency in South and North Ayrshire compared to East Ayrshire, although it is known that East Ayrshire has the highest level of DLA receipt. As could be expected, the largest groups receiving home care in East, North and South Ayrshire in 2011 were the 75 to 84 years and the 85 years and over age groups.

0

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2009 2010 2011 2009 2010 2011 2009 2010 2011


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4-10 Hrs

Under 4 Hrs




Table 19: Free personal and nursing care (FPNC) provided to clients


FPNC - Care home - number of clients

2007-08 180 260 360

2008-09 180 290 340

2009-10 180 310 340

2010-11 180 330 380

FPC - Care at home - number of clients

2007-08 1,400 1,230 1,440

2008-09 1,500 1,410 1,540

2009-10 1,460 1,350 1,650

2010-11 1,500 1,310 1,730

FPNC - Care home - expenditure £000s

2007-08 1,848 2,855 4,043

2008-09 1,985 3,091 3,937

2009-10 1,988 3,399 4,178

FPC - Care at home - expenditure £000s

2007-08 8,702 4,952 11,142

2008-09 8,792 8,223 12,066

2009-10 8,716 9,216 12,871

Provision of FPNC 2009-10 care home

Rate per 1,000 population 9 12 15

Provision of FPC 2009-10 home care

Rate per 1,000 population 70 54 70


3.4 Societal and environmental factors

A range of wider societal and environmental factors will impinge on the lives of the population and is likely to affect more vulnerable people to a greater degree.

3.4.1 Internet use

The internet can be used to access and provide a whole range of services, as well as providing a useful communication tool and source of information. There is a view within society that older people tend not to use the internet as much as younger people, which to some extent is reflected in statistics such as the Scottish Household Survey. However, this picture is varied and many older people are happy to explore online services. Furthermore, research undertaken for the Joseph Rowntree Foundation17 revealed that even those who did not use the internet recognised the benefits that it might bring. Table 20 shows information taken from the Scottish Household Survey 2007-08, and shows that around 20,000 people over 60 across Ayrshire use the internet. Table 20: Internet use by people aged 60 years and over, 2007-08

East Ayrshire

North Ayrshire

South Ayrshire

Internet user (%) 29 38 46

Internet user (estimate) 4,674 7,069 9,007

Does not use the internet at all (%) 71 62 54

Does not use the internet at all (estimate) 11,443 11,533 10,573 Source http://www.scotland.gov.uk/Topics/Statistics/16002/LATables2009-2010


http://www.scotland.gov.uk/Topics/Statistics/16002/LATables2009-2010


3.4.2 Crime and fear of crime

Hirschfield18 highlighted that there is a complex relationship between

crime, the fear of crime and health. Hirschfield suggested that crime and fear of crime were known to cause symptoms such as stress, sleeping difficulties, loss of appetite, depression, loss of confidence and health harming ‘coping mechanisms’ such as smoking and alcohol. The fear of crime can alter people’s lifestyles and may affect them in ways that lessen their quality of life and impact upon their physical and psychological health. Robinson and Keithley19 explain that crime poses substantial risks to the health of victims and consequently, generates additional demand on health services. Table 21 indicates perceptions of personal safety.

Table 21: Perceptions of safety when walking alone in the neighbourhood and in own home at night

Alone at night East Ayrshire

North Ayrshire

South Ayrshire

Walking alone – people aged 65+

Very or fairly safe (%) 68 66 68

Very or fairly safe (estimate) 10,959 12,277 13,314

Very or a bit unsafe (%) 31 31 31

Very or a bit unsafe (estimate) 4,996 5,767 6,070

Don’t know (%) 1 3 1

Don’t know (Estimate) 161 558 196

At home – people aged 65

Very or fairly safe (%) 98 97 95

Very or fairly safe (estimate) 15,794 18,044 18,601

Very or a bit unsafe (%) 2 3 5

Very or a bit unsafe (estimate) 322 558 979

Don’t know (%) - - -

Don’t know (estimate) - - - Source http://www.scotland.gov.uk/Topics/Statistics/16002/LATables2009-2010

3.4.3 Fuel poverty

According to the Scottish Fuel Poverty Statement, “a household is in fuel poverty if, in order to maintain a satisfactory heating regime, it would be required to spend more than 10% of its income (including Housing Benefit or Income Support for Mortgage Interest) on all household fuel use20. Adequate warmth is defined as 21oC to 23oC in the main living areas and 18oC in other areas. Fuel poverty has a negative impact on health and can exacerbate ill health in older people. Older people spend more time in their homes than the general population and lower temperatures can increase respiratory disease, high blood pressure, coronary thrombosis and other diseases of the circulatory system20. There are three contributory factors to fuel poverty:

Energy efficiency / performance of the property

Income of household

Price of energy The National Home Energy Rating Scheme (NHER) is both a UK accreditation scheme for energy assessors and a rating scale for the energy efficiency of housing. The NHER scale runs from 0 to 20, with 20 being the highest level of energy efficiency. A dwelling with an NHER rating of 20 achieves zero CO₂ emissions along with zero net running costs. Currently, an average dwelling would score between 4.5 and 5.5 on the NHER scale. Table 22 shows the proportion of pensioner households with a ‘poor’ National Housing Energy Rating (NHER) score that is between 0 and 5, as well as the proportion of pensioner households living in fuel poverty.

http://www.scotland.gov.uk/Topics/Statistics/16002/LATables2009-2010


Table 22: Proportion of pensioner households living in ‘poor’ NHER rated housing and in fuel poverty

East Ayrshire

North Ayrshire

South Ayrshire

Ayrshire and Arran

Pensioner households living in dwelling with NHER* Rating of 0 – 5 (%)

17% 22% 30% 23%

Pensioner households living in dwelling with NHER Rating of 0 – 5 (Estimated number)

2,740 4,092 5,874 12,706

Pensioner households in fuel poverty (%)

41% 53% 50% 48%

Pensioner households in fuel poverty (Estimated number)

6,608 9,859 9,790 26,257

Source: http://www.scotland.gov.uk/Topics/Statistics/SHCS Around half of pensioner households across Ayrshire are living in fuel poverty, which has implications for the health and well-being of these households. Fuel poverty in East, North and South Ayrshire

Figure 38 presents data that demonstrate that householders over the age of 60 are more than twice as likely to experience fuel poverty as those householders under the age of 60. In 2008-10 North Ayrshire had the highest percentage of householders over the age of 60 in fuel poverty at 52.8 percent, the figure for South Ayrshire was 50 percent and in East Ayrshire it was lowest at 40.2. The increases in utility bills over the last decade appear to have had disproportionately negative impact on the levels of fuel poverty in the older age group.

Local partnership coordination related to housing improvement measures and energy efficiency, such as insulation and double glazing, particularly in the social rented housing is of importance in addressing the issues. Local policy implementation could for example, focus on age rather than, or as well as, on geography related to SIMD.

Figure 38: Percentage of households in fuel poverty in East, North and South Ayrshire by age, 2004-07 to 2008-10

Source: http://www.sns.gov.uk/default.aspx

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3.4.4 Climate change A report written by the Intergovernmental Panel on Climate Change (IPCC) (2007) confirmed that climate change is expected to increase the incidence of extreme weather events. The Climate Change (Scotland) Act 2009 places a duty on public bodies to consider ways to deliver a reduction in carbon emissions and operate in the most sustainable way. It also places an obligation on public bodies to consider the impact of climate change and ways of mitigating and adapting to the negative impacts of climate change as far as possible.

Various research projects and findings have started to emerge, although it will be some time before a full understanding of what the impacts of climate change will be for older people and the health, care and housing services they will require. What is important to recognise is that the risks associated with the impacts of climate change are not distributed equally throughout society, but are likely to have a more significant impact on already vulnerable households, including vulnerable older people. A recent Scottish Parliament Information Centre (SPICe) briefing21 outlines a range of potential impacts on health and wellbeing. These include:

Increases in heat-related deaths and illness in summer (estimates around 100 extra heat - related deaths per year)

Marine and fresh water pathogens

Health problems due to air pollution

The many health impacts of flooding

Increased respiratory conditions associated with algal and fungal growth in housing

Increased rates of food poisoning

Increased exposure to UV radiation

Reduction in cold-related health problems, including falls and deaths (estimated to be a drop of around 20–32% of excess winter deaths – a reduction of about 1% of overall mortality rates by 2050, with concomitant fall in cold-related hospital admissions).


Chapter 4: Lifestyle factors

It is not only life circumstances that impact on people’s health. Life circumstances and the social, economic and cultural environment can affect and/or influence the lifestyle choices people make and these have a major impact on health across the life course. Increasing the number of people with better lifestyles is crucial for the longer-term health of older people; “it is never too early and never too late” to improve lifestyle behaviours. However, it the risk taking behaviours, such as smoking and alcohol misuse in young and middle adulthood that have a negative effect in later life. Public health interventions, such as smoking cessation and alcohol brief interventions early in life as well as later in life will increase the chances of a longer, healthier and more independent old age22.

4.1 Smoking

4.1.1 Smoking prevalence

Smoking tobacco is recognised as the single largest preventable cause of ill health and early death in Scotland. Smoking has been evidenced as a contributing factor in heart disease, stroke, cancer, and lung disease. It is also recognised as a major contributor to health inequalities23. Figure 39 presents the smoking prevalence estimates for Ayrshire and Arran from 2003-04.The Scotland-level findings from the Scottish Health Survey 2009 are shown in Figure 40. All these data show that the percentage of smokers within the adult population is highest among those in their 20s and 30s before dropping steadily with each successive age band.

Similar findings were observed from data extracted in 2009 from NHS Ayrshire & Arran’s electronic recording system for General Practice (then GPASS), with 20% of patients aged 65-74 years and 11% of patients aged 75 years and over being recorded as smokers (Figure 41 and Table 23). Around 30% of patients aged 65 and over were recorded as ex-smokers. Over 90 percent of cases on the recording system were found to have smoking status recorded, indicating a high degree of coverage for population prevalence. Figure 39: Estimated percentage of smokers in the adult population of Ayrshire and Arran by age and sex, 2003-04

Source: An Atlas of Tobacco Smoking in Scotland (2007)

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Figure 40: Percentage of adults in Scotland that smoke by age group, 2009

Source: Scottish Government. Scotland’s People – Annual Report: results from 2009 Scottish Household Survey. 2010.

Figure 41: Smoking status of patients in Ayrshire and Arran at 1 Jan 2009 as a percentage of all patients with smoking status recorded by GPs, by age group

Source: GPASS, Primary Care Department, NHS Ayrshire and Arran

Table 23: Smoking status of patients in Ayrshire and Arran at 1 Jan 2009 as a percentage of all patients with smoking status recorded by GPs, by age group and CHP area

Age group CHP area % smoker % ex-smoker % non smoker

East 29.6% 7.0% 63.4%

15-34 yrs North 31.9% 7.5% 60.6%

South 30.6% 8.6% 60.8%

All 15-34 yrs 30.8% 7.6% 61.6%

East 30.4% 18.0% 51.7%

35-64 yrs North 31.3% 16.5% 52.2%

South 27.4% 18.4% 54.3%

All 35-64 yrs 29.9% 17.5% 52.6%

East 22.4% 33.8% 43.8%

65-74 yrs North 20.4% 30.2% 49.4%

South 18.2% 33.4% 48.4%

All 65-74 yrs 20.4% 32.2% 47.4%

East 13.2% 34.6% 52.1%

75+ yrs North 11.1% 28.7% 60.2%

South 9.4% 34.1% 56.5%

All 75+ yrs 11.2% 32.2% 56.6%


4.1.2 Smoking-related mortality Tobacco smoking is a significant factor in the mortality of older people. Based on estimates from 2000-04, it is believed that 25% of deaths among males aged 70 years and over, and 20% of deaths among females aged 70 years and over, can be attributed to smoking24 (Table 24).

27

33 32 28

17

10

26 23

25 27 26

20

11

23

0

10

20

30

40

16-24 25-34 35-44 45-59 60-74 75 plus All

Per

cen

tage

Male Female

31% 30% 20%

11%

8% 18% 32% 32%

62% 53% 47%

57%

0%

20%

40%

60%

80%

100%

15-34 yrs 35-64 yrs 65-74 yrs 75+ yrs

% smoker % ex-smoker % non smoker


The proportion of deaths which are estimated to be smoking-attributable among adults aged 35-69 years is higher than for those aged 70 years and over. This is likely to be a factor in the decreased prevalence of smoking among older people which is partly due to the fact that smoking related illnesses are a major cause of premature mortality. Table 24: Estimated smoking-attributable mortality by age and sex, NHS board, 2000–2004 Males

(35-69) Males (70+) Females

(35-69) Females (70+)

All persons

n % n % n % n % n %

Ayrshire & Arran

938 27 1,669 25 672 28 1,923 20 5,202 23

Source: An Atlas of Tobacco Smoking in Scotland, 2007. 4.1.3 Smoking cessation services Smoking cessation services are delivered in Ayrshire and Arran through two main providers; Fresh Air-shire Smoking Cessation and Prevention Service, and community pharmacies. Local smoking cessation services were used by 293 older people in Ayrshire and Arran during 2009 (Figure 42).

Figure 42: Age of clients using local smoking cessation services in Ayrshire and Arran, 2009

Source: NHS Ayrshire & Arran Smoking Cessation Service

4.2 Alcohol and drugs misuse 4.2.1 Alcohol Alcohol is the most commonly used drug in Scotland today. Consumption of alcohol is associated with a wide range of medical conditions, including cirrhosis of the liver, acute and chronic pancreatitis, brain damage, cancers, stroke, mental health problems and heart disease. In addition, alcohol features as a major contributor to accidents, domestic abuse, violence, and anti-social behaviour, and can have a major detrimental effect on families. Like smoking, it is recognised as a major contributor to health inequalities.

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Alcohol can present specific health risks to older people as tolerance to alcohol reduces with age due to a number of factors including:

a reduced ratio of body water to fat (less water for the alcohol to be diluted in);

decreased hepatic blood flow (liver will receive more damage);

inefficiency of liver enzymes (alcohol will not be broken down as efficiently);

altered responsiveness of the brain (alcohol will have a faster effect on the brain)25.

In addition, the use of prescribed medicines is more prevalent among older people. This increases the risk of adverse interactions with alcohol as it is contraindicated for use with many of the medicines commonly used by older people26. A range of life changes and significant life events associated with the ageing process have been identified as factors which can lead to problematic alcohol consumption among older people25. These include emotional and social changes such as bereavement or loss of occupation; medical problems such as physical disabilities or chronic pain; and practical problems such as altered financial circumstances or reduced coping skills. However, the identification of alcohol problems among older people can be problematic26. Due to stigma around problematic alcohol use, older people may be likely to under-report their alcohol consumption and professionals involved in their care and wellbeing may be reluctant to broach alcohol issues. Furthermore, screening instruments that are validated for the general adult population may be less effective when used with older people.

Older people often have a higher ‘sensitivity’ to alcohol, commonly used questions about the frequency and level of consumption should be used with care. Similarly, the threshold of dependency is lower for older drinkers and screening tools such as CAGE have been found to have a lower validity in this population group. 4.2.1.1 Alcohol consumption No current local data on alcohol consumption was available at the time of writing. The Scottish Health Survey (2008, 2009 and 2010 combined) does however provide Scottish-level estimates of alcohol consumption for older people. Older people were found to consume substantially less alcohol than Scottish working age adults. While over one quarter of adults aged 16-64 years reported consuming over the maximum weekly recommended amount of alcohol (14 units of alcohol for females; 21 units of alcohol for males), this reduced steadily through each subsequent age band to 6% of those aged 85 years and over (Table 25). Similarly, 45 percent of adults aged 16-64 years reported consuming over the recommended maximum daily amount of alcohol (3 units of alcohol for females; 4 units of alcohol for males); compared with 6% aged 85 years and over (Table 26). However, it should be noted that when weekly and daily limits were taken together, a significant minority of older people reported drinking in excess of the government guidelines (Table 27). For all age bands, males reported higher alcohol consumption than females.


Table 25: Estimated usual weekly alcohol consumption in Scotland, 2008, 2009 and 2010 combined, by age Alcohol units per week Age Total

65+ 16-64 65-

69 70-74

75-79

80-84

85+

% % % % % % %

All adults

Drank over 14/21 units per week

26 21 14 11 9 6 14

Mean units per week 13.5 10.8 7.9 6.3 5.2 3.5 7.7

Bases (weighted):

All adults 16675 1249 1097 910 591 375 4222

Source: SheS 2008-10 combined

Table 26: Estimated alcohol consumption on heaviest drinking day in last week, 2008, 2009 and 2010 combined, by age, Scotland

Alcohol units per day

Age Total 65+

16-64 65-69

70-74

75-79

80-84

85+

% % % % % % %

All adults

Consumed over 3/4 units

45 27 20 12 6 5 17

Consumed over 6/8 units

26 9 4 2 1 1 4

Mean units per day 5.3 2.8 2.1 1.4 1.1 0.7 1.9

Bases (weighted):

All adults 16586 1251 1098 911 591 376 4226


Table 27: Adherence to weekly and daily drinking advice, 2008, 2009 and 2010 combined, by age and sex, Scotland

Adherence to weekly and

daily drinking advice

Age Total 65+

16-64

65-69 70-74 75-79 80-84 85+

% % % % % % %

Men

Never drunk alcohol

4 3 4 5 7 11 5

Ex drinker 5 10 12 13 15 15 12

Drinks within government guidelines a

37 43 50 57 59 59 51

Drinks outwith government guidelines b

53 45 34 26 19 15 33

Women

Never drunk alcohol

6 10 12 20 21 27 16

Ex drinker 6 11 11 10 12 13 11


43 55 58 57 61 56 57


45 24 18 12 6 5 15

All adults


Never drunk alcohol

5 7 9 14 15 22 11

Ex drinker 6 10 12 11 13 13 12


40 49 54 57 60 57 55


49 34 26 18 11 8 23

Bases (weighted):

Men 8041 581 502 375 235 116 1809

Women 8425 667 594 534 355 259 2409

All adults 16466

1248 1096 909 590 375 4218

a Drank no more than 4 units (men) or 3 units (women) on heaviest drinking day, and drank no more than 21 units (men) or 14 units (women) in usual week.

b Drank more than 4 units (men) or 3 units (women) on heaviest drinking day, and/or drank more than 21 units (men) or 14 units (women) in usual week.


