13Mar14 - One Year On


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Are we ready to make the UK the best country to grow old in?

One year ago, the House of Lords Committee on Public Services and Demographic Change produced a hard-hitting report which argued that the Government and society was “woefully underprepared” for a rapidly ageing population.

On the first anniversary of the ‘Ready for Ageing?’ report, we are in the unenviable position that sees the United Kingdom ranked unlucky number 13 in a global index of the best countries in the world to grow old in. The principal recommendations in the ‘Ready for Ageing?’ report have not yet been properly addressed or acted on.

In his October 2013 speech on ‘The Forgotten Million’, Secretary of State for Health, Jeremy Hunt MP, set down a challenge that the UK should in fact aspire to be best country to grow old in, but the question remains: why are our public services so poorly prepared for major demographic change, and what as a society can we do to ensure future generations of older people thrive in later life?

Lord Filkin, Chair of the Committee on Public Services and Demographic Change, hosted a House of Lords breakfast debate looking forward to 2030, a date by which there will be 50% more people aged 65 and over in England and a doubling in the numbers of people aged 85 and over. As a society, we need to prepare for the next 15 years right now and certainly in the next Parliament.

At this event, Independent Age and ILC-UK, supported by members of the Ready for Ageing Alliance, launched 2030 Vision: Making the UK the best country to grow old in, which will look to the long term and consider what politicians and policy makers need to now, both in preparation for next year’s General Election, and between 2015 and 2020, to prepare for the long term opportunities and challenges ahead.

During the debate, we invited contributions on the economic and societal implications of population ageing and the major policy decisions all the main parties face to ready the UK and its public services for dramatic population ageing.

It’s clear that our political, social and cultural approach towards old age today is already hopelessly out of date, so this event will provide Parliamentarians and stakeholders from across civil society with an opportunity to mark the first anniversary of the House of Lords’ Committee report on demographic change and look ahead, so as a society we can seize the opportunities presented by an ageing population.

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  • If the UK population experiences an increase in its highly dependent, frail elderly (e.g. persons with dementia), then we will need to take of them. Such care falls largely on family members but often the frail must be cared for in nursing homes. Are there going to be enough family members and professional carers for this vital role.After the October 2012 Hearings, Lord Filkin asked me to provide confidence intervals around the national projections and I supplied a memorandum which was included in the Evidence volume. From the projected numbers of people by age I computed what is known as the very old age support ratio, which relates the numbers aged 85 and over (at highest risk of high dependency) to the population aged 50-64 (where most of their children are located). You can see from the table that this declines precipitously from 2010 to 2050 by 63%. The 95% confidence interval estimated here is quite narrow, though subsequent work suggests it is more like the 80% confidence interval.What can we do about the coming tsunami of demand for carers?Limit the demand: maintain the health of the potential highly dependent for as long as possible. E.g. better health checks by GP practices, raise the take up of flu and pneumonia immunisation, Tai Chi for elders every dayImprove carer productivity: e.g. develop the use telecare much more in people’s own home and in care homesMaintain the supply of carer labour: don’t turn off the immigration flow of people into caring, people from other countries are a vital resourceOff-shore the care of the frail elderly to cheaper countries (e.g. India)The Very Old Age Support Ratio is important for assessing the potential numbers of carers available in future in relation to the numbers potentially needing care. Here the support ratio declines severely and the uncertainty becomes considerable though there are changes both upwards and downwards. Fortunately, the Queen’s speech earlier in May 2013 indicated that some of the Dilnot Commission’s proposals on the funding of care of the infirm elderly are to be implemented. However, the Ready for Ageing report suggests that the need to go further in implementing the Dilnot proposals.
  • 13Mar14 - One Year On

