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ILC-UK/Actuarial Profession Robert Butler Memorial Lecture, in partnership with Age UK and JRF

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A memorial lecture and debate on Centenarians and the Oldest Old …

A memorial lecture and debate on Centenarians and the Oldest Old

The ILC-UK was saddened last summer, by the loss of Dr. Robert N. Butler, founder of the first International Longevity Centre in the United States and Pulitzer prize-winning gerontologist. His invaluable contribution has changed the approach and research on ageing and longevity.

In tribute to Dr Butler, ILC-UK organised a memorial lecture and debate, in partnership with Age UK and the Joseph Rowntree Foundation, on Centenarians and the Oldest Old.

In 1911 there were just 100 Centenarians living in England and Wales, a figure which grew to 9,000 people in 2006 and represented a 90-fold increase over the previous 100 years (Dini and Goldring. 2008). There was a fourteen-fold increase in male centenarians and a 23-fold increase in female centenarians over the last 50 years of the twentieth century (Dini and Goldring. 2008).

The number of people aged over 100 is expected to nearly double between 2030 and 2035, when it is projected there will be 97,300 centenarians in the UK. It is then expected to more than double again during the next decade, to stand at 202,100 by 2045. (DWP/ONS December 2010).

The ONS estimates that by 2066 there will be at least 507,000 people in the UK aged 100 or over, including 7,700 super centenarians who are aged 110 or over. By 2080, there may be 626,900 people aged over 100. 21,000 of these will be over 110. (DWP/ONS December 2010).

Even the conservative estimates for the growth in the number of the oldest old will have a significant impact on services. Yet whilst policy makers seem aware of the growth in the number of people living to 100, there has been little or no explicit exploration about the impact of the growth in numbers of oldest old on public policy.

Professor Tom Kirkwood, Associate Dean for Ageing at Newcastle University gave the Lecture. The ILC-UK presented early findings of work for Age UK on the oldest old.

Agenda from the event:

16:30 – 16.35
Welcome and introduction from chair Baroness Sally Greengross, Chief Executive, International Longevity Centre – UK

16.35 – 17.20
The Robert Butler Memorial Lecture by Professor Tom Kirkwood, Associate Dean for Ageing at Newcastle University. For a copy of Professor Kirkwood's slides please email events@ilcuk.org.uk

17.20 – 17.30
Centenarians and the Oldest Old, ILC-UK
David Sinclair

17.30 - 17.35
A personal contribution on the life of a Centenarian
Noreen Siba

17.35 – 17.45
First telegram at 110? The implications of longevity
Dr Matthew Norton

17.45 – 17.55
'What older people want and value in life?' Joseph Rowntree Foundation
Ilona Haslewood

