Older People

There is no one commonly accepted definition of ‘old age’ or older people. The National Service Framework for Older People (Department of Health, 2001) defined three groups of older people:

  • Those entering old age on completing paid employment and child-rearing (50-60 years);
  • Those in the transitional stage between healthy active life and frailty (70-80 years); and
  • Frail older people who are vulnerable because of health or social care needs.

In 2011, the average age at which the public defined the start of ‘old age’ was 59 (Age UK, 2011).

The Department of Work and Pensions (DWP) refers to people aged 60 and over as older people, but also includes people in their 50s as a period when many people take early retirement or prepare for retirement (DWP, 2005).
 

Last updated: 2016-01-27 14:20:25
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1. What are the key issues?

The number of older people in Hartlepool is estimated currently estimated at 15,700 but is expect to rise to 22,300 by 2030 (POPPI, 2013). The sharpest rise will be in people aged over 85 years where the numbers are expected to increase from 1,900 in 2012 to 5,300 in 2030. It is this age group that is the heaviest users of care and support services.

A growing number of older home-owners on low incomes live in poor and unsuitable housing and struggle to meet the cost of repairing and adapting their homes and manage energy costs and household finances. This is particularly true in the North East (Housing Association Charitable Trust, 2012).

 
 

Last updated: 04/06/14

2. What commissioning priorities are recommended?

2012/01
Promote and develop accessible information for older people
that is available in the right place at the right time.

2012/02
Ensure that the public transport needs of older people are taken into account
when planning all services.

2012/03
Provide clear information about housing options
.

2012/04
Develop and promote early intervention, reablement and preventative services
to maximise people’s opportunity to remain fit and well and living independently within the community for as long as they wish and are able to do so.

2012/05
Improve access to services for all individuals who have cognitive impairment, impaired mental health or dementia
.

2012/06
Improve efforts to inform older people of the local changes to public transport to hospital
and how to access them.

2012/07
Continue to promote help for carers
so they can continue in their caring role; be acknowledged as ‘expert’ partners in caring; and be acknowledged as individuals in their own right  with their own needs.

2012/08
Ensure that all planning and commissioning reflects a personalised approach
.

2012/09
Maximise the use of new technology
so that people can summon or receive help at home.

2012/10
Promote and commission training that reflects the changing ways that services are delivered
. The workforce needs to be fully aware and confident when working with new systems and be aware of different ways of working. This needs to include personal assistants who are directly employed by people to provide their care.

2012/11
Ensure that planned urgent care support services are able to respond flexibly
to needs that occur outside ‘traditional’ care and support plans.

 

 

Last updated: 04/06/14

3. Who is at risk and why?

Age
The prevalence of many conditions increases with age.  In the UK, 34% of people aged 65-74 and 48% of those aged 75+ have a limiting longstanding illness.  More than two-thirds (69%) of people aged 85 and over in the UK have a disability or limiting longstanding illness.

Particular health risks within this age group include:

About half of people aged 75 and over live alone.  Older people are more likely to live in residential and care homes than the general population.


Gender
In older populations the proportion of women increases markedly.

Socioeconomic status
In the UK, about one in seven pensioners lives in poverty.  About half of these live in severe poverty, with incomes less than half of the median.

Ethnicity
The proportion of older people from black and minority ethnic communities is smaller than the general population but growing.

There is a greater prevalence of some illnesses among specific groups of people. For example, there are increased rates of hypertension and stroke among African-Caribbeans and of diabetes among South Asians.

 

Last updated: 04/06/14

4. What is the level of need in the population?

An estimated 15,700 older people live in Hartlepool.

Older people, who make up 20% of the population, are users of a larger proportion of some key resources, such as up to 65% of hospital beds. Of those people, approximately one third may have some symptoms of dementia.

In Hartlepool, there are about 5,800 older people living alone, of whom 1,800 are men and 4,000 are women.

Hartlepool Council currently supports 18% of the older people.

In 2011 it was estimated that 8,500 people aged 65 years and over+ had a limiting long term illness (LLTI), 5,000 were estimated to need help with self-care and 6,000 were estimated to need help with domestic care.