    1. 1. One year on: Are we ready to make the UK the best country to grow old in? Thursday 13th March 2014 This event is kindly supported by members of the Ready for Ageing Alliance #future2030
    2. 2. Lord Filkin CBE Chair Centre for Ageing Better Chairman Public Service and Demographic Change Committee This event is kindly supported by members of the Ready for Ageing Alliance #future2030
    3. 3. Julia Unwin CBE Chief Executive Joseph Rowntree Foundation This event is kindly supported by members of the Ready for Ageing Alliance #future2030
    4. 4. Professor Phillip Rees CBE Professor Emeritus, School of Geography University of Leeds This event is kindly supported by members of the Ready for Ageing Alliance #future2030
    5. 5. A Review of Trends in Life and Health Expectancies for the UK, with an International Comparison Philip Rees School of Geography, University of Leeds, Leeds LS2 9JT, UK E: p.h.rees@leeds.ac.uk Presentation at the International Longevity Centre/Independent Age Meeting at the House of Lords, Thursday 13th March 2014
    6. 6. Table: Trends and Projections of Period and Cohort Life Expectancy, 1982-2062 Life table Gender Years Life Expectancies Annual Change (arithmetic) 1982 2012 2042 2062 1982- 2012 2012- 2042 2042- 2062 Period MEN Age 0 71.1 79.0 84.7 87.3 0.26 0.19 0.13 Age 65 13.0 18.3 22.8 24.9 0.18 0.15 0.11 WOMEN Age 0 77.0 82.7 87.9 90.3 0.19 0.17 0.12 Age 65 17.0 20.7 25.2 27.2 0.12 0.15 0.10 Cohort MEN Age 0 85.1 90.6 95.1 98.0 0.18 0.15 0.15 Age 65 14.2 21.2 24.7 27.0 0.23 0.12 0.12 WOMEN Age 0 89.2 93.9 98.0 100.7 0.16 0.14 0.14 Age 65 18.0 23.9 27.2 29.5 0.20 0.11 0.12 Gaps PERIOD Age 0 5.9 3.7 3.2 3.0 -0.07 -0.02 -0.01 Age 65 4.0 2.4 2.4 2.3 -0.05 0.00 0.00 COHORT Age 0 4.1 3.3 2.9 2.7 -0.03 -0.01 -0.01 Age 65 3.8 2.7 2.5 2.5 -0.04 -0.01 0.00 Source: ONS (2013) National Population Projections, 2012 Based Principal projection, Mortality assumptions Trends in life expectancy, past and future, UK • There is a rapid increase in LEs in the past 2 decades, slows down in the next 50 years • Men have caught up with women over the past 2 decades, but this catch up will not continue much further in the next 5 decades • The cohort LEs are better indicators for individuals and social policies but they depend on projections of age-specific mortality
    7. 7. The projected life expectancies are uncertain and so therefore are the projected numbers of older people  How many UK centenarians will there be in 2113?  ONS say the number of 2013 babies surviving to 2113 could be as low as 47k and as high as 530k, based on the lowest and highest life expectancy variants  Rees 2013 said that the 95% confidence interval based on a set of 19 projections of the UK’s population for 100 year olds in 2050 was 59k to 367k  Keilman 2013 said that this confidence interval was too conservative and likely to be ~0k to ~720k, based on a 1,000 simulations using the Uncertain Population of Europe methodology
    8. 8. Table: Time Series of Life and Health Expectancies, Great Britain, 1981-2011 Age, sex Indicator 1981 1991 2001 2000-02 2008-10 At birth Men Life Expectancy 70.9 73.2 75.7 75.7 78.1 Notes: GH3-HE 64.4 66.1 67.0 66.8 Indicators GH5-HE 60.4 63.9 GH3-HE = General Health 3 Category Health Expectancy YNGH (GH3) 6.5 7.1 8.7 8.9 3 Categories = "Good", "Fair", "Poor" YNGH (GH5) 15.3 14.2 LLI-HE 58.1 59.1 60.5 60.4 64.4 GH3 Good Health = "Good" and "Fair" YWD 12.8 14.1 15.2 15.3 13.7 GH5-HE = General Health 5 Category Health Expectancy Women Life Expectancy 76.8 78.7 80.4 80.4 82.1 5 Categories = "Very good", "Good", "Fair", "Bad", "Very Bad" GH3-HE 66.7 68.6 68.8 69.9 GH5-HE Good Health = "Very Good" and "Good" GH5-HE 62.4 66.1 YNGH (GH3) 10.1 10.1 11.6 10.5 LLI-HE = Long standing Illness Health Expectancy YNGH (GH5) 18.0 16.0 LLI-HE 60.8 61.6 62.7 62.9 65.4 YNGH= Expected Year Not in Good Health YWD 16.0 17.1 17.7 17.5 16.7 YWD = Expected Years With Illness, Disability or Infirmity At age 65 Men Life Expectancy 13.0 14.2 15.9 16.0 17.9 Source: Office for National Statistics GH3-HE 9.9 10.8 11.6 11.9 Health Expectancy Statistics GH5-HE 9.4 10.2 YNGH (GH3) 3.1 3.4 4.3 4.1 YNGH (GH5) 6.6 7.7 LLI-HE 7.6 7.9 8.8 8.8 10.5 YWD Women Life Expectancy 16.9 17.9 19.0 19.0 20.5 GH3-HE 11.9 13.0 13.2 14.0 GH5-HE 10.8 11.7 YNGH (GH3) 5.0 4.9 5.8 5.0 YNGH (GH5) 8.2 8.8 LLI-HE 8.5 9.3 10.1 10.3 11.3 YWD 1981 to 2001: HEs increase more slowly than LEs 2000-02 to 2008-10: HEs increase faster than LEs, at birth Trends in life and health expectancies and years not spent in good health