4.2.1.2 Primary care The data in Table 28 show numbers of patients with a diagnosis of alcohol abuse or alcohol dependency. Counts are mutually exclusive, based respectively on a first-time diagnosis of abuse with no preceding diagnosis of dependency, and a first-time diagnosis of dependency with no preceding diagnosis of abuse. It should be noted that patients do not necessarily have a current alcohol problem, only that the GP has recorded an alcohol problem at some point in their history of contact with the patient. Alcohol abuse was found to reduce with age among females and was recorded in less than 1% of cases for females aged 65 years and over. Among males, however, alcohol abuse was recorded most commonly among those aged 65-74 years (2.7%) Alcohol dependency was found to be highest for both males and females aged between 65-74 years (2.57% and 1.12% respectively) but reduced among patients aged 75 years and over. Again, there was a clear deprivation gradient with the proportion of patients recorded as having a primary diagnosis for alcohol abuse or dependency being observed to rise consistently with deprivation.


Table 28: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of alcohol abuse or alcohol dependency – diagnosis appearing first on GP record, by age group and deprivation category

Age group of patients Deprivation category Female patients Male patients

Alcohol abuse* Alcohol dependency* Alcohol abuse* Alcohol dependency*

n % n % n % n %

SIMD 1 188 1.7 53 0.5 321 3.0 138 1.2

SIMD 2 172 1.5 41 0.3 234 2.0 88 0.7

15-34 years SIMD 3 91 1.2 9 0.1 101 1.4 38 0.5

SIMD 4 35 0.6 0 0 53 1.0 15 0.2

SIMD 5 28 0.6 2 - 31 0.7 6 0.1

All 15-34 years* 522 1.3 106 0.2 746 1.8 290 0.7

SIMD 1 299 1.8 304 1.8 777 4.1 712 4.2

SIMD 2 224 1.2 217 1.1 556 3.0 572 3.0

35-64 years SIMD 3 122 0.9 104 0.8 305 2.3 241 1.8

SIMD 4 66 0.5 67 0.6 136 1.2 128 1.0

SIMD 5 40 0.4 25 0.2 90 0.9 68 0.6

All 35-64 years* 758 1.0 727 1.0 1,889 2.6 1,737 2.4

SIMD 1 54 1.5 49 1.4 165 4.6 134 3.7

SIMD 2 48 1.2 70 1.7 126 3.1 133 3.0

65-74 years SIMD 3 19 0.7 31 1.1 62 2.0 56 2.0

SIMD 4 16 0.6 10 0.3 39 1.0 45 1.7

SIMD 5 9 0.4 12 0.6 19 0.8 27 1.3

All 65-74 years* 146 0.9 173 1.1 419 2.7 399 2.5

SIMD 1 27 1.2 12 0.5 68 3.0 41 1.8

SIMD 2 28 1.0 24 0.9 49 1.7 41 1.5

75+ years SIMD 3 19 1.0 13 0.7 24 1.3 15 0.8

SIMD 4 10 0.5 9 0.5 19 1.0 11 0.6

SIMD 5 6 0.4 2 0.1 10 0.7 13 0.9

All 75+ years* 91 0.9 60 0.6 171 1.6 122 1.2

Source: GPASS Primary Care Department, NHS Ayrshire and Arran -NB*Includes unknown SIMD


4.2.1.3 Acute care Figure 43 shows the pattern of crude rates of alcohol-related acute hospital discharges in Ayrshire and Arran between 2000 and 2008 for patients aged 30 years and above (shown by 5-year age bands). Although the rate of alcohol-related discharges has historically peaked among people aged in their fifties, there has been an upwards trend of discharge rates among older people over the past decade. In particular, large increases have been observed among those aged 65 to 74 years. Figure 43: Crude rates of all alcohol-related acute hospital discharges (SMR01) for all persons aged 30 years or over by 5-year age band in Ayrshire and Arran (2000, 2004, 2008)

Source: SMR01

4.2.1.4 Specialist addiction services The majority of alcohol assessments made by NHS Ayrshire & Arran Specialist Addiction Services are for people aged 35-54 years (Figure 44). People aged 65 and over accounted for 3.9% of alcohol assessments made between 2005/06 and 2008/09, equating to 198 assessments over this time period.

Figure 44: Alcohol assessments by specialist addictions services (2005-06 to 2008-09); age at referral (banded)

Source: SAMS database

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4.2.1.5 Alcohol-related brain damage Alcohol-related brain damage (ARBD) refers to the effects of changes to the structure and function of the brain resulting from the long-term consumption of alcohol, including the toxic effects of alcohol on brain cells, impairment caused by vitamin and nutritional deficiencies, and disturbances to the blood supply to the brain. People who have an ARBD condition can acquire a number of cognitive problems, including confusion, difficulty in processing new information, and confabulation to compensate for gaps in memory. They may suffer from apathy and depression. They may also sustain physical harms, such as damage to the liver, vision, and gait, and can experience numbness or pain in hands, feet, and legs. Since ARBD requires high levels of alcohol consumption over a considerable period of time, it is relatively rare among younger adults with the prevalence increasing with age. Persons aged 65 years and over have a significantly higher rate of hospital discharges with a diagnosis of ARBD than those aged 35-64 years (Figure 45). In addition the rate of discharges among persons aged 65 years and over has increased both nationally and within Ayrshire and Arran.

Figure 45: General acute inpatient and day case discharges with a diagnosis of alcohol-related brain damage in any position: five-year average age standardised rate per 100,000 population, by health board 2001-02 to 2010-11

Source: ISD Scotland (SMR01)

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2003/04 2004/05 2005/06 2006/07 2007/08 2008/09


4.2.2 Drugs Illicit drug use is not common among older people in Scotland, with 0.2% of adults aged 60 years and over reporting having used illicit drugs during the last year, and 0.1% in previous month (Scottish Crime and Justice Survey (SCJS 2010-11)). This compares with reported rates of two percent among people aged 15 to 64 years of age. Few older people in Ayrshire and Arran are recorded as having a GP diagnosis for drug abuse or dependency (Table 29). Similarly, low rates of drug-related discharges have been observed in older people in Ayrshire and Arran (Figure 46). However, it is worth noting that there has been an increase in drug-related discharges among patients aged 30-54 years over the last decade. The patterns of drug use among this cohort may have implications on the care and treatment of older people in future years. As presented in Table 29, drug assessments of older people by specialist addiction services in Ayrshire and Arran have been very rare in recent years. Less information is available on the adverse effects of licit drugs on the older population. As people age, they tend to develop health conditions that require continuing medication (e.g. osteoarthritis, diabetes), and are also more vulnerable to infection and the development of acute conditions. Drugs are used frequently in the management of health problems in older people and several drugs may be prescribed for any individual. Adverse consequences of drug combination are not uncommon and more research is being conducted to elucidate this.


Table 29: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of drug abuse or drug dependency – appearing anywhere on GP record, by age group and deprivation category (51 of 59 local practices)

Age group of patients Deprivation category Female patients (%) Male patients (%)

Drug abuse* Drug dependency* Drug abuse* Drug dependency*

n % n % n % n %

SIMD 1 226 2.1 278 2.6 317 2.9 416 3.8

SIMD 2 148 1.3 161 1.4 244 2.1 288 2.5

15-34 years SIMD 3 54 0.8 55 0.8 91 1.2 107 1.5

SIMD 4 18 0.4 13 0.3 39 0.7 31 0.6

SIMD 5 15 0.4 4 0.1 18 0.4 17 0.4

All 15-34 years* 468 1.2 520 1.3 719 1.8 874 2.2

SIMD 1 222 1.4 273 1.7 391 2.3 538 3.2

SIMD 2 159 0.8 156 0.8 287 1.5 362 1.2

35-64 years SIMD 3 67 0.5 64 0.5 119 0.9 154 1.2

SIMD 4 41 0.3 38 0.3 50 0.4 51 0.4

SIMD 5 38 0.4 10 0.1 28 0.3 22 0.2

All 35-64 years* 531 0.7 551 0.8 889 1.2 1,135 1.5

SIMD 1 23 0.6 24 0.6 9 0.2 12 0.3

SIMD 2 19 0.4 21 0.4 8 0.1 11 0.2

65-74 years SIMD 3 12 0.4 11 0.3 2 - 5 0.2

SIMD 4 2 - 5 0.2 3 0.1 7 0.2

SIMD 5 4 0.1 2 - 1 - 2 -

All 65-74 years* 60 0.3 63 0.3 23 0.1 37 0.2

SIMD 1 52 1.4 7 0.2 15 0.6 1 -

SIMD 2 13 0.3 9 0.2 10 0.4 5 0.1

75+ years SIMD 3 24 0.8 9 0.3 7 0.4 0 -

SIMD 4 2 - 5 0.2 1 - 0 -

SIMD 5 4 0.2 4 0.2 0 0 0 -

All 75+ years* 96 0.6 34 0.2 1 0.3 6 -

Source: GPASS, Primary Care Department, NHS Ayrshire and Arran NB*Includes unknown SIMD


Figure 46: Crude rates of all drug-related acute hospital discharges (SMR01) for all persons aged 10 years or over by 5-year age band in Ayrshire and Arran (2000, 2004, 2008)

Source: SMR01

4.3 Healthy weight Obesity is defined as “a condition characterised by excessive body fat”. Body fat tends to be stored predominantly around the waist or around the hips. Obesity has been linked to an increased risk of coronary heart disease, diabetes, cancer, kidney failure, arthritis, back pain and psychological damage, and decreased life expectancy. As a result,

obese people are more likely to be hospitalised, and more generally be in contact with health care services, than non-overweight people27. The Body Mass Index (BMI) is used to measure general obesity. BMI is defined as: A BMI of between 18.5 and 25 kg/m² is considered to be a healthy weight. Scotland-level data drawn from the Scottish Health Survey 2008-10 found that 25% of people aged over 65 years were between 18.5 and 25 kg/m² compared with 35% of people aged 16-64 years (Table 30). The proportion of older people who reported being a healthy weight did however increase with each age band. A BMI of between 25 and 30 kg/m² is considered to be overweight, while a BMI of >30 kg/m² is considered to be obese. Forty-two per cent of people aged 65 and over were recorded as being overweight compared with 36% of people aged 16-64 years. Thirty per cent of people aged 65 years and over were recorded as being obese compared with 24% of those aged 16-64 years. A BMI of <18.5 kg/m² is considered to be underweight. One per cent of people 65 years of age and over were found to be underweight. A higher proportion of older females were observed to be underweight than older males.

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Table 30: Adult body mass index (BMI), 2008, 2009 and 2010 combined, by age and sex, Scotland

BMI (kg/m2) Age Total

65+ 16-64 65-69 70-74 75-79 80-84 85+

% % % % % % %

Men

Less than 18.5 2 - 1 1 1 1 1

18.5 to less than 25 32 21 20 22 27 34 22

25 to less than 30 40 44 46 47 53 51 47

30 to less than 40 25 33 32 29 19 14 29

40+ 1 2 2 1 0 - 1

Mean 27.3 28.7 28.5 28.1 27.2 26.3 28.2

Women

Less than 18.5 2 1 1 2 4 2 2

18.5 to less than 25 38 24 28 26 32 34 28

25 to less than 30 32 39 38 38 38 42 39

30 to less than 40 23 33 30 30 24 21 30

40+ 4 3 2 4 2 1 2

Mean 27.3 28.6 28.2 28.4 27.1 26.8 28.1

All adults

Less than 18.5 2 1 1 1 3 2 1

18.5 to less than 25 35 23 24 25 30 34 25

25 to less than 30 36 41 42 42 44 45 42

30 to less than 40 24 33 31 30 22 19 30

40+ 3 2 2 2 1 0 2

Mean 27.3 28.6 28.3 28.2 27.1 26.6 28.1

Bases (weighted):

Men 7325 504 434 303 159 83 1483

Women 7242 556 488 395 254 141 1835

All adults 14567 1060 922 699 413 223 3318

a 25 and over = overweight (including obese). b 30 and over = obese.

Source: SHeS 2008-10

Primary Care Data on BMI is also collected at a local level through GP electronic recording systems (Table 31). Data from 2009 showed similar proportions to the findings from the Scottish Health Survey. Looking at the GP data between 1999 and 2009 it can be seen that the proportion of patients aged 65-74 years with a BMI <25 kg/m² has decreased, as has the proportion of those classified as overweight. The proportion of obese patients, however, has increased over this time period. A similar trend towards obesity can be observed in patients aged 75 years and over. The national data is reflected in the local data with 28.7 percent of those aged 65 to 74 years recorded as being overweight or obese.


Table 31: Body Mass Index (BMI) of patients in Ayrshire and Arran at 1 Jan 1999, 2004, 2009 – counts of all patients with BMI recorded by GPs, by age group and CHP area (51 of 59 local practices)

Age group of patients 1999 2004 2009

BMI 00-25

BMI 25-30

BMI 30-40

BMI 40+

BMI 00-25

BMI 25-30

BMI 30-40

BMI 40+

BMI 00-25

BMI 25-30

BMI 30-40

BMI 40+

15-34 years n 20,297 7,157 2,592 216 23,426 7,879 3,776 489 27,280 10,300 6,180 969

% 67.1% 23.7% 8.6% 0.7% 65.9% 22.2% 10.6% 1.4% 61.0% 23.0% 13.8% 2.2%

35-64 years n 25,132 21,555 10,121 947 40,464 34,305 18,565 2,279 43,307 42,611 28,588 4,285

% 43.5% 37.3% 17.5% 1.6% 42.3% 35.9% 19.4% 2.4% 36.5% 35.9% 24.1% 3.6%

65-74 years n 4,922 5,302 2,142 141 8,254 9,976 5,179 401 9,059 12,158 7,760 772

% 39.4% 42.4% 17.1% 1.1% 34.7% 41.9% 21.8% 1.7% 30.5% 40.9% 26.1% 2.6%

75+ years n 2,267 1,779 638 32 7,192 6,184 2,491 122 9,983 8,676 4,151 235

% 48.1% 37.7% 13.5% 0.7% 45.0% 38.7% 15.6% 0.8% 43.3% 37.6% 18.0% 1.0%

BMI not recorded 162,325 (60.7%) 109,630 (39.1%) 66,602 (23.5%)



4.4 Diet and nutrition

The Scottish Government recommends that adults consume at least five portions of fruit and vegetables per day28. Data on diet and nutrition is collected at a national level through the Scottish Health Survey (Table 32). Eighteen per cent of respondents aged 65 years and over reported consuming five or more portions of fruit and vegetables per day, compared with 22% of respondents aged 16-64 years. The proportion of older respondents meeting the recommended five portions per day was highest among those aged 65-69 years and lowest among respondents aged 85 years and over. No difference was observed between males and females in relation to fruit and vegetable consumption.

Table 32: Prevalence of fruit and vegetable consumption, 2008, 2009 and 2010 combined, by age and sex, Scotland

16-64 65-69 70-74 75-79 80-84 85+ Total 65+

% % % % % % %

None 10 6 6 4 6 6 5

Less than 1 portion

4 4 5 4 5 3 4

1 portion 18 15 16 18 16 18 16

2 portions 17 17 18 20 21 22 19

3 portions 16 16 19 16 17 18 17

4 portions 12 14 12 17 14 15 14

5 portions or more

22 27 24 21 21 18 23

Mean portions 3.2 3.5 3.4 3.3 3.3 3.2 3.4

Bases (weighted):

All adults 16984 1253 1099 914 591 380 4237

Source: SHeS 2008-10 combined

4.5 Physical activity and exercise Scottish Government guidance in recent years has been to recommend that adults participate in 30 or more minutes of moderate or vigorous activity on at least 5 days a week. Fourteen per cent of respondents aged 65 years and over reported meeting the recommended weekly physical activity levels, compared with 44% of respondents aged 16-64 years. The proportion of older people reduced with each increasing age band from 22% of those aged 65-69 years to 3% of those aged 85 years and over (Table 33). A higher proportion of older males than females indicated they met the physical activity recommendations. When asked about specific forms of activity, a higher proportion of males reported engaging in these activities than females, with the exception of heavy housework (Table 34).


