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David Melzer: Health care quality for an active later life


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Dr David Melzer, Professor of Epidemiology and Public Health at the University of Exeter Medical School, spoke at our conference, Making health and care services fit for an ageing population. David analysed the UK's performance in preventing later life disease and disability and considered how well we are delivering treatment for the common disabling diseases of later life.

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David Melzer: Health care quality for an active later life

  1. 1. Professor David Melzer University of Exeter Medical School
  2. 2. Quantitative evidence (~previous 5 years):   As a country, how successful have we been in preventing later life disease and disability? How well are we delivering high quality medical treatments for the common disabling diseases of later life?
  3. 3.        prevention or treatment of common conditions Having a clear connection to the well-being of older people Based on substantial research Representative of large segments of the ageing population Based on reliable, preferably nationwide data Easy to understand by a wide range of audiences Balanced, so that no single area dominates the report Section Section Section Section 1: 2: 3: 4: Population, disease prevalence Health risks Quality of treatment for common conditions Older people’s experiences
  4. 4. Source data: General Lifestyle Survey, ONS 201151 Figure 20: Smoking trends in men and women aged 50+ years, England, 1974 - 2009
  5. 5. Image from Chart 15: Major reductions in coronary heart disease death rates Source: Scarborough et al, 201040 Figure 15: Age-specific death rates from coronary heart disease (CHD) in men aged 35+ years, UK, 1968 to 2008.
  6. 6. Source: ONS, 2011 Figure 14: Mortality by major cause, in men and women (all ages), England and Wales, 1911-2010
  7. 7. doing well, but could do better? Figure 3: International changes in life expectancy in men and women at age 65, 1980-2007 Source data: OECD Health Data 2011 - Frequently Requested Data, Update - November 2011 LTH_STAT
  8. 8. Image from The Guardian, Feb 2013 Source data: Scarborough et al, 201040 Figure 21:Prevalence of obesity in men and women age 55+ years, England, 1994-2008
  9. 9. Chart 31: Diabetes – an epidemic unfolding Source data: HSE, 200958 Figure 31: Percentage of respondents with doctor diagnosed diabetes (all types) in men and women aged 55+ years, England, 1994-2009
  10. 10. Chart 27: Burden of disease: 60+ years old – much is potentially avoidable Source data: World Health Organisation: Last visited 30/04/2012 Figure 27: Proportion of ‘Disability Adjusted Life Years’ (DALYS) in high-income countries of the European region caused by specific risk factors in people aged 60+
  11. 11. Chart 18: Social inequalities – shorter lives with more disability Source data: Health Statistics Quarterly 50, summer 2011, ONS48 Figure 18: Life Expectancy with Disability (LEWD) and Disability Free Life Expectancy (DFLE) for men and women at age 65 years, by Index of Multiple Deprivation (IMD) 2007 quintile, England, 2006–08
  12. 12. Chart 41: Common mental health problems – accessing treatments Source data: Cooper et al120 2010 Figure 41: Adjusted odd ratios for those accessing mental health treatments: Comparison of older age groups with the 16-34 age group, England, 2007 Note: Significant trend with age, but wide CIs for individual age-groups
  13. 13. Assessing the Care of Vulnerable Elders Steel et al, BMJ 2008 Based on ELSA respondents - 2004/5 Condition No of quality indicators % Quality indicators achieved (95% CI) Ischaemic heart disease 5 83 (79.7 to 86.4) Hearing problems 2 79 (76.7 to 81.1) Diabetes 5 74 (72.2 to 76.0) Depression 3 64 (57.3 to 69.8) Osteoporosis 2 53 (49.3 to 57.2) Urinary incontinence 4 51 (47.2 to 54.2) Falls 2 44 (36.5 to 50.6) Osteoarthritis 4 29 (26.0 to 31.9) Conditions with 2+ indicators, From Steel et al, BMJ 2008
  14. 14. Image from Merck Manual 30 Percentage 25 20 15 10 17.1% 16.0% 50-64 65-74 Age bands 19.8% 5 0 75+ Source data: ELSA 2010 Figure 34: Percentage of people aged 50+ years with diabetes who reported not receiving their annual foot check. ELSA, 2010