However, only 2,650 were supported to live at home by the local authority and 500 older people were permanently living in residential or nursing care (Hartlepool Borough Council, 2013). This number can be broken down as:

  • 60 were in nursing care  for Older people with mental Illness / dementia
  • 150 were in residential care for Older people with mental Illness / dementia
  • 40 were in nursing care for frail older people
  • 250 were in residential care for frail Older People


Within Hartlepool, it was estimated in 2011 that:

  • more than half of the older people population (8,500) had life limiting long term illnesses.
  • 980 older people were estimated to have a dementia.
  • There were 1,310 older people with depression, with twice as many women as men having this condition.  Of these, 400 are predicted to have severe depression.
  • About 4,000 will have falls resulting in over 300 requiring hospital admission.
  • The prevalence of falls is higher for women in 65-79 age groups, but evens out as people reach 80 and 85+.
  • About 350 will have a long lasting health condition caused by stroke.  Men are disproportionately represented (62%).
  • About 750 will have a long standing health condition due to a heart attack.  Again men are disproportionately represented (55%) but the proportion is much higher for men aged 65-74 (70%).
  • About 5,000 older people are unable to carry out at least 1 self-care task.  Women disproportionately represented 3,550 or 72%.
  • 6,100 older people are unable to manage at least one domestic task on their own. Again women are disproportionately represented; 5085 or 69%.
  • 2,700 older people unable to manage at least 1 or more mobility activity on their own. Women are disproportionately represented 1,850 or 69%.

 

 

A comprehensive set of data is available through the Older People's Health and Wellbeing Atlas.
 

Last updated: 09/06/14

5. What services are currently provided?

Social care

Person-centred social care assessment: “personalisation” is well established, with 92% of people eligible for support having a ‘personal budget’.

Assistive technology /telecare: now considered part of mainstream services to maintain people’s independence in the community by use of simple but effective remote sensing and contact technology.

Domiciliary  care: in-house direct care and support team offering short-term rapid response home care and supporting telecare, carers emergency respite care; contracted area-based registered domiciliary providers and specialist niche providers.

Housing with Extra care: 5 schemes run by 2 organisations offering in excess of 500 potential accommodation units.

Day services: for older people, people with disabilities and people with mental health problems, both in traditional day centres and activity specific facilities.

Community support: for older people, people with disabilities and people with mental health problems to assist them to use community resources and avoid social isolation.

Intermediate care working closely with health colleagues to avoid unnecessary hospital admissions and enable rapid hospital discharge including home-based support and step-up/ step-down rehabilitation and transition care beds.

Reablement: the service assists people with poor physical or mental health to accommodate their illness (or condition) by learning or re-learning the skills necessary for daily living and increase their confidence. This is done by:

  • helping people ‘to do’ rather than ‘doing to or for’ people;
  • being outcome-focused with defined maximum duration;
  • recognising that assessment for ongoing care packages cannot be defined by a one-off assessment but requires observation over a defined period;
  • providing aids, equipment and adaptation to assist activities of daily living; and
  • using personal budgets including the use of ‘Direct Payments’ to enable people to manage their own care needs; often employing their own personal assistant.
Health

Primary care / GP interventions, including walk-in and out of hours support.

Community nursing: including ‘rapid response’ nursing service to assist hospital discharge and avoid hospital admissions; and ‘out of hours’ service.

Intermediate care working closely with social care colleagues to avoid unnecessary hospital admissions and enable rapid hospital discharge including home-based support and step-up/ step-down rehabilitation and transition care beds.

In-patient acute services: most support to older people in Hartlepool is provided by North Tees and Hartlepool Hospitals and South Tees Hospitals offering a full range of general hospital and sub-regional specialist services.

Community older people mental health services provided by Tees, Esk and Wear Valley NHS Foundation Trust, including support to primary care and nursing homes, memory clinic, secondary out-patient and in-patient services.

In-reach by mental health staff into acute hospitals to assist colleagues identify and adapt treatment for people with dementia and delirium.