Table 33: Summary physical activity levels, 2008, 2009 and 2010 combined, by age and sex, Scotland

Summary activity level

a

Age Total 65+

16-64 65-69 70-74 75-79 80-84 85+

% % % % % % %

Men

Meets recommendations

50 24 19 14 10 6 17

Some activity 27 30 28 26 18 10 26

Low activity 23 46 53 60 72 84 57

Women


38 21 15 9 4 2 12

Some activity 36 35 30 23 18 7 26

Low activity 25 44 56 68 78 91 62

All adults


44 22 17 11 7 3 14

Some activity 32 33 29 24 18 8 26

Low activity 24 45 55 65 76 89 60

Bases (weighted):

Men 8324 584 504 377 236 116 1816

Women 8651 668 595 534 355 262 2414

All adults 16976 1252 1099 911 590 378 4230

a Meets recommendations: 30 minutes or more on at least 5 days a week; some activity= 30 minutes or more on 1 to 4 days a week; Low activity= fewer than 30 minutes of moderate or vigorous activity a week. Source: SHeS 2008-10

Table 34: Participation in different activities in the past 4 weeks, 2008, 2009 and 2010 combined, by age and sex, Scotland

Age Total 65+

16-64 65-69 70-74 75-79 80-84 85+

% % % % % % %

Heavy Housework

Male 51 48 42 39 27 18 40

Female 69 60 52 40 25 12 44

Heavy Manual/Gardening/ DIY

Male 27 28 23 20 11 9 22

Female 10 12 8 5 3 1 7

Walking (brisk/fast pace)

Male 45 22 18 13 9 5 16

Female 37 22 15 11 7 3 13

Sports and Exercise

Male 58 37 35 29 25 12 31

Female 50 34 29 19 15 7 24

Any physical activities

Male 88 73 68 59 48 33 63

Female 87 73 65 52 38 20 56

Bases (weighted):

Male 8317 583 503 376 236 117 1815

Female 8647 667 593 532 355 262 2410

Source: SHeS 2008-10


Chapter 5: Health Status

Health status refers to the experience of wellbeing and disease in the population.

5.1 Life expectancy

Life expectancy is a broad indicator of overall health, an estimate of the number of years a newborn child would live if it was to experience current local mortality rates for all of its life. Life expectancy at birth in Ayrshire and Arran has increased; the average life expectancy for males in 1992-94 was 71.9 years and by 2008-10 it had increased to 75.5 years. The average life expectancy at birth for females in Ayrshire and Arran in 1992-94 was 77.3 years and by 2008-10 it was 80 years. Improved projections of life expectancy allow us to see the size of the elderly population and plan ahead for this.

Table 35: Expectation of life at birth (LE), by sex in East, North and South Ayrshire, 2006-2010

(where MD=most deprived 15% and LD=least deprived 85%)

Area Males Females

LE

Lower 95% CI

Upper 95% CI

LE

Lower 95% CI

Upper 95% CI

East Ayrshire LD 75.7 75.2 76.3 79.5 79.0 80.1

East Ayrshire MD 70.3 68.9 71.7 75.9 74.7 77.1

East Ayrshire 75.0 74.5 75.5 79.0 78.6 79.5

North Ayrshire LD 75.2 74.7 75.8 80.1 79.6 80.5

North Ayrshire MD 69.2 67.8 70.5 75.7 74.5 76.9

North Ayrshire 74.3 73.8 74.8 79.4 79.0 79.8

South Ayrshire LD 77.3 76.8 77.9 81.4 81.0 81.9

South Ayrshire MD 68.9 67.4 70.5 78.2 76.9 79.5

South Ayrshire 76.1 75.5 76.6 81.0 80.6 81.5

Source: http://www.gro-scotland.gov.uk/statistics/theme/life-expectancy/scotland/index.html

Table 35 shows the differences in life expectancy at birth between the most and least deprived areas in East, North and South Ayrshire. Females living in the least deprived areas of South Ayrshire have the highest life expectancy overall at 81.4 years. Males from the most deprived area of South Ayrshire have the lowest life expectancy in Ayrshire and Arran at 68.9 years. The gap in LE between males from the least and most deprived areas of South Ayrshire is 8.4 years and this is the largest inequality gap when compared to North Ayrshire at six years and East Ayrshire at 5.4 years. However, the numbers of males in the most deprived areas of South Ayrshire are small and therefore these values are not as robust as the numbers of males for Ayrshire and Arran. Females living in the most deprived areas of North Ayrshire have the lowest life expectancy in Ayrshire and Arran at 75.7 years. Females living in the least deprived areas of North Ayrshire have a higher life expectancy (80.1 years) compared to those living in the least deprived areas of East Ayrshire (79.5 years). The estimated life expectancy for males and females at the age of 65 is presented in Table 36 along with the ranking of Ayrshire & Arran among the 14 NHS Board areas and the ranks for East, North and South out of 32 Scottish local authorities. Table 36: Life expectancy at age 65, in East, North and South Ayrshire, Ayrshire & Arran and Scotland, 2008-2010

Males - Years Rank Females - Years Rank

Ayrshire & Arran 16.7 11 19.1 12

East Ayrshire 16.3 25 18.9 25

North Ayrshire 16.7 21 18.7 28

South Ayrshire 16.9 18 19.7 14

Scotland 16.8 - 19.3 -

Source: http://www.gro-scotland.gov.uk/statistics/theme/life-expectancy/scottish-areas/2008-2010/tables.html

http://www.gro-scotland.gov.uk/statistics/theme/life-expectancy/scotland/index.html

http://www.gro-scotland.gov.uk/statistics/theme/life-expectancy/scotland/index.html

http://www.gro-scotland.gov.uk/statistics/theme/life-expectancy/scottish-areas/2008-2010/tables.html

http://www.gro-scotland.gov.uk/statistics/theme/life-expectancy/scottish-areas/2008-2010/tables.html


Figure 47 shows the marked differences in life expectancy between males and females across East, North and South Ayrshire. The confidence interval between males and females from the most and least deprived areas shown in Table 35 indicate only a small difference. Again the life expectancy of males from the most deprived area of South Ayrshire is less robust than in the other areas because of the small numbers involved. Figure 47: Expectation of life at birth (LE), by sex for East, North and South Ayrshire, split by level of deprivation, 2006-2010

Source: http://www.scotpho.org.uk/population-dynamics/healthy-life-expectancy/data/community-health-partnerships

Healthy Life Expectancy compared with Life Expectancy

Figures 48 and 49 present male and female life expectancy (LE) and healthy life expectancy (HLE) at birth in years for the five year period 1999 to 2003. Males in South Ayrshire have the highest LE and shortest period in ‘not healthy’ health at 6.31 years. Females have a longer life expectancy than males and, as is shown in Figure 49, have a longer period of life in ‘not healthy’ health. Females in South Ayrshire have the highest LE and the shortest period in ‘not healthy’ health at 7.42 years. Females in North Ayrshire experience 8.81 years in ‘not healthy’ health, the longest period and in East Ayrshire the number of years is 8.44 just below the Scottish figure of 8.45 years. Figure 48: Male life expectancy and healthy life expectancy at birth in years for East, North and South Ayrshire CHPs, 1999-2003


60 65 70 75 80 85

South AyrshireMD

South AyrshireLD

North AyrshireMD

North AyrshireLD

East AyrshireMD

East AyrshireLD

Age

Expectationof Life atbirth Females

Expectationof Life atbirth Males

72.50 72.63 74.20

73.29

65.09 65.20

67.89 66.26

East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP Scotland

Male Life Expectancy Male Healthy Life Expectancy

http://www.scotpho.org.uk/population-dynamics/healthy-life-expectancy/data/community-health-partnerships





Figure 49: Female life expectancy and healthy life expectancy at birth in years for East, North and South Ayrshire CHPs, 1999-2003


Having estimates on the levels of morbidity at an average age (for males of 65 and females of 70 in Ayrshire and Arran) provides a guide to whom and when the demand for health and social care will increase for groups within the population. Taking into account the differences in life expectancy between those older people living in the most and least deprived areas adds to the profile. Knowing where older people live in relation to deprivation will increase the information for the planning of services to meet the needs where they are likely to be higher.

5.2 Mortality

As with most of the West of Scotland, age standardised mortality rates in Ayrshire & Arran have been above the Scottish level. Over the past five years they have been reducing at a faster rate than Scotland leading to a merging of values in 2010 (Figures 50-53). South Ayrshire has the lowest rates until 2010 when East Ayrshire was lower, North Ayrshire has seen a steeper decline. Female mortality rates in East and North Ayrshire have seen steeper declines than those in South Ayrshire. Figure 50: Age-standardised death rates for all causes, NHS Ayrshire & Arran and Scotland, 2006 to 2010

Source: http://www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/age-standardised-rates.html

77.27 78.26 78.89 78.69

68.83 69.45

71.47 70.24


Female Life Expectancy Female Healthy Life Expectancy

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Figure 51: Age-standardised death rates for all causes, East Ayrshire and Scotland, 2006-2010


Figure 52: Age-standardised death rates for all causes, North Ayrshire and Scotland, 2006-2010


Figure 53: Age-standardised death rates for all causes, South Ayrshire and Scotland, 2006-2010


Winter Mortality

There is no single cause of 'additional' deaths in winter29. Most are from respiratory and circulatory diseases such as pneumonia, coronary heart disease and stroke. Influenza is recorded as the underlying cause in a small proportion of deaths. Very few are caused by hypothermia The seasonal increase in mortality in the winter is defined as the difference between the number of deaths in the four-month 'winter' period (December to March, inclusive) and the average number of deaths in the two four-month periods which precede winter (August to November, inclusive) and follow winter (April to July, inclusive).

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Figure 54 presents the seasonal increase in winter mortality in Ayrshire and Arran between 2001-02 and 2010-11 as a five year average. The seasonal increase in winter mortality for persons aged 0-64 years and 65-74 years has been fairly stable over this time period, but has risen for persons aged 75-84 years and 85 years and over. Figure 54: Seasonal increase in mortality in the winter, by age-group and NHS Board area of usual residence, 2001-02 to 2010-11; Ayrshire and Arran; 5 year average

Source: National Records of Scotland

The Increased Winter Mortality (IWM) Index is the unrounded number of 'additional' winter deaths divided by the unrounded average number of deaths in a four month 'non-winter' period, expressed as a percentage.

Figure 55 presents the IWM Index scores for Scotland and Ayrshire and Arran between 2001/02 and 2010/11 as a five year average. At national level the IWM Index score can be seen to rise steadily both with increasing age band and across the time period. A similar pattern in relation to age can be observed within Ayrshire and Arran. For persons aged 75 years and over there has been an increase over the time period, while for younger older people (65-74 years) there has been a slight decrease29. Figure 55: Increased Winter Mortality index, by age-group and NHS Board area of usual residence, 2001-02 to 2010-11; Ayrshire and Arran; 5 year average

Source: National Records of Scotland

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5.3 Self-reported health status

Many of the reports on health status are based on self reported general health and the presence of long standing illness. Some may argue that a person’s judgement about their own health is highly subjective and therefore has little validity. However, studies have shown that people’s perceptions of their own health can be good predictors of future health care use and of mortality rates30, 31.

The Scottish Health Survey asks respondents to rate their health status on a scale from “very good” to “very bad” (Figure 56). The proportion of respondents who reported being in “very good” health declined with each increasing age band, while the proportion who reported “fair” or “bad” health increased. Little difference was observed between male and female respondents. Logistic regression analysis was conducted to identify associated risk factors for reporting poor/very poor general health among respondents aged 65 years and over. Increasing deprivation status and being a current or ex-smoker were found to significantly increase the odds of reporting poor/very poor general health.

Consumption of alcohol above the weekly recommended limits was found to significantly reduce the odds of reporting poor/very poor general health, however, this finding is likely to be related to the fact that people in poor health who have been advised not to drink were included in the reference category along with people who drink within the recommended limits.

Figure 56: Self-assessed general health, 2008, 2009 and 2010 combined, by age, Scotland

Source: SheS 2008-10

39 26 24 19 17 16

40

40 38

36 37 37

14

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16-64 65-69 70-74 75-79 80-84 85+

Very good Good Fair Bad Very bad


5.4 Long-term conditions

Evidence has shown that long-term conditions affect the lives of the one in three people - or six in 10 adults but this burden of illness is particularly increased among older people, affecting around two -thirds of those aged over 75, 45 percent of whom have more than one long-term condition. The local available data (Scotland’s Census OnLine) estimates that the average age of a person in Ayrshire & Arran with a limiting illness is 59 years (North 58; East 58 and South 61 years) whereas Scotland as a whole is 58 years. Long-term or limiting conditions clearly have a significant impact and represent a challenge for the NHS and local authorities. The problem is estimated to grow due to increasing obesity and more sedentary lifestyles, particularly within an ageing population. This is likely to place increasing long-term demands on health care systems. Not only will chronic conditions be the leading cause of disability, but if not successfully prevented or managed, they will become the most expensive problems faced by our health care and local authority services. As the population ages, caring for people with long-term conditions and limiting illness such as heart disease, asthma and diabetes is likely to require increased service responses from the NHS, local authority, voluntary sector as well as informal carers. Patients with long-term conditions are known to use a significant proportion of all appointments with GPs and outpatient clinics and of inpatient hospital bed days as described previously32.

Current policy on long-term conditions seeks to reduce this burden through prevention, early intervention and developing services that enable people to remain living independently in their own homes. It also seeks to empower patients, give them information about their condition, how to manage it better and offer them choice about where and how they are treated and achieve the outcomes they want for themselves. A local example of this is the Co-creating Health Initiative which aims to embed self-management support into patient pathways for people with chronic obstructive pulmonary disease (COPD) and enable it to become a core element of developing relationships between patients and clinicians. Phase 1 focused on COPD, however during Phase 2 there are plans to extend to include other long-term conditions. The Scottish Health Survey asks whether respondents have any long-term physical or mental conditions or disabilities that had affected, or were likely to affect, them for at least twelve months. Those who reported having such a condition were asked to say whether it limited their daily activities in any way. This enabled conditions to be further classified as either 'limiting' or 'non-limiting'. As the question did not specify that conditions had to be doctor-diagnosed, responses were subject to some distortion due to variation in individuals' perceptions. Long-term conditions were reported by one-third (33%) of men aged 16-64 years and two-thirds (66%) aged 65 years and over (Figure 57). Prevalence was slightly higher in younger women (37%) than younger men, but similar in older women (67%) compared to older men. The prevalence of long-term conditions increased with age above 65 years in a similar manner for both sexes, from 62% in adults aged 65-69 years to 73% in those 85 years and over.


Figure 57: Prevalence of long-term conditions, 2008, 2009 and 2010 combined, by age, Scotland


The reported rates of selected long term conditions are presented in Table 37. The three most common categories of conditions in men and women aged 65 and over were musculoskeletal conditions (280 per 1,000 in men, 370 per 1,000 in women); conditions of the heart and circulatory system (298 per 1,000 in men, 266 per 1,000 in women); and endocrine and metabolic disorders (124 per 1,000 in men, 137 per 1,000 in women). Although musculoskeletal conditions were also the most common condition for those aged 16-64, the corresponding rates were much lower (117 per 1,000 in men, 126 per 1,000 in women). Heart and circulatory system conditions were the next most common in men aged 16-64 (69 per 1,000) while mental disorders were the next most common condition among younger women (78 per 1,000). Mental disorders and skin complaints were the

only conditions to have higher rates among men and women aged 16-64 than in the 65 and over age group. In addition, nervous disorders were more common in younger than older women.

Among those aged 65 and over, heart and circulatory conditions, musculoskeletal conditions, ear and eye problems, and skin conditions increased with age (though heart conditions in men and skin conditions in women declined in the oldest age group). In contrast, mental disorders and endocrine and metabolic conditions decreased with age (though mental disorders in women increased again in the 85 and over group). Respiratory conditions decreased with age in women, while there was no effect of age in men; thus these conditions were more common in the 'young old' women and in the 'older old' men. While heart and circulatory disease, ear conditions, and genito-urinary disorders were more common in men than women, musculoskeletal problems and mental disorders were generally more common in women. The prevalence of neoplasms, infections, and conditions of the digestive system and blood and related organs did not vary by age or sex.

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Table 37: Rate of reported long term conditions per 1000 adults, 2008, 2009 and 2010 combined, by age and sex, Scotland

Condition Group ( ICD 10 chapters)

a

Age Total 65+ 16-

64 65-69

70-74

75-79

80-84

85+

Rate per 1000

Men

XIII Musculoskeletal system

117 266 286 289 304 269 280

IX Heart & circulatory system

69 257 309 318 356 280 298

IV Endocrine & metabolic

47 134 132 125 107 72 124

X Respiratory system 66 113 114 79 123 98 107

XI Digestive system 32 43 60 68 93 56 60

VII Eye complaints 12 29 31 55 84 105 47

VIII Ear complaints 8 26 46 49 101 135 53

II Neoplasms & benign growths

8 39 50 64 66 56 52

VI Nervous System 36 53 39 36 52 27 44

V Mental disorders 53 35 12 23 5 19 21

XIV Genito-urinary system

11 50 38 54 47 92 50

Women


126 319 322 403 433 441 370


57 243 273 273 271 289 266


64 155 125 161 111 100 137






13 39 41 46 23 31 38




15 18 24 18 38 23 20

All adults


122 295 305 356 382 388 330


63 249 289 292 305 286 280


56 145 128 146 109 91 131






11 39 45 53 40 38 44




13 33 30 32 41 45 30

Bases (weighted):

Men 8332 584 503 378 235 118 1818

Women 8659 669 596 537 356 263 2421

All adults 16991

1253 1100 914 591 381 4239



5.5 The occurrence of specific health problems common in older age

Coronary heart disease The prevalence of coronary heart disease (CHD) rises quickly after 65 years, with 19% of patients aged 65-74 years and 26% of patients aged 75 years and over having a history of CHD (Table 38). Male patients and those from more deprived areas were consistently observed to have a higher rate of CHD history. Mortality rates for all heart disease have reduced in Ayrshire and Arran over the last decade for older people as in the general population (Figure 58). Among those aged 65-74 years the rate of heart disease deaths decreased from 2,130 per 100,000 population in 2001 to 1,081 per 100,000 population in 2010. Over the same time period the rate of heart disease deaths among those aged 75 years and over decreased from 6,631 per 100,000 population in 2001 to 4,268 per 100,000 population in 2010. Heart disease death rates among males were observed to be consistently higher than among females (Figures 59 and 60). Little variation was observed between CHP areas (Figure 61). East Ayrshire appeared to have slightly higher death rates than North or South for part of the time period however this seems to have reduced in recent years. Earlier recognition and active management of CHD has contributed to this decline.