17.55 – 18.25
Panel and Audience Debate

18.25 - 18.30
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  • 1. Robert Butler Memorial Lecture and Debate onCentenarians and Oldest Old 29 November 2011 This event is kindly supported by JRFThe ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 2. WelcomeBaroness Sally Greengross ILC-UK This event is kindly supported by JRF The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 3. Robert Butler Memorial LectureProfessor Tom Kirkwood University of Newcastle This event is kindly supported by JRF The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 4. Please contact us at events@ilcuk.org.uk to request a copy of Professor Kirkwood’spresentation in PDF format. This event is kindly supported by JRF The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 5. Centenarians and Oldest Old David Sinclair ILC-UK This event is kindly supported by JRF The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 6. Who wants to live forever. Centenarians and the oldest oldInternational Longevity Centre -UK
  • 7. Centenarians and the oldest old• While advances have been made in researching antecedent factors that predict living to 100, less attention has been paid to life as a centenarians• The body of evidence on http://www.flickr.com/photos/pondspider/4170990903/ sizes/m/in/photostream/ centenarians is far from consistent or extensive (hence looking at oldest old).
  • 8. Limitations• Panel surveys tend to have a very small sample of the oldest old (IFS, 2010, p 229).• ―Those who were very ill or frail had higher dropout rates, and people in worse health were less likely to be re-contactable‖. Chatfield et al (2005)• ―a strong link between attrition and cognitive decline…cognitive decline may be underestimated by epidemiological studies as a result‖• Are the predictions right?
  • 9. How many centenarians are there?• There are currently 11,800 people in the UK who are currently at least 100 (DWP)• There are fewer than 100 people who are aged more than 110. (DWP)• In 1911 there were just 100 Centenarians living in England & Wales• Growth has been about 7% http://www.flickr.com/photos/un_photo/5 p/a 832685007/sizes/z/in/photostream/
  • 10. Projected number of centenarians in the UK
  • 11. How likely is it that we will reach 100? The likelihood of living from birth to 100 might have increased from 1 in 20 million to 1 in 50 for females in low- mortality nations, such as Japan and Sweden. (Vaupel and Jeune, 1995) http://www.flickr.com/photos/iain_ritchie/2739823588/ sizes/z/in/photostream/
  • 12. Number of people currently alivewho can expect to see their 100th birthday, by age in 2010
  • 13. Public policy seems oblivious to the growth• Opportunity Age: did not mention centenarians (2005)• Lifetime Homes, Lifetime Neigbourhoods: Mention of centenarians in passing.• Don’t Stop Me Now, Audit Commission (2008). Mentioned that services for a 50 year old may be different to services for an 80 year old• Building a Society for All Ages (2009) growth in the number of centenarians as a reason ―why we need to go further‖
  • 14. But are the predictions right?In PopulationTrends, 1999, Thatcherprojected a rise in the numberof centenarians to 95,000 by2066 (Thatcher, 1999).By 2010 the DWP and ONSwere projecting that therewould be at least 507,000people in the UK aged 100 orover in 2066. http://www.flickr.com/photos/drs2biz/71468437/sizes/m/ in/photostream/
  • 15. And are the numbers today right?
  • 16. More than 230,000 Japanese centenarians missing
  • 17. The majority of centenarians are femaleIn 2003, among the oldest oldthere were 257 women forevery 100 men.(Tommassini2005).Between 2001 and2006, the number of menaged between 90 and 99increased by 24 per centwhereas for women theincrease was just over 8%(Dini and Goldring. 2008).
  • 18. And they live in Southern England In the UK, a higher concentration of the oldest old live in Southern England and a lower proportion in urban areas and Northern Ireland. http://www.flickr.com/photos/lawrence_chernin/5716015430/sizes/z/in/phot (Tomassini ostream/ C, 2005)
  • 19. Life is not easy for the oldest old• Three quarters of the oldest old suffer from limiting longstanding illnesses, and one out of three perceive themselves as being in poor health. (Tomassini C, 2005) http://www.flickr.com/photos/pondspider/4170• ―almost 50% of men and 990903/sizes/m/in/photostream/ women aged 80-84 report severe limitations in activities‖ (IFS, 2010)
  • 20. And many find it difficult to do day to day tasks Sixty per-cent of over 90s report difficulties shopping for groceries, almost a quarter report difficulties http://www.flickr.com/photos/pinkchoc making telephone calls and olate/3039589789/sizes/m/in/photostr eam/ 35% report difficulties managing money. (Sinclair, 2010/ELSA)
