ILC-UK/Actuarial Profession Robert Butler Memorial Lecture, in partnership with Age UK and JRF - David Sinclair
Robert Butler Memorial Lecture and Debate onCentenarians and Oldest Old 29 November 2011 This event is kindly supported by JRFThe ILC-UK work on “Centenarians and Oldest Old” is supported by Age UK
Centenarians and Oldest Old David Sinclair ILC-UK This event is kindly supported by JRF The ILC-UK work on “Centenarians and Oldest Old” is supported by Age UK
Who wants to live forever. Centenarians and the oldest oldInternational Longevity Centre -UK
Centenarians and the oldest old• While advances have been made in researching antecedent factors that predict living to 100, less attention has been paid to life as a centenarians• The body of evidence on http://www.flickr.com/photos/pondspider/4170990903/ sizes/m/in/photostream/ centenarians is far from consistent or extensive (hence looking at oldest old).
Limitations• Panel surveys tend to have a very small sample of the oldest old (IFS, 2010, p 229).• “Those who were very ill or frail had higher dropout rates, and people in worse health were less likely to be re-contactable”. Chatfield et al (2005)• “a strong link between attrition and cognitive decline…cognitive decline may be underestimated by epidemiological studies as a result”• Are the predictions right?
How many centenarians are there?• There are currently 11,800 people in the UK who are currently at least 100 (DWP)• There are fewer than 100 people who are aged more than 110. (DWP)• In 1911 there were just 100 Centenarians living in England & Wales• Growth has been about 7% http://www.flickr.com/photos/un_photo/5 p/a 832685007/sizes/z/in/photostream/
How likely is it that we will reach 100? The likelihood of living from birth to 100 might have increased from 1 in 20 million to 1 in 50 for females in low- mortality nations, such as Japan and Sweden. (Vaupel and Jeune, 1995) http://www.flickr.com/photos/iain_ritchie/2739823588/ sizes/z/in/photostream/
Number of people currently alivewho can expect to see their 100th birthday, by age in 2010
Public policy seems oblivious to the growth• Opportunity Age: did not mention centenarians (2005)• Lifetime Homes, Lifetime Neigbourhoods: Mention of centenarians in passing.• Don’t Stop Me Now, Audit Commission (2008). Mentioned that services for a 50 year old may be different to services for an 80 year old• Building a Society for All Ages (2009) growth in the number of centenarians as a reason “why we need to go further”
But are the predictions right?In Population Trends, 1999,Thatcher projected a rise inthe number of centenarians to95,000 by 2066 (Thatcher,1999).By 2010 the DWP and ONSwere projecting that therewould be at least 507,000people in the UK aged 100 orover in 2066. http://www.flickr.com/photos/drs2biz/71468437/sizes/m/ in/photostream/
More than 230,000 Japanese centenarians missing
The majority of centenarians are femaleIn 2003, among the oldest oldthere were 257 women forevery 100 men.(Tommassini2005).Between 2001 and 2006,the number of men agedbetween 90 and 99increased by 24 per centwhereas for women theincrease was just over 8%(Dini and Goldring. 2008).
And they live in Southern England In the UK, a higher concentration of the oldest old live in Southern England and a lower proportion in urban areas and Northern Ireland. http://www.flickr.com/photos/lawrence_chernin/5716015430/sizes/z/in/phot (Tomassini C, ostream/ 2005)
Life is not easy for the oldest old• Three quarters of the oldest old suffer from limiting longstanding illnesses, and one out of three perceive themselves as being in poor health. (Tomassini C, 2005) http://www.flickr.com/photos/pondspider/4170• “almost 50% of men and 990903/sizes/m/in/photostream/ women aged 80-84 report severe limitations in activities” (IFS, 2010)
And many find it difficult to do day to day tasks Sixty per-cent of over 90s report difficulties shopping for groceries, almost a quarter report difficulties http://www.flickr.com/photos/pinkchoc making telephone calls and olate/3039589789/sizes/m/in/photostr eam/ 35% report difficulties managing money. (Sinclair, 2010/ELSA)
But dependency is not inevitableDependency is notinevitable and a”considerableproportion of thecentenarians maintaina good level of auto http://www.flickr.com/photos/driever/5525684658/sizes/m/in/phsufficiency for the otostream/basic performance ofthe everyday life”.(Antonini et al, 2008)
Many live independently• Substantial numbers of centenarians and nonagenarians continue to live independently in the community, either alone or with family members.• 8% of those aged 90 and over were living in privately rented accommodation and 30% in socially rented accommodation. 2009 Understanding Society
A relatively high proportion live alone Of those living in private households, four in ten very old men and seven out of ten very old women live alone. One out of five very old people live in communal establishments. (Tomassini C, 2005). http://www.flickr.com/photos/sbeebe/515416979 5/sizes/m/in/photostream/
And the proportion living alone is growing.Over the last 20 yearsthere has been asignificant increase in theproportion of the oldest oldliving alone. The likelihoodof the oldest old men livingalone has grown by one-third for men and onequarter for women. http://www.flickr.com/photos/driever/55256846(Tomassini C, 2006). 58/sizes/m/in/photostream/
Many, but not all, have adapted their homesResearch finds that the oldest old are muchmore likely than other ages to have hadmade adaptations to their homes. Forexample. 40% of over 90s have had handrails installed (compared to 16% of all over50s), 41% had bathroom modifications(compared to 15% of all over 50s), and 24%are likely to have an alerting device(compared to 6% of the over 50s). (Atkinsonand Hayes (2010).