Inpatient older people mental health services.

Falls service: multi-factorial assessment addresses risks with a high correlation of falls (Indicated in NICE 2004 guidance); appropriate intervention to modify risk and reduce incidence of further fall and consequential injury.  Core service includes physiotherapy, occupational therapy and preventative activity including supporting falls prevention activity, organised by the voluntary sector.

 
 

Last updated: 04/06/14

6. What is the projected level of need?

The number of older people in the borough is expected to rise from 15,700 to 22,300 by 2030 (POPPI, 2013). The sharpest rise will be in older people aged over 85 years where the numbers are expected to double to 2,900 by 2030. Increased age does not automatically mean that a person has a disability or illness but, proportionately, this age group has traditionally been the heaviest users of care, support and health services.

There are high levels of deprivation and ill health in Hartlepool. This is in part due to factors such as its heavy industrial past, historic and current high level of unemployment and a disproportionate impact of low income for older people. This means that a local health and lifestyle improvements gap remains.

It is predicted that by 2030 the number of people with life-limiting long-term illnesses will increase to 12,500 people, of whom 7,400 will need help with self-care, and 9,000 will need help with domestic tasks.  Using current levels of uptake, only a projected 3,800 will be supported by the local authority.

Levels of disability are high and are likely to remain so for the foreseeable future.  Within the population of Hartlepool it is estimated that by 2030:

  • 12,500 older people will have life limiting long term illnesses (more than half of the older people population).
  • 1,600 older people will have a dementia  an increase of 60% from 2011.
  • 1,900 older people with depression, with twice as many women as men having this condition.  Of these, 600 will have severe depression.
  • 5,900 will have falls resulting in 470 requiring hospital admission.
  • 540 will have a long-lasting health condition caused by stroke.  Men are disproportionately represented (62%).
  • 1,100 will have a long-standing health condition due to a heart attack.  Again men are disproportionately represented (58%) but the proportion is higher for men aged 65-74 (70%).
  • 2,750 will have diabetes.
  • 5,000 older people will be unable to carry out at least 1 self-care task.  Women disproportionately represented 3550 (72%).
  • 6,100 older people will be unable to manage at least one domestic task on their own.  Women are disproportionately represented 5,100 (83%).
  • 2,700 older people will be unable to manage at least 1 or more mobility activity on their own. Women are disproportionately represented 1,850 (69%).

The number of people with dementia in Hartlepool is set to increase from about 1,000 to 1,600 by 2030. This 60% increase in the number of people who suffer from dementia should be seen as a key priority for commissioning services and support.

At a time of increasing need it is likely that the number of people who are in a position to offer support as carers both professionally and  informally carers will not increase at the same rate.

Forecast growth in the number of  older people, Hartlepool, 2012 to 2030

 

2012

2015

2020

2025

2030

People aged 65-69

4,600

5,200

5,000

5,500

6,400

People aged 70-74

3,700

3,700

4,800

4,600

5,100

People aged 75-79

3,300

3,400

3,200

4,200

4,100

People aged 80-84

2,200

2,500

2,600

2,600

3,400

People aged 85-89

1,300

1,300

1,700

1,900

1,900

People aged 90 and over

600

600

800

1,100

1,400

Total population 65 & over

15,700

16,700

18,100

19,900

22,300

Population aged 65 and over

(as a proportion of the total population)

17.10%

18.00%

19.17%

20.82%

23.08%

Population aged 85 and over

(as a proportion of the total population)

2.07%

2.05%

2.65%

3.14%

3.42%

Total females 75 and over

27.39%

27.54%

26.52%

27.64%

27.36%

Total males 75 and over

63.05%

63.47%

62.99%

63.32%

63.23%

total aged 75 and over

46.50%

46.70%

45.30%

48.75%

48.44%

Source: POPPI

 

 

Last updated: 04/06/14

7. What needs might be unmet?

The number of people who fund their own care and support and who do not make contact with the local authority is difficult to ascertain.

