Public health in an ageing society - an ILC-UK debate
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Public health in an ageing society - an ILC-UK debate

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Wednesday 4 December, 9.00 (for 9.30) – 11.30, Royal Society of Medicine, 1 Wimpole Street, London, W1G 0AE ...

Wednesday 4 December, 9.00 (for 9.30) – 11.30, Royal Society of Medicine, 1 Wimpole Street, London, W1G 0AE

Funded by an unrestricted grant from Sanofi Pasteur MSD

The recent public health reforms have now been in action for a few months, with local areas taking advantage of their newfound responsibilities and taking strategic decisions on what their public health focusses should be. Demographic change presents multi-faceted challenges for these decision makers, so how are these new structures responding an ageing society in their public health planning?

At this debate, we explored the extent to which the new public health structures in England are able to respond to an ageing population. The debate covered issues such as how public health spending should be allocated across the life-course. With the current climate of concern around intergenerational fairness, particularly across public spending, how can we ensure that the next steps in public health are fair for all age groups?

During this debate we heard an overview of the public health changes at a nation level, and then a policy perspective from an ILC-UK speaker on some of the challenges facing the new structures in light of an ageing population. This was followed by a series of experts presenting key examples of important aspects of public health for an ageing society, and how these issues are being addressed thus far by the new structures.

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  • The brief will include a number of case study topics on different facets of public health and ageing interact. Delighted that we will hear from experts on some of these topics today. In putting together the agenda we’ve tried to go for the more traditional straight health topics first, and then move on to some of the broader topics such as housing and road safety.From an ILC-UK perspective, we’re interested in this topic generally as a part of public policy responding to ageing. We’re also a life course organisation, focussing on preparation for ageing throughout life – so public health is central to this - but also interested in what the impacts might be on intergenerational fairness in the spending in public health. Brief will be published in January next year.
  • On leftLesley Gillespie, ClareRobertson, Bill Gillespie, Cathy Sherrington , Simon Gates, Lindy Clemson, Sally Lamb.Interventions for preventing falls in older people living in the community. Cochrane Review Published Online: November 14, 2012On rightCathy Sherrington, Julie Whitney, Stephen Lord, Robert Herbert, Robert Cumming, Jacqueline Close.Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis J Am Geriatr Soc 2008 DOI: 10.1111/j.1532-5415.2008.02014.xON LEFT Gillespie et al Cochrane Review included 159 trials with 79,193 participants. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Most trials compared a fall-prevention intervention with no intervention or an intervention not expected to reduce falls. Sixty-two percent (99/159) of trials were at low risk of bias for sequence generation, 60% for attrition bias for falls (66/110), 73% for attrition bias for fallers (96/131), and only 38% (60/159) for allocation concealment. RaR = Rate Ratios RR= Risk Ratio Multiple-component group exercise significantly reduced rate of falls (RaR 0.71, 95% CI 0.63 to 0.82; 16 trials; 3622 participants) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96; 22 trials; 5333 participants), as did multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80; 7 trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; 6 trials; 714 participants).  Multiple-component exercise (balance and strength training) embedded in activities of daily living in people with a history of falls significantly reduced rate of falls (RaR 0.21, 95% CI 0.06 to 0.71; 1 trial; 34 participants) but not risk of falling.  