There is no one commonly accepted definition of ‘old age’ or older people. The current pension scheme has age has 67 for eligibility. The UN has not adopted a standard criterion, but generally uses 60+ years to refer to the older population. The National Service Framework for Older People (Department of Health, 2001) defined three groups of older people:
In 2011, the average age at which the public defined the start of ‘old age’ was 59 (Age UK, 2011). More recent studies (April 2015) have argued that old age now starts at 74, with middle age lasting at least nine years longer than current estimates. Academics from the International Institute for Applied Systems Analysis (IIASA) in Vienna, Austria, argue that old age should be measured not by age, but by how long people have left to live. In the 1950s a 65-year-old in Britain could expect to live a further 15 years, with better healthcare and lifestyles this would take old age to 74.
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).
1. What are the key issues?
Between 2001 and 2008 the Borough population has increased by 1.9%. By 2018 Stockton on Tees’s population is projected to have a rise of 6% from a baseline of 190,500 in 2008 to 201,600 in 2018. By 2031 the projected rise is 10% to 209,900. (Source ONS 2010). For older people, Stockton on Tees had an estimated population of 30,000 people aged 65 or over in 2011. This population is forecast to grow by 25% in the next 10 years and to continue to grow in the following decade to stand at 48,000 in 2031, representing a 50% increase in two decades.
The JSNA confirms that Stockton on Tees, as with other north east localities, is an area where inequalities and health challenges are comparatively high against national figures and that progress is needed to reduce the inequality gap.
In 2008-2010, life expectancy for new born females in Stockton on Tees was 81.8 years compared to the England average of 82.2 years. For new born males, the life expectancy was 77.6 years in comparison to the England average of 78.2. (Source ONS 2010).
In 2010, Stockton on Tees ranked as the 101st most deprived of the 327 local authorities in England. This has worsened since the JSNA process began in 2007. (Source Department of Communities and Local Government, indices of deprivation, 2010).
Tackling inequalities and supporting the ageing process remains a core part of our agenda in Stockton on Tees. The Council, NHS Tees and other key partners have formed effective and robust partnerships to ensure overall commitment to the ageing well agenda.
Stockton on Tees Local Strategic Partnership is committed to supporting older people and the strategic vision and purpose is highlighted in the Borough’s Sustainable Community Strategy, Older People’s Strategy 2008 and Vision for Adults 2009-14 that highlights our strategic intent.
2. What commissioning priorities are recommended?
Help carers continue to care. Updated by 2016/01.
Support older people to remain physically and mentally able, and to live in the best of health and remain at home for as long as possible; and to provide best quality care when dependent and unable to care for themselves remains a priority.
Ensure services are of good quality, efficient, timely and convenient. Objective removed as a priority.
Build social capital both as a means of promoting health and wellbeing, but also as a way of better meeting people's wider support needs and tackle issues such as social isolation and excess winter deaths. Remains a priority.
Develop early intervention and preventative models of support. Elements of this include support for issues such as falls and malnutrition.
Remains a priority.
Ensure that older people are given choice, have control and a sense of purpose in their daily lives. Remains a priority.
Help carers to continue to care. Acknowledge them as individuals with support needs in their own right. Comply with the requirements of the Care Act 2014, the national Carers’ Strategy and the Joint Carers’ Strategy for Stockton-on-Tees to develop support to assist carers to access benefits, support them into training, education and employment, access breaks where required and offer advice and training on health issues.
Signposting. Improve how we signpost and support older people to access services.
3. Who is at risk and why?
In the 20th century, one-in-twenty of the UK population being pensioners was widely accepted. In the 21st century it is one-in-five. The Office for National Statistics shows that there are more people over 65 than there are under 16. Older people, some 20% of the population, consume a large portion of some key service, such as 66% of hospital beds.
The main users of health services are people aged 65+. Over 80% of people aged 70+ will suffer from a significant (i.e. in need of treatment) physical illness (Rossman 1979). Further, the prevalence of many conditions increases with age. In the UK, 42% of people aged 65-74 and 48% of those aged 75+ have a limiting longstanding illness. More than two-thirds 71% of people aged 85 and over in the UK have a disability or limiting longstanding illness.
Older people represent 60 per cent of all hospital admissions and at any one time in the UK older people occupy around two-thirds of hospital beds. (Department of Health, 2001). Between 2000 and 2010, the amount of hospital activity for people over 75 has grown by 66 per cent, and on average their stays are around 2.5 times longer than people between the ages of 15 and 59.
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.
Physical inactivity is a serious and increasing public health problem. The estimated cost of physical inactivity in England is £8 billion annually. Physical activity decreases with age, with seven out of ten men and eight out of ten women aged 75 years and over being inactive. In later life the benefits of an active lifestyle play an important role in helping people to keep mobile, maintain their independence and reduce falls. There is also a relationship between good physical and mental health, as both impact on the other.