If current funding arrangements continue there is a risk that people who fund their own care may in the future require local authority support. However, until government plans for reforms of support of personal care are clarified estimating the impact is problematic.

In 2011, it was estimated that 8,550 people aged 65 years and over were predicted to have a limiting long-term illness; 5,000 were estimated to need help with self-care and 6,100 were estimated to need help with domestic care. However, only 2,900 are supported by the local authority. Lack of access to appropriate information can have a considerable impact.

The level of unreported falls in older people is not clear.

There is likely to be a largely unknown group of older house owners with low income who do not have access to support to enable them to repair or adapt their homes to meet their changes needs as they age or become frailer.

The age profile of the social care workforce shows a greater proportion of older workers. Measures to attract new entrants, supported by flexible and modern working opportunities, are an important element in bringing more staff into the sector. It will also be crucial to ensure flexible working practices are fully utilised to maintain workforce capacity.

 

Last updated: 04/06/14

8. What evidence is there for effective intervention?

National Service Framework for Older People (Department of Health, 2001).

Under Pressure: Tackling the financial challenge for councils of an ageing population (Audit Commission, 2011).
The report outlines if care service costs simply increase in line with population change, they could nearly double by 2026.  Carers aged over 60 provide care worth twice public spending on care services for older people. The biggest single financial impact will be on social care spending.  There are big differences in care costs – some council spend three times more than the average per person on some services.  Small investments in services such as housing and leisure can reduce or delay care costs and improve wellbeing.

Preventive Social Care. Is it cost-effective? (King’s Fund, 2006).
There is little quantified information of the effectiveness of preventive services.  Available cost-effectiveness analyses are often small scale and not comparable with other studies.    It is often not clear quantitatively or qualitatively what element(s) of a reportedly successful service elsewhere have contributed to its success and could be potentially replicated.  “Measuring the effectiveness of community services (e.g. improved public transport) has seemingly proved too complex”.  Although the benefits are difficult to quantify, low level interventions provided informally, and by all sectors, are highly valued.

‘The billion dollar question’: embedding prevention in older people’s services – 10 ‘high impact’ changes (University of Birmingham, 2010).
This paper draws on Interlinks, an EU review of prevention and long term care in older people’s services across 14 European countries and ‘The case of adult social care reform - the wider social and economic benefits’ and finds evidence to invest in: Healthy life styles; Vaccination; Screening; Falls prevention; Adaptations/practical support; Telecare; Intermediate care; Re-ablement; Partnership working; and Personalisation.

Confident Communities, Brighter Futures - framework for developing wellbeing (Department of Health, 2010).
Age-related decline in mental wellbeing should not be viewed as an inevitable part of ageing.  The factors affecting mental health and wellbeing for older people are the same as in the general population.  To promote the wellbeing of older people: psychosocial interventions, high social support before and during adversity, prevention of social isolation, multi-agency response to prevent elder abuse, walking and physical activity programmes, learning, volunteering. To reduce prevalence of depression: early intervention, target prevention in high risk groups.  For dementia: exercise and anti-hypertensive treatment.

 

Last updated: 04/06/14

9. What do people say?

Findings from consultation with older people

There has been a succession of consultation events stemming back to the original Older person’s strategy in 2004 , the older people’s housing care and support strategy in 2007 and several town wide events to update the older people’s strategy action plan the latest of which was in 2011 and the draft town wide Housing Care and support strategy.

Several common themes occur throughout this work:

Information - often information existed but it was not easily accessible or appropriate, “signposting” was inadequate and individuals felt they often needed to chase the information, sometimes being referred to several organisations.

Transport - this can be problematic as public services have been cut and taxi rates are often varied, a dial-a-ride service has been discontinued; the recent the closure of the local hospital accident and emergency unit means people have to travel out of town and service transferring to other hospitals, coupled with a marked reduction in bus services.

Hospital - issues were:

  • hospital changes that required travel to North Tees or James Cook Hospitals or use the One Life Centre Minor Injuries Unit whose usage, purpose and function remains unclear to many of the public at large
  • lack of a clear, consistent and easy to understand discharge process which was felt to be necessary to ensures patients and carers are clear about the next steps including intermediate care, reablement, care at home and self-care.