For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; 5 trials; 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87; 6 trials; 1625 participants). Multifactorial interventions, which include individual risk assessment, reduced rate of falls (RaR 0.76, 95% CI 0.67 to 0.86; 19 trials; 9503 participants), but not risk of falling (RR 0.93, 95% CI 0.86 to 1.02; 34 trials; 13,617 participants). Overall, vitamin D did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; 7 trials; 9324 participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03; 13 trials; 26,747 participants), but may do so in people with lower vitamin D levels. Home safety interventions when delivered by an occupational therapist reduced rate of falls (RaR 0.69, 95% CI 0.55 to 0.86; 4 trials; 1446 participants) and risk of falling (RR 0.79, 95% 0.69 to 0.90; 5 trials; 1156 participants). An intervention to treat vision problems (616 participants) resulted in a significant increase in the rate of falls (RaR 1.57, 95% CI 1.19 to 2.06) and risk of falling (RR 1.54; 95% CI 1.24 to 1.91). When regular wearers of multifocal glasses (597 participants) were given single lens glasses, all falls and outside falls were significantly reduced in the subgroup that regularly took part in outside activities. Conversely there was a significant increase in outside falls in intervention group participants who took part in little outside activity. Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93; 3 trials; 349 participants) but not risk of falling. First eye cataract surgery in women reduced rate of falls (RaR 0.66, 95% CI 0.45 to 0.95; 1 trial; 306 participants), but second eye cataract surgery did not. Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95% CI 0.16 to 0.73; 1 trial; 93 participants), but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95% CI 0.41 to 0.91; 1 trial; 659 participants). An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95% CI 0.22 to 0.78; 1 trial; 109 participants). One trial (305 participants) comparing multifaceted podiatry including foot and ankle exercises with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR 0.64, 95% CI 0.45 to 0.91) but not the risk of falling. There is no evidence that cognitive behavioural interventions reduced the rate of falls (RaR 1.00, 95% CI 0.37 to 2.72; 1 trial; 120 participants) or risk of falling (RR 1.11, 95% CI 0.80 to 1.54; 2 trials; 350 participants).Trials testing interventions to increase knowledge/educate about fall prevention alone did not significantly reduce the rate of falls (RaR 0.33, 95% CI 0.09 to 1.20; 1 trial; 45 participants) or risk of falling (RR 0.88, 95% CI 0.75 to 1.03; 4 trials; 2555 participants). No conclusions can be drawn from the 37 trials reporting fall-related fractures. There is some evidence that a home-based exercise programme can be cost saving within one year in over 80-year-olds, similarly home safety assessment and modification in those with a previous fall, and one multifactorial programme targeting eight specific risk factors. Group and home-based exercise programmes, and home safety interventions delivered by an occupational therapist reduce rate of falls and risk of falling.Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; Tai Chi reduces risk of falling. ON RIGHT Sherrington et al JAGS 2008 Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-AnalysisOBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls. DESIGN: Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included.SETTING: Older people.PARTICIPANTS: General community and residential care.MEASUREMENTS: Fall rates.RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)0.83, 95% confidence interval (CI)0.75–0.91, P<.001, I2=62%). The greatest relative effects of exercise on fall rates (RR0.58, 95% CI0.48–0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (450 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program.CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement exercise programs for falls prevention.
  • So what is ProFouND?21 partners in 12 countries (plus 10 associate members with more than 40 countries!)We aim to – follow the slide
  • * We think that everyone has a right to a good quality home in a healthly, well designed environment.
  • The first Garden City to be developed – by Ebeneezer Howard and his friends – was Letchworth in Hertfordshire. One hundred years later it remains a highly desirable place to live, with good green spaces.It was highly influential all over the world.We think that there is a lot to learn from Letchworth and from Ebenezer Howard’s original vision for garden cities – and that they are increasingly relevant as we learn to understand the benefits that high quality green infrastructure can bring – including increased opportunities for biodiversity to flourish as well as for people to flourish.

