To aid service planning it is important to understand the future demand for services. The population is expected to rise in the coming years, people will on average live longer. Increasing longevity can be attributed to numerous factors including improved living conditions and better healthcare. As the numbers of the oldest in the population expand, the demand for NHS and social services will increase. It is therefore ever more important to understand demographic trends, where need exists and to evaluate service provision to ensure that it is appropriate and sufficient.
In those aged 65 and over the leading causes of death in England are circulatory disease (coronary heart disease, stroke and other circulatory problems) followed by cancers and respiratory disease. These three account for 84% of deaths in men and 75% in women. The most common chronic disease is arthritis, which can be very disabling. Sensory and visual impairment is also increasingly common with age and can seriously affect quality of life and the ability to perform daily tasks.
Another way of identifying needs are to look at which diseases cause the most early deaths (under 75 years).
2005 2020 Gloucester 5.0% (4,437) 5.7% England 5.8 (2.3m) 7.3 Gloucester Males 6.0 (2,617) 7.0 Gloucester Females 4.0 (1,820) 4.4 Vascular Disease: Heart, stroke, diabetes, kidney 200,000 deaths per year (38% total) > £20 billion NHS budget Major cause of adult disability (£ to be estimated) 50% mortality gap between rich and poor
One in five people over 80 has a form of dementia and one in 20 people over 65 has a form of dementia. Typically symptoms will include: • Loss of memory – for example, forgetting the way home from the shops, or being unable to remember names and places. • Mood changes – these happen particularly when the parts of the brain which control emotion are affected by disease. People with dementia may feel sad, angry or frightened as a result. • Communication problems – a decline in the ability to talk, read and write. Delaying the onset of dementia by five years would halve the number of UK deaths due to dementia to 30,000 a year. According to the 2003 World Health Report Global Burden of Disease estimates, dementia contributed 11.2% of all years lived with disability among people aged 60 and over; more than stroke (9.5%), musculoskeletal disorders (8.9%), cardiovascular disease (5.0%) and all forms of cancer (2.4%). ................................. Median survival with Alzheimer’s disease at 7.1 years (6.7–7.5 years) Vascular dementia 3.9 years (3.5–4.2 years). Possibly 80,000 deaths per year The contribution of dementia to mortality is difficult to assess, as people with dementia often have one or more comorbid health conditions that may or may not be related to the dementia process, and which themselves may hasten death. Death certificates are acknowledged to be an imperfect source of information on dementia-related mortality
• The nature of activities older people may choose to spend time on depends on their health, living arrangements and financial circumstances. The take up of leisure activities is generally lower for people in older age groups, due to declining health and Mobility
It is important that adequate disease prevention, effective treatment regimes and early intervention are in place and that consideration is also given to wider determinants of health such as housing, education, transport, income and the environment.
We can identify the gaps in life expectancy between the most affluent and most deprived but how would you change this?
Can look at the disease groups where the most gains can be made for the most deprived groups.
Demography Seminar - Liz Rolfe, South West PHO (05.11.2009)
<ul><li>Health Inequalities within an Ageing Population </li></ul><ul><li>SWO seminar – Gloucestershire LIN </li></ul><ul><li>Liz Rolfe </li></ul><ul><li>5 th November 2009 </li></ul>
Health Inequalities within an Ageing Population <ul><li>Population changes </li></ul><ul><li>Key aspects of mortality and morbidity </li></ul><ul><li>The importance of prevention </li></ul><ul><li>The effects of inequalities </li></ul>
An ageing population <ul><li>England : The proportion of the total population aged 65 and over </li></ul>Source :Office of National Statistics http://www.statistics.gov.uk/downloads/theme_population/NPP-2006/NPP06_NSOnline.pdf
An ageing population <ul><li>The predicted increase in population for all ages and those aged 75 and over in South West PCTs 2006-2020 </li></ul>Source : ONS Sub National Population Projections, www.statistics.gov.uk/ snpp / accessed September 2008
Cause of Death <ul><li>2007 </li></ul>Source: Office of National Statistics Mortality data DH1
Cancer <ul><li>Predicted cases for 2020 and mean actual diagnoses in 2004-2006 (ICD10 C00-C97 excluding C44 non-melanoma Skin Cancer) for Primary Care Trusts in the South West </li></ul>Source: SWPHO Cancer Registry (SWPHO forthcoming report)
Dementia <ul><li>One in five people over 80 years </li></ul><ul><li>Estimated over 680,000 people with dementia in the UK </li></ul><ul><li>Forecast to rise by 38% by 2021 (over 900,000 people) and 154% by 2051 (1.7m people) </li></ul><ul><li>62% (over 400,000) have Alzheimer’s disease </li></ul><ul><li>Contributes 11% of all years lived with disability among people aged 60 and over, more than stroke, cancer or cardiovascular disease (2003 World Health Report Global Burden Of Disease) </li></ul><ul><li>Overall, 10% of deaths in men over 65 years, and 15% of deaths in women over 65 years may be attributable to dementia. </li></ul><ul><li>Total cost of dementia in the UK is £17.03 billion </li></ul>Source: Dementia UK
Prevention – Dementia example <ul><li>If onset of dementia could be delayed by 5 years, by a combination of improvements in public health (cardiovascular risk factor reduction and diet) and specific preventive treatments. </li></ul><ul><li>This would halve the prevalence of dementia in each five year age band and, in principle, halve the numbers of death attributed here to dementia – saving nearly 30,000 lives annually. </li></ul>
Participation in sports, games or physical activity
SWPHO work programme 2009/10 <ul><li>Health of older people </li></ul><ul><ul><li>predicted trends and changes in mortality and morbidity </li></ul></ul><ul><li>Demographic profile </li></ul><ul><ul><li>migration adjusted life expectancy </li></ul></ul><ul><li>Public Health chapter </li></ul><ul><ul><li>State of the South West 2010 </li></ul></ul>
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