Cardiovascular disease (CVD) including heart attack and stroke accounts for one third of all deaths in England and, like many other health concerns, is disproportionately high in older people.
The incidence and prevalence of dementia rises significantly with age and is therefore more prevalent in older people. One in three people aged over 65 will die with some form of dementia (Alzheimer’s Research UK).
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.
Older people are the main users of social care services. National surveys demonstrate that the ratio of incidents of disabilities, incapacities and dependencies grow with age. This is compounded by the expectation that the current economic environment coupled with specific welfare reforms in housing and disability benefits will impact disproportionately on older people.
People with long-term conditions frequently have more than one condition. Around half of the older population will have major health problems and around a quarter will have three or more problems. (British Household Panel Survey, 2001).
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-Caribbean’s and of diabetes among South Asians.
4. What is the level of need in the population?
Older People population growth
The increase in the number of older people has been rather more marked in the Tees Valley than the national changes, rising from 13% in 1971 (well below the national figure) to 19% in 2010, the same as the national average. Thus, there has been a considerable change in the sub-region’s population from a population younger than the average in 1971 to one that is close to the average now. (Source ONSI)
Table1: Population changes in Tees Valley
There are currently 29,224 over 65s registered with NHS Stockton’s GPs; of these 15,616 are thought to have a long term condition; over 7,000 are likely to be living alone. (Source IC NHS / POPPI)
Many older people live alone, over 8,000 females and nearly 4,000 males now live alone in Stockton (largely reflecting the longer female life expectancy). Approximately 4,000 older people in Stockton are helped to live independently by Social Care. 0ver 11,000 hours of home care per week are commissioned directly or indirectly through Personal Budgets by Stockton Social Care. Of the 11,000 older people living alone in Stockton, 7,000 of them were estimated to be without transport in 2001. Stockton-on-Tees Council also supports over 1,400 older people in residential and nursing care homes.
Furthermore, 45% of Tees Valley’s people of pensionable age receive at least one other state benefit on top of the state pension. (Source DWP/ONS). A fuel poor household is one that needs to spend more than 10% of its income on fuel. Fuel poverty is a significant contributor to illness, especially COPD. The number of older people living in Stockton without central heating in 2011 was 932 a fall in the past 10 years (2001 showed 2,600 without central heating).
Approximately 10% of households have a carer, many of whom are older people. Stockton has an estimated 3,000 older Carers who all have the legal right to an assessment of their needs.
Table 2: Estimated population in Stockton on Tees aged 65+ with a Limiting Long-Term Illness (LLTI)
In Stockton over 2,000 older people are predicted to have a longstanding health condition caused by CVD which will need long-term care and rehabilitation.
Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and emphysema, accounts for one fifth of all deaths in England and, like many other health concerns is disproportionately high in older people. In Stockton over 500 older people are predicted to have a longstanding health condition caused by COPD which will need long-term care and rehabilitation.
Diabetes is one of the most common chronic disorders in the UK. There are currently over 3 million people with diabetes in the UK split 15:85 between type 1 and 2. There are nearly 4,200 people in Stockton with diabetes.
Being obese increases the likelihood of someone developing type 2 diabetes and can bring reduced mobility and independence as well as adversely affecting many medical conditions. It is estimated that nearly 9000 older people in Stockton are obese.
The number of older people predicted to have a fall is almost 9000, nearly 700 of which will result in hospital admission.
In Stockton-on-Tees, the number of older people with depression or dementia is over 6,000. Adult education in Stockton is delivered through Stockton Learning Skills. Older people in Stockton tend engage in non-accredited learning through courses including Pilates, aromatherapy, art & crafts, history and languages. In 2014/15 there were 693 learners over 65, in 2015/16 there was a similar to 696 learners over 65.
5. What services are currently provided?
6. What is the projected level of need?
In the short to medium term, Stockton is likely to follow the national trends of increasing numbers of people over retirement age due to improved survival rates in that age group, particularly among men.
Stockton on Tees had an estimated population of 30,000 people aged 65 or over in 2011. This population is forecast to grow by 25% in the next 10 years and to continue to grow in the following decade to stand at 48,000 in 2031, representing a 50% increase in two decades.
More noticeably the sub set of age 90+ residents is set to increase by 300% over the same period.
The number of older people living alone will grow in line with population growth and Stockton can anticipate 14,000 older residents living alone with a 2:1 female to male ratio. It is reasonable to assume that, over the next 10 years an additional 3,800 hours of home care per week will be required and an additional 300 people in residential or nursing homes.
The number of older people with dementia is set to rise at a rate of greater than 30% over the next 10 years in Stockton, resulting in a total of 2,700 residents with symptoms. There is a growing national awareness that dementia is an area where early intervention can be cost-effective and increase quality of life and that new strategies need to be formed. The number of older people with depression or dementia currently stands at 5,500 and will be over 6,000 in the next three years.