Transcript

  • 1. Public health in an ageing society Wednesday 4th December 2013 This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 2. Welcome Baroness Sally Greengross Chief Executive ILC-UK This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 3. National overview – how public health structures can respond to an ageing society Dr Mike Brannan Adult Life Course Lead Health and Wellbeing Directorate, Public Health England This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 4. National overview: How public health structures can respond to an ageing society Dr Mike Brannan Adult life course Lead, Public Health England 4/12/2013
  • 5. Changing UK demographics UK demographics 2008-30 • Increasing number of people aged over 65: 2010 2030 2050 4.5m people (1 in 6) 10 m 19 m (1 in 4) • Health and social care needs increase in older years 5 5
  • 6. Economic & social contribution of active ageing Time use of older people in the UK 6 6
  • 7. Less than 50% of people disability-free at 65 years 7 Public Health England (London) 27/08/2013 7
  • 8. Disease risk factors in the UK 8
  • 9. Changing global burden of disease over next 20 years Source: WHO Global Burden of Disease 2004. 9
  • 10. An integrated whole system approach to public health Government Public Health England 10 Local authorities NHS 10
  • 11. A ‘place’ based public health system 3rd sector providers People and communities NHS & IS Providers Health and wellbeing boards PHE centre Local government CCGs & their support NHS England area team Public health advice Commissioner of public health services 11 11
  • 12. Role of public health system • Anticipates changing nature of populations • Enables wider mitigation of damage to health • Harnesses evidence, knowledge and technological advances to improve health and wellbeing equitably • Unites fragmented means of service delivery through good partnership and high quality commissioning • Secures equitable access to appropriate care • Achieves impact at scale 12 12
  • 13. Role of Public Health England • Articulating an authoritative national voice for public health in England • Protecting the population from communicable disease and environmental hazards • Providing knowledge, evidence, intelligence and research • Influencing through national/international relationships and acting as opinion leaders for health • Developing the public health specialist workforce • Providing direct advice and services 13 13
  • 14. Creating a sustainable approach to health and social care 14
  • 15. An evidence-based approach 15
  • 16. E.g. Mapping needs and service usage to deliver equity North East England work mapping deprivation, service access and admissions for chest pain to plan equitable services and resources. 16
  • 17. E.g. Commissioning systematic interventions at population scale • Commissioning high impact interventions with system and scale to improve population level outcomes • Tracking and evaluating outcomes 17
  • 18. E.g. Cross-sector work on social determinants of health Facilitating local government and voluntary sector collaborations on cold homes. 18
  • 19. Key messages • Changing demographics require a new approach – Adapting systems to older people (e.g. expectations, new technologies) – Valuing contribution of older people & focus on functionality in later life – Addressing inequalities (e.g. disability, dependency) • New public health system can facilitate this process – Integrated, cross-sector working – Focus on people, place & outcomes (including life course approach) – Needs-led, evidence-based interventions • Public Health England will provide evidence, knowledge, advice to the NHS and local government and advocacy to enable more age friendly societal development 19
  • 20. Planning tomorrow’s health: policy challenges for public health in an ageing society Jessica Watson Research and Public Affairs Officer ILC-UK This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 21. Planning tomorrow’s health: policy challenges for public health in an ageing society Jessica Watson, International Longevity Centre – UK @ilcuk #pubhealthageing The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 22. ILC-UK Planning Tomorrow, Today          think tank evidence based policy focussed independent respected experts international life course intergenerational The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 23. Interests Report and event kindly funded by an unrestricted grant from Sanofi Pasteur MSD. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 24. Public health http://exhibits.hsl.virginia.edu/hands/ http://profiles.nlm.nih.gov/ps/access/VCBBBS.jpg http://aphl.smugmug.com/Other/Miscellaneous/iwfRGwTQ/0/M/SyphilisPoster-M.jpg The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 25. Public health http://static.guim.co.uk/sysimages/Guardian/Pix/pictures/2011/6/8/1307555290051/British-HeartFoundation--007.jpg http://costcutter.co.uk/images/change4life-logo.jpg http://4.bp.blogspot.com/_sUJR6CdA52Y/SSj3x_w2woI/AAAAAAAAAAc/wR1 6mRgxrHU/s1600-h/cigarette_penis_2.jpg The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 26. Policy brief  Challenges of ageing society  Need to approach holistically (highlighted by Select Committee on Public Service and Demographic Change)  Case studies  ILC-UK focus The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 27. Planning tomorrow’s health The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 28. Public health post reforms  An exciting time  Integration of public health with the delivery of other services  Legal responsibility to Local Authorities  Knowledge of the local area and its needs  Popular with public and local authority workers The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 