  15. 15. Image from BBC News Source data: ELSA 2009 – graph updated 2013 Figure 39: Percentage of people aged 65+ years who reported falling and who answered “no” when asked if a doctor or nurse had tested balance or strength or watched the respondent walk
  16. 16. Image from 80 70 Percentage 60 50 40 30 20 55.8% 62.8% 43.6% 10 0 50-64 65-74 75+ Age bands Source data: ELSA 2010 – graph updated 2013 Figure 37: Weighted percentage of people aged 50+ years with painful osteoarthritis who answered “no” when asked if a doctor had ever recommended physiotherapy or an exercise programme. ELSA, 2010 Chart revised by Luke Mounce 2013, using Wave 5 ELSA data
  17. 17. Conditions Difference: Achievement % (CI) (%, p-value) 75.2 80.1 4.9 (73.0 to 77.4) (78.6 to 81.7) p=0.023 40.7 37.7 -3 (37.9 to 43.6) Geriatric 2008-9 or 10-11 Achievement % (CI) General Medical 2004-5 (36.1 to 39.3) P=0.25 Table: Achievement rates aggregated by condition category, adjusted for weighted data, for subset of indicators from 2004-5 that were repeated in 2008-9 or 2010-11 (data from ELSA study)
  18. 18. Chart 42: Cancer – a disease of ageing Source data: Cancer Research UK Date accessed: 21st March 2012 Figure 42: Average number of all cancers (excluding non-melanoma skin cancer) per year by age group, UK, 2006-8
  19. 19. Chart 45: Cancer survival – international comparison Source data: Table 14, Web appendix, Coleman 2010134 Figure 45: Age-specific relative survival estimates (%) at five years for colorectal cancer for ages 55-99, international comparisons, 2005–2007
  20. 20. Image from healthcare Chart 48: Sicker people’s experiences of poor care coordination – international comparison Similar pattern for medical errors Source: Commonwealth Fund International Health Policy Survey, 2011 Figure 48: Percentage of patients self-reporting gaps in coordination of services in the past two years, all adults, international comparisons, 2011
  21. 21. Including:  Obesity (physical inactivity) /diabetes prevention ◦ a major threat to health in later life   Percentage of population aged 65 and over EU-27 2035 help for 20% of 65-74 yr olds still smoking Improving quality of treatment especially for: ◦ the ‘geriatric’ and disabling syndromes  E.g. Incontinence, falls, bone health, mental health ◦ Cancer in later life as chosen)  (awareness, early diagnosis, treatment But - lots of data poor areas ◦ severity & functional impact, use of ‘geriatric assessment’ approaches in primary care, oldest old etc Source: Office for National Statistics, Eurostat Population Ageing in the United Kingdom, its Constituent Countries and the European Union Date: 02 March 2012
  22. 22. Nick Steel et al, UEA (Acove) Exeter Ageing Research Group Members: Prof Paul Dieppe: Professor of Medical Education and Consultant Rheumatologist, PCMD Prof William Henley: Professor of Medical Statistics, PCMD & PenCLAHRC Colleague advisors: Dr Susan Bedford: Dr Richard Byng: Prof John Campbell: Dr Phil Evans: Dr Slav Pajovic: Dr Jonathan Powell: Public Dr David Strain: Dr Nicholas Steel: Age UK Advisory Group Members: Prof David Oliver: Mr David Buck: Prof Peter Crome: Ms Helen Bradburn: Mrs Sue Howell-Richardson: Prof James Goodwin: Dr Matthew Norton: Ms Ruthe Isden: Associate Specialist, Psychiatry of Old Age General Practitioner and Senior Clinical Lecturer, PCMD & PenCLAHRC General Practitioner and Professor of Primary Care, PCMD General Practitioner and Senior Clinical Research Fellow, PCMD General Practitioner Honorary Senior Research Fellow, PCMD and former Co-director of the Ageing Research Programme, Unilever PLC Senior Lecturer in Geriatrics, PCMD Clinical Senior Lecturer in Primary Care and Honorary Consultant in Health, University of East Anglia National Clinical Director for Older People, Department of Health Senior Fellow, Public Health and Health Inequalities, The King’s Fund Professor of Geriatric Medicine, Department of Primary Care and Population Health, University College London Director of Public Affairs Communications, The Health Foundation Research, Development and Quality Manager, Age UK Devon Head of Research, Age UK Social Research Manager, Age UK Programme Manager, Public services, Age UK NIHR PenCLAHRC Patient and Public Involvement Team Members: Dr Andy Gibson: Research Fellow, Patient and Public Involvement, PCMD & PenCLAHRC Ms Lynn Tatnell: Service user Mr Jim Harris: Service user Ms Kath Maguire: Service user