Professor David Melzer University of Exeter Medical School

Quantitative evidence (~previous 5 years): As a country, how successful have we been in preventing later

life disease and disability?

How well are we delivering high quality medical treatments for the common disabling diseases of later life?

prevention or treatment of common conditions Having a clear connection to the well-being of older people Based on substantial research

Representative of large segments of the ageing population Based on reliable, preferably nationwide data Easy to understand by a wide range of audiences Balanced, so that no single area dominates the report

Section 1: Population, disease prevalence Section 2: Health risks Section 3: Quality of treatment for common conditions Section 4: Older people’s experiences

Source data: General Lifestyle Survey, ONS 201151

Figure 20: Smoking trends in men and women aged 50+ years, England, 1974 - 2009

Source: Scarborough et al, 201040

Figure 15: Age-specific death rates from coronary heart disease (CHD) in men aged 35+ years, UK, 1968 to 2008.

Chart 15: Major reductions in coronary heart disease death rates

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Source: ONS, 2011

Figure 14: Mortality by major cause, in men and women (all ages), England and Wales, 1911-2010

doing well, but could do better?

Figure 3: International changes in life expectancy in men and

women at age 65, 1980-2007

Source data: OECD Health Data 2011 - Frequently Requested Data, Update - November 2011

http://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT

Source data: Scarborough et al, 201040

Figure 21:Prevalence of obesity in men and women age 55+ years, England, 1994-2008

Image from The Guardian, Feb 2013

Chart 31: Diabetes – an epidemic unfolding

Source data: HSE, 200958

Figure 31: Percentage of respondents with doctor diagnosed diabetes (all types) in men and women aged 55+ years, England, 1994-2009

Chart 27: Burden of disease: 60+ years old – much is potentially avoidable

Source data: World Health Organisation: http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html Last visited 30/04/2012

Figure 27: Proportion of ‘Disability Adjusted Life Years’ (DALYS) in high-income countries of the European region caused by

specific risk factors in people aged 60+

Chart 18: Social inequalities – shorter lives with more disability

Source data: Health Statistics Quarterly 50, summer 2011, ONS48

Figure 18: Life Expectancy with Disability (LEWD) and Disability Free Life Expectancy (DFLE) for men and women at age 65 years, by

Index of Multiple Deprivation (IMD) 2007 quintile, England, 2006–08

Chart 41: Common mental health problems – accessing treatments

Source data: Cooper et al120 2010

Figure 41: Adjusted odd ratios for those accessing mental health treatments: Comparison of older age groups with the 16-34 age

group, England, 2007

Note: Significant trend with age, but wide CIs for individual age-groups

Condition

No of quality indicators % Quality indicators achieved (95% CI)

Ischaemic heart disease 5 83 (79.7 to 86.4)

Hearing problems 2 79 (76.7 to 81.1)

Diabetes 5 74 (72.2 to 76.0)

Depression 3 64 (57.3 to 69.8)

Osteoporosis 2 53 (49.3 to 57.2)

Urinary incontinence 4 51 (47.2 to 54.2)

Falls 2 44 (36.5 to 50.6)

Osteoarthritis 4 29 (26.0 to 31.9)

Assessing the Care of Vulnerable Elders Based on ELSA respondents - 2004/5

Conditions with 2+ indicators, From Steel et al, BMJ 2008

Steel et al, BMJ 2008

17.1% 16.0% 19.8%

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50-64 65-74 75+

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Age bands

Figure 34: Percentage of people aged 50+ years with diabetes who reported not receiving their annual foot check. ELSA, 2010

Source data: ELSA 2010

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Image from BBC News

Source data: ELSA 2009 – graph updated 2013

Figure 39: Percentage of people aged 65+ years who reported falling and who answered “no” when

asked if a doctor or nurse had tested balance or strength or watched the respondent walk

Image from http://www.cedars-sinai.edu

Source data: ELSA 2010 – graph updated 2013

Figure 37: Weighted percentage of people aged 50+ years with painful osteoarthritis who answered “no” when asked if a doctor had ever recommended physiotherapy or an exercise programme. ELSA, 2010