Table 38: Counts and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of coronary heart disease (CHD)

Deprivation category

All Male Female

n % n % n %

35-64 years SIMD 1 1637 5.0% 1019 6.1% 618 3.8%

SIMD 2 1531 4.0% 977 5.2% 554 2.9%

SIMD 3 788 3.0% 539 4.1% 249 1.9%

SIMD 4 600 2.5% 439 3.8% 161 1.4%

SIMD 5 531 2.6% 391 3.9% 140 1.4%

All 35-64

years*

5162 3.6% 3,419 4.8% 1,743 2.4%

65-74 years SIMD 1 1756 23% 983 27.4% 773 19.0%

SIMD 2 1791 20% 1,006 24.4% 785 16.2%

SIMD 3 1034 17.7% 619 22.6% 415 13.3%

SIMD 4 868 15.2% 561 21.1% 307 10.1%

SIMD 5 605 14% 424 19.8% 181 8.3%

All 65-74

years*

6127 18.6% 3,640 23.5% 2,487 14.2%

75+ years SIMD 1 1759 28.8% 773 33.8% 986 25.8%

SIMD 2 2101 27.8% 967 34.8% 1,134 23.8%

SIMD 3 1267 26.2% 593 32.3% 674 22.5%

SIMD 4 1097 23.9% 546 30.5% 551 19.7%

SIMD 5 715 22.6% 368 27.8% 347 18.9%

All 75+ years* 7021 26.4% 3,287 32.4% 3,734 22.7%


NB*Includes unknown SIMD


Figure 58: Coronary heart disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band and year of death registration

Source: Registrar General for Scotland, Death Records

Figure 59: Coronary heart disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age 65-74 years and year of death registration


Figure 60: Coronary heart disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age 75 years and over and year of death registration


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Figure 61: Coronary heart disease deaths in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band, local authority of residence and year of death registration

Source: Registrar General for Scotland, Death Record

The incidence rate for heart disease (CHD) is the number of new cases of CHD per 100,000 population. New cases are defined to be hospital admissions or deaths, with no prior hospital admission for CHD in the previous 10-year period. Figure 62 shows continued reductions in the incidence of CHD in Ayrshire and Arran in those aged under 75 years with a 30.9% decrease over the period for men and 29.1% for women. The Scotland incidence rate has decreased by 28.4% over the period and this trend is reflected in Ayrshire and Arran where it has gone down by 28.3%.

Figure 62: Incidence of Coronary Heart Disease; Ayrshire & Arran and Scotland, <75 years

Source: www.isdscotland.org/Health-Topics/Heart-Disease/Topic-Areas/Incidence/

The total number of cases of coronary heart disease for those aged under 75 years in Ayrshire and Arran as at the 31 March 2010 was 9558. The crude prevalence rate per 100 of the population allows for comparisons within and across areas and is presented below in Figures 63 to 65.

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Figure 63: Coronary heart disease estimated prevalence by age and sex for Ayrshire & Arran and Scotland, 2010

Source: http://www.isdscotland.org/Health-Topics/Heart-Disease/

Figure 63 presents the estimated prevalence rate per 100 of the population by age group and sex and compares Ayrshire and Arran rates with the Scotland rates. As shown the rates for Ayrshire and Arran are very similar to Scotland, being slightly less than one percent difference for each group presented. Figure 64 shows that East Ayrshire has the highest prevalence of CHD for males aged 45 - 64 at 6.3 per 100 and for males aged 65 - 74 at 18 per 100. The rate per 100 for males aged 45 - 64 in North and South Ayrshire is 5.7 and 5.4 respectively, however Scotland has a lower rate at 5.3. The pattern for 65 - 74 year old males in North (17 per 100) and South Ayrshire and Scotland is similar to the 45 - 64 year olds, however South Ayrshire has a lower rate than Scotland at 16.8 and 16.9 respectively.

Figure 64: Coronary heart disease estimated prevalence for males by CHP, 2010


Figure 65 shows that East Ayrshire has the highest prevalence of CHD for females aged 45 - 64 at 2.9 per 100 and for females aged 65 - 74 at 9.6 per 100. The lowest rate for females aged 45 - 64 is the Scotland rate at 2.3, the South Ayrshire rate is 2.3 per 100 and the North Ayrshire rate is 2.6 per 100. North Ayrshire has the lowest CHD prevalence rate for women aged 65 - 74 years old at 8.1, the Scotland rate is 8.3 and the rate for females in South Ayrshire in this age group is 8.6 per 100.

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Figure 65: Coronary heart disease estimated prevalence for females by CHP, 2010


It should be noted that numbers of cases for small geographical areas are less robust than rates for larger geographical areas, and wide variations at this level is common.

Source: www.isdscotland.org/Health-Topics/Heart-Disease/Topic-Areas/Prevalence/

The prevalence of coronary heart and cerebrovascular disease increases markedly after the age of 65. The public health evidence shows that lifestyle interventions to reduce the level of risk factors associated with these two conditions addressing alcohol consumption, tobacco use, obesity and physical activity, are effective at all ages. Investment in early intervention and prevention with upstream public health programmes when adults are young is likely to have the largest long-term benefits in keeping people disability free into old age. However health promotion interventions relating to lifestyle behaviour in older people have also been shown to be beneficial for leading a more independent and disability free life33.

Cerebrovascular disease

Cerebrovascular disease is recognised as much more prevalent among older people as can be observed from Ayrshire and Arran GP records (Table 39). At 1 January 2009, 7% of patients aged 65-74 years and 13% of patients aged 75 years and over were recorded as having a history of stroke. As with cardiovascular disease, male patients and those from more deprived areas were consistently observed to have a higher rate of stroke history.

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http://www.isdscotland.org/Health-Topics/Heart-Disease/Topic-Areas/Prevalence/


Table 39: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of stroke – appearing anywhere on GP record, by age group and deprivation category

Deprivation

category All Male Female

n % n % n % 35-64 years SIMD 1 577 1.8% 293 1.8% 284 1.7%

SIMD 2 608 1.6% 330 1.7% 278 1.4%

SIMD 3 342 1.3% 186 1.4% 156 1.2%

SIMD 4 244 1.% 147 1.3% 97 0.9%

SIMD 5 182 1% 122 1.2% 60 0.6%

All 35-64

years*

1980 1.4% 1,089 1.5% 891 1.2%

65-74 years SIMD 1 626 8.2% 338 9.4% 288 7.1%

SIMD 2 702 7.8% 395 9.6% 307 6.3%

SIMD 3 394 6.7% 241 8.8% 153 4.9%

SIMD 4 323 5.7% 186 7.0% 137 4.5%

SIMD 5 229 5.3% 137 6.4% 92 4.2%

All 65-74

years*

2304 7% 1,316 8.5% 988 5.7%

75+ years SIMD 1 892 14.6% 378 16.6% 514 13.5%

SIMD 2 987 13.1% 442 15.9% 545 11.4%

SIMD 3 614 12.7% 253 13.8% 361 12.0%

SIMD 4 572 12.5% 285 15.9% 287 10.3%

SIMD 5 416 13.2% 207 15.6% 209 11.4%

All 75+

years*

3531 13.3% 1,582 15.6% 1,949 11.9%



Mortality rates for cerebrovascular disease in older people have reduced in Ayrshire and Arran over the last decade as in the general population (Figure 66). Among those aged 65-74 years, the rate of

cerebrovascular disease deaths decreased from 412 per 100,000 population in 2001 to 173 per 100,000 population in 2010. During the same time period mortality rates for cerebrovascular disease reduced among those aged 75 years and over from 2,326 to 1,026 per 100,000 population. Cerebrovascular mortality rates were observed to be higher among males than females for persons aged 65-74 years (Figure 67) but not between males and females aged 75 years and over (Figure 68). The mortality rate for females aged 75 years and over was in fact slightly higher than for males between 2007 and 2010. Again, little difference in mortality rates was observed between CHP areas (Figure 69). A slightly higher rate was observed for persons aged 75 and over in North Ayrshire between 2006 and 2009, however, this gap had narrowed by 2010. Earlier recognition and more assertive management of strokes have led to a large reduction in mortality and morbidity.


Figure 66: Cerebrovascular disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band and year of death registration


Figure 67: Cerebrovascular disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population, (age 65-74 years) and year of death registration


Figure 68: Cerebrovascular disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age (75 years and over) and year of death registration


Figure 69: Cerebrovascular disease mortality in Ayrshire & Arran, with age-sex standardised mortality rates per 100,000 population by age band, local authority of residence and year of death registration


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Figure 70: Incidence of cerebrovascular disease; Ayrshire & Arran and Scotland, <75 years

Source: www.isdscotland.org/Health-Topics/Stroke/Topic-Areas/Incidence/ (Table IS1)

The trend for the incidence for cerebrovascular disease (CVD) is less marked than for CHD; although rates continue to reduce, the overall reduction since 2001 is 23%. The rates are very much higher in people over 75 and in 2010 were 1554 per 100,000 compared to those under 75 years of age with a rate of 100 per 100,000. However the trend for the incidence in the over 75 age group has contributed more to the overall reduction in incidence, reducing by 32% since 2001.

Cancer

The prevalence of cancer rises steeply after 65 years as can be observed from Ayrshire and Arran GP records (Table 40). At 1 January 2009, 9% of patients aged 65-74 years and 12% aged 75 years and over were recorded as having a history of cancer. No overall difference was observed between gender or deprivation category. Evidence shows different patterns of incidence are dependent on cancer type.

The increased number and rate of cancers among older people can also be observed in cancer registrations in Ayrshire and Arran between 2006 and 2010 (Figures 71(a) and 72). As expected, while the absolute numbers of registrations reduce for persons aged 80 years and over, this is not mirrored in the rate of registrations. The rate of cancer registrations in Ayrshire and Arran between 2006 and 2010 appears to be slightly lower than the Scottish rate (Figure 71). Changes in lifestyle, particularly smoking, alcohol use and diet, early detection and more effective treatments contribute to the mortality and morbidity from cancer.

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Table 40: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of cancer by age group and deprivation category


All Male Female

n % n % n %

35-64 years SIMD 1 765 2.3% 271 1.6% 494 3.0%

SIMD 2 894 2.3% 299 1.6% 595 3.1%

SIMD 3 620 2.3% 200 1.5% 420 3.1%

SIMD 4 620 2.6% 211 1.8% 409 3.4%

SIMD 5 528 2.6% 200 2.0% 328 3.2%

All 35-64 years* 3498 2.4% 1,202 1.7% 2,296 3.2%

65-74 years SIMD 1 651 8.5% 288 8.0% 363 8.9%

SIMD 2 740 8.3% 315 7.7% 425 8.8%

SIMD 3 521 8.9% 224 8.2% 297 9.5%

SIMD 4 517 9.1% 217 8.2% 300 9.9%

SIMD 5 368 8.5% 160 7.5% 208 9.5%

All 65-74 years* 2842 8.6% 1,228 7.9% 1,614 9.2%

75+ years SIMD 1 692 11.3% 297 13.0% 395 10.3%

SIMD 2 859 11.4% 345 12.4% 514 10.8%

SIMD 3 535 11.1% 250 13.6% 285 9.5%

SIMD 4 561 12.2% 260 14.5% 301 10.8%

SIMD 5 397 12.6% 192 14.5% 205 11.2%

All 75+ years* 3090 11.6% 1,366 13.5% 1,724 10.5%



Figure 71: Age-specific incidence rates of cancer (all types) registrations in Scotland, by five year age band between 1986 and 2010

Source: Scottish Cancer Registry, ISD Scotland

Figure 71(a): Age-specific incidence rates of cancer (all types) registrations in Ayrshire and Arran, by five year age band between 2006 and 2010


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Figure 72: Age-specific incidence rates of cancer (all types) registrations in Ayrshire and Arran, by five year age band between 2006 and 2010


The number and rate of cancer deaths is also higher among older people in Ayrshire and Arran during the same time period (Figures 73 and 74). There is little difference between the rate for cancer deaths in Ayrshire and Arran and for Scotland.

Figure 73: Number of cancer (all types) mortality in Ayrshire and Arran, by five year age band between 2006 and 2010


Figure 74: Age-specific mortality rates from all cancers in Ayrshire and Arran, by five year age band between 2006 and 2010


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Type 2 Diabetes

Diabetes is associated with hypertension, CHD, CVD, peripheral vascular disease, renal disease and sight loss; all of which can be major problems for older people. Type 2 diabetes (maturity onset) has higher prevalence rates for older people, males and patients living in more deprived areas (Table 41). Twelve per cent of patients aged 65-74 years had a diagnosis of type 2 diabetes on their GP record and 11% of patients aged over 75 years, compared with less than 1% for type 1 diabetes in either age band.

Table 41: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of maturity onset of diabetes type 2 by age group and deprivation category


All Male Female n % n % n %

35-64 years SIMD 1 1658 5.0% 921 5.5% 737 4.5%

SIMD 2 1583 4.1% 937 5.0% 646 3.4%

SIMD 3 990 3.7% 588 4.5% 402 3.0%

SIMD 4 737 3.1% 464 4.0% 273 2.3%

SIMD 5 571 2.8% 361 3.6% 210 2.1%

All 35-64 years* 5632 3.9% 3,329 4.6% 2,303 3.2%

65-74 years SIMD 1 1102 14.4% 556 15.5% 546 13.4%

SIMD 2 1173 13.1% 623 15.1% 550 11.4%

SIMD 3 683 11.6% 401 14.6% 282 9.0%

SIMD 4 571 10.0% 329 12.4% 242 8.0%

SIMD 5 402 9.3% 251 11.8% 151 6.9%

All 65-74 years* 3983 12.1% 2,196 14.2% 1,787 10.2%

75+ years SIMD 1 828 13.6% 372 16.3% 456 11.9%

SIMD 2 889 11.8% 392 14.1% 497 10.4%

SIMD 3 559 11.6% 273 14.9% 286 9.5%

SIMD 4 436 9.5% 212 11.9% 224 8.0%

SIMD 5 286 9.0% 151 11.4% 135 7.3%

All 75+ years* 3031 11.4% 1,419 14.0% 1,612 9.8%

Source: GPASS, Primary Care Department, NHS Ayrshire and Arran - NB*Includes unknown SIMD

Preventative public health interventions such as addressing obesity and increasing physical activity in early to mid life will contribute to reducing or delaying the onset of type 2 diabetes in turn reducing the increasing demand on services in the future.


Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) refers to the conditions in patients with airflow obstruction who were previously diagnosed as having chronic bronchitis or emphysema. The disease is almost always caused by smoking; however, other factors - particularly occupational exposures - may contribute to the development of COPD. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months. COPD becomes more common with age, increasing to a peak among those aged 75 years and over (Figure 75 and Table 42). COPD is a common cause of hospital admission.