29. The case for a local approach http://www.ons.gov.uk/ons/interactive/healthy-life-expectancy-at-birth-for-upper-tier-local-authorities--england-2009-11/index.html The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 30. The case for a local approach http://www.ons.gov.uk/ons/interactive/healthy-life-expectancy-at-birth-for-upper-tier-local-authorities--england-2009-11/index.html The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 31. Challenges The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 32. Politics and public health  Public health decisions – and outcomes – are not necessarily election-friendly  Results and payoffs are long term – Particularly for ageing  Budget constraints and ring-fencing  Intergenerational fairness The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 33. Getting public health front of mind  Breaking down administrative and mental barriers  Ensuring good knowledge and evidence  Realising the potential for what might be achieved The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 34. Example – pedestrian road safety  Older people suffer greater injuries as a pedestrian in a road accident compared to younger age groups  Association with lack of confidence and isolation  Potential for coordination with control over road crossing timings, speed control measures on roads The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 35. Who else could be involved?  Employers – Extending working lives agenda – Occupational health to play a role?  Insurance industry – Some interesting use of incentives The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 36. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 37. Many thanks Jessica Watson Research and Public Affairs Officer International Longevity Centre-UK jessicawatson@ilcuk.org.uk 02073400440 Twitter: @ilcuk #pubhealthageing The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  • 38. Vaccination Helen Donovan Public Health Nursing Advisor Royal College of Nursing This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 39. Immunisation Not just for Children..... Helen Donovan RCN UK Public Health nursing advisor
  • 40. • Joint Strategic Needs Assessments should take a life-course approach to Immunisation, • Health and Wellbeing Boards should ensure that that life-course vaccination is adequately considered as part of health planning and commissioning, • Commissioning arrangements for immunisation should support the uptake of adult vaccination.
  • 41. Build on the success of children's immunisation  Disease rates have fallen but cases of VPD remain. - Pertussis - increase in number of cases - Polio - outbreaks in Syria - Diphtheria and diphtheria like illness and deaths in unvaccinated PHA health protection report http://www.hpa.org.uk/hpr/archives/2008/hpr1908.pdf  Tetanus requires individual immunity - risks for the older age group.
  • 42. Vaccines for Adults  Influenza, pneumococcal and now shingles Also check;  Tetanus Diphtheria and polio?  MMR?  Pregnant? Pertussis  Meningiococcal C <25 years
  • 43. CDC adult immunization schedule
  • 44. Check adults are up to date?
  • 45. PH nursing ‘Making every contact count’   Travel vaccination Health screens  Use other opportunities to check, discussion with parents and grandparents?  Information and resources on vaccination available?  Ask routinely about vaccination history?  Accurate records of vaccination history? – Reminders and recall?  All health care professionals responsibility?
  • 46. UK Office for National Statistics: Travel Trends 1992 – 2012 Source: International Passenger Survey (IPS) - Office for National Statistics http://www.ons.gov.uk/ons/rel/ott/travel-trends/2012/rpt-travel-trends--2012.html#tab-Trends-in-visits-abroad-by-UK-residents
  • 47. Recognised barriers to immunisation?           Difficulty in getting access Discrimination Administrative Financial problems Language or literacy limitations Lack of cultural health beliefs and knowledge Lack of knowledge on health and vaccination Religious reasons Fatalistic approach to life Distorted perceptions of risks vs benefits
  • 48. Resources NHS Choices - under adult vaccination; http://www.nhs.uk/Conditions/vaccinations/Pages/vac cination-saves-lives.aspx  PHE Immunisation series on .Gov; https://www.gov.uk/government/collections/immunisati on  Immunisation against infectious disease (The Green Book) – on line; https://www.gov.uk/government/collections/immunisati on-against-infectious-disease-the-green-book  NaTHNaC; http://www.nathnac.org/pro/  PHE Algorithm; http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/ 1194947406156  CDC; http://www.cdc.gov/vaccines/ 
  • 49. Falls Dr Emma Stanmore Lecturer in Nursing University of Manchester This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 50. Falls – Implementing best practice Dr Emma Stanmore www.profound.eu.com
  • 51. Older people at risk of falls  In > 75s, falls are the leading cause of death resulting from injury.  500 admitted to Hospital every day, 33 never go home  1 in 3 >65’s and 1 in 2 >80’s fall p.a.  Fractures costs £1.8 billion p.a. 1 Hip Fracture every 10 mins 1 Wrist Fracture every 9 mins 1 Spine Fracture every 3 mins (World Health Organization (2007) WHO Global report on falls prevention in older age. Masud, Morris Age & Ageing 2001; 30-S4 3-7 Rubenstein. Age & Ageing; 2006; 35-S2; ii37-41 )
  • 52. Falls most serious frequent home accident Fatal injuries in the EU amongst older people (65+) by cause and gender EuroSafe/IDB Injuries in the EU 2005-2007 (2009)
  • 53. www.iofbonehealth.org
  • 54. www.iofbonehealth.org Projected number of hip fractures worldwide 2050 Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285-9.