Chart revised by Luke Mounce 2013, using Wave 5 ELSA data

43.6% 55.8%

62.8%

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50-64 65-74 75+

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Age bands

Table: Achievement rates aggregated by condition category, adjusted for weighted data, for subset of indicators from 2004-5 that were repeated in 2008-9 or 2010-11 (data from ELSA study)

Conditions 2004-5 2008-9 or 10-11

Difference:

Achievement % (CI)

Achievement % (CI)

(%, p-value)

General Medical

75.2 80.1 4.9

(73.0 to 77.4) (78.6 to 81.7) p=0.023

Geriatric 40.7 37.7 -3

(37.9 to 43.6) (36.1 to 39.3) P=0.25

Chart 42: Cancer – a disease of ageing

Source data: Cancer Research UK http://info.cancerresearchuk.org/cancerstats/incidence/age. Date accessed: 21st March 2012

Figure 42: Average number of all cancers (excluding non-melanoma skin cancer) per year by age group, UK, 2006-8

Chart 45: Cancer survival – international comparison

Source data: Table 14, Web appendix, Coleman et.al. 2010134

Figure 45: Age-specific relative survival estimates (%) at five years for colorectal cancer

for ages 55-99, international comparisons, 2005–2007

Chart 48: Sicker people’s experiences of poor care coordination – international comparison

Source: Commonwealth Fund International Health Policy Survey, 2011 http://www.commonwealthfund.org/Surveys/2011/Nov/2011-International-Survey.aspx

Figure 48: Percentage of patients self-reporting gaps in coordination of services in the past two years, all adults,

international comparisons, 2011

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Similar pattern for medical errors

Including:

Obesity (physical inactivity) /diabetes prevention ◦ a major threat to health in later life

help for 20% of 65-74 yr olds still smoking Improving quality of treatment

especially for: ◦ the ‘geriatric’ and disabling syndromes

E.g. Incontinence, falls, bone health, mental health

◦ Cancer in later life (awareness, early diagnosis, treatment as chosen)

But - lots of data poor areas ◦ severity & functional impact, use of ‘geriatric

assessment’ approaches in primary care, oldest old etc

Population Ageing in the United Kingdom, its Constituent Countries and the European Union Date: 02 March 2012

Source: Office for National Statistics, Eurostat

2035

Percentage of population aged 65 and over EU-27

Exeter Ageing Research Group Members: Prof Paul Dieppe: Professor of Medical Education and Consultant Rheumatologist, PCMD Prof William Henley: Professor of Medical Statistics, PCMD & PenCLAHRC Colleague advisors: Dr Susan Bedford: Associate Specialist, Psychiatry of Old Age Dr Richard Byng: General Practitioner and Senior Clinical Lecturer, PCMD & PenCLAHRC Prof John Campbell: General Practitioner and Professor of Primary Care, PCMD Dr Phil Evans: General Practitioner and Senior Clinical Research Fellow, PCMD Dr Slav Pajovic: General Practitioner Dr Jonathan Powell: Honorary Senior Research Fellow, PCMD and former Co-director of the Ageing Research Programme, Unilever PLC Dr David Strain: Senior Lecturer in Geriatrics, PCMD Dr Nicholas Steel: Clinical Senior Lecturer in Primary Care and Honorary Consultant in Public Health, University of East Anglia Age UK Advisory Group Members: Prof David Oliver: National Clinical Director for Older People, Department of Health Mr David Buck: Senior Fellow, Public Health and Health Inequalities, The King’s Fund Prof Peter Crome: Professor of Geriatric Medicine, Department of Primary Care and Population Health, University College London Ms Helen Bradburn: Director of Public Affairs Communications, The Health Foundation Mrs Sue Howell-Richardson: Research, Development and Quality Manager, Age UK Devon Prof James Goodwin: Head of Research, Age UK Dr Matthew Norton: Social Research Manager, Age UK Ms Ruthe Isden: Programme Manager, Public services, Age UK NIHR PenCLAHRC Patient and Public Involvement Team Members: Dr Andy Gibson: Research Fellow, Patient and Public Involvement, PCMD & PenCLAHRC Ms Lynn Tatnell: Service user Mr Jim Harris: Service user Ms Kath Maguire: Service user

Nick Steel et al, UEA (Acove)