Figure 75: Age-specific rate per 10,000 population of COPD admissions by sex and age group for Ayrshire and Arran; for 1997-98 to 2006-07

Source: SMR 01

Table 42 shows that in all age groups the prevalence of COPD is higher in the more deprived SIMD areas. Table 42: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of COPD by age group and deprivation category


All Male Female

n % n % n %

35-64 years SIMD 1 1000 3.0% 456 2.7% 544 3.3%

SIMD 2 743 1.9% 329 1.7% 414 2.2%

SIMD 3 341 1.3% 177 1.3% 164 1.2%

SIMD 4 202 0.9% 96 0.8% 106 0.9%

SIMD 5 135 0.7% 65 0.7% 70 0.7%

All 35-64 years* 2466 1.7% 1,144 1.6% 1,322 1.8%

65-74 years SIMD 1 925 12.1% 469 13.1% 456 11.2%

SIMD 2 814 9.1% 399 9.7% 415 8.6%

SIMD 3 420 7.2% 220 8.0% 200 6.4%

SIMD 4 260 4.6% 127 4.8% 133 4.4%

SIMD 5 158 3.7% 80 3.7% 78 3.6%

All 65-74 years* 2610 7.9% 1,316 8.5% 1,294 7.4%

75+ years SIMD 1 732 12.0% 311 13.6% 421 11.0%

SIMD 2 746 9.9% 322 11.6% 424 8.9%

SIMD 3 412 8.5% 193 10.5% 219 7.3%

SIMD 4 242 5.3% 127 7.1% 115 4.1%

SIMD 5 140 4.4% 72 5.4% 68 3.7%

All 75+ years* 2294 8.6% 1,037 10.2% 1,257 7.6%

Source: GPASS, Primary Care Department, NHS Ayrshire and Arran NB*Includes unknown SIMD

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Parkinson’s disease Parkinson’s disease is a progressive neurological condition which affects mobility through tremor, rigidity and slowness of movement. It occurs mainly among older people34, 35. Data collected from Ayrshire and Arran GP records for a local neurology needs assessment36 reflects this pattern with 790 patients aged 65 years and over recorded as having Parkinson’s disease compared with 84 patients aged 16-64 years per 100,000 population (Table 43). Table 43: Number and approximate rates per 100,000 population of patients with Parkinson's disease in Ayrshire and Arran GP practice survey by age, gender and location (June 2006)

Number Rate per 100,000 population

Population 16+ yrs 618 168

16 – 64 106 84

65+ 512 790

Male 350 249

Female 268 169

East Ayrshire 215 222

North Ayrshire 217 197

South Ayrshire 186 201



5.6 Sensory impairment

The prevalence of sensory impairment increases with age (Table 44). Hearing impairment was identified in general practice as being more common among older people than visual impairment, and more common among older males than females. There was little difference in the prevalence of visual impairment between older male and female patients. It is likely that what is recorded in GP practice relates to significant vision loss such as glaucoma or cataract. Sensory impairment was also found to be more prevalent among older patients in more deprived areas (further information at 7.7). Visual impairment is likely to be less commonly recorded in general medical practice as short sight/long sight and reducing visual acuity in old age and these are common and managed through community optometry services Table 44: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of hearing impairment or visual impairment by gender, age group, and deprivation category

Female Male

Age band Deprivation

category Hearing impairment Visual impairment Hearing impairment Visual impairment

n % n % n % n %

SIMD 1 576 3.5% 71 0.4% 692 4.1% 96 0.6%

SIMD 2 520 2.7% 60 0.3% 653 3.5% 74 0.4%

35-64 years SIMD 3 304 2.3% 49 0.4% 420 3.2% 36 0.3%

SIMD 4 270 2.3% 20 0.2% 352 3.0% 39 0.3%

SIMD 5 221 2.2% 14 0.1% 332 3.3% 33 0.3% All 35-64 years* 1,915 2.6% 218 0.3% 2,488 3.5% 284 0.4%

SIMD 1 328 8.1% 59 1.5% 403 11.2% 58 1.6%

SIMD 2 290 6.0% 33 0.7% 419 10.2% 45 1.1%

65-74 years SIMD 3 173 5.5% 21 0.7% 263 9.6% 16 0.6%

SIMD 4 176 5.8% 21 0.7% 239 9.0% 18 0.7%

SIMD 5 112 5.1% 10 0.5% 177 8.3% 15 0.7%

All 65-74 years* 1,089 6.2% 145 0.8% 1,517 9.8% 152 1.0%

SIMD 1 562 14.7% 160 4.2% 437 19.1% 83 3.6%

SIMD 2 618 13.0% 171 3.6% 475 17.1% 78 2.8%

75+ years SIMD 3 377 12.6% 102 3.4% 297 16.2% 54 2.9%

SIMD 4 351 12.5% 98 3.5% 311 17.4% 40 2.2%

SIMD 5 199 10.8% 40 2.2% 200 15.1% 38 2.9%

All 75+ years* 2,119 12.9% 580 3.5% 1,731 17.0% 298 2.9%

Source: GPASS, Primary Care Department, NHS Ayrshire and Arran - NB*Includes unknown SIMD


5.7 Oral health

Oral health is perceived to deteriorate with age, as can be observed in Figure 76 and Table 45. However, this is not an unavoidable consequence of ageing per se. The two most prevalent oral diseases, dental caries and periodontal disease, are largely preventable, therefore strategies and action plans to improve the oral health of older people and the oral care of older people need to be underpinned by prevention. Figure 76: Percentage with 20 or more natural teeth, and percentage with no natural teeth, 2008, 2009, 2010, by age band, Scotland

Source: SHeS

Epidemiological trends in oral health have shown major change over the 20th century. The generations dominated by having all their teeth extracted at a relatively young age are being replaced by subsequent generations, born since the 1930s, retaining some of their teeth but often experiencing high levels of decay, consequently requiring a high level of maintenance. Changing trends are also evident in children and younger adults, with reducing rates of dental disease and restorations37 but this will not impact on the older people population for at least another 25 years or more. Prior to this cohort reaching old age a generation with many teeth, many restorations and high demands on the oral health care system will become old. This shift in patterns of disease has a profound impact on the demand placed on dental services and also on the types of dental treatment required38.

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Table 45: Number of natural teeth, and percentage with no natural teeth, 2008, 2009, 2010, by age and sex, Scotland

Age

16-24 25-34 35-44 45-54 55-64 65-74 75+

% % % % % % %

All adults

2008

No natural teeth 0 1 2 5 15 33 51

Fewer than 10 - 1 2 4 10 13 13

Between 10 and 19 1 3 9 13 23 22 19

20 or more 99 96 88 78 52 32 17

2009r


Fewer than 10 0 0 2 4 8 15 10

Between 10 and 19 1 4 8 15 22 21 19

20 or more 98 95 88 75 56 33 20

2010


Fewer than 10 - 0 2 4 8 14 13

Between 10 and 19 1 2 8 14 23 20 19

20 or more 99 98 89 77 53 37 19

Bases (weighted):

All adults 2008 902 966 1179 1140 981 709 566

All adults 2009 1046 1134 1324 1347 1151 836 666

All adults 2010 1004 1114 1224 1309 1111 805 646

The 2009 figures have been revised to correct an error in the weighting. They replace the original 2009 report figures. The impact of this revision is minimal. Source: SHeS


5.8 Sexual health and blood-borne viruses Sexual health in older life

Sexual health has been defined as “the integration of somatic, emotional, intellectual and social aspects of sexual being, in ways that are positively enriching” and as such encompasses more than sexual intercourse and related infections39. While sexually transmitted infections tend to peak among people in their 20s, there are a number of conditions related to sexual health which increase with age as a consequence of hormone changes, disease progression and medication side effects.

Although sexual function tends to decline in older age it is a misperception that sexual activity is solely the preserve of young people. The second half of the 20th century witnessed significant social changes in relation to sexual health and relationships such as more open access to hormone contraception and menopause management; increased rates of divorce and remarriage; and civil partnerships and open same-sex relationships, which are likely to have an impact on the sexual health of older people. Societal perceptions of old age have also changed with longer life expectancies and older people enjoying better health. In addition better health outcomes and new types of medication such as those for erectile dysfunction can be seen as a catalyst for changing perceptions of sexuality in older life.

The increased diversity of sexual behaviours into older age has implications for how sexual health services will need to be delivered in the future. There is some evidence that older patients and their GPs have reservations about raising sexual health issues. There may also be issues around awareness of sexual health issues among older people as they have not traditionally been targeted by health promotion campaigns.

Blood borne viruses

Whilst considerable attention is given to reducing the risk of long term conditions such as cardiovascular disease and respiratory disease, there is less of a focus on the impact of long term illness or disability related to blood borne viruses such as hepatitis C virus (HCV) or Human Immunodeficiency Virus (HIV).

Improvements in screening, diagnosis and treatment of HIV and hepatitis C over recent years, means that people with these conditions can now hope to live into later life. An estimated 39,000 people are currently living in Scotland with chronic (long-term) hepatitis C infection. At present, potentially 50 to 60% of people chronically infected with hepatitis C are undiagnosed (approximately 22,500). Of the 16,500 who are diagnosed, around 75% are not currently in specialist care40. Chronically infected people are at increased risk of serious liver disease and cancer. However, even with improved diagnosis, treatment and care there is still a number of patients presenting with complications of liver disease, mainly cirrhosis and hepatocellular cancer and this number is likely to increase. Nationally, a twofold increase in the annual number of diagnosed persons developing end-stage liver disease has been observed between 1999 and 2009.

Hepatitis C and HIV are now considered to be long-term chronic conditions. As such, primary care services are an important part of the care pathway for people living with these long term conditions and have an important role in monitoring and minimising co-morbidities of HIV and its treatment. Despite decreases in the incidence of acute hepatitis C, the prevalence of long term chronic hepatitis C is increasing among older adults. Regardless of the improvements in antiviral treatment for hepatitis C and HIV, the future burden of HIV and HCV related disease is likely to be substantial. All national data sources (hospital admissions for HCV-related end-stage liver disease,


liver transplants and deaths) show that HCV-related liver disease is continuing to rise. 5.9 Bone health

As people age, so loss of bone structure and density occurs, rendering them more vulnerable to fractures, particularly as the result of a fall. Falls are more common in older people who may be unsteady due to frailty, circulatory or neurological conditions and vulnerability to the effects of alcohol or prescribed medication. Fall related hospital discharges have been occurring frequently with a gradual increase throughout the past decade. Figure 77 clearly shows the rise in both the number and the crude rate of fall-related hospital discharges among older people, particularly among females aged 75 years and over. This may reflect a number of factors – maintaining independence may be associated with increased falls due to loose flooring, uneven floor surfaces, steps and stairs at home, with wet spills on kitchen floors, when cooking and other risks that do not exist for residents in care homes / sheltered environments.

Figure 77: The number of fall related hospital discharges by gender, age group and year, 1997-2009, in Ayrshire and Arran

Source: SMR01

Figure 78: The crude rate per 100,000 population of fall related hospital discharges by gender, age group and year, 1997-2009, in Ayrshire and Arran

Source: SMR01

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The incidence of fracture of the neck of femur, a common and significant fracture in older people, has increased throughout the same time period (Figures 79 and 80). People over 75 years of age constitute 75% of the overall number of fractures of the neck of femur within Ayrshire and Arran over the time period of 1997 to 2009. The average length of stay in hospitals also increases with age (Table 46). This fracture almost always requires surgical fixation with pinning, plating or possibly hip replacement depending on the nature and severity of the fracture Figure 79: Number of hospital discharges with fracture of the neck of femur as a result of a fall by gender, age group and single year (1997-2009) in Ayrshire and Arran

Source: SMR01

Figure 80: The crude rate per 100,000 population of hospital discharge with fracture of the neck of femur as a result of a fall by gender, age group and single year (1997-2009) in Ayrshire and Arran

Source: SMR01

Table 46: Average length of stay for fracture of the neck of femur by age group in Ayrshire and Arran in 2009

Age Group Average Length of Stay (days) n

30 - 49 8 9 50 - 64 18 40 65 - 74 15 112

75 + 20 555

All ages 19 717 Source: SMR01

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5.10 Screening and immunisation

Breast screening uptake

Breast cancer is the second most common female cancer. Breast cancer rates are known to rise with age, especially among women aged 75 years and older, although cancers may be less aggressive in older women than in younger women. The national screening programme for breast cancer aims to identify and address cancers early to reduce mortality. In Scotland, women aged 50-64 years have been invited for a routine screen once every three years until 2003-04, when the age range for invitation was extended to include women up to the age of 70 years. Women over 70 years may still be screened three yearly on request. The uptake rate for breast screening services in Ayrshire and Arran has consistently been within 1% of the Scottish average in recent years and consistently halfway between the national minimum standard and target uptake rates (Figure 81).

Figure 81: Breast screening uptake by NHS Board of residence: Ayrshire and Arran, Scotland, 1st April 2004 to 31st March 2011; Percentage uptake (three year rolling periods), females aged 50-70 years

Source: Scottish Breast Screening Programme (SBSP) Information System - KC62 Returns

Bowel screening uptake

Cancer of the large bowel is second commonest in men and third in women. If detected early is more amenable to treatment The Scottish Bowel Screening Programme commenced a phased roll out in June 2007 and by December 2009 all NHS Boards in Scotland were participating in the Programme. All men and women registered with a Community Health Index (CHI) number and aged 50-74 years are invited to participate and be screened every two years. The programme has an uptake target of 60%. Data for bowel screening packs issued between 1 November 2008 and 31 October 2010 indicated that 53 percent of packs were returned in Ayrshire and Arran41. This was lower than the programme target but similar to the Scottish average (54 percent). Females had a higher uptake rate than males and people living in less deprived areas had a higher uptake than those living in more deprived areas. Influenza immunisation uptake

In Scotland, a seasonal immunisation programme is available for those most vulnerable to influenza complications. This includes people aged 65 and over as a priority group for vaccination. The national target for vaccination uptake was 70% of priority groups until 2010-11 when it was raised to 75%. The uptake rate in Ayrshire and Arran has exceeded the national target every year since 2005-06, and has been within 2% of the national average (Figure 82).

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Figure 82: Seasonal influenza immunisation uptake among people aged 65 years and over, 2004-05 to 2010-11

Source: NHS Ayrshire & Arran Immunisation Annual Report

5.11 Mental health and wellbeing 5.11.1 Mental wellbeing

Mental health and wellbeing is important in sustaining an active and healthy life into older age. Positive mental wellbeing is now measured in the Scottish Health Survey using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)42. WEMWBS is a 14 item scale of mental wellbeing covering subjective wellbeing and psychological functioning, in which all items are worded positively and address aspects of positive mental health. The scale is scored by summing responses to each item answered on a 1 to 5 Likert scale. The minimum scale score is 14 and the maximum is 70.

WEMWBS data can be analysed by grouping the survey population into three groups: 1. those with relatively "good mental wellbeing" (a WEMWBS score

of over one standard deviation above the mean); 2. those with "average mental wellbeing" (a WEMWBS score of

within one standard deviation of the mean); and 3. those with relatively "poor mental wellbeing" (a WEMWBS score of

more than one standard deviation below the mean).

Figures 83 and 84 shows that while the younger age bands of older people report higher mean WEMWBS scores and higher proportion classified as having “good wellbeing” than those aged 16-64 years, the mean WEMWBS score decreases with subsequent increases in age band and the proportion of older people classified as having “poor wellbeing” increases to about 20% among those aged 80 years and over. Figure 83: Mean WEMWBS scores, 2008, 2009 and 2010 combined, by age and sex; Scotland

Source: SHeS

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Figure 84: Good, average and poor WEMWBS scores, 2008, 2009 and 2010 combined, by age and sex; Scotland

Source: SHeS

Factors contributing to mental health

Logistic regression models that examined the association between individual factors and mental wellbeing, found that marital status, the presence of a limiting long-term condition, and reporting low physical activity levels were each significantly associated with poorer wellbeing. Compared with married or cohabiting people, the odds ratios for poor mental wellbeing were 2.22 for men who were single, separated or divorced, 2.03 for widowers or surviving civil partners, and 1.47 for widows or surviving civil partners. In women but not men, living in the most deprived 15% of areas increased the odds of poor mental wellbeing, but drinking above the weekly limit decreased the odds. The odds of poor mental wellbeing were 4.16 times higher in men with a limiting long-term condition than

in men with no condition; the equivalent odds ratio for women was 2.76. Men and women with low physical activity levels also had higher odds of poor wellbeing than those who met the activity recommendations (odds ratios of 3.32 and 2.98, respectively). Age was not significantly associated with the outcome in men or women once other factors were included in the model. 5.11.2 Mental health problems Disabilities and mental health problems in older adults

The World Health Organisation has estimated that, by 2020, depression will have become the second largest cause of disability in the world after cardiovascular disease. There is a large literature indicating that women are twice as likely as men to experience depression, the risk of all persons with a disability developing depression is higher than the general population and the rate of depression in women with a disability is higher than that for men with a disability43. Many older people have one or more long term conditions and a high proportion also have ‘co-morbid mental health problems’ with disproportionately higher rates amongst those living in deprived areas. The combination of multiple long term conditions, mental health problems and deprivation not only has a negative impact on the health outcomes for the individual but contributes to maintaining inequalities in health. The negative effect on health outcomes for individuals, families and communities increases public sector expenditure in those areas. The Kings Fund recommends closer integration of mental health services and health and social care services44.

13 20 20 13 15 12

72 69 67

72 67 70

15 11 13 15 19 18

0%10%20%30%40%50%60%70%80%90%

100%

16-64 65-69 70-74 75-79 80-84 85+

% Good wellbeing % Average wellbeing % Poor wellbeing


Negative mental health is measured in the Scottish Health Survey using the General Health Questionnaire (GHQ12) scale. GHQ12 is designed to detect possible psychiatric morbidity in the general population. The questionnaire contains twelve questions about the informant’s general level of happiness, depression, anxiety and sleep disturbance over the past four weeks. Responses to these items are scored, with one point given each time a particular feeling or type of behaviour was reported to have been experienced ‘more than usual’ or ‘much more than usual’ over the past few weeks. These scores are combined to create an overall score of between zero and twelve. A score of four or more (referred to as a ‘high’ GHQ12 score) has been used in this report to indicate the presence of a possible psychiatric disorder45. GHQ12 scores of 4 or more were more common in those aged 16-64 years compared with adults 65-69 years (13% vs. 9% for younger and older men and 18% vs. 14% respectively for women) (Figure 85 and 86). There was an increase in prevalence of GHQ12 scores of 4 or more with increasing older age for women, from 11% of those aged 65-69 years to 21% of those aged 85 years and over, whereas the equivalent figures among men did not vary by age. More women than men across all age groups had a GHQ12 score of four or more. The prevalence of GHQ12 scores of 1-3 increased with age among both older men and women.