  • 21. But dependency is not inevitableDependency is notinevitable and a”considerableproportion of thecentenarians maintaina good level of auto http://www.flickr.com/photos/driever/5525684658/sizes/m/in/phsufficiency for the otostream/basic performance ofthe everyday life”.(Antonini et al, 2008)
  • 22. And some of the oldest old become more active
  • 23. Many live independently• Substantial numbers of centenarians and nonagenarians continue to live independently in the community, either alone or with family members.• 8% of those aged 90 and over were living in privately rented accommodation and 30% in socially rented accommodation. 2009 Understanding Society
  • 24. Proportion living in communal establishments
  • 25. A relatively high proportion live alone Of those living in private households, four in ten very old men and seven out of ten very old women live alone. One out of five very old people live in communal establishments. (Tomassini C, 2005). http://www.flickr.com/photos/sbeebe/515416979 5/sizes/m/in/photostream/
  • 26. And the proportion living alone is growing.Over the last 20 yearsthere has been asignificant increase in theproportion of the oldest oldliving alone. The likelihoodof the oldest old men livingalone has grown by one-third for men and onequarter for women. http://www.flickr.com/photos/driever/55256846(Tomassini C, 2006). 58/sizes/m/in/photostream/
  • 27. Many, but not all, have adapted their homesResearch finds that the oldest old are muchmore likely than other ages to have hadmade adaptations to their homes. Forexample. 40% of over 90s have had handrails installed (compared to 16% of all over50s), 41% had bathroom modifications(compared to 15% of all over 50s), and 24%are likely to have an alerting device(compared to 6% of the over 50s). (Atkinsonand Hayes (2010).
  • 28. Centenarian as a model for healthy ageingA substantial number ofcentenarians remain physicallyhealthy and cognitively intact intothe last years of their lives.Health and functional status ofcentenarians shows they arehealthy and independent for mostof their lives and experience arelatively rapid terminal decline‖. http://www.flickr.com/photos/jess e55lv/455360558/sizes/m/in/phot ostream/(Hitt et al, 1999).
  • 29. Self reported health is pretty good?(Just?) One in of three ofthe oldest old perceivethemselves as being inpoor health. (TommassiniC, 2005).―despite substantial levels http://www.flickr.com/photos/animm/4333568373/sizes/m /in/photostream/of disease andimpairment‖.Collerton, Davies andJagger (2010)
  • 30. Most centenarians consult their GP 98% of centenarians and near centenarians consulted a GP and received prescription medicine during follow up. (Roughead, Kalisc h et al, 2010) http://www.flickr.com/photos/rwjensen/2288339230/sizes/m/in/photostrea m/
  • 31. Centenarians do use drugs heavilyA study of 602 centenarians in Italy found that avery high proportion of this age group wereusers of drugs. They identified just 5% of thisgroup who did not take any drugs. 13% ofparticipants took one drug a day, 16% took 2drugs per day, 65% took three drugs a day, and5.5% took more than 3 drugs a day.
  • 32. Some evidence of longer hospital stays26 centenarians who had suffered from a hipfracture between 2000 and 2007 and comparedthem to a randomly selected control group of 50hip fracture patients aged between 75 and 85. “themean stay in acute orthopaedic wards forcentenarians was 20.7 days and for the controlgroup was 14.9 days”. They suggested that thelonger acute hospital stay in our centenarian cohortwould amount to a mean extra cost of £ 2511 perpatient. (Verma et al)
  • 33. Dementia among centenariansThe prevalenceof dementia-freesurvival past100 years ofage variedbetween 0 and50 percent.‖ http://www.flickr.com/photos/thousandshipz/4679235/sizes/m/in/photostream/
  • 34. Depression• ―23% of those aged 85 and over had levels of depressive symptoms indicative of clinical relevance‖• ―Almost 13% of men and women aged 80 and over had high levels of depressive symptoms in 2008-09 but not in 2002-03‖ (IFS, 2010) http://www.flickr.com/photos/junglearctic/ 3002442666/sizes/m/in/photostream/ ELSA
  • 35. Falls• 60% of interviewees aged over 90 had had a fall and that of these, 4 in five were unable to get up after at least one fall and almost a third had lain on the ground for an hour or more.• Call alarms were widely available but not used.(Fleming and Brayne, 2008; Cambridge Cityover 75-Cohor. BMJ)
  • 36. OAP recovering after getting trapped in bath for 5 days