    9. 9. Global Burden of Disease 2010 Study Results for the UK Source: Salomon et al. (2012) Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010, Lancet 2012; 380: 2144–62 Sex, indicator 1990 2010 Change MEN Life Expectancy 72.9 77.8 +4.9 Healthy Expectancy 62.8 65.7 +2.9 Years without Good Health 10.1 12.1 +2.0 WOMEN Life Expectancy 78.3 81.9 +3.6 Healthy Expectancy 65.9 67.9 +2.0 Years without Good Health 12.4 14.0 +1.6 GBD2010 estimates for health prevalence rates uses disease incidence data rather than survey data on self- reported health The GBD2010 results show continuing morbidity expansion but misses detailed changes that could have occurred in the 2000s compared with the 1990s
    10. 10. Figure 1: Age-specific mortality in the UK Ranks among 15 EU members + 4 Others (AU,CA,US,NO) B: Men, C: Women Source: Murray et al. (2013) UK health performance: findings of the Global Burden of Disease Study 2010, Lancet, http://dx.doi.org/10.1016/S0140- 6736(13)60355-4 The UK ranks worsen up to ages 50-54. UK ranks poorly in the older ages but ranks for men have improved for ages 65-69 and 70-74 How does the UK compare?
    11. 11. Source: Rees et al 2013 The Implications of Ageing and Migration for the Future Population, Health, Labour Force and Households of Northern England, Applied Spatial Analysis and Policy, DOI 10.1007/s12061- 013-9086-7 What if favourable trends for 2000-2010 continued?
    12. 12. Study Matthews et al. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II, Lancet 2013: 832: 1405-12, http://dx.doi.org/10.1016/S0140-6736(13)61570-6 Interpretation This study provides further evidence that a cohort effect exists in dementia prevalence. Later-born populations have a lower risk of prevalent dementia than those born earlier in the past century. Study Christensen et al. Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart Lancet 2013; 382: 1507–13 http://dx.doi.org/10.1016/S0140-6736(13)60777-1 Interpretation Despite being 2 years older at assessment, the 1915 cohort scored significantly better than the 1905 cohort on both the cognitive tests and the activities of daily living score, which suggests that more people are living to older ages with better overall functioning. Two recent studies show lower dementia prevalence for British and Danish cohorts Steve Connor, “Moderate but regular exercise can boost the size of the parts of the brain that shrink with age, according to scientists who believe that light physical activity is one of the best ways of preventing senile dementia.” The Independent, 17 February 2014
    13. 13. Confidence in very old age support ratios (Pop aged 50-64/Pop aged 85+) Year Median projection Percentile 97.5 Percentile 2.5 95% Percentile Interval PI as % Median 2010 8.32 8.22 8.59 0.37 4 2020 7.89 6.07 7.60 1.53 19 2030 5.65 4.57 5.78 1.21 22 2040 3.64 3.48 4.28 0.80 22 2050 3.11 2.66 3.68 1.02 33
    14. 14. Source: The Independent, 17 February, 2014
    15. 15. Andrew Kaye Head of Policy and Campaigns Independent Age This event is kindly supported by members of the Ready for Ageing Alliance #future2030
    16. 16. Rt Hon Paul Burstow MP Member for Sutton and Cheam This event is kindly supported by members of the Ready for Ageing Alliance #future2030
    17. 17. One year on: Are we ready to make the UK the best country to grow old in? Thursday 13th March 2014 This event is kindly supported by members of the Ready for Ageing Alliance #future2030