Figure 85: GHQ12 scores for men, 2008, 2009 and 2010 combined, by age

Source: SHeS

Figure 86: GHQ12 scores for women, 2008, 2009 and 2010 combined, by age

Source: SHeS

64 73 69 67

56 61

23 18 23 25

34 29

13 9 9 9 10 10

0%

20%

40%

60%

80%

100%

16-64 65-69 70-74 75-79 80-84 85+

0 1-3 4 or more

58 69 61 55 52

40

25 21

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39

18 11 13 16 16 21

0%

20%

40%

60%

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16-64 65-69 70-74 75-79 80-84 85+

0 1-3 4 or more


5.11.2.1 Mental health problems commonly treated within Primary Care Common mental health problems such as depression and stress/anxiety are regularly treated within the Primary Care setting. Table 47 presents the percentage, at 1 January 2009, of patients in Ayrshire and Arran with a history of depression or stress/anxiety appearing anywhere on the GP recording system. The highest proportions of patients with history of a common mental health problem are aged between 36-64 years, with a slight decrease among older age bands. A higher proportion was observed among females and patients living in more deprived areas. Table 47: Percentage, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of depression or stress/anxiety by age group, sex and deprivation category


% Depression % Stress/anxiety

Male Female Male Female

SIMD 1 7.7 16.1 7.30 11.4

SIMD 2 5.8 12.0 5.3 9.0

15-34 years

SIMD 3 3.9 9.5 3.6 7.0

SIMD 4 3.5 7.1 3.3 6.2

SIMD 5 2.6 5.0 2.5 5.3

All 15-34 years* 5.3 11.3 4.9 8.5

SIMD 1 16.2 28.3 15.7 26.8

SIMD 2 11.5 21.4 11.5 20.0

35-64 years

SIMD 3 9.2 17.6 9.6 16.2

SIMD 4 7.5 13.8 8.9 14.3

SIMD 5 6.4 11.5 7.6 13.0

All 35-64 years * 10.7 19.5 11.1 18.8

SIMD 1 12.5 21.8 12.5 21.4

SIMD 2 10.1 15.5 9.9 18.8

65-74 years

SIMD 3 8.2 14.4 8.5 16.8

SIMD 4 6.7 10.7 8.4 12.8

SIMD 5 6.5 10.4 7.3 11.1

All 65-74 years * 9.2 15.2 9.6 16.9

SIMD 1 9.2 16.9 8.0 16.8

SIMD 2 6.2 12.1 6.5 13.5

75+ years SIMD 3 6.7 12.1 7.2 12.2

SIMD 4 5.8 8.8 5.9 9.3

SIMD 5 4.2 7.9 6.0 7.6

All 75+ years* 6.6 12.1 6.8 12.6



5.11.2.2 Inpatient mental health services The vast majority of mental illness, at all ages is managed in community settings. Changes in management and a reduction in mental health hospital accommodation have led to a fall in hospital discharges in recent years. Severe mental illness may require periods of hospitalisation and intensive community programmes. The rate of mental illness discharge from psychiatric hospitals is highest among persons aged 25-44 years (Figures 87 and 88). People aged 45-74years have lower rates but the rate rises in those aged 75 and over, mainly due to the inclusion of people with dementia.


Figure 87: Discharges from mental health units, by age on discharge, males; rate per 100,000 population; Scotland

Source: SMR04 – NB Discharges also include deaths

Figure 88: Discharges from mental health units, by age on discharge, females; rate per 100,000 population; Scotland

Source: SMR04 - – NB Discharges also include deaths

Figures 89 and 90 present the percentages of mental illness speciality discharges in Scottish hospitals, and Figures 91 and 92 present the percentage of psychiatric inpatient residents, by age and length of stay. The discharge data can be seen to be skewed towards shorter lengths of stay, while the psychiatric inpatient resident data is skewed toward longer lengths of stay. This indicates that there is a cohort of older people using inpatient mental health services for a short length of stay but also a cohort of long-term inpatient residents. Tables 48 and 49 present mental illness discharges by main diagnosis. Dementia can be seen here to be the most common diagnosis for discharge among older people constituting two thirds of the diagnoses in those aged 75 and over with mood (affective) disorders (i.e. anxiety and depression), being the second most common main diagnosis. Figure 89: Mental illness specialties in Scottish hospitals: percentage of male discharges by age and length of stay: year ending 31 March 2011; Scotland

Source: SMR04

0

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Per

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Figure 90: Mental illness specialties in Scottish hospitals: percentage of female discharges by age and length of stay: year ending 31 March 2011

Source: SMR04

Figure 91: Mental illness specialties in Scottish hospitals: percentage of male residents by age and length of stay: year ending 31 March 2011

Source: SMR04

Figure 92: Mental illness specialties in Scottish hospitals: percentage of female residents by age and length of stay: year ending 31 March 2011

Source: SMR04

0

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75 andover


Table 48: Mental illness discharges of male by age and main diagnosis on discharge; rate per 100,000 population: year ending 31 March 2011; Scotland

all ages

25-44 45-64 65-74 75 and over

All diagnoses 415.6 653.9 432.0 394.8 603.2

Dementia 50.9 0.4 12.5 144.0 419.6

Alcohol misuse 78.4 135.8 123.9 48.6 16.2

Drug misuse 23.8 64.9 7.1 0.5 0.5

Schizophrenia 77.9 167.1 83.6 22.7 12.8

Mood (affective) disorders

86.0 120.1 113.2 104.9 72.3

Bipolar affective disorder

27.8 41.8 42.6 24.1 9.5

Depressive episode 43.0 61.7 49.0 59.1 44.7

Recurrent depressive disorder

8.9 8.1 12.9 15.9 14.7

Other psychotic disorders

23.7 40.3 18.2 14.1 21.4

Disorders of childhood 1.9 2.2 - - -

Neurotic, stress-related and somatoform disorders

22.3 34.0 23.4 18.6 21.4

Personality disorders 9.8 23.6 6.7 3.6 *

Mental handicap 1.3 2.2 2.0 * *

Other conditions 39.7 63.2 41.1 37.7 37.6

Source: ISD Scotland SMR04

Table 49: Mental illness discharges of female by age and main diagnosis on discharge; rate per 100,000 population: year ending 31 March 2011; Scotland

all ages

25-44 45-64 65-74 75 and over

All diagnoses 372.1 519.9 376.9 375.6 562.6

Dementia 50.5 * 8.7 101.7 340.7

Alcohol misuse 33.6 61.0 53.0 14.2 4.9

Drug misuse 10.5 27.3 4.4 * *

Schizophrenia 28.2 45.3 42.4 26.4 10.9

Mood (affective) disorders

119.8 163.0 148.1 139.9 118.4

Bipolar affective disorder 37.7 53.1 58.2 43.0 16.8

Depressive episode 58.7 79.6 62.5 64.2 72.2

Recurrent depressive disorder

15.5 19.3 19.7 25.2 20.8

Other psychotic disorders

20.1 23.6 21.7 20.1 35.0

Disorders of childhood 0.9 1.3 - - -

Neurotic, stress-related and somatoform disorders

28.2 41.2 30.2 30.3 22.8

Personality disorders 39.2 92.9 25.8 5.5 2.0

Mental handicap 0.8 1.0 1.2 * *

Other conditions 40.3 62.9 40.7 35.5 26.7

Source: ISD Scotland SMR04


5.11.2.3 Dementia

Most dementias are progressive deterioration in cognitive functioning and early signs and symptoms may be difficult to detect. Diagnosis at an earlier stage may allow opportunities to enhance cognitive performance and is becoming more common. Figure 93 provides data on the percentage of males and females over the age of 65 with a diagnosis of dementia. The percentages for 2007 in East, North and South Ayrshire compared to the projected levels in 2021 do not show large increases, however the numbers of people over the age of 65 is increasing, and therefore the numbers with dementia will increase. The higher percentage of females with a diagnosis of dementia compared to males may be because of the higher proportion of older women than men over the age of 65. The slight increase in the future for men may be that the proportion of older men is also increasing in relation to improved life expectancy. Figure 93: Percentage of those over 65 with dementia, 2007 and 2021 in East, North and South Ayrshire

Source: http://alzheimers.org.uk/site/scripts/download_info.php?fileID=8

Figure 94 demonstrates this last point showing the percentage of males and females with dementia in East, North and South Ayrshire populations. Again the prevalence is fairly low with the trend increasing between the two time periods. This may be explained by the projected increases in the older population groups and reflects the gender differences in life expectancy. Figure 94: Percentage of all males and females with dementia, 2007 and 2021 in East, North and South Ayrshire

Source: http://alzheimers.org.uk/site/scripts/download_info.php?fileID=8

0123456789

10


Per

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of

ove

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5 y

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old

s

2007 Males 65+

2021 Males 65+

2007 Females 65+

2021 Females 65+

0

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East Ayrshire North Ayrshire South AyrshirePer

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of

all m

ale

and

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po

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2007 All males

2021 All males

2007 All females

2021 All females

http://alzheimers.org.uk/site/scripts/download_info.php?fileID=8

http://alzheimers.org.uk/site/scripts/download_info.php?fileID=8


Chapter 6: Use of health and social services

6.1 Primary care consultation rates in Scotland

Practice Team Information (www.isdscotland.org/pti) collects information from a sample of Scottish general practices. The pyramids Figures 95 and 96 present data for male and female consultations with a GP in 2003-04 and 2010-11. The changes in this short period are small but the patterns reflect the demographic changes that are also occurring in Ayrshire and Arran. There is a 1.8 percent increase in female consultations for those aged over 75 years of age with less of an increase for males over 75 years at 1.5 percent.

Figure 95: Estimated number of consultations, for financial year 2003-04 by gender and age group, Scotland

Source: www.isdscotland.org/pti

Males over the age of 65 accounted for just under a quarter of all consultations in 2003-04 to just over a quarter in 2010-11.

Figure 96: Estimated number of consultations, for financial year 2010-11; by gender and age group, Scotland

Source: www.isdscotland.org/pti

Females over 65 years old accounted for 23 percent of the consultations in 2003-04 increasing to 24.3 percent in 2010-11. These gradual increases in the consultation rates in the over 65s could be interpreted as there being a growing population over the age of 65 and/or these cohorts have more conditions (possibly long-term) that prompts them to go to the GP more often than in the past. However, it may not be that older adults have poorer health but that better responses are now available which need closer review; there are more therapeutic interventions now available (mostly pharmaceutical) which require GP consultations for monitoring. As new programmes are developed to deal with long-term conditions and GP awareness of the prevention agenda increases, it is likely that levels of surveillance and monitoring will increase into the future.

18 16 14 12 10 8 6 4 2 0 2 4 6 8 10 12 14 16 18

0-4

5-14

15-24

25-34

35-44

45-54

55-64

65-74

75+

Percentage of males and females consulting their GP 2003-04

Males (%)

Females (%)

18 16 14 12 10 8 6 4 2 0 2 4 6 8 10 12 14 16 18

0-4

5-14

15-24

25-34

35-44

45-54

55-64

65-74

75+

Percentage of males and females consulting their GP 2010-11

Males (%)

Females (%)

http://www.isdscotland.org/pti




6.2 Emergency hospital admissions With multiple morbidities, multiple medications and increased susceptibility to a range of conditions including infections and falls, older people are much more likely to be admitted to hospital in an emergency than younger adults. The rate of emergency hospital admissions among persons aged 65 years and over is significantly higher than for younger age groups (Figure 97). Between 2006/07 and 2010/11 the emergency admission rate among persons aged 65 years and over in Ayrshire and Arran has been consistently above 25,000 per 100,000 population, while the rate for younger age bands has been around 10,000 per 100,000 population or less. Figure 97: Admission rates per 100,000 population of all emergency admissions, all Ayrshire & Arran residents 2006-07 to 2010-11 by age group.


Whilst remaining above the rates for younger age groups, there is a clear deprivation gradient to emergency admissions among older people in Ayrshire and Arran (Figure 98). Between 2006/07 and 2010/11 the emergency admission rate in Ayrshire and Arran for persons aged 65 years and over within the most deprived quintile has been around 30,000 per 100,000 population, while the rate for those in the least deprived quintile has been around 20,000 per 100,000 population. The rate of emergency admissions has steadily increased during the study time period for all deprivation categories. Figure 98: Admission rates per 100,000 population of all emergency admissions for Ayrshire & Arran Residents aged 65 years and over, 2006-07 to 2010-11 by age and deprivation category


0

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SIMD1 SIMD2 SIMD3

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6.2.1 Multiple emergency admissions

The rate of multiple emergency hospital admissions during one year is also significantly higher among persons aged 65 years and over than for younger age groups (Figure 99). Figure 99: Admission rates per 100,000 population for patients with 3 or more emergency admissions for all Ayrshire & Arran residents 2006-07 to 2010-11 by age group


Figure: 100 shows the changing rates per 100,000 population for patients with one or more emergency admissions per year. Around 12,000 patients per 100,000 population had one emergency admission per year during the time period, while about 3,500 patients per 100,000 population had two emergency admissions and 2,000 patients per 100,000 population had three or more emergency admissions.

Figure 100: Patient rates per 100,000 population for patients with one or more emergency admissions per year for Ayrshire & Arran residents aged 65 years and over, 2006-07 to 2010-11


Differences in emergency admission rates can again be observed when looking at patients aged 65 years and over with three or more admissions in one year (Figure 101). Between 2006/07 and 2010/11 the patient rate per 100,000 population in the most deprived quintile is approximately double the rate in the least deprived quintile, although numbers are relatively small so year to year variations may be high.

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Figure 101: Patient rates per 100,000 population for patients with 3+ emergency admissions for Ayrshire & Arran residents aged 65 years and over, by deprivation category, 2006-07 to 2010-11


6.2.2 Risk of emergency admission to hospital in the following year

Scottish Patients at Risk of Readmission and Admission (SPARRA) is an algorithm developed by Information Services Division (ISD) to predict a patient's risk of being admitted to hospital as an emergency in a particular year. SPARRA scores can range from 1 to 99% for patients in the cohort. Patients with a score of 50%, for example, are generally said to have a 1 in 2 chance of being admitted to hospital in the prediction year. Figure 102 presents the number of Ayrshire and Arran patients aged 65 years and over at risk of emergency admission to hospital in the following year by risk category.

Figure 102: Number of patients (65 years and over) at risk of emergency admission to hospital in the following year; by risk category; Ayrshire and Arran

Source: ISD Scotland (SPARRA)

A patient with a SPARRA score of under 10% is classed as being “low risk”, while a score of over 30% is classed as being at “high risk” and a score over 90% is classed as “very high risk”. From Figure 103 it can be seen that the proportion of SPARRA cohort patients is broadly similar for each risk category at national, health board and CHP area level. Among the three CHP areas, the highest proportion of patients classed as being at “high risk” was in East Ayrshire, 1% higher than the Ayrshire and Arran proportion and 2% higher than the national proportion Figure 104.

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1,617 854 420 139 13 0

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Figure 103: Percentage of patients (65 years and over) at risk of emergency admission to hospital in the following year; by risk category; selected areas, 2012


Figure 104: Percentage of patients (65 years and over) classed as being at “high risk” of emergency admission to hospital in the following year; for selected areas, 2012


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6.3 Older adults with high support needs

A recent paper from the Joseph Rowntree Foundation16 provides an overview on the demographic issues related to older adults with high support needs. The intention of the paper is to stimulate and inform thinking on a better life for older people. It indicates that the population over the age of 85 (termed the ‘oldest old’) is the fastest growing age group in the UK. The gender differences become more defined in adults aged over 90 (termed the ‘very old’) with women out-numbering men by 3:1 and this ratio rising in centenarians to 6.5:1. The paper highlights the fact that the prevalence of disability rises with age and is most evident after the age of 74. The paper cites the prevalence of severe disability in the UK as below 5 percent in those aged less than 55 years rising to 40 percent in those aged 85 years and over. However it is noted that not all of the oldest old have high support needs.

6.3.1 Supply and demand of informal care

With the increase in older people and the fall in birth rates over recent decades, there is a change in the proportion of working age adults to the older people (see 2.7 Figures 18-21). For many older people, their children who are 20-30 years younger will act as informal carers.

The population projections to 2041 show that there are expected to be more care-receivers than care-providers in England in all years46. Scotland has a similar picture and this has consequences for increasing demands on services. Responses to the demographic change are complex. For example, encouraging women to train in order to provide formalised health and social care will affect the total fertility rate unless policies are developed to ensure that families can balance work and private life.

The increasingly common expectation that all adults will be seeking employment and the raised retirement age also indicate reduced availability of, and increased stress on, informal carers. 6.3.2 Potential supply and demand for informal care

Figures 105, 106, 107 and 108 present potential care-recipient /care-provider scenarios projecting that supply could outstrip demand in the future. These are merely scenarios of the projected potential supply and demand of informal care based on crude assumptions that everyone over 75 would need care and that those aged 50 to 64 would be the principle providers. It does however give an indication of the likely deficit of informal care as a result of population ageing. Whilst increasing the female working population with the pension reforms and increasing the retirement age to 66 has a positive effect on the dependency ratio, research in England suggests that the greater reliance on women in the provision of informal care means that this may create a different problem47. As the number of older people increases the demand for informal care will increase but as women will be working for longer the availability of informal care could be reduced.