  • 55. Osteoporosis, falls and fractures EVOS/EPOS Group www.iofbonehealth.org Falls explain betweencenter differences in the incidence of limb fracture across Europe. JBMR 2002 Low BMD is less predictive than risk of falling for future limb fractures in women across Europe. Bone 2005
  • 56. Falls can be prevented! • Multiple-component group exercise • Multiple-component homebased exercise • Tai Chi • Multifactorial intervention individual risk assessment • Vitamin D NB low Vit D • Home safety interventions by OT Gillespie et al 2012, 159 trials, 79193 pts
  • 57. Modifiable risk factors for falls Intrinsic History of falls Medications Medical conditions Age Impaired mobility Postural instability Depression Visual impairments Foot problems Incontinence Nutritional deficiences Extrinsic Environmental hazards Walking aids/assistive devices Footwear and clothing Exposure Physical activity Behaviour
  • 58. • Prevention programmes are efficacious • Implementation gap – Falls prevention not a priority – Services not available – Evidence not used or modified • Training needs to be challenging, progressive & regular • Programmes often too short term – Refusal/non-adherence=50-90%; prevention not effective?
  • 59. Resources ProFaNE: http:/profane.co (Prevention of Falls Network Earth) - Online Community of healthcare professionals committed to the Prevention of Falls. Later Life Training: www.laterlifetraining.co.uk Training programmes, Advice, Booklets, Videos/training DVDs, Websites ProFouND: http://profound.eu.com disseminate best practice in falls prevention
  • 60. • 21 partners 12 countries (+associate members) • disseminate best practice in falls prevention • embed evidence based programmes in at least 10 countries/15 regions by 2015 • use internet & ICT to facilitate widespread implementation • collate resources library • create PFPApp - distribute tailored, customised, best practice guidance • cascade model e-learning to create cadre of accredited exercise trainers across Europe • create “ICT for Falls Forum” www.profound.eu.org
  • 61. Loneliness Kate Jopling Director Campaign to End Loneliness This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 62. Loneliness as a public health issue Kate Jopling Campaign to End Loneliness www.campaigntoendloneliness.org.uk
  • 63. What is loneliness • Loneliness: “an individual’s subjective evaluation of his or her social participation or social isolation and is the outcome of …having a mismatch between the quantity and quality of existing relationships on the one hand and relationship standards on the other” [Perlman and Peplau, 1981] • Social or emotional loneliness • Can be transient, situational or chronic • Social isolation: is objective – a measure of contacts or interactions • Solitude: “Language... has created the word "loneliness" to express the pain of being alone. And it has created the word "solitude" to express the glory of being alone.” [Paul Johannes Tillich]
  • 64. Is loneliness a public health issue? • Department of Health: “Public health is about helping people to stay healthy, and protecting them from threats to their health” • Faculty of Public Health:““The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society”. So…. Yes • It’s a threat to health • Lonely people struggle to make healthy choices • It requires a whole society response • Linked to a range of other recognised public health issues – e.g. alcohol, healthy eating etc
  • 65. Loneliness in the UK Over half (51%) of all people aged 75 and over live alone (ONS, 2010) A higher % of women than men report feeling lonely “some of the time” or “often” (ONS, 2013) www.campaigntoendloneliness.org.uk
  • 66. Loneliness and health: The evidence • Loneliness and isolation have a negative impact on health: Research from the United Kingdom • Loneliness increases our risk of depression (Green et al, 1992) • Loneliness has potentially adverse effects on biological stress mechanisms, including greater fibrinogen (higher levels are associated with cardiovascular disease) and changes to cortisol levels (Steptoe et al., 2004)