The UK is facing a huge increase in the number of people with diabetes. Since 1996 the number of people diagnosed with diabetes has increased from 1.4 million to 2.6 million. By 2025 it is estimated that over four million people will have diabetes. Most of these cases will be Type 2 diabetes, because of our ageing population and rapidly rising numbers of overweight and obese people. In Stockton-on-Tees, the number of people aged 65 and over with diabetes is forecast to increase from 3,900 in 2012 to 4,700 in 2020 (POPPI, 2013).
7. What needs might be unmet?
It is important to note, however, that there is a gap between the numbers of people with dementia and diagnosis rates, as nationally the diagnosis rate is only about 40%.
With current service capacity unchanged, 13,000 people aged over 65 will have unmet needs by 2030.
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).
Preventive Social Care. Is it cost-effective? (King’s Fund, 2006).
‘The billion dollar question’: embedding prevention in older people’s services – 10 ‘high impact’ changes (University of Birmingham, 2010).
Confident Communities, Brighter Futures - framework for developing wellbeing (Department of Health, 2010).
Excess winter deaths and illness and the health risks associated with cold homes. NICE guidelines [NG6] March 2015
Home care: delivering personal care and practical support to older people living in their own homes. NICE guidelines [NG21] September 2015
Home care for older people. NICE quality standard [QS123] June 2016
Older people with social care needs and multiple long-term conditions. NICE guidelines [NG22] November 2015
Older people: independence and mental wellbeing. NICE guidelines [NG32] December 2015
Older people in care homes. NICE advice [LGB25] February 2015
Improving later life series (Age UK, 2016). Research findings written by experts, in a lay-friendly manner, to help inform older people, or those who work with or on behalf of older people. These short books have brief 'chapters' on many topics relevant to older people's lives. These books aim to: highlight and inform on coming issues and trends; provide the impetus and the start of an evidence base for strategic planning policy and services; and help professionals advise older people, their families, and carers.
9. What do people say?
NHS Personal Social Services Adult Social Care Survey 2014-2015
The above charts shows that levels of satisfaction among service users and carers are higher in Stockton than regional and national rates.
In addition to feedback from people, there is a range of evidence from inspections and audits relating to care and support of older people.
The National Audit of Dementia (2011) hints at one of the reasons for failures in providing high quality care. It found that only 5 percent of hospitals had mandatory training in awareness of dementia for all staff. This is despite estimates that people with dementia over 65 years are using up to one-quarter of hospital beds at any one time.
10. What additional needs assessment is required?
In addition to feedback from people, there is a range of evidence from inspections and audits relating to care and support of older people.
In 2011, the Care Quality Commission (CQC) carried out 100 spot inspections of hospitals in England and reported: ‘time and time again, we found cases where patients were treated by staff in a way that stripped them of their dignity and respect’ and that people were ‘not given assistance to do the basics of life – to eat, drink, or go to the toilet’. The language and issues described are almost identical to those identified in a Health Advisory Service report called Not Because They Are Old, published in 1998. In its write-up of the report, the BBC explained that some NHS staff were overtly ageist and lacked respect for older people and that ‘many [older people] were not given enough to eat or drink’.
The fundamental question of why older people cannot expect to be treated with dignity remains unaddressed.
The CQC inspections found that one in five of the hospitals visited were not meeting the very minimum standards of care for older people with respect to dignity and nutrition.29 In February 2011, the Health Service Ombudsman published a report, Care and Compassion?, concluding that
the cases it described ‘present a picture of NHS provision that is failing to respond to the needs of older people with care and compassion and to provide even the most basic standards of care’.
The National Audit of Dementia, published at the end of 2011, hints at one of the reasons for such failures. It found that only 5 per cent of hospitals had mandatory training in awareness of dementia for all staff. This is despite estimates that people with dementia over 65 years are using up to one-quarter of hospital beds at any one time.
The CQC report “The state of health care and adult social care in England 2014/15” highlighted “Our challenge to all health and social care services, and the sector overall, is therefore to continue to put quality of care at the centre of change, and not fall into the trap of seeing innovation as only driven by the need to save money. Alongside this, we encourage all partners in adult social care to come together and set out a common vision and plan for how to address the current fragility and uncertainty in the adult social care market, and ensure they can continue to provide good care. People deserve high-quality care. It is therefore our duty to the people who use services to be open and transparent about the quality of care that we see, and not lower our expectations of quality in the challenging times ahead”.
Name: Rob Papworth
Job title: Strategic Commissioning Manager
Phone number: 01642 528441
Local strategies and plans
Stockton-on-Tees Borough Council (2009). A Strategy for Adult Health & Care Services in Stockton-on-Tees 2009-2014.
Newcastle University (2012). The North East Charter for Changing Age (endorsed by ANEC, ADASS, Newcastle University, Age UK and councils across North East England including Stockton-on-Tees)
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.
Age UK (2011). A Snapshot of Ageism in the UK and across Europe.
Age UK (2016). Later Life in the United Kingdom (June 2016).
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.