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UK Population estimates and projections (2010-based), ONS 2011
UK population pyramid (mid-2010 estimate) Source: ONS 2011
Ageing of the UK population Source: ONS 2010
“ At current rates, life expectancy in the UK is increasing at the rate of about two years for each decade that passes”
Source: House of Lords Science and Technology Committee 2005
Ageing: Scientific Aspects
Life Expectancy at birth (UK)
Life expectancy at birth (UK)
1980 2000 2011
Males 70.8 75.3 78.2
Females 76.9 80.1 82.3
Source: World Bank Development Indicators 20 Nov 09 and ONS Oct 2011
Life Expectancy at Birth 1980-82 to 2006-08 Source: ONS 2011
Ageing - Internationally
Across EU population growth over next 25 years:
7% 18-59 year olds
Across the world, by 2050 people over 60 will make up
1/3 of rich world
1/5 of developing world
Sources: see Age UK Later Life International Fact Sheet 2011
Global Population – Aged 80+ years
1950 – 14 million
Today – 300 million
Longevity Revolution - Global Source: WHO 2010
The World’s ‘Oldest’ Countries (2009) Source: WHO WORLD HEALTH STATISTICS, 2011 Country Aged 60+ (%) Japan 30 Germany 26 Italy 26 Sweden 25 Bulgaria 24 Finland 24 Greece 24 Austria 23 Belgium 23 Croatia 23 Denmark 23 France 23 Portugal 23 Switzerland 23 Czech Republic 22 Estonia 22 Hungary 22 Latvia 22 Slovenia 22 Spain 22 United Kingdom 22
“ The number of centenarians in Japan increased almost one-hundredfold from 154 in 1963 to more than 13,000 at the beginning of this century and is projected to increase to almost 1,000,000 by 2050”
Source: Ageing Horizons, 3,1 (2005)
N.B. This is assuming that records are accurate and there has not been any large scale fraudulent reporting (some uncovered in Japan, August 2010)
Longevity Revolution - Japan
Italy – population pyramid Source: US Census Bureau 2011
China – population pyramids (millions, by age and sex) 1950 2000 Male Female Male Female Age Source: World Population Prospects: The 2004 Revision (2005). 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Age 2050 Female 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Male
Later life in the UK- an overview
Over 1.3 million people are aged 85 or over. One in four children born today
will live to 100
People aged 65 now have an average life expectancy of 82-85 years, the
last 7-9 years with a disability
Nearly 2.5 million people aged 65+ in England have care needs
3.7 million people aged 65+ currently live alone
821,000 people aged 65+ currently have dementia. is This is projected to
double in less than 40 years
Sources available in Age UK Later Life in UK fact sheet January 2012
Later Life – internationally: an overview
Of the current total world population of over 6.8 billion, there are over 790 million people aged 60 and over
Life expectancy at birth ranges from 82.6 years in Japan to 39.6 years in Swaziland
70% of the world’s older people (60+) live in less developed countries
60% of people with dementia live in developing countries, and this is expected to rise to 71% by 2040
70% of mortality in low income countries is due to communicable disease and 30% to chronic long term illness; this will be reversed by 2030
Sources available in Age UK International Later Life fact sheet 2011
Health and wellbeing
In eight years’ time, demographic change alone would mean that there would be:
Nearly 2.7 million people aged 75+ with at least one limiting long term illness and over 4.3 million people aged 65+ with LLTI
People living an average of 7-9 years at the end of their lives with a disability
Nearly seven million older people who cannot walk up one flight of stairs without resting
One-and-a-half million older people who cannot see well enough to recognise a friend across a road
Over 4 million with major hearing problems
Up to a third of a million people aged 75+ with dual sensory loss
A third of a million who have difficulty bathing
Nearly a million with dementia
Between 4-7 million with urinary incontinence
One-and-a-half million suffering from depression
Demographic projections based on ONS population projections for the UK and currently available prevalence figures (sources in Age UK Later Life in UK fact sheet, January 2012
Why is this important?