  • 67. Loneliness and health: The evidence • Loneliness and isolation have a negative impact on health Research from Europe • Loneliness (not social isolation) is linked to an 64% increased risk of developing clinical dementia (Holwerda et al, 2012) • Adults that feel lonely are more likely to suffer from psychological distress and poor self-rated health (Stickley et al., 2013) • People that feel lonely are more likely to rate their health as poor (Stickley et al., 2013; Kaasa, 1998)
  • 68. Loneliness and health: The evidence • Loneliness and isolation have a negative impact on health Research from North America • Weak social connections are an equivalent risk factor for early mortality to smoking 15 cigarettes a day, and have a great impact than other risk factors such as physical inactivity and obesity. (Holt-Lunstad, 2010) • Loneliness increases the risk of high blood pressure, and this association increases with age (Hawkley et al, 2010)
  • 69. Loneliness and health: The evidence • Loneliness and isolation contribute to harmful health behaviours Research from the United Kingdom • Loneliness can make older people uniquely vulnerable to alcohol problems: alcohol may be used as a coping mechanism for loneliness, and may be linked to boredom (Wadd et al., 2011) • Our relationships and friendships have an influence on our diet: Older adults who live alone and have infrequent contact with friends eat fewer vegetables each day. (Conklin et al., 2013)
  • 70. Loneliness and health: The evidence • Loneliness and isolation contribute to harmful health behaviours Research from Australia • Lonely adults are more likely to be smokers and more likely to be overweight (Lauder et al., 2006.) Research from North America • Lonely adults are less likely to engage in physical activity and exercise (Hawkley et al., 2009; Newall, et al.,2013)
  • 71. What does a public health response to loneliness look like? • Targeting health and wellbeing boards to put the issue on the agenda • Need a whole community response with focus on both prevention and “cure” • Some population-wide measures, and some targeted interventions • Evidence based approaches – are group based, centre around people’s interests and involve older people in their design and delivery • Build into plans for whole community – but not just about being “age friendly”, also about how other interventions are delivered (e.g. social care, but also alcohol services etc)
  • 72. Housing/planning Julia Thrift Project Manager Town and Country Planning Association This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 73. Public Health in an Ageing Society: Planning and Housing ICL Julia Thrift, Project Manager Town & Country Planning Association julia.thrift@tcpa.org.uk www.tcpa.org.uk
  • 74. About the TCPA: What we want to achieve? - Decent, well designed homes for everyone - Thriving, healthy, places - People empowered to influence decisions about their places
  • 75. About the TCPA Leading the planning debate in the UK
  • 76. Garden cities: health and prosperity
  • 77. Reuniting Health with Planning (Phase 1) • Helps planners and public health practitioners understand implications of NHS and planning reforms. • Maps out areas of overlap in planning and public health policy. • Suggests ways in which the two professions could collaborate. • Launched July 2012
  • 78. Reuniting Health with Planning (Phase 1) The built environment is a major factor in the ‘wider determinants’ of health. ‘Too often we intervene too late in the pathway to ill health and forget that health starts where we live, work and play.’ Institute for Health Equity
  • 79. Place-based approaches to health objectives
  • 80. Reuniting Health with Planning (Phase 2) Local planning, local health priorities Place-based approaches in: Stockport Manchester Knowsley Hertfordshire Lincolnshire Bristol Newham West Midlands (published November 2013)
  • 81. Reuniting Health with Planning (Phase 2) Lincolnshire: • Number of people aged 65+ expected to double by 2030 • Parts of the county will have very few people of working age • This will have a significant impact on transport, services, etc.