Housing options - there is often not enough information provided or available for the various options. There remains no extra care housing for people with mild to moderate dementia. Also many older people live in large or unsuitable accommodation that no longer meet their requirements or needs.

Low level support - it was important to have assistance with jobs that they couldn’t manage by themselves. Many felt that without assistance they would either leave the job, wait until family or friends could help, if this was not an option they would attempt the job themselves (even if this was unsafe). The SAILS service that attempts to begin to address this is still only in its infancy and is not universally known.

Social isolation - addressing the needs of older lone adults and carers who may face social and family isolation which in turn affects health and wellbeing.

Engagement - widening engagement of older people in service planning, decision making and consultation.

 

Last updated: 04/06/14

10. What additional needs assessment is required?

Social isolation has been identified as an increasing factor in the lives of older people. Even where help is available, older people have been at best “living in two worlds” – a ‘service world’ and ‘ordinary life’. Most of their contact is with people who are either paid for providing a particular role or who have a formal volunteering relationship.  It is often their ‘ordinary life’ and their ordinary social networks that shrink – and their ‘care life’ or ‘support life’ with its ‘formal’ network that now dominates. Particular problems can arise for older people and their families when the service world starts to dominate and not support - or allow for – an ‘ordinary life’ to continue or restart.” (Bowers et al, 2007).  Personal budgets in social care are now established and personal health budgets are being piloted. If used creatively, these can attempt to link the two worlds but more work is needed to establish meaningful best practice that puts the older person in control.

Groups of older, vulnerable, home-owners have been identified who are in need and require appropriate forms of funding to maintain, repair or adapt their property. Hitherto, they have largely not been ‘on the radar’ in terms of policy development or identification of appropriate forms of funding. These vulnerable older home-owners are likely to need trusted sources of information, advice and support that are accessible. The suggested mechanism is for joined up delivery through Home Improvement Partnerships. This requires leadership, effective support infrastructures and the need for development or scaling up of available innovative affordable finance (Bowers et al, 2007). At present these structures and resources are not available locally.

Access by people with dementia or cognitive impairment to mainstream physical support and therapy remains problematic. The true size of the issue has been difficult to quantify. However, recent local developments such as those for dementia in acute hospital settings and the North Tees Dementia collaborative and North Tees and Hartlepool dementia strategy group will  be major players in addressing this.

 

Last updated: 04/06/14

Key Contacts

Name: To be advised

Job title:

e-mail: 

Phone number: 

References

Local strategies and plans

Hartlepool strategy for assistive technology 2010-2015; The way forward for Telecare and Tele-health, including Tele-monitoring and Telemedicine.

Hartlepool Older People Strategy 2004

Hartlepool Housing Care and Support Strategy 2012

 

National strategies and plans

Department of Health (2001). National Service Framework for Older people.

Department of Health (2009). Living well with dementia: A national dementia strategy.

Quality Indicators for Dementia (Quality Outcomes Framework (QOF))

Department of Health (2011) No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages.

 

Other references

Age UK (2011). A Snapshot of Ageism in the UK and across Europe.

Audit Commission (2011). Under Pressure: Tackling the financial challenge for councils of an ageing population .

Bowers, H; Bailey, G; Sanderson, H et al (2007). Person Centred Thinking with Older People: Practicalities and Possibilities.

Department of Health (2010). Confident Communities, Brighter Futures - framework for developing wellbeing.

Department of Work and Pensions (2005). Opportunity Age – Opportunity and security throughout life.

Housing Association Charitable Trust (2012).  Living well in retirement: An investment and delivery framework to enable low income older home-owners to repair, improve and adapt their homes.

King’s Fund (2006). Preventive Social Care. Is it cost effective?

POPPI (2013). Projecting Older People Population Information System.

Public Health England (2013). Older People's Health and Wellbeing Atlas.

University of Birmingham (2010). ‘The billion dollar question’: embedding prevention in older people’s services – 10 ‘high impact’ changes.