Figure 105: Projected potential informal care to people aged 75 years and older by people aged 50-64 years in Ayrshire & Arran

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/projections

Figure 106: Projected potential informal care to people aged 75 years and older by people aged 50-64years in East Ayrshire


Figure 107: Projected potential informal care to people aged 75 years and older by people aged 50-64years in North Ayrshire


Figure 108: Projected potential informal care to people aged 75years or older by people aged 50-64years in South Ayrshire


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6.3.3 Older adults with learning disability

The life expectancy of adults with learning disabilities is increasing and the parents who are often the primary carers are ageing too. There is evidence to show that adults with Down’s syndrome have a four times higher risk of dementia compared to the general population. Further information is available in We want good health the same as you - A Strategy to Improve the Health of Adults with Learning Disabilities, NHS Ayrshire and Arran (2009). It is estimated that over 33 percent of people with Down’s syndrome aged 50 to 59 and over 50 percent aged 60 to 69 will have dementia. It is recommended that improvements in data relating to older people with learning disabilities are required in order to meet future needs16. NHS Ayrshire & Arran has developed systems to ensure that people with learning disabilities are provided with an annual health check with their GP. The Public Health department has developed a Health Improvement Plan with an extensive programme of work for people with learning disabilities. A dementia pathway for adults with learning disabilities has been developed in Ayrshire & Arran.

6.4 Carers

The 2001 Census revealed that carers are often at greater risk of suffering from ill health, poverty and discrimination. In particular, carers who provide high levels of unpaid care for sick or disabled relatives and friends are more than twice as likely to suffer from poor health compared to people without caring responsibilities. Moreover, older people who take on carer responsibilities are far more likely to develop health problems than other people in their same age group. Research undertaken by Carers UK47 indicate that the causes of carers’ poor physical and mental health are:

a lack of information, lack of support – either through the right kind or the right amount

worry about finances and the general stresses and strains of caring full-time with everyday life

isolation.

Carers Scotland48 reported that there are “many costs associated with poor health in carers”, such as:

direct costs in treating the carer’s own health problems

potential costs that would result if the carer is less able to care because of ill-health

indirect costs associated with carers being unable to work whilst caring or after their caring role has ended because of ill health.

Table 50 draws on data from the Scottish Household Survey (SHS) (2009) to show the estimated number of households that contain at someone who needs regular help and care across Ayrshire and Arran.


Table 50: Estimates of households with someone requiring regular help and care, 2009

East Ayrshire

North Ayrshire

South Ayrshire

Total

Total Number of households 53,722 62,006 51,526 167,254

Households with someone who needs regular help and care (%)

17% 14% 13% 15%

Households with someone who needs regular help and care (estimated number)

9,133 8,681 6,698 24,512

Compared to national average -13% ↑ ↑ ↔ ↑

Source – SHS 2009

The proportion of households in South Ayrshire with someone who needs regular help and care is around the same as the national average, with higher proportions of these households in East Ayrshire and North Ayrshire.

The SHS (2009) suggests that in relation to single pensioner households around a quarter across Ayrshire, require regular help and care: East Ayrshire – 25percent, North Ayrshire – 24 percent and South Ayrshire - 23%.

Table 51 draws on data from the SHS (2009) to provide estimates on households that require care. Just under 25,000 people across Ayrshire and Arran provide some sort of unpaid care, with each area having a higher proportion of unpaid carers than the national average. Around two thirds of those unpaid carers provide care to someone outwith their household. Proportionally, this is highest in East Ayrshire and lowest in North Ayrshire. Just under a third of those unpaid carers provide care to someone within their household. Proportionally, this is highest in North Ayrshire. A small proportion – around 5% of the

unpaid carers, have a double burden of care – caring for both someone within and outwith their household. Table 51: Profile of unpaid carers in Ayrshire and Arran, 2009 East

Ayrshire North

Ayrshire South

Ayrshire Ayrshire & Arran

Someone in the household provides unpaid care (% of all households)

15.0% 13.2% 14.0% 14.02%

Someone in the household provides unpaid care (estimated number)

8,058 8,185 7,214 23,457

Someone in the household provides unpaid care outside the household (%)

10.2% 7.6% 9.1% 8.90%

Someone in the household provide unpaid care outside the household (estimated number)

5,480 4,712 4,689 14,881

Someone in the household provides unpaid care within the household (%)

3.9% 5.2% 3.8% 4.35%

Someone in the household provides unpaid care within the household (estimated number)

2,095 3,224 1,958 7,277

Someone in the household provides unpaid care both within and outside the household (%)

0.9% 0.4% 1.1% 0.78%

Someone in the household provides unpaid care both within and outside the household (estimated number)

483 248 567 1298

Source SHS 2009 Table 10


6.5 Palliative care and end of life care The pattern of death and dying in the UK has changed dramatically in the past 100 years. At the end of the 19th century, 85 percent of people died at home, the majority from acute infections. Today 58 percent of the UK’s 500,000 deaths each year occur in hospital, mainly from chronic long-term conditions. Long-term projections by Gomes and Higginson (2008)49 suggest that if current trends continue unchecked, fewer than one in 10 people will die at home by 2030 while deaths in institutions will rise by over 20 percent. Projections also show that although annual numbers of deaths fell by 8 percent from 1974 to 2003, they are expected to rise by 17 percent from 2012 to 2030. People will die increasingly at older ages, with the percentage of deaths among those aged 85 are expected to rise from 32 percent in 2003 to 44 percent in 203049. A Scottish Government short life working group reported in 2010 that 75% of people are admitted to hospital during their last year of life. Just over 58% of people die in hospital, 23.4% die at home, 15.5% die in homes for the elderly and 2.8% in hospice care. Acute hospitals have difficulty in meeting the increasing demand for end-of-life care, there are reports of unmet need with 50% of NHS complaints about this aspect www.scotland.gov.uk/Resource/Doc/924/0097237.doc. The NHS Healthcare Quality Strategy has a quality outcome measure to monitor the percentage of the last 6 months of life spent at home or in a community setting. The aim of this is to enhance the patient and carer experience of end of life care. http://www.scotland.gov.uk/Topics/Health2/Policy/QualityStrategy/TheQualityStrategy

Improving ‘active ageing’ and supporting older people to live in their own homes independently, reduce isolation and address end of life care are all important and should be considered when planning and

developing services. The main ways in which this will be achieved are through improved community services, rapid response nursing teams, developing specialist palliative outreach services, introducing quality standards against which the performance of service providers can be measured, and giving a more central role to carers. There will be a new focus on improving the skills of the vast number of generalist staff who are involved in end-of-life care but have little formal training. 6.5.1 Choosing place of death - spending last months at home

One of the aspirations set out in the reshaping care agenda is to allow people to remain in their own homes. One of the clearest indications of the achievement of this aspiration is the proportion of people able to spend the last six months of life at home or in a community setting. Figure 109 shows the proportion of people spending the last six months of their lives at home or in a community setting. It reveals that South Ayrshire has the highest proportion of people spending their last six months at home, but this has decreased since 2007/08. Figures have increased in both East and North Ayrshire over the past few years.

http://www.scotland.gov.uk/Resource/Doc/924/0097237.doc

http://www.scotland.gov.uk/Topics/Health2/Policy/QualityStrategy/TheQualityStrategy

http://www.scotland.gov.uk/Topics/Health2/Policy/QualityStrategy/TheQualityStrategy


Figure 109: Percentage of people spending last 6 months of life spent at home or in a community setting

Source: Health and Social Care Data - Tab 5

6.6 Polypharmacy - pharmacy needs of older people

As people age, so disease processes mean that medical care including medication is required to improve functioning. On average, older people are prescribed more drugs than other any age group within the population. It is estimated that four out of five people over the age of 75 take some form of prescription medicine and that 36 percent are prescribed four or more medicines. Half of drugs are not taken as prescribed, and many drugs prescribed can cause adverse drug reactions (ADRs): such responses are implicated in 5 to 17 percent of hospital admissions50. Patients on multiple medicines are at an increased risk of experiencing drug side effects, and this can also be related to the number of health conditions they have. However, admission patterns show that

patients admitted with one drug side effect are more than twice as likely to be admitted with another50. One study in two large general hospitals in Merseyside of 18,820 patients over the age of 16 found that 1,225 patients had adverse drug reactions (6.5%) with the ADR precipitating the admission of 80 percent of cases. The median stay in hospital was eight days and this was estimated to account for four percent of bed capacity. The projected annual cost, to the NHS in England, of admissions due to ADRs was £466m (in 2004) and the authors concluded that most of these admissions were avoidable51. The risk of ADRs is higher in frail older people and interactions may occur with a very wide range of drugs, which can aggravate side effects that are disabling, such as confusion, falls and forgetfulness thus increasing contact with health services and the likelihood of hospitalisation. Frail older people who experience cognitive decline and/or those with dementia are likely to have more impact on health services due to non-adherence to their medication and are at an increased risk of hospitalisation51. It is therefore important to ensure that medication is used appropriately and when medication presents risks that can be harmful, a review is required. NHS Grampian has set out a framework with guidance for reducing polypharmacy, this estimates that 72 percent of all ADRs are avoidable. The benefit: harm ratio needs to be applied in regular reviews of medication to minimise drug related complications to older people. There is also evidence to show that de-prescribing (reducing) medication in certain cases has little harmful effects. This is highly likely to reduce the costs to the NHS and improve quality of life for the patient 52.

87.5

88.0

88.5

89.0

89.5

90.0

90.5

91.0

91.5

92.0

2005/06 2006/07 2007/08 2008/09 2009/10

Per

cen

tage

East Ayrshire North Ayrshire South Ayrshire Scotland


Chapter 7: Equity and healthy ageing This chapter refers to a number of issues impacting on the health and social care needs of older people, where only limited local data are available. These include poverty and social exclusion, multiple deprivation, gender, ethnicity and health inequalities. The future population of older adults is not heterogeneous and is likely, with the ‘baby boomer’ cohort currently coming up to retirement, to be more diverse than in the past. The needs of older people from different equality groups will require flexible and sensitive services. Service providers need to avoid stereotyping of older people and recognise that the diversity of the ageing population has to be considered alongside that of the rest of the population with equal access, socially, economically and politically, to available resources and services assisting in the maximisation of social inclusion53, 54. Age discrimination in service provision can stem from assumptions about older people being dependent and/or in ill health. Older adults are often not considered in mainstream national and local policies. 7.1 Poverty, social exclusion and multiple deprivation

Old age and poverty are not synonymous. However, there are arguments that future cohorts of older people, the ‘baby boomers’, have high current credit debt that may indicate many will be much poorer than they had expected. Changes now with the Welfare Reform Act will also have an impact on the pensions of future generations. Economic disadvantage in old age is known to be associated with poorer health55.

Relative povertya is often applied as a one dimensional monetary

indicator relating to 60 percent of the median income. Relative poverty limits full participation in the social, economic, political and cultural activities that allow individuals to be integrated into society. Relative poverty also brings high costs to society and, in the context of the social exclusion of older adults, it has the potential to increase demands on health and social care services and also stifle economic growth 56. Relative poverty can significantly reduce an older person’s ability to remain independent and in their own home. Although pensioner poverty has declined in Scotland over the last ten years, 57 there are specific groups within society that are more vulnerable to poverty and/or social exclusion. The small proportion of some equality groups in the Ayrshire and Arran population such as ethnic minorities which form less than one percent overall adds to the difficulty of assessing local needs to tailor services. Similarly, lesbian and gay older people at 5 to 7% of the total population58 are likely to be a more hidden population but with a higher potential of lower care and support from family than the general population59. It is noted that LGBT older people are an under-researched group and that service responses tend to focus on ‘health risks and psychological problems’ rather than on what contributes to this group’s wellbeing and quality of life54.

a People are said to be living in relative poverty if their income and resources are so

inadequate as to preclude them from having a standard of living considered acceptable in the society in which they live. Because of their poverty they may experience multiple disadvantage through unemployment, low income, poor housing, inadequate health care and barriers to lifelong learning, culture, sport and recreation. They are often excluded and marginalised from participating in activities (economic, social and cultural) that are the norm for other people and their access to fundamental rights may be restricted (European Commission, Joint Report on Social Inclusion, 2004).


Inequality Where national data are available and reliable, the patterns of inequality nationally are likely to be reflected at the local level for these groups. Currently the most common method of assessing inequality in Scotland is geographically - based on the Scottish Index of Multiple Deprivation. Data from the SIMD indicates multiple deprivation, where the health and wellbeing of communities are being affected by many social and economic factors. It is possible to estimate the number of older adults living in the most deprived areas compared to the number living in the least deprived areas (see Figures 22 to 25). However, this method ‘masks’ the profile and needs of other equality groups apart from geographic communities, making any focus and targeting of resources to increase equality and reduce inequality within those geographies difficult. Figure 110 shows that the percentage of the Scottish population experiencing relative poverty is more concentrated in the 15% most deprived areas compared to those in the 85% least deprived areas. These data will include older adults. It shows that the gap has decreased in 2009/10 compared to the preceding year.

Figure 110: Proportion of individuals in relative poverty before housing costs by area of residence: Scotland 2008-09 to 2009-10

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Social-Welfare/IncomePoverty

7.2 Impact of health inequalities

There are strong links between poverty and poor health, with individuals who experience poverty and low incomes having poorer mental and physical health and wellbeing than those with higher incomes. The top four priorities in NHS Ayrshire & Arran for improving population health are alcohol, tobacco, obesity and mental health (ATOM), all of which are risk factors for common diseases and premature death. Individuals, groups and communities living within areas of multiple deprivation experience poorer health across the

33 29

15 15

0

10

20

30

40

% %

2008/09 2009/10

per

cen

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15% most deprived datazones Rest of Scotland

http://www.scotland.gov.uk/Topics/Statistics/Browse/Social-Welfare/IncomePoverty



broad spectrum of health priorities and this has implications for the ageing population. Health inequalities i.e. the gap in health, social and economic factors between those living in the most and least geographically defined areas of deprivation, are outlined below by comparing the rates of ill health and premature mortality between those areas at the Scotland level. 7.2.1 Healthy life expectancy

Healthy Life Expectancy (HLE) at the national level in the most deprived decile was 22.5 years lower for males and 22.1 years lower for females than the HLE of those living in the least deprived decile60. 7.2.2 Premature mortality

Premature mortality from all causes for those aged under 75 years is 3.4 times higher in the most deprived decile compared to the least deprived decile60. This means that people living in more deprived areas are less likely to live longer lives than those in areas of greater affluence. 7.2.3 First hospital admission for coronary heart disease

The rate of first ever hospital admission for coronary heart disease is two and half times higher in the most deprived areas compared to the least deprived areas. This indicates higher service demand from those living in the most deprived areas compounded by the earlier onset of long term conditions and has implications for the increase of service use in these older adults60. It may also be an indicator of differential treatment with those in least deprived areas more likely to seek medical advice and receive preventative treatment and early intervention, avoiding hospital admission.

7.2.4 Cancer incidence and mortality

The incidence of cancer is more common in deprived areas than in less deprived areas in Scotland. People aged 45 to 74 years living in the most deprived areas are more than twice more likely to die of cancer than those in the least deprived areas60. Data on cancer and older adults is detailed on pages 86 to 88. 7.2.5 First hospital admission for alcohol and alcohol mortality

The rate of first ever admission to hospital for alcohol for people aged 45 to 74 years is significantly higher in the most deprived areas compared to the least deprived areas: 464 per 100,000 population compared to 96 per 100,000 population in areas of low deprivation. The overall mortality rate in this age group in the most deprived areas is ten times higher than in areas of low deprivation60. 7.2.6 Mental wellbeing

The mean WEMWBS score for those in the most deprived decile was 3.8 points lower than the least deprived decile in 2009 (Scotland). The absolute inequality has increased with the mean score in 2011 for the most deprived decile at 5.0 points below that of the least deprived decile60. 7.2.7 Incidence and mortality of falls amongst older people

A large research study conducted to quantify the incidence and mortality of falls in primary care in the UK found that these are associated with relative deprivation and increased mortality. Women in the older age groups and from the least advantaged social groups had a higher incidence of falls and recurrent falls61.


7.3 Ethnic background and equality

People from minority ethnic groups experience specific difficulties in accessing services in general with language as a barrier, stigma, lack of confidence in one’s rights, low expectations of services and lack of appropriate service provision. This is particularly difficult for those with high support needs - for example, having dementia when English is not a first language59. Specific services for older people from ethnic minorities can be welcomed. There was high satisfaction with exercise classes for falls prevention by many ethnic minority groups because it involved social contact. Classes run in ethnic minority languages demonstrated inclusion of the whole community. It was noted that respect for cultural and religious beliefs were important to older adults from ethnic minority groups who may prefer gender segregated classes54. Older people from minority ethnic communities have often had breaks in their work histories usually due to the immigration process and this means that their pension may be at a reduced level. This group are also disproportionately over-represented in more deprived communities, have relatively poorer health and more long term conditions. Figure 111 shows that percentage of each ethnic group in relative poverty is higher than the percentage of white – British in relative poverty. Research has shown that around 30 to 40 percent of older people from minority ethnic groups entitled to Pension Credits do not claim them and that a high number do not claim pensions and other benefits. A range of issues have been identified as barriers to claiming

benefits and pension such as language and lack of culturally specific services together with educational, attitudinal and cultural issues62. Figure 111: Percentage of people in relative poverty (before housing costs) by ethnic group: Scotland 2007-08 to 2010-11

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Social-Welfare/IncomePoverty There is currently a lack of data about the number of older people from minority ethnic groups within Ayrshire and Arran. Scotland’s Census 2011 should provide improvements to information in this area.