While health is clearly an outcome in itself, it is also a key driver of outcomes in other domains, including employment and ability to contribute.
ELSA (Wave 2, 2006) indicates the two-way relationship between health and wealth: greater financial resources reduce the chances of poor health, and good health has a positive relationship to financial wellbeing
Services are hospital focused, prioritising cure rather than prevention or complex case management, commissioning is in early stages of development, question marks over value for money, realisation that some target-driven achievements occurred at the expense of quality.
National priorities remain but emphasis on local decision making
Choice as a patient right and a tool to drive up quality along with contestability between providers for contracts framed by ambition to provide care closer to home
What do older people think?
Mental health – older people’s preference for services include peer support; a range of activities and opportunities of things to do; 24-hour help in a crisis that helps you maintain everyday life; supported housing options, technologies and skills and learning opportunities that enable independent living. More broadly older people suggest the following to improve mental health and wellbeing: improve public attitudes; provision of activities for older people; befriending schemes (esp. those aged 90+); improved access to quality public services, and improving standard of living (mostly younger respondents).
Community Services –priority areas for action include: improving the range of support for carers; making services personalised and holistic; joining up health and social care so there is one point of call; considering the transport implications of any changes to services
Intermediate care – help with keeping out of long term care is important e.g. mentoring and advocacy to help them through the health and social care system; more time from care assistants; more availability and affordability of high quality home and telecare; help with practical matters such as laundry, adequate refreshments and warmth.
Long Term Health Conditions: The Strategic Challenge
There are over 15 million people in England with long-term health needs.
Long term conditions are those that cannot, at present, be cured, but can be controlled by medication and other therapies.
The impact on the NHS and social care for supporting people with long term conditions is significant.
Currently 69% of the total health and social care spend in England is spent on the treatment and care of people with long term conditions (DH Annual Report 2008).
By 2025 the number of people will at least one long term condition will rise by 3 million to 18 million (DoH 2008).
This will be due to a rise in the ageing population and the increased survival of pre-term babies.
Sources available in Age UK Later Life in UK fact sheet January 2012 unless otherwise stated
Coronary Heart Disease – 2.6 million people are living with CHD in the UK (89% of 190,000 deaths per year were in people 65 years or older)
Stroke – 80% of 150,000 cases per year are over 65. Stroke is the leading cause of severe adult disability
Diabetes – 2 million people in the UK are diagnosed. Prevalence rises with age from one in 20 people over age of 65 to one in five in people over 85 years
Chronic Obstructive Pulmonary (Lung) Disease – 3 million people in the UK diagnosed. There are approximately 25,000 deaths from this every year, with over 90% occurring in people 65 years and older
Prevalence of Long Term Conditions (1) Sources available in Age UK Later Life in UK fact sheet January 2012
Cancer – incidence increases with age – of the 155,000 deaths each year, three quarters occurred in people aged 65 and over.
Arthritis – Osteoarthritis affects over half the population by age 65, and 10% of people aged 65+ have a major disability due to OA.
Osteoporosis – Up to 21,000 people die following osteoporotic hip fractures each year in the UK.
Parkinson’s Disease – The second most common neuro-degenerative disorder (120,000 have clinical diagnosis in the UK). The incidence increases with age.
Sensory impairments - 1 in 5 people over 75 years old has a significant visual impairment. Over 7 million people over 60 years are deaf or hard of hearing.
Prevalence of Long Term Conditions (2) Sources available in Age UK Later Life in UK fact sheet January 2012
Prevalence of Long Term Conditions (3)
Depression – The commonest mental health condition in the older population. A quarter of older people living in the community have symptoms which warrant intervention, but it is estimated that 85% of people over 65 do not receive any help from the NHS.
Dementia – Over 820,000 people are estimated to be suffering from late onset dementia in the UK. This overall figure is forecast to increase to 1,735,087 by 2051. Dementia affects 1 person in 6 over 80 and 1 in 3 over 95.