  • 37. Poverty is a very real challenge• There is evidence that the oldest old (aged 85 and over) are, as a group, at greater risk of poverty than younger older people (aged 65-85) (National Equality Panel, 2010).• Up to 10% of the oldest old have total net wealth of £3,000 or less (Banks and Tetlow, 2009).• Yet, over 61% of over 90s report that they never have too little money to spend on their needs. (Sinclair, 2010)
  • 38. Their family carers are likely to be olderThe advanced age ofcentenarians means thatfamily caregivers are alsolikely to be relatively old.Younger cohorts of retiredpeople (50-74 years) oftenprovide care for their veryold relatives and, even ifuntrained andunmonitored, have asignificant role ascaregivers(Richmond, 2008).
  • 39. Quality of Life falls with age
  • 40. Quality of life for oldest old – getting worse?―longitudinal analysescomparing 2002-03 and2008-09 show that mostof the oldest oldexperienced a substantialdecrease in quality of lifeover the period. Just over10% experienced asubstantial improvementof 5 or more points‖(IFS, 2010) http://www.flickr.com/photos/anabadili /2963913137/sizes/m/in/photostream/
  • 41. Recommendations• Energy companies to ensure that their oldest customers access the best deals• Employers to ensure that they find ways to provide flexible working to ensure that caring responsibilities do not pull people out of the workforce early.• The Government should introduce a care voucher scheme for adults, similar to childcare vouchers, which would allow people of all ages to buy care vouchers to support the needs of older adults. This may help older carers of centenarians stay in the workplace longer.
  • 42. Recommendations• Significant development of the evidence base about centenarians in order to inform current and future ageing strategies.• Policy-makers to take a more holistic approach to designing interventions that integrate health, care and housing solutions.• Developers to plan for growing numbers of centenarians through ensuring that housing and neighbourhoods are better designed and/or adequately adapted to meet the needs of a growing centenarian population
  • 43. David SinclairInternational Longevity Centre UKdavidsinclair@ilcuk.org.uk@sinclairda@ilcuk
  • 44. A personal contribution on the life of a centenarian Noreen Siba Managing Director ILC-UK This event is kindly supported by JRF The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 45. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 46. Healthy Ageing  good health  mentally strong  physically robust  never any sign of dementia Until broken hip at 90 years old through major fall at home, typical scenario. My mother survived two world wars and rationing but had a good diet with fresh food all her life.The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 47. Positive AttitudeEspecially significant! pleasant , sociable, relaxed approach to life very independent and always not wanting to be a trouble to anyoneThe International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 48. Active AgeingVery active throughout.Tennis, Golf, Bowls until mid 90 yearsPlaying cards and social activities, attending church,local bridge club, until 101 yearsAnd actively helping in the home until the last monthsof her lifeThe International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 49. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 50. MobilityDrove car until 90 yearsGreat mobility until major fall in the home, coupledwith knee weakness after 90 yearsThen progressed from walking stick and frame towheelchair and then finally electric hoist in the home.The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 51. Family SupportCrucial element especially after 90 years whenmoved from marital home to live next door toextended familyGrandchildren kept their grandmother daily occupiedand interested in their activitiesElder sister who is unmarried gradually became thefull time carer supported by much social stimulationand help from all the family until our mother passedaway.The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 52. Key WorkersOccupational therapist – first significant key worker,providing invaluable equipment in the home:ramps, grab rails, electric chair and hospital bed, hoist,water bed.OT and GP - also key to arranging physiotherapy,dentistry, optics, chiropody and the following services:Carers – 8 a day for the last two years and two districtnurses a week for 4 years to treat a none lifethreatening skin cancer. Crossroads respite care oncea fortnight and finally Hospice led homecare and nighttime Marie Curies’ nursing through her final days.The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 53. Neighbours and FriendsA network of support at home came through theextended family and neighbours and friends especiallygave that in between support with shopping, shortspells of respite care, hairdressing and social contactand interaction.The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 54. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 55. Many thanksNoreen SibaInternational Longevity Centrenoreensiba@ilcuk.org.uk02073400440Twitter: @ilcukThe International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 56. First telegram at 110. Theimplications of longevity Dr Matthew Norton Age UK This event is kindly supported by JRF The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 57. First telegram at 110? The implications of longevityDr Matthew Norton, Age UK
