Older People- Predicting Need

According to GLA projections the borough’s 80+ population will rise by 13% over the next decade. Within this, the comparatively small 90+ age group is set to increase by 1,100 (46%). Those aged 75 to 79 will decrease by 400. The 40-54 age group will increase by 17,000 (25%).

The reasons for the differences are:

Those now aged between 75-79 were born around 1931 when birth rates were probably normal despite the depression. By 2018, 75 to 79 year olds will have been born in the middle of WW2 when birth rates were presumably low because of male conscription.

With the 90+ population, in 2008 many of them had been born in WW1 and the following ‘flu outbreak so their numbers are artificially low. By 2018 the 90+ population will have been born in 1928 – back to normal birth rates. Key features affecting the population include the increase in single person households, including quite a dramatic increase from 2011 and the increase in diversity for the population which is shown below in terms of ethnicity, both feature captured on the table below.

Single person householdsDCLG 2004 based household prjections, January 2007

0

5000

10000

15000

20000

25000

65+

75+

85+

65+ 15508 15491 15436 16002 17557 19258

75+ 9468 9556 9677 9775 10069 10892

85+ 3249 3097 3249 3529 3837 4110

2001 2004 2006 2011 2016 2021

One of the key features of change for the older population is

We know that income is linked to deprivation and deprivation has an impact on a range of health outcomes affecting demand for social care. This map shows the greatest numbers of older people in terms of the percentage of each area’s older population claiming means tested benefits. This varies from a low of 3% to a high in one area of 43% - which is within the 3% most deprived areas nationally on this measure. We know that we also need to take into account current factors affecting personal wealth; we are likely to see average savings decrease as a result of changes in pension arrangements, changes in house values and more peoples working lives will extend beyond the age of 65.

Targeted work can be undertaken to ensure supplementary pension benefits are claimed to help reduce: depression, poor nutrition, hypothermia and social isolation.

Equality issues are a major theme for older people as it is recognised that not only are older people as a group discriminated against in society; but also many face additional discrimination because of their race, gender, mental frailty etc. The Employment Equality (Age) Regulations 2006 came into force in England, Wales and Scotland two years ago. While it does not currently apply to goods and services, the campaign against age discrimination is at the forefront of current national debate.

One of our key priorities in the commissioning strategy of older people is to tackle inequalities and social exclusion that lead to poor health and improve access to services for vulnerable people.

Responding to Changing Need

The direction of travel over the next ten years needs to ensure a robust continuum of care is developed for older people. The reason for this approach is to better support older people at an earlier stage based on the principle that early intervention leads to better prevention, enabling a much higher level of self managed care. This builds on the lesson learnt from the Expert Patient Programme and research on the benefits of better management of people with long term chronic health conditions. Greater independence can be promoted by ensuring that older people can exercise increased choice and control, and find their own solutions to many of the problems that they face in older age. This approach requires a rethink in the way services are planned. Traditionally, social care and health managers have managed services. They decided who received services and ensured delivery to time, cost and quality. With services increasingly purchased from the private and voluntary sectors, managers need to take a wider perspective; understanding the complex nature of demand and the options to meet it. Events that lead to major expenditure for one agency, such as hospital or care home admission may have their antecedents in the work of another. For example, lower health service physiotherapy provision may impact a person’s capacity to recover from a stroke, leading to increased social care provision. The absence of an early social care intervention may impact health services through hospital admission. Current information systems have been designed to meet the needs of service managers. Information to answer questions on the choice of service or the consequences of delays is often not available or not collated. Key areas which require a joined up approach1 are

Incontinence

Dehydration

Dentures

Falls

Housing

Podiatry

Stroke Recovery

Mental Health

Key Messages

There is evidence to suggest that by adopting positive approaches to mental health in older people, this will impact on the use of specialist and acute services later on (reducing dependence) and therefore on this basis it needs to be a public health priority.

Stigma and discrimination remain powerful forces and although many older people remain independent and make an active contribution to their families and to their

1 Demand Forecasting and Capacity Planning Configuring Future Services Toolkit A Structured Approach to Delivering Better Outcomes for Older People Version 1.0 October 2007

neighbourhoods well into their 90s and beyond, the view prevails that older people are only recipients of care services. The local authority and the PCT have a clear role to challenge this view and develop effective channels for the voices of older people to be heard.

We know that to address health and well being in later life we need to pay attention to ageing, the practical impact on people’s lives and how communities and neighbourhoods can be more ‘geared up’ to independence. Developing initiatives around health and well being should achieve better inclusion for older people; promotion of physical activity including walking, ‘age-proofing’ the local environment through influence of planning priorities, more active civic involvement of older people.

Recognise the benefits for the whole population of using the wisdom and experience of many older people, and how the place shaping role of the local authority can be used to promote intergenerational activity for example via schools - all promoting health & well being.

Older people are more likely to suffer from chronic and long term conditions and are also more likely to suffer from falls / factures which bring them into contact with health services. Older people represent the largest proportion of users of NHS services, however can and do get better after a period of rehabilitation and convalescence. It is vital that these episodes of acute/ medical treatment are used as opportunities for people to optimise their functioning and return home safely.

For the increasing number of people living longer in their own homes, with shorter and shorter hospital admissions time, there can be a greater impact of families and carers. We also recognise that many carers are older people themselves. The development of the carer’s strategy and building a better infrastructure to respond to carers’ needs is vital to militate against the strain on carers.

Most older people in Barnet are home owners and we need ensure all advice and information is geared to this large and significant segment in the borough. The LBB private sector housing strategy is developing this approach. Timely access to practical help for home owners through approaches such as the Care and Repair or Handyman services are critical factors in supporting older people to live in their own homes and promote peace of mind.

The use of telecare initiatives is growing and needs more research on the impact and in how to use technology to greater effect to empower older citizens. There are still challenges of linking up customer information across different agencies and this challenge will become greater as wider choice involves a greater number of agencies.