  • 82. Reuniting Health with Planning (Phase 2) Knowsley - roundtable theme: ‘Take a co-ordinated approach to housing and health interventions across new and existing properties in Knowsley, espcially for an ageing population.’
  • 83. NPPF Planning reform: National Planning Policy Framework (2012) ‘Local planning authorities should... plan for a mix of housing based on current and future demographic trends, market trends and the needs of different groups in the community... such as... families with children, older people, people with disabilities...’ enable communities to achieve lasting growth in a way that meets all of their needs: economic, social and environmental.
  • 84. A few final thoughts: • We need to build 240,000 new homes a year. • Building homes designed for older people might free up larger homes (which elderly often struggle to maintain & can cause poor health). • But – new generations of old people will demand well-designed, desirable homes if they are to be tempted to move. • Anecdotal evidence suggests some planning authorities refuse developments aimed at older people as they think they will be a burden on social services.
  • 85. www.tcpa.org.uk Julia Thrift, Project Manager Town and Country Planning Association julia.thrift@tcpa.org.uk
  • 86. Road safety Elizabeth Box Head of Research RAC Foundation This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing
  • 87. Road safety case study Elizabeth Box Head of Research RAC Foundation November 2013
  • 88. Older drivers in GB Over 4 million people over the age of 70 hold a full valid driving licence Older drivers up the age of 80 have collision rates that are comparable to those of middleaged drivers. The increased frailty of older drivers means that they are more likely to be killed or injured in collisions than their younger counterparts It has been estimated that 34% of older drivers give up driving too early, with only 10% giving up later than they should do. Public health in an ageing society 9 December, 2013
  • 89. 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 1998/00 1995/971 1992/94 1989/91 1985/86 1975/76 % of population who hold a licence Licence holding amongst those aged 70+ 90 80 70 60 50 40 All 30 Men Women 20 10 -
  • 90. Trips by mode of transport for those aged 70 and over 1.5 1.3 1.0 0.6 0.3 10.9 Car/van driver Car/van passenger 42.2 Walk Bus 20.5 Taxi Other private transport Rail Bicycle Other public transport 21.8
  • 91. ‘When you’re getting older, you don’t want to give up the things you’ve been doing for years. You’ve got the time and leisure to do it. What else am I going to do?’ Male participant, over 75s group, Banbury ‘I mean I wouldn’t move if that’s what you mean? Would I move into a town so that I could get round on the transport? No.’ Male participant, over 75s group, Banbury
  • 92. 1.18i - % of adult social care users who have as much social contact as they would like according to the Adult Social Care Users Survey 1.10 Killed and seriously injured casualties on England’s roads 2.23i-iv. –Selfreported wellbeing (satisfaction/wort hwhile/happiness /anxiety scores) 2.24. Injuries and falls in people aged 65 and over Hip fractures? Cardiovascular disease? Access to green spaces? Physical activity?
  • 93. Thank you Elizabeth Box MA MSc MCIHT Head of Research RAC Foundation 89-91 Pall Mall, LONDON. SW1Y 5HS Tel no: 020 7747 3489 Email: elizabeth.box@racfoundation.org Website: www.racfoundation.org Public health in an ageing society 9 December, 2013
  • 94. Panel Debate and Q&A • How are the new structures responding to the varied public health challenges of an ageing population? • What should be their key focuses in order to ameliorate some of the health challenges an older age structure presents? • Are the new public health structures focussing spending fairly across different generations? • How should public health spending be allocated across the life course? • How can we best evaluate, gather and disseminate evidence about what works in public health?
  • 95. Public health in an ageing society Wednesday 4th December 2013 This event is kindly funded by an unrestricted grant from Sanofi Pasteur MSD #pubhealthageing