16 17

37

29 32

0

5

10

15

20

25

30

35

40

White - British White - Other Asian / AsianBritish

Mixed, Black /Black British,

Chinese &Other

Total MinorityEthnic

Per

cen

tage




7.4 Gender inequality

Until recently, male employment rates have been higher than female employment rates. Many women have experienced breaks in their working lives to have children and many have had part-time and/or low paid work with reduced pensions. This results in a higher proportion of women than men being poorer in old age63. More women than men live into old age and are more likely to be affected by poverty and social isolation56. Figure 112 shows the inequality between male and female single pensioners without children with a higher percentage of women in relative poverty. However this could change with future cohorts of older people as the recent recessions have adversely affected male employment compared to female employment and are likely to impact men’s pensions64. Figure 112: Percentage of adults in relative poverty (before housing costs) by gender and by single-adult household composition, Scotland 2010-11

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Social-Welfare/IncomePoverty

Access to services also demonstrates gender differences with more women than men accepting and using befriending services and handyman services, particularly older women living on their own. Women are higher users of day care services and one explanation is that they live longer and have a higher prevalence of long term conditions. Men do not necessarily want to socialise with other men as it was found that they often prefer the company of women54. 7.5 Rural inequality

Scottish projections show that there will be a higher percentage (21%) of people aged over 60 living in rural areas compared to the percentage (17%) living in urban areas1. Rural populations are ageing and rural local authorities in Scotland tend to see in-migration of older people and out-migration of younger people65. This has implications for the dependency ratio and reduces the potential of informal family care. Rural living therefore adds complexity and involves higher costs to meet health and social care demand of older adults. For older adults living in rural areas, that have experienced a reduction in local post offices and shops as well as public transport, it can be difficult to keep engaged with the community and social isolation can affect independence and quality of life. The risk of social isolation on mortality has been compared to risk factors such as smoking. It has also been stated that it can increase the risk of falls and other injuries66.

15 17 20

15 19 19

0

5

10

15

20

25

All adults Single pensionerswithout children

Single working ageadults without children

Per

cen

tage

Adult Males Adult Females




7.6 Expenditure-poor older adults

Research by the Department for Work and pensions has found that older pensioners spend a much smaller proportion of their income than younger pensioners and the general population. As well as spending less in general they were spending lower absolute amounts on consumables including food. Explanations given for these findings include that they were trying to build up savings, a lack of mobility and exclusion from social relations. Common factors identified in the research of low expenditure households were that they were less likely to be headed by a woman, less likely to be a couple, more likely to own their home outright and less likely to have built up savings before retirement. Those in receipt of Disability Living Allowance and Attendance Allowance were more likely to be low spenders than those not in receipt of these benefits67. This has implications for older people both in terms of managing budgets and in terms of ensuring adequate heating and nutrition to maintain good health, independence and ability to stay in their own home. 7.7 Sensory impairment and older adults

It is estimated that one in seven people in Scotland are affected by hearing loss, that 4.3 percent of the population are partially sighted and four people in every 10,000 are deafblind. The incidence of hearing and sight loss increases with age. Of those registered as visually or hearing impaired, 76% are aged over 65 years and and 65% are aged over 75 years old. With the ageing population, it is estimated that the incidence of sensory impairment will increase by 15 percent over the next decade. Sensory impairment, particularly dual sensory impairment (combined hearing and sight impairment), presents problems for the individual as well as service providers. With older adults, it can result in reduced mobility, social withdrawal, isolation,

mental health problems, increased falls, sleep disturbance with potential for confusion and disorientation68. These factors will affect the older person’s independence and ability to remain in their own home. It is reported that older people who are disabled, in ill health and/or housebound who also have a hearing and/or sight impairment, feel less connected to information networks that assist with access to services than older people who are not. A proactive approach by services to include these older people is recommended69. 7.8 Early intervention and prevention

Prevention resources are a key driver within older people’s policy development and are needed in order to reduce demand and relieve future pressures. Public health interventions earlier in life will go towards mitigating the future pressures on the health and social care system. Keeping people well across the life course will be imperative and interventions appropriate to the older population need to be researched and developed to ensure this is achieved to a greater rather than a lesser degree. Many of the lifestyle issues affecting older people have the same social gradient as in all other age bands. Inequalities affect individuals across their lives and policies need to tackle inequalities through targeting those with most needs. Increasing the number of people with better lifestyles is crucial for the longer-term health of older people; evidence shows that lifestyle behaviour change at any life stage and age can be of benefit to health status. However, it is the risk-taking behaviours, such as smoking and


alcohol misuse in young and middle adulthood that have a negative effect in later life. Public health interventions, such as smoking cessation and alcohol brief interventions early in life, combined with appropriate interventions in later life will increase the chances of a longer, healthier and more independent old age. Active ageing is about encouraging healthy ageing, social inclusion and independent living70. It is argued that the combined impact of the Welfare Reform Bill and tightening of public sector expenditure will have a disproportionately negative effect on older people and in particular older women, many of whom already live in poverty. The Welfare Reform Bill involves a new assessment processes for disability related benefits, reductions in monetary levels awarded may lead to an increase in poverty and this will impact on health. Cuts to public services, health, social care, transport, rights and advice services will have a significant impact on poorer older women. It is reported nationally that the poorest older women are finding it difficult to meet the cost of food and fuel that have risen more quickly than inflation71. If inequalities accumulate over the life course and into old age then policies across all areas, such as education, employment and health are required to address them. Life expectancy is increasing each year, but policies to increase healthy life expectancy for children, adults and older people need to be in place to allow older people to live well, have an improved quality of life and be valued by society.


References

1. Scottish Government Social Research (2010). Demographic Change in Scotland Office of the Chief Researcher. Office of the Chief Economic Advisor.

2. Office for Budget Responsibility (July 2011). Fiscal Sustainability

Report. Available at: http://budgetresponsibility.independent.gov.uk/wordpress/docs/FSR2011.pdf

3. European Commission (2007). The social situation in the

European Union, 2005-2006 – Overview, Luxembourg: Office for the Official Publications of the European Communities.

4. Scottish Government, COSLA and NHS Scotland (2011). Reshaping Care for Older People: a Programme for Change 2011 - 2021

5. Age, Home and Community (2011). A Strategy for Housing for Scotland's Older People: 2012 – 2021. The Scottish Government.

6. Legislation Relevant to Social Services in Scotland – extract from http://www.iriss.org.uk/node/432

7. Chetty, K., Dalrymple, J. & Simmons, H. (2012). Personalisation and Human Rights, a Discussion Paper. Scottish Human Rights Commission, Neighbourhood Networks, Alzheimer Scotland and the Centre for Welfare Reform. http://www.centreforwelfarereform.org/uploads/attachment/332/personalisation-and-human-rights.pdf

8. Graham, E. (2006). Policy Intervention and the Reversal of Scotland’s Fertility Decline. University of Glasgow.

9. UK Parliament (2010). Pensions Act 2010-12

http://services.parliament.uk/bills/2010-11/pensionshl.html

10. Clark, D. (2004). Life Expectancy of Baby Boomers. Information Services Division, NHS Scotland.

11. General Register Office for Scotland (2011). Scotland’s

Population 2010. The Registrar General’s Annual Review of Demographic Trends 156th Edition. www.gro-scotland.gov.uk/files2/stats/annual-review-2010/rgar2010.pdf

12. Cangiano, A. (2012). The Impact of Migration on UK Population

Growth. The Migration Observatory, University of Oxford.

13. National Records of Scotland (2010). Council Area Demographic Factsheets, East, North and South Ayrshire.

14. OECD (2007). Society at a glance: OECD Social Indicators – Age-Dependency Ratios (Definition and measurement) 2006 Edition.

15. Economic & Social Research Council (2004). The Demographic Trends in Scotland – A Shrinking and Ageing Population. Seminar Series Mapping the Public Policy Landscape

16. Falkingham, J., Evandrou, M., McGowan, T., Bell, D and Bowes, A. (2010) Demographic issues, projections and trends: Older people with high support needs in the UK. Joseph Rowntree Foundation - programme paper: A Better Life.

http://budgetresponsibility.independent.gov.uk/wordpress/docs/FSR2011.pdf

http://budgetresponsibility.independent.gov.uk/wordpress/docs/FSR2011.pdf

http://www.iriss.org.uk/node/432

http://www.centreforwelfarereform.org/uploads/attachment/332/personalisation-and-human-rights.pdf

http://www.centreforwelfarereform.org/uploads/attachment/332/personalisation-and-human-rights.pdf

http://services.parliament.uk/bills/2010-11/pensionshl.html

http://www.gro-scotland.gov.uk/files2/stats/annual-review-2010/rgar2010.pdf

http://www.gro-scotland.gov.uk/files2/stats/annual-review-2010/rgar2010.pdf


17. Sourbati, M (2004). Internet Access and Online Services for Older

People in Sheltered Housing. York: Joseph Rowntree Foundation.

18. Hirschfield, A. (2004). The Health Impact Assessment of Crime

Prevention. In Health, Impact Assessment: Concepts, Theory,

Techniques and Applications (pp. 341 - 349). Oxford: Oxford

University Press.

19. Robinson, F., & Keithley, J. (2000). The Impacts of Crime on

Health and Health Services: a Literature Review. Health, Risk

and Society , 2 (3), 253 - 266.

20. Scottish Executive (2002). The Scottish Fuel Poverty Statement.


21. SPICe. (2012). Climate Change and Health in Scotland.

Edinburgh: Scottish Parliament Information Centre.

22. Oxley, H. (2009) Policies for Healthy Ageing: An Overview, OECD

Health Working Papers, No. 42, OECD Publishing. http://dx.doi.org/10.1787/226757488706

23. Scottish Executive (2004). Improving Scotland’s Health: The

Challenge. Tobacco Control Action Plan.

24. Boreham, J. (2007) An Atlas of Tobacco Smoking in Scotland. University of Oxford.

25. Institute of Alcohol Studies (2010). Alcohol & the Elderly Factsheet. IAS: St Ives

26. Dar K. (2006). Alcohol use disorders in elderly people: fact or fiction? Advances in Psychiatric Treatment. 12:173181.63.

27. Scottish Public Health Observatory (2007). Obesity in Scotland: An Epidemiology Briefing.

28. Scottish Office (1996). Eating for Health: a Diet Action Plan for Scotland. Edinburgh: The Scottish Office, 1996.

29. National Records of Scotland (2011). Winter Mortality in Scotland 2010/11. National Records Scotland: Edinburgh.

30. Idler, E. L. & Benyami, Y. (1997). Self- Rated health and Mortality; A review of Twenty-Seven Community Studies. Journal of Health and Social Behaviour, 38, 1.

31. McCallum, J., Shadbolt, B & Wang, D. (1994). Self reported health and Survival: A 7-year Follow-up Study of Australian Elderly, American Journal of Public Health, 84, 7, 1100-1105

32. Scottish Government (2010). Long Term Conditions. http://www.scotland.gov.uk/Topics/Health/Services/Long-Term-Conditions

33. Age Scotland (2012) Health & Wellbeing , Keeping Healthy. http://www.ageuk.org.uk/scotland/health-wellbeing


http://dx.doi.org/10.1787/226757488706

http://www.scotland.gov.uk/Topics/Health/Services/Long-Term-Conditions

http://www.scotland.gov.uk/Topics/Health/Services/Long-Term-Conditions

http://www.ageuk.org.uk/scotland/health-wellbeing


34. MacDonald, B.K., Cockerall, O.C & Sander, W.A.S. (2000). The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain. 123:4; 665-76.

35. Newman, E.J., Grosset, K.A & Grosset, D.G. (2009). Geographical

differences in Parkinson’s disease prevalence within West Scotland. Movement Disorders. 2009

36. NHS Ayrshire & Arran (2007). Neurology Services Needs

Assessment. NHS Ayrshire & Arran: Ayr. 2007; 24:3; 401-406.

37. Pine, C. M. (1997). Community oral health. [Oxford], Wright.

38. NHS Ayrshire & Arran (2010) Oral Health Needs Assessment for Older People.

39. World Health Organization, (1975). Education and treatment in human sexuality: The training of health professionals. Technical Report Series No. 572, Geneva: World Health Organisation.

40. Scottish Government (2011). Sexual health and Blood Borne Virus Framework August 2011.

41. ISD Scotland (2010) Scottish Bowel Screening Programme: Key Performance Indicators: May 2010 Submission (ISD Scotland: Edinburgh)

42. Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich,

S., Parkinson, J., Secker, J., & Stewart-Brown, S, L. (2007) The Warwick-Edinburgh Mental Well-being Scale (WEMWBS):

development and UK validation. Health and Quality of Life Outcomes, Vol.5 (No.63). ISSN 1477-7525

43. Pagan-Rodiguez, R. & Perez, S (2012) Depression and Self-Reported Disability among Older People in Western Europe. Journal of Ageing and Health XX(x) 1-26. SAGE.

44. Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. & Galea, A. (2012). Long term conditions and mental health. The cost of co-morbidities. The Kings Fund. Centre for Mental Health.

45. Scottish Government (2011). The Scottish Health Survey 2010 – Volume 2: Technical Report).

46. Pickard, L. (2008) Informal Care for Older people by their Adult Children: Projections of Supply and Demand to 2041 in England. Report to the Strategy Unit (Cabinet Office) and the Department of Health. PSSRU Discussion Paper 2515 www.pssru.ac.uk/pdf/dp2515.pdf

47. Carers UK. (2004). In Poor Health The Impact of Caring on

Health. Carers Trust.

48. Carers Scotland. (2011). Sick, Tired and Caring. Glasgow: Carers

UK.

49. Gomes, B & Higginson, I.J. (2008). Where people die (1974-

2030). Past trends, future projections and implications for care. Palliative Medicine; 22: 33-41. http://www.kingsfund.org.uk/topics/endoflife_care/index.html

http://www.pssru.ac.uk/pdf/dp2515.pdf

http://www.kingsfund.org.uk/topics/endoflife_care/index.html


50. The Scottish Government (2012). Appropriate prescribing for

patients and polypharmacy guidance for review of quality, safe and effective use of long-term medication, CEL 36.

51. Pirmohamed, M., James, S., Maekin, S., Green, C., Scott, K. A., Walley, T. J., Farrar, K., Park, K.B. & Breckinbridge, A.M. (2004) Adverse drug reactions as a cause of admission to hospital: prospective analysis of 18,820 patients. British Medical Journal. Volume 329.

52. Hoyle, G. Bostock, C. MacLeod, J. (2012) NHS Grampian Guidance on Reducing Polypharmacy in Frail Older People.

53. Minister of Public Works and Government Services Canada (1998). Principles of the National Framework on Ageing: a Policy Guide, Health Canada, Division of Ageing and Seniors. Ottawa.

54. Moriarty, J. & Manthorpe, J. (2012). Diversity in older people

and access to services – an evidence review. A report of research carried out by the Social Care Workforce Research Unit at King’s College London. Published by Age UK.

55. McKee, M. & Stuckler, D (2012). Older people in the UK: under attack from all directions. Age and Ageing 2012; 0: 1-3. Oxford University Press.

56. Hoff. A. (2008). Tackling Poverty and Social Exclusion of Older People – Lessons from Europe. Working Paper. Oxford Institute of Ageing.

57. Aldridge, H. Kenway. P. MacInnes, T & Parekh, A. (2012). Monitoring Poverty and Social Exclusion. Joseph Rowntree Foundation. www.jrf.org.uk

58. Knocker, S. (2012) Perspectives on Ageing: Lesbians, gay men and bisexuals. Joseph Rowntree Foundation.

59. Blood, I & Bamford, S, M. (2010). Equality and diversity and

older people with high support needs. International Longevity Centre – UK. Joseph Rowntree Foundation.

60. Scottish Government (2012). Long-term Monitoring of Health Inequalities: Headline Indicators

61. Gribben, J., Hubbard, R., Smith, C., Gladman, J & Lewis, S. (2009)

Incidence and mortality of falls amongst older people in primary care in the United Kingdom. QJ Med 2009; 102:477 483

62. Equality Scotland (2007). Just for the Record. Findings from the

Pension Benefit Outreach Project. Trust Housing Association Ltd., Hanover Scotland and Bield Independence for Older People.

63. Key Issues for Tackling Inequalities in Older People’s Health: Interviews with Key Stakeholders [Unpublished].

64. Equality and Human Rights Commission (2009). Monitoring the impact of the recession on various demographic groups. Department of Works and Pensions. Government Equalities Office.

http://www.jrf.org.uk/


65. Godden, D. Heaney, D. Farmer, J (2007). Health and Rurality Digest (HeaRD) Contemporary Issues in Scottish Rural Health Care. Health and Rurality Digest Issue 12.

66. Commission for Rural Communities (2012) Social isolation experienced by older people in rural communities. Tackling Rural Disadvantage. www.defra.gov.uk/crc

67. Finch, N & Kemp, P, A (2006). Which pensioners don’t spend

their income and why? Research Report No 334.

68. Kerr, B., Cunningham, C., Martin, S & Dick, M. (2011). Telecare and Sensory Impairment. The Dementia Services Development Centre, Joint Improvement Team & University of Stirling.

69. Sykes, W., Hedges, A., Ward, K., Melvin, K & Bose, M. (2005). Understanding the service needs of vulnerable pensioners: Disability, Ill-health and access to The Pension Service. DWP Research Report No 263.

70. European Commission (2012) Demography, active ageing and pensions. Social Europe Guide/ Volume 3. http://ec.europa.eu/social/

71. Stephenson, M. A., Harrison, J & Stewart, A. (2012) Getting off Lightly or Feeling the Pinch? A Human Rights and Equality Impact Assessment of the Public Spending Cuts on Older Women in Coventry. A joint Report by the Centre for Human Rights in Practice, University of Warwick and Coventry Women’s Voices.

http://www.defra.gov.uk/crc

http://ec.europa.eu/social/