Except for Japan, the world’s 15 oldest countries are all in Europe. The U.S. population is relatively “young” by European standards, with less than 13 percent age 65 or older, ranking as the 38 th oldest country. The aging of the baby-boom generation in the United States will push the proportion of older Americans to 20 percent by 2030; it will still be lower than in most Western European countries. The older share of the population is expected to more than double between 2000 and 2030 in Asia and Latin America and the Caribbean. Aging is occurring more slowly in sub-Saharan Africa, where relatively high birth rates are keeping the population “young.”
This figure illustrates China’s shrinking young and working-age population and growing elderly population. Dramatic fertility decline (due to the success of the “one-child” policy) and improved longevity over the past two decades are causing China’s population to age at one of the fastest rates ever recorded. China now faces the prospect of having too few children to support its rapidly aging population. Meeting the health and long-term care needs of this growing elderly population will result in soaring health care costs and fewer working-age people to share the burden.
Wide disparity in birth rates. China noteworthy. Kenya. Less than replacement growth in developed economies will bring different problems.
Cardiovascular Disease – 89% of 190,000 deaths per year where 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 – 2.3 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 Lung Disease – 900,000 people in the UK diagnosed. In 2004 there were 10,740 deaths – 92% occurred in people 65 years and older. Cancer – incidence increases with age – of the 135,000 deaths in 2004, three quarters occurred in people aged 65 and over. Arthritis – Osteoarthritis affects about 60% of men and 70% of women aged over 65. Osteoporosis – leading case of morbidity and mortality among older people. Up to 14,000 people die following osteoporotic hip fractures each year in the UK.
Parkinson’s Disease – The second most common neurodegenerative disorder (120,000 have clinical diagnosis). The incidence increases with age. The average age of onset is in the early to mid 60’s. Sensory impairments : 2 million people in the UK have a sight problem. Of these, 1 in 10 people over 75 years and 1 in 3 over 90 years has a significant visual impairment (RNIB, 2007). Over 6 million people over 60 years are deaf or hard of hearing ( RNID, 2007) . Depression: A quarter of older people living in the community have symptoms which warrant intervention. Around half of these meet the clinical criteria for a diagnosis of depression. Dementia: 683,597 people in the UK have a diagnosis of dementia of these 1 in 20 people are over 65 years and 1 in 5 people are over 80 years.
Associations between housing and health exist. They support the argument that good quality housing has a role to play in both physical and mental health
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
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
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
Why is this important? Policy Trends 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.
Prevention package Mental health – new horizons Quality accounts New regulatory system Personal health budgets Dementia strategy Stroke strategy End of life care strategy Primary care strategy Transforming community services LINks and local accountability Physical activity strategy POPPS World class commissioning HEALTH
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 (DoH 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.
Cancer – incidence increases with age – of the 135,000 deaths in 2004, three quarters occurred in people aged 65 and over.
Arthritis – Osteoarthritis affects about 60% of men and 70% of women aged over 65.
Osteoporosis – Up to 14,000 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). The incidence increases with age.
Sensory impairments - 2 million people in the UK have a sight problem. Of these, 1 in 10 people over 75 years and 1 in 3 over 90 years has a significant visual impairment. Over 6 million people over 60 years are deaf or hard of hearing.
Depression – The commonest mental health condition in the older population. A quarter of older people living in the community have symptoms which warrant intervention. Around half of these meet the clinical criteria for a diagnosis of depression.
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.
All those who want to work, need to be in work – however older workers are particularly disadvantaged by lack of educational qualifications - employment rates are significantly lower for those with no qualifications whatsoever Mental activity like learning can also slow cognitive decline reduce morbidity and facilitate healthier lives
Lack of interest and feeling too old are the man barriers to learning as people get older.
The number of people undertaking learning decreases significantly with age Why is this important? Policy Trends What do older people think?
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
Access to learning centres becomes more difficult with age – with FE colleges, adult education centres and the home being main locations of learning WORK AND LEARNING
Flexible New Deal;
Train to Gain programmes;
Pathways to work;
Extending Working Life proposals;
Age Positive initiative on employer attitudes
Digital inclusion strategy
Informal adult learning white paper though funding largely focused
on skilling “adults of working age” up for joining/re-joining the
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
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
In line with other OECD countries, Britain has adopted Active Labour Market Policies (ALMPs) to combat unemployment and economic inactivity.
Government initiatives have generally been designed to combat :
Youth unemployment, particularly longer-term unemployment (e.g. Future Jobs Fund announced in 2009 Budget) and
the high cost of unemployment benefits (Welfare Reform)
Incentives to stay at work likely to increase (ELSA Wave 3)
Why is this important? Policy Trends 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.
The employment rate of those over SPA remains relatively small at 8.8% (Nov 2010), although those between 50-State Pension Age have closed the employment rate gap on the 16-SPA group by 5.3% since 1993.
ELSA respondents report increasing expectation of working longer
Increasing the female SPA may also lead to higher employment rates
According to the latest LMO survey (Summer 2009), employers say they are more likely to recruit 19–24-year-olds (63%) and older workers (60%).
Employment rates of people aged above SPA vary considerably between regions (range of 8.8% up to 14.3%)
Poor health, absence of qualifications, and caring responsibilities are key barriers to employment, and these barriers can interact with each other
Redundancy rates during the recession have increased more slowly in the 50+ age group than any other.
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 post SPA.
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)
Currently developments led by market not by Government policy
Pension reform, including introduction of auto enrolment from
2012 (DWP developing 10 yr pension communication strategy)
Money guidance service being developed following Throresen review
Range of govt info services including ageing strategy, one-stop-shop and increased collaboration with Third Sector, but unclear how these link up
Financial services sector doesn’t understand what opportunities are available for them in care funding/equity release/advice
Need for Govt. to oversee private financial industry solutions
Why is this important? Policy Trends 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):
Increasing reliance on private sector, complexity in products on offer
Individual exposure to risk – more individuals are directly exposed: 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 of websites as 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.
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 to live in older, non-decent homes (English House Condition Survey, 2009)
Why is this important? Policy Trends What do 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
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
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)
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).
Empowering older people with supported self-care
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 has increased (from 14% to 27%), many older people continue to be excluded from the benefits of new technologies (Age Agenda 2008, Age Concern).
As people age, the risk of being lonely increases For details of trends in volunteering and digital inclusion, see Appendix
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)
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 mil 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
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.
One person households are projected to overtake married couple households by 2030 Why is this important? Policy What do older people think? Satisfaction with current levels of social interaction could be a barrier to individuals building up social networks Trends SOCIAL INCLUSION 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