Centenarian as a model for healthy ageingA substantial number ofcentenarians remain physicallyhealthy and cognitively intact intothe last years of their lives.Health and functional status ofcentenarians shows they arehealthy and independent for mostof their lives and experience arelatively rapid terminal decline”. http://www.flickr.com/photos/jess e55lv/455360558/sizes/m/in/phot ostream/(Hitt et al, 1999).
Self reported health is pretty good?(Just?) One in of three ofthe oldest old perceivethemselves as being inpoor health. (TommassiniC, 2005).“despite substantial levels http://www.flickr.com/photos/animm/4333568373/sizes/m /in/photostream/of disease andimpairment”. Collerton,Davies and Jagger (2010)
Most centenarians consult their GP 98% of centenarians and near centenarians consulted a GP and received prescription medicine during follow up. (Roughead, Kalisch et al, http://www.flickr.com/photos/rwjensen/2288339230/sizes/m/in/photostrea 2010) m/
Centenarians do use drugs heavilyA study of 602 centenarians in Italy found that avery high proportion of this age group wereusers of drugs. They identified just 5% of thisgroup who did not take any drugs. 13% ofparticipants took one drug a day, 16% took 2drugs per day, 65% took three drugs a day, and5.5% took more than 3 drugs a day.
Some evidence of longer hospital stays26 centenarians who had suffered from a hipfracture between 2000 and 2007 and comparedthem to a randomly selected control group of 50hip fracture patients aged between 75 and 85. “themean stay in acute orthopaedic wards forcentenarians was 20.7 days and for the controlgroup was 14.9 days”. They suggested that thelonger acute hospital stay in our centenarian cohortwould amount to a mean extra cost of £ 2511 perpatient. (Verma et al)
Dementia among centenariansThe prevalenceof dementia-freesurvival past100 years ofage variedbetween 0 and50 percent.” http://www.flickr.com/photos/thousandshipz/4679235/sizes/m/in/photostream/
Depression• “23% of those aged 85 and over had levels of depressive symptoms indicative of clinical relevance”• “Almost 13% of men and women aged 80 and over had high levels of depressive symptoms in 2008-09 but not in 2002-03” (IFS, 2010) http://www.flickr.com/photos/junglearctic/ 3002442666/sizes/m/in/photostream/ ELSA
Falls• 60% of interviewees aged over 90 had had a fall and that of these, 4 in five were unable to get up after at least one fall and almost a third had lain on the ground for an hour or more.• Call alarms were widely available but not used.(Fleming and Brayne, 2008; Cambridge Cityover 75-Cohor. BMJ)
OAP recovering after getting trapped in bath for 5 days
Poverty is a very real challenge• There is evidence that the oldest old (aged 85 and over) are, as a group, at greater risk of poverty than younger older people (aged 65-85) (National Equality Panel, 2010).• Up to 10% of the oldest old have total net wealth of £3,000 or less (Banks and Tetlow, 2009).• Yet, over 61% of over 90s report that they never have too little money to spend on their needs. (Sinclair, 2010)
Their family carers are likely to be olderThe advanced age ofcentenarians means thatfamily caregivers are alsolikely to be relatively old.Younger cohorts of retiredpeople (50-74 years) oftenprovide care for their veryold relatives and, even ifuntrained and unmonitored,have a significant role ascaregivers (Richmond,2008).
Quality of life for oldest old – getting worse?“longitudinal analysescomparing 2002-03 and2008-09 show that mostof the oldest oldexperienced a substantialdecrease in quality of lifeover the period. Just over10% experienced asubstantial improvementof 5 or more points” (IFS,2010) http://www.flickr.com/photos/anabadili /2963913137/sizes/m/in/photostream/
Recommendations• Energy companies to ensure that their oldest customers access the best deals• Employers to ensure that they find ways to provide flexible working to ensure that caring responsibilities do not pull people out of the workforce early.• The Government should introduce a care voucher scheme for adults, similar to childcare vouchers, which would allow people of all ages to buy care vouchers to support the needs of older adults. This may help older carers of centenarians stay in the workplace longer.
Recommendations• Significant development of the evidence base about centenarians in order to inform current and future ageing strategies.• Policy-makers to take a more holistic approach to designing interventions that integrate health, care and housing solutions.• Developers to plan for growing numbers of centenarians through ensuring that housing and neighbourhoods are better designed and/or adequately adapted to meet the needs of a growing centenarian population
David SinclairInternational Longevity Centre UKdavidsinclair@ilcuk.org.uk@sinclairda@ilcuk