Sources available in Age UK Later Life in UK fact sheet January 2012
Disability, Age and Activities of Daily Living % Dependent
Older people and functional limitations
37% of men and 40% of women aged 65 and over have at least one functional limitation (seeing, hearing, communication, walking, or using stairs) .
This increases to 57% and 65% respectively in those aged 85 and over.
More than half of men and women reporting any functional disability were unable to walk 200 yards or more unaided without stopping or discomfort. Both prevalence and severity increased with age.
The number of functional limitations also increased with age with 17% of men and 19% of women aged 85 and over with three or more functional limitations.
Functional limitations can result in depression and social isolation.
Analysis of English Longitudinal Study of Ageing (ELSA) Waves 1-3
Severe Cognitive Limitation by Age and Gender (US)
Healthy Life Expectancy
Life expectancy is increasing and until recently, healthy life expectancy has been increasing at a slower rate
This has meant that many older people are living longer in poor health
There is little evidence of consistent success in compressing morbidity and some evidence that disability rates are declining, but an average 65-year-old can expect to live 7- 9 years with a disability
Age UK analysis of life expectancy and healthy life expectancies at age 65, ONS 2011 published in Agenda for Later Life 2011
Work and Learning
Older workers are particularly disadvantaged by lack of educational qualifications - employment rates are significantly lower for those with no qualifications whatsoever.
Access to learning centres becomes more difficult with age, with FE colleges, adult education centres and the home being main locations of learning
Education and age Source: NIACE annual surveys of learning Economic activity by highest qualification, 50-69 y/o 0% 20% 40% 60% 80% 100% Degree/ equiv Higher edu A-Level /equiv GCSE A*-C/equiv Other No Qual Those 50+ with no qualifications experience employment rates over 20% lower than those with qualifications – much of the difference explained by illness or disability Employed Unemployed Inactive: sick or disabled Inactive: Other Inactive: looking after family/home Inactive: Retired
The number of people undertaking learning decreases significantly with age
But mental activity like learning can slow cognitive decline, reduce morbidity, and facilitate healthier lives.
Continuing learning Source: NIACE annual surveys of learning. The 2011 and 2012 reports follow this trend
Advantages of learning in later life (1) In the community
The Benefits of lifelong learning for adults over 50 have been categorized under the following headings:
Helps to reduce poverty through various mechanisms, including new employment and improved knowledge (NIACE IFLL Thematic Paper 6 2010)
Money saving (DIY savings on contractors’ labour)
• Helps to reduce isolation through improved social contacts
Offers an inexpensive way to try new activities
Improved self esteem (achievement of set goal)
New topic of conversation with family and friends (anecdotal evidence only)
MEDICAL AND PSYCHOLOGICAL
May help to slow cognitive decline. So far, limited evidence, much of it anecdotal, about keeping your mind sharp, improving some aspects of memory (recall)
Self-reported reduction in symptoms of depression
There is no authenticated proof yet of physical benefits related directly to learning activities except where they involve extra exercise or sport
Note: Although there is a great deal of research on the benefits of learning in general, there is a shortage of reliable data on improvements to the health (physical and mental/ psychological) to older learners.
In care settings, learning opportunities for older people can:
improve both physical and mental health;
reduce dependence on medication;
improve recovery rates; reduce dependency on others and
lead to a greater enjoyment of life which gives residents something to look forward to.
Advantages of learning in later life (2) In care settings Source: “Enhancing Informal Adult Learning for Older People in Care” NIACE 2010
Barriers to learning
Lack of interest and feeling too old are the main barriers to learning as people get older.
Poor information about availability of learning opportunities and inappropriate courses may explain lack of interest.
One survey found 43% of older people agree that there is not enough information on what education courses are available and 30% believe courses on offer are not appropriate for older learners.
7,368,000 people aged from 50 to State Pension Age (SPA, currently 60 for women and 65 for men) are in employment
849,000 people aged 65 or over were employed in July – September 2011, a rise of 0.1 per cent over the last year; this is about 3% of the UK labour force
The employment rate for 50 to SPA is 65% and for SPA+ it is 8.4%
The latest figures (Jul-Sep 2011) show the unemployment rate for people aged 50+ in the UK is 4.7%
In October 2011, 241,100 people aged 50 or over claimed Jobseekers Allowance.
Median hourly pay for workers in their 50s is £12.00 and £10.00 for workers aged 60+, as opposed to £13.03 for workers in their 30s
There has been a trend of people leaving the workforce (presumably for retirement) later. For men, the estimate of average age of withdrawal increased from 63.8 years in 2004 to 64.5 in 2009. For women, it increased from 61.2 years in 2004 to 62.0 years in 2009
Sources: Labour Market Statistics, ONS 2009 - 2011
What do older people think?
More people enjoy work:
The majority of those aged 55 and over would prefer to be working full time than not working at all, and it is common for older people to view working as the ‘ideal’ situation for them
… and want to keep working:
A 2003 survey found over two-thirds of respondents aged between 50-70 who were in, or looking for, a job planned to work in some capacity during retirement or never retire
The average age at which workers over 50 retired reached its highest level for men (64.6 years) since 1984. For women comparable figures showed an increase from 60.7 in 1984 to 61.9 in 2008.
Sources in Age UK Later Life in UK fact sheet, January 2012
Why is this important?
Employment supports an individual’s ability to contribute in addition to their material wellbeing (ELSA Wave 3 presentation, Banks and Tetlow 2008).
All those who want to work need to be in work – and work needs to be promoted as a mechanism for achieving wellbeing and independence in later life
The impact of projected pension shortfalls on the timing of retirement is not yet clear, but concern about financial security is likely to bring about a further rise in working past SPA.
Increasing reliance on private sector, complexity in products on offer
More individuals are directly exposed to risk: a significant percentage of 50-65 year olds are in danger of having replacement rates below benchmarks of adequacy
Increase in need for info and advice to access entitlements and make appropriate decisions about finances
Increasing use by organisations of websites as the main channel rather than (more expensive) face to face (although Pension Service home visits)
Digital exclusion now leading to increase in financial exclusion, not just in banking, but increasingly public services and private care funding (poor risks?)
Greater exposure to financial abuse
Gaps in support for frail vulnerable older people, especially around money management.
What do older people think?
Confusion regarding choices of pensions, savings and care
Lack of interest in accessing products online
Concern about pensions (55-65 year-olds currently finding out that their pensions will not be adequate):
Source: Turner final report, 2005
Why is this important?
An individual’s income clearly supports their material wellbeing. It also enables independent living and appropriate housing
ELSA (2006 and 2008) provides strong evidence of a positive correlation between higher income/ wealth and reduced risk of developing most of the age-related chronic conditions, including type 2 diabetes, high blood pressure, raised cholesterol, disability (reduced strength and mobility)
Health and financial status
1.8 million pensioners live in poverty. Nearly two-thirds of these are women.
Older people on higher incomes are more likely to report their health as ‘good’ or ‘very good’.
People on lower incomes are more likely to report asthma, chronic lung disease and diabetes. High blood pressure is more common among poorer older people.
Sources: Households below Average Income and Pensioner Income Series, DWP 2011
Wealth and health: Odds of poor health increase with poverty
Net Worth by Health of Husband and Wife
Pension coverage in UK For the latest figures on pensions and pension coverage, see Age UK Later Life in UK fact sheet, January 2012
Forecast change in public pension spending 2000–2040 (%)
Do Pension Incentives Matter? Survival probabilities, by pension status UK men No Occupational Pension With Occupational Pension
Do Pension Incentives Matter? Survival probabilities, by pension status UK women No Occupational Pension With Occupational Pension
Home and Care
Housing Why is this important?
Decent and appropriate housing is a key element in quality of life and good health in older age
Demographic changes, combined with changes in policy on care provision and home ownership have meant - and will continue to mean - an increasing number of the oldest old living longer, and often alone, in their own homes
Older people (especially single people aged 75+) are more likely than younger people to live in older, non-decent homes)
Source: Older People, Decent Homes and Fuel Poverty. An Analysis of the English House Condition Survey, Help the Aged and BRE, 2006
Government encouraging institutional investment more in private rented sector to make up the shortfall in social housing.
Growing debate around reconciling housing related support, social care and health services to deliver independence at home (role of common assessment framework)
Cuts in preventative services - housing related support - more funding diverted to social care Further decline in retirement housing in the social sector - increased focus on the most vulnerable
Reforms to security of tenure (see Hills report) possibly less security for both private and social residents – issue around offering settled accommodation to older people
Calls for improved coordination - partnership with LAs and PCTs increasing focus on the role of retirement communities - some growth
Increasing push towards assistive technology to replace or reduce
housing support workers - increased pressure to cut labour costs through assistive technology but likely to remain marginal for next 5-10 years (except top end of market)
What older people think
92% of adults say they envisage living in a home they have for life, but 23% said their current home was unsuitable to live in in old age (B&Q survey, 2008)
More older people refusing to purchase preventative services to save money as the result of increased 'choice' and rising charges
Opinions sharply divided between those who benefit from Assistive Technology and those who see reduced contact with 'human' support
Concern about inheritance tax is not necessarily exclusive to the very rich. ELSA (Wave 3, Emmerson Muriel 2008) found that 1 in 8 of their representative 50+ sample have assets above the IHT threshold
Whatever the merits of residential in comparison with living in the community, over 70% of adults surveyed view it negatively: 48% of homeowners 18+ say they can’t think of anything worse than moving into a care home.
A further 14% say they would be nervous and 9% frightened (B&Q survey 2008)
5% of people aged 65+ in the UK need but do not receive help with everyday jobs such as hoovering or changing a light bulb
Continued push on homeownership - experience of Right to Buy generation unable to maintain housing should provide lessons
Growth in need for local housing advice and advocacy – opportunities for one-stop shop services
Growing inequality of retirement provision between private and public sectors
Growing regional and local inequality in regard to poor housing Expansion in private rented sector - more older people living in insecure tenancies
Increasingly difficult to obtain additional resources from PCTs
Housing support and service charges - growing divide between those receiving benefits and those paying for themselves - likely to increase friction within retirement housing
Likely increase in numbers of older homeless people resettled in poor temporary accommodation
Public sector will focus on the most vulnerable
Possible further decline in specialist housing. Growing debate around mobility (moving to be nearer friends and relatives offering support) and flexibility within social rented sector
Health and Home
The majority of older people live within the community.
26% of households with someone aged over 75 live in social housing and 68% are home owners.
6% of older households live in sheltered housing
4% of older people live in a care home.
Poor housing has a detrimental impact on both physical and mental health.
2.7 million households with at least one person aged over 60 are living in a non-decent home.
Older people are more likely to be living in non-decent homes in the private sector if they are over 75, or aged 60 or more and living alone.
1.5 million women aged 75 and over live alone compared to 0.5 million men of the same age .
Sources: see Age UK Later Life in UK fact sheet, January 2012
Care and support at home
There are 6 million carers in the UK.
2.8 million people aged 50 and over provide unpaid care; nearly 1 million of these are aged 65+ and nearly 50,000 are aged 85+.
There are 8,000 carers aged 90+ (4000 providing 50+ hours of care per week.
Unpaid carers currently provide 65% of care compared to 25% paid for by the state (10% is privately purchased).
73% of English local authorities have plans to limit care to people with substantial and critical needs only.
The growing number of older people means that the need for support from unpaid carers could rise by 30% over the next 35 years (9.1 million).
Sources: see Age UK Later Life in UK fact sheet, January 2012
Older people and their carers want services that will:
improve their quality of life, health and well-being and enable them to be more independent.
Be supported and enable them to self care and have active involvement in decisions about their care and support.
To have choice and control – services built around the needs of individuals and carers.
The 2006 White Paper Our health, our care, our say , promoted telecare and assistive technology in helping people retain their independence and improve their quality of life.
The use of the internet by older people, particularly over 75s is increasing steadily but over half of all older people continue to be excluded from the benefits of new technologies.
Source: Internet Access Quarterly Update Q3 2011, ONS 2011
Why is this important? (1) Source: ESRC/NATCEN research (Dec 11) and Age UK Later Life in UK fact sheet, January 2012
3.7 million people aged 65+ live alone and 600,000 older people leave their homes once a week or less and 17% of have less than weekly contact with family, friends and neighbours
Over one million older people experience (poor social relations and) social exclusion.
Older people who live alone spend a lot of time with friends and acquaintances, but on average, they can also spend eleven hours alone on a week day and ten and a half hours alone at weekends (excluding sleep).
Why is this important? (2)
Social isolation prevents ability to contribute. It also is a risk factor for health.
Inactivity and isolation accelerate physical and psychological declines, creating a negative spiral towards premature, preventable ill health and dependency. A recent ELSA study revealed that social detachment reduces quality of life.
Depression is associated with lack of social support (36% of men and 54% of women with severe lack of social support have high depressive symptoms)
Source: ELSA waves 1-3 and Age UK Later Life in UK fact sheet, January 2012
Social Inclusion impacts negatively on older people’s quality of life Source: ELSA waves 1-3
Social isolation is a cross-cutting issue and the responsibility for alleviating it lies with several Government departments.
Policies which may directly impact on social isolation are fragmented but include:
Linkage Plus aimed to improve outcomes for older people through better joining-up between services and linking older people to services.
Developments in transport policy including making the freedom pass available, amending community transport regulations and
Investment of £5.5 million into intergenerational volunteering
Individual budgets for those that access social care
Positive duty as applied to culture and leisure opportunities
Neighbourhood warden schemes
Informal learning white paper
What do older people think? Source: Own surveys and analysis of ELSA wave 3
29% of respondents to an Age Concern survey saw friends and 36% saw family a few times and month or less
However many people at mid- to later life may not consider they need to expand their social networks
44% state they do not need lots of friends
45% disagreed that they feel lonely from time to time
Analysis of ELSA wave 3 has found that life satisfaction significantly decreases after certain life events, with many underlying factors clustering around themes of social isolation and lack of support.
Satisfaction with current levels of social interaction could be a barrier to individuals building up social networks
Trends Source: DCLG household estimates, 2006 One person households are projected to overtake married couple households by 2030 As people age, the risk of being lonely increases. For details of trends in volunteering and digital inclusion, see Appendix 226,000 797,000 923,000 834,000 947,000 1,061,000 1,659,000 254,000 1,048,000 1,460,000 1,415,000 1,792,000 1,559,000 2,359,000 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 Under 25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 and over 2026 2003
Public Policy Challenges
Long term challenges
A decade of spending cuts – doing more with less?
Demographic change – a manageable transition (working longer; pensions reform) but we must now prepare our public services
Income – pensioner poverty stuck around 20% for the next decade despite pension reform
Healthy life expectancy - remains an elusive goal, avoid longer periods of disability
Social and technological change – changes in family life, communities and the digital divide – what next?
2011: Uncertainty and Opportunity
Older people not immune from the recession
Job losses hitting older workers
Rising costs of living
Impact on savings and annuities
Now - a focus on employment and skills; an end to forced retirement
The aftermath – public service cuts must not disproportionately harm older people
A new ageing strategy
Social care reform - 2011 is ‘make or break’ for the long term
The Equality Bill – new rights outside work; end forced retirement?
Pensioner poverty – Child poverty Bill focuses minds on ending pensioner poverty
Coalition pressing older people’s priorities
Equal citizens, equal rights
Use Equality Bill to outlaw age discrimination in goods and services, rapidly and with minimal exemptions
Support EU directive on discrimination beyond the workplace
Robust enforcement and promotion of existing age discrimination law
Extend Human Rights Act to private providers of public services
68% say politicians see older people as a low priority
60% say age discrimination exists in older people’s lives
60% say age discrimination exists in the workplace
53% say people in very old age are treated like children
52% say those planning services don’t pay enough attention to older people