  • 58. Historically difficult to predict life expectancy
  • 59. Large rise in centenarians • 1952: 255 centenarians received a birthday message • 2007: 8,439 centenarians received a birthday message • One in five young people aged under 20 can expect to become a centenarian • But unlikely to see dramatic rises in record life expectancy (UK record115 years)
  • 60. How fast is the population ageing?“I’ve turned 60 and I can barely believe nearly a third of my life is over” Woody Allen
  • 61. Blue Zones – Dan Buettner• Okinawa, Japan• Sardinia, Italy• Loma Linda, California• Nicoya, Costa Rica• Ikaria, Greece
  • 62. How to become a blue zone: Jeanne Calment - 122• Came from a long-lived family, did not allow herself to feel stressed and (reputedly): ―She used to eat two lbs. of chocolate per week until her doctor persuaded her to give up sweets at the age of 119. She quit smoking only at 119, but her doctor said her abstinence was due to pride rather than health — she was too blind to light up herself, and hated asking someone to do it for her.‖
  • 63. Power of 9
  • 64. Are we all to become Blue Zones?• DWP estimates: ~ 500 000 by 2066• Pale blue? – Public Health messages – Health and public policy• What is required to make the UK a Blue Zone? – Modifiable risk factors • Combination of lifestyle and policy initiatives
  • 65. Challenges• Proportion and length of stay in institutional care• Loneliness: Half people aged over 75 live alone• Mental Health: 13% of those 85+ have depressive symptoms (IFS 2010)• Poverty and Material Deprivation – Material Deprivation peak in 85+ cohort: 12% (DWP) – Up to10% of 85+ have less than £3000 (Banks and Tetlow)• Older carers – Carers of 85+• Gender – Australia 1 in 5 centenarian men and 1 in 20 centenarian women had spouse (Richmond 2008)
  • 66. Policy considerations• Evidence on centenarians is limited – Centenarians linked to lower levels of hospitalisation and non- communicable diseases across the life course • Important from a biological perspective • Must learn more from life of centenarians• In terms of policy considerations are centenarians actually any different to the oldest old? – More research with centenarians – Specific inclusion and consideration of people in 80s and beyond
  • 67. What older people want and value in life? IlonaHaslewood JRF This event is kindly supported by JRF The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK
  • 68. What do older people want and value in life? Robert Butler Memorial Lecture 29 November 2011 Ilona Haslewood Joseph Rowntree Foundation
  • 69. Published today…New research report byJeanne Katz, Caroline Holland,Sheila Peace and Emily Taylor,The Open University(edited by Imogen Blood)Focus on older people with highsupport needsOther recent Better Lifepublications:http://www.jrf.org.uk/work/workarea/better-life
  • 70. A model to explore what people want and value… in life, not only whatservices or policiesdecide they can have.Possible uses:as a promptin trainingcommissioningresearch
  • 71. Diverse perspectives on ageing and high support needs• What lesbian, gay or bisexual older people want and value (Sally Knocker)• An insight into the lives of Gypsy families (Pauline Lane)• The voices of South East Asian elders (ManjitKaurNijjar)• The future for people ageing with learning difficulties (Cally Ward)• The Scottish Dementia Working Group’s experience of activism (Dot Weaks)Expected publication date: 18 January 2012
  • 72. CentenariansChris Steele-Perkinsexplores what life is likewhen you reach 100“I feel very oldsometimes and othertimes I feel I could doanything when my back’sall right....”
  • 73. ‘The new old age’ micrositeA digitalplatform forolder people’swords andimagesLaunches on18 January2012 Accessible from http://www.jrf.org.uk/work/workarea/better-life
  • 74. Joseph Rowntree FoundationVisit our website www.jrf.org.uk www.twitter.com/jrf_uk www.twitter.com/ilonahaslewood www.facebook.com/JosephRowntreeFoundation
  • 75. Robert Butler Memorial Lecture and Debate onCentenarians and Oldest Old 29 November 2011 This event is kindly supported by JRFThe ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK