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: 2014-06-09 12:28:56
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1. What are the key issues?

The local authority strategy for older peoples’ services, ‘Ageing Well 2009-14’ has a strong focus on preventative services, promoting wellbeing and helping people to stay healthy as well as developing the personalisation agenda.

The ‘Ageing Well’ strategy was refreshed during 2011 and, with the help of the Older Peoples Partnership, the number of objectives and targets was reduced to 4 priorities to be achieved over the coming 3 years as follows:

  • Easier access to information, preferably through availability in one stop shops and in leaflets;
  • Befriending schemes to provide company to support older people to attend coffee mornings, undertake home visits and assist with shopping and gardening;
  • Increased community social activities; and
  • Support for family carers.

The department of Adult Social Care in Redcar & Cleveland is also working to assist as many older people as possible to continue to live in their own homes by providing a wider range of housing options with new Extra Care Housing schemes under consideration as well as the reconfiguration of the re-ablement and rehabilitation services which promote greater independence.

 

Last updated: 04/06/14

2. What commissioning priorities are recommended?

2012/01
Develop priorities from the refresh of the Ageing Well strategy.

2012/02
Extend the remit of the children and families website to include services for people of all ages.

2012/03
Develop increased community activities as part of the national “Ageing Well” programme.

 

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?

In 2012, 27,400 people (20.3%) in Redcar & Cleveland were aged over 65, compared with 18.1% in England.

Maps in the Ageing Well strategy 2009-14 show the wards in Redcar & Cleveland with the highest numbers / proportions of older people are St Germains, Saltburn, Ormesby, Teesville, Guisborough & Hutton. The lowest proportions are in South Bank and Grangetown.

Trends in use of services from 2008 to 2011 show that a decreasing proportion of the population aged over 65 is receiving services from Adult Social Care in Redcar & Cleveland. This is in line with national trends. (Audit Commission, 2011). The figure has dropped from 10.7% to 9.7% of the population aged over 65.

However of those receiving services, the proportion who are in residential or nursing care has risen from 20% to 27% of all service users between April 2008 and March 2011. The trend in numbers of people in residential care has risen from 400 to 525 between April 2008 and March 2011. Over the same period the numbers in nursing care (funded by the council) have dropped from 180 to 170.

Between 2008/9 and 2010/11 the numbers of available beds in care homes in Redcar & Cleveland has risen from 1026 (March 2009 – 929 in the private sector plus 97 in the LA homes) to 1042, all in the private sector. The number of places in sheltered housing has risen from 397 to 400 with the opening of Moordale Court in June 2011 and reclassification of Prospect Place (35 units). Provision in Extra Care Housing has remained at 113 units since August 2008 when Barnaby Lodge opened. The highest rates of admission, funded by the LA, to care homes are not in the wards with the highest proportion of older people but in Kirkleatham, Coatham, Eston, Skelton and Guisborough.

Service users and over 65 population, Redcar & Cleveland, Apr 2008/09 to Mar 2010/11

Residential and nursing care, Redcar & Cleveland, Apr 2008 to March 2011

Flu vaccinations
The uptake of the flu vaccination programme for people aged 65+ years was 78.1% in 2010/11, compared with 72.8% in England.

Falls
Information from Coast and Country Housing shows the number of alarms for falls they have received in an 18 month period. The overall trend is increasing but this is likely to be due to the increasing number of falls monitors that are being issued. The chart below shows the responses provided to these alerts over the same period. On average 7 people per month require an ambulance or GP response after a fall.

Responses to alarms for falls, Redcar & Cleveland, Jan 2010 to Jul 2011


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?

Care home provision
All care homes in Redcar & Cleveland have a contractual relationship with the council to receive new residents at an agreed fair cost of care. Residents can choose to live in care homes elsewhere in the country if this better meets their needs.

The level of demand for residential care strains the budget of the local authority. The Council is looking at ways to support people for longer in their own homes so that they can maintain their independence.

Care at home provision
People who are living in their own homes are able to obtain support from Care at Home agencies which are contracted under a preferred provider list. In future, people who come to Adult Social Care for support and who meet the criteria of having substantial or critical needs, will be assessed for a personal budget and they will be able to buy care at home services with a direct payment.

Comparative information from the CIPFA benchmarking exercises in 2009-10 suggested that in Redcar & Cleveland, clients have more hours care per week on average than in other local authorities, though the costs per hour were less than elsewhere. This may suggest that Redcar & Cleveland Social Care has a different threshold of provision than elsewhere. The types of services that are considered essential to maintain people at home are being reviewed.

During 2008 to 2011 the annual number of hours of care at home provided to older people dropped from 517,747 to 512,115. The general trend is upwards and the latest figures may be an under reflection because more older people now buy their care at home services through a personal budget and direct payment.

Use of care at hiome services, Redcar & Cleveland, 2008/09 to 2011/12

Day care
There are three commissioned day services for older people, each provided by the third sector. The number of available places funded by the council has been reduced in 2011/12 and providers are encouraged to increase the number of local self-funders who attend, to provide a resource for the local community. The LA currently commissions 200 places per week and occupancy is high with 80% attendance each week. Over time it is hoped that these services will be sustained through contracts with individual service users and local self-funders by developing new activities which are attractive to a wide range of older people.

Telecare services
These are provided to older people and their carers to increase their confidence in living in their own homes in the knowledge that if the alarm is raised then a named responder or a warden from Home Call will respond to the alert.  In February 2012 there were nearly 700 people (of all ages) with a telecare installation.

Homecall
Coast and Country Housing provide a pendant alarm service. All residents can apply for an alarm. “Supporting People” has historically subsidised the costs of 3,119 users who are in receipt of benefits. Many other people pay for their own service. When an alarm is raised, Coast & Country Housing will either alert a friend, neighbour or family member to respond or will send their own Homecall wardens.
                                    
Re-ablement services
The re-ablement teams work in people’s own homes for up to 6 weeks to help elderly people and people with a disability adapt to their abilities. This helps residents to manage independently in their own home with a reduced dependence on social care services.

Initially re-ablement services have been provided on a pilot basis to the Redcar locality.  Re-ablement funds have been made available from the Department of Health to extend the area covered by the services to facilitate rapid and safe discharge and help to avoid hospital readmission.

Housing options
The Ageing Well strategy includes maps showing the locations of sheltered homes, Extra Care Housing and care homes.

Befriending
During 2011/12 a new befriending service was funded in East Cleveland. The service was provided by British Red Cross. As at March 2012, 11 volunteers have been fully accredited and 32 older people have received services. Although no longer funded by Redcar & Cleveland Borough Council, the British Red Cross befriending scheme continues to take referrals and provide help throughout Redcar & Cleveland.

Respite
Respite care is available as part of the self-directed support plans and care packages offered to some older people. Over the last 3 years there has been a steady increase in the number of people per month receiving residential respite care. The Council is planning to block book 4 respite care beds in local care homes so that carers can book respite several months in advance, which will help them to make holiday plans.

Screening
Cancer screening programmes are available to this age group for female breast cancer and bowel cancer.

The Health Heart Check programme offers those aged 40-74 years without existing diagnosed cardiovascular disease, a free NHS Health Check, which can identify those at risk of coronary heart disease, stroke, diabetes and kidney disease.

A lung health check programme identifies those at risk from respiratory illness.

 

Last updated: 04/06/14

6. What is the projected level of need?

Using data from Projecting Older Peoples Population Information (POPPI, 2013) the forecast number of people aged 65+  is estimated to be:

Forecast population aged 65+, Redcar & Cleveland, 2010 to 2020

Year

Population aged 65+

2010

26,300

2015

29,500

2020

31,700

Source: POPPI

 

This is a 12% increase in the 5 years between 2010 and 2015 and 21% increase between 2015 and 2020.

However, this increase varies between age groups within the older population. The increase in each age band between 2010 to 2015 and 2015 to 2020 is shown below.

Forecast population change by age band, Redcar & Cleveland, 2010 to 2015 and 2015 to 2020

Age band

Change 2010 to 2015

Change 2015 to 2020

65-69

21%

7%

70-74

3%

27%

75-79

16%

22%

80-84

5%

27%

85-89

4%

17%

90+

30%

60%

Source: POPPI

 


This shows that by 2020 there will be a marked increase in those aged between 70 and over 90 years.

When compared to neighbouring local authorities, Redcar & Cleveland is second only to North Yorkshire in the high % of the population in the 65+ age band. The figure for England is 16.45% in 2010; 18% in 2015 and 18.9% in 2020.

 

 

2010

2015

2020

No

% of total pop

No

% of total pop

No

% of total pop

Redcar and Cleveland total population 65 and over

26,300

19.1%

29,500

21.4%

31,700

22.9%

Hartlepool total population 65 and over

14,900

16.3%

16,600

17.8%

18,000

19.0%

Middlesbrough total population 65 and over

21,100

15.0%

23,200

16.3%

25,100

17.4%

North Yorkshire total population 65 and over

121,700

20.3%

142,500

23. %

157,500

24.6%

Stockton-on-Tees total population 65 and over

29,800

15.5%

34,400

17.5%

38000

18.8%

 

Ageing Well 2009-14 also includes info from the Projecting Older People Population Information website to show the prevalence of ill health and projected numbers of people with certain health conditions.

 

Number of people affected in 2008

2008-2015

Increase in prevalence

2015-2025 Increase in prevalence

Number of people affected in 2025

Depression in people over 65 (higher level estimate) 

3825

17.6%

17.3%

5280

Dementia

1689

18%

34.1%

2681

Heart attack

1767

18.1%

19.1%

2486

Strokes

638

19.3%

27.8%

972

Bronchitis

558

18.8%

17%

776

Visual impairment

2224

18.9%

23.8%

3223

Mobility problems

3912

17%

25.9%

5760

BMI over 30

6183

17.4%

17.6%

8540

People aged 55+ with a learning disability

955

8%

15%

1195

People aged over 65 who cannot manage 1 self-care activity

8184

17.2%

23%

11792

 

Of particular note is the potential overall increase over 15 years in the numbers of people with dementia and a stroke both of which conditions make heavy demands on NHS; social care and individual families.

 

Last updated: 04/06/14

7. What needs might be unmet?

Participation in a wider range of community activities and interests for all adults would help to keep people mentally and physically healthier and promote their wellbeing. Experiencing greater wellbeing in earlier adult life may support people to enjoy a healthier old age.

Through work with the Office of Public Management as part of the national Department of Work and Pensions ‘Ageing Well’ programme the council is working closely with Area Management to develop an area-based approach to the provision and publicising of community assets, facilities and support mechanisms. This will help more people to retain their independence. It is hoped to develop more befriending services to help people who are at risk of becoming house bound.

Adult Social Care is developing services to help maintain people’s independence and support them to continue living at home. Three re-ablement teams and a rapid response team, which will work with individuals at the point of discharge from hospital, are being set up using funding has been received from the NHS for re-ablement services and to support social care services. The social care funding will help to manage increased pressures on social care budgets (for example, telecare and services which support older people to manage in their own homes).

A wider range of extra care housing and supported living options are needed throughout Redcar & Cleveland to provide alternative housing options where people can continue to live independently for longer.  Discussions are being led by the council’s Regeneration department to clarify the re-development of the sites of 3 former local authority care homes.

 

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?

No further consultation has been undertaken by Adult Social Care about the provision of services for older people in Redcar & Cleveland since the large scale consultation on Real Voices and Real Choices in 2008. The views expressed in that consultation, have been checked out in a small scale exercise undertaken with the Older Peoples Partnership in June 2011 when members indicated that their priorities for service improvement are:

  • Provision of easily accessible literature about services and facilities in Redcar & Cleveland to be made available in one stop shops and by post.
  • Befriending services
  • Community activities
  • Support to informal family carers.

The Ageing Well pilots in Carlin How and Dormanstown each held two participatory meetings with local residents to identify the issues that were affecting their lives and what assets existed in the community. The issues raised in Carlin How were:

  • Lack of availability of affordable public transport at times to suit individuals;
  • Need to identify big events which could  bring the community together (for example, Diamond Jubilee celebrations).

In Dormanstown residents raised issues about:

  • Affordable public transport;
  • Need for buddying and befriending services for those who are living alone or are reluctant to go out alone.

 

 

Last updated: 04/06/14

10. What additional needs assessment is required?

To understand better the needs of older people and to identify the sorts of alternative activities and services they would like to use, better intelligence is needed about how older people are using direct payments when they take them, or what they would prefer to do with their personal budget which would enhance their quality of life.

 

Last updated: 04/06/14

Key Contacts

Name: Sue Renvoize

Job title:  Commissioning Lead, Older People and Carers

e-mail:  susan.renvoize@redcar-cleveland.gov.uk

Phone number: (01642) 771500

References

Local strategies and plans

 

 

 

Redcar & Cleveland Borough Council (2009). Ageing Well in Redcar and Cleveland 2009-2014.

 

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.