The Director of Public Health             Annual Report 2015/16

There are 64,000 people in Dudley aged 65 and over (and 121,000 people aged 50 and over). Together these people make an enormous contribution to life in our borough.

 

Older people in Dudley contribute significantly to the local economy. About a third (39,000) of people aged 50 and over in Dudley are in paid employment and they make up 27% of the borough’s workforce.

Introduction

According to research undertaken by Age UK, nationally 58% of people aged 65 and over participate in volunteering or civic engagement(1). If this figure was applied to Dudley it would mean that more than 37,000 older people are involved in volunteering and activities in their local community; and are active members of local clubs, societies and community groups, at which they share their knowledge, skills and interests. More than 22,000, or almost one in four Dudley residents aged 50 and over, provide informal care for family members or friends, and countless more enable families to work by looking after grandchildren before and after school and in the school holidays.

 

The number of older people aged 65 and over in Dudley is predicted to increase from 64,000 in 2015 to 80,000 in 2030 (see figure 1.1), so we can expect to see the positive contribution that older people make to life in Dudley increase in years to come, particularly if working together with older people we can unlock the potential of an ageing population.

Figure 1.1 Trends in over 65 population in Dudley

 

Despite all the evidence about the contribution that older people make to society, we are commonly confronted with a much more negative narrative, in which the ageing population is blamed for challenges in health, social care and welfare. Issues such as rising demand for, and costs of, health services; bed blocking and welfare costs are often attributed to older people. There is a real danger that these negative perceptions are already working to exclude older people, feed discrimination against them and ultimately undermine the contribution that they make to life in Dudley and elsewhere.

 

However, according to the Centre for Ageing Better(2), ageing alone adds just 1% to the growth in the costs of the NHS. Overall population growth, wage growth and medical advances all drive increases in the costs of health services to a greater extent than ageing.

 

In a society that chooses to provide a financial safety net for people no longer in employment, universal healthcare and social care prioritised for those most in need, public spending is inevitably drawn towards people at older ages. This means that the longer older people stay healthy, active and independent, the greater the potential to relieve pressure on public expenditure.

 

As we age there is an accumulation of positive and negative effects on our health and wellbeing. There is good evidence to show that healthy behaviours such as being physically active, stopping smoking, eating well and being connected to our family and friends all have positive impacts on our health even at an older age.

 

Advances in health care and public health have resulted in people living longer than ever before, with average life expectancy in Dudley increasing from 75.6 (male) and 80.3 (female) in 2000-02 to 79.3 (male) and 83.2 (female) in 2012-14. However, according to the Foresight Future of an Ageing Population project(3) which analysed trends in the UK, as life expectancy has increased, the number of years that older people live in poor health has increased. This is particularly apparent in deprived communities. This time spent in ill health limits the ability for older people to play an active role in community life and increases their dependence on public services(4).

 

Figures 1.2 and 1.3 show average life expectancy and average healthy life expectancy for males and females in each small area of Dudley borough (known as middle super output areas) ranked by deprivation. Average life expectancy is the total of the red and green parts of each column and healthy life expectancy is the green part of the column. These charts clearly show that although there is a deprivation related social gradient in overall length of life, this gradient is much more pronounced for healthy life expectancy. This means that, on average, people in our deprived areas spend both a greater proportion of their lives and more years in ill health than those who live in the more affluent areas.

 

Figure 1.2 Healthy life expectancy and total life expectancy at birth for males

 

Figure 1.3 Healthy life expectancy and total life expectancy at birth for females

 

The main causes of ill health among older people in Dudley

Looking in more detail at the main causes of ill health and death among older people in Dudley, we can summarise five main groups of diseases. These are circulatory diseases (which include coronary heart disease, stroke and hypertension), respiratory diseases (including chronic obstructive pulmonary disease and pneumonia), cancers, diseases of the musuloskeletal system (including osteoporosis, osteoarthritis and associated fractures often caused by falls) and dementia (including Alzheimer’s disease and vascular dementia). The incidence of all of these diseases increases significantly with age.

There are also more deaths in the winter months than the rest of the year. These are known as excess winter deaths and the overwhelming majority of these deaths occur in older people, and the main causes of the excess deaths are respiratory disease and circulatory disease. In 2015, England and Wales saw the largest rise in the number of deaths for more than 10 years. Initial analysis has found that most of the increase was due to increased deaths during the first few months of the year in people aged 75 and over and were associated with flu and dementia(5).

Information about each of the five main causes of ill health and death in Dudley is summarised below, highlighting the position in Dudley. Further information about the health and wellbeing of older people in Dudley is available in our information chapter.

Circulatory diseases

Circulatory diseases including heart disease and stroke are the largest cause of death among older people (aged 65 and over) in Dudley. Death rates from circulatory diseases in people aged 65 and over in Dudley have been falling steeply in males and females and are similar to national rates. Death rates in males remain statistically significantly higher than those in females however the gap is slowly closing. There are no significant inequalities in death rates from circulatory diseases between areas within Dudley. The proportion of people recorded by their GP as having heart disease or a stroke is higher than the national average. Along with dementia and musculoskeletal problems, stroke is one of the leading causes of disability among older people in Dudley. Risk factors for ill health, hospitalisation and death from circulatory disease include high blood pressure, diabetes, smoking, lack of physical activity, obesity, unhealthy diet, alcohol misuse, cold homes, poor air quality and social isolation.

Respiratory diseases

Respiratory diseases are the second largest cause of death among older people in Dudley after circulatory diseases. The death rate from these conditions is falling and although the rate has been higher in Dudley than nationally, the gap between Dudley and England has been narrowing in the last decade and now there is no significant difference. There are, however, significant inequalities in deaths from respiratory disease among people aged 65 and over within Dudley, with rates highest in the most deprived areas.

Emergency hospital admissions among older people from respiratory diseases have been rising over the last decade and are significantly higher in people who live in the most deprived parts of the borough; these unplanned admissions to hospital can indicate the need for improvements in the management of long term conditions such as chronic obstructive pulmonary disease by primary care services and the patient themselves.  Smoking, poor air quality, cold homes and low uptake of flu and pneumococcal vaccine are all risk factors for respiratory diseases.

Cancer

Cancer is primarily a disease of older people, with incidence rates increasing with age for most cancers. In the UK in 2011-2013, on average half of cancer cases were diagnosed in people aged 70 and over. In Dudley, death rates from all types of cancer in people aged 65 and over are similar to the national average and have been slowly falling in males while in females, rates have remained almost static over the last decade. Death rates from cancer in people aged 65 and over are higher in the most deprived parts of the borough. In Dudley, the type of cancer with the highest mortality rate is lung cancer and there are large inequalities in deaths from lung cancer within the borough with rates being higher in the more deprived areas.

Cancer screening programmes aim to identify people who are likely to go on to develop cancer as early as possible so that preventative treatment can be provided. Seventy-six percent of eligible women aged 53-70 received breast screening in 2015, which is similar to the national rate. Fifty-nine percent of people aged between 60 and 74 eligible for bowel cancer screening, were screened in 2015. By far the biggest risk factor for cancer is tobacco smoking. Other risk factors include: being overweight  or obese, unhealthy diet (not enough fruit and vegetables, eating processed and red meat, low fibre diet), drinking alcohol, lack of physical activity, exposure to workplace hazards such as asbestos and radiation, certain infections including human papilloma virus and not breastfeeding.

Musculoskeletal disease and falls

Falls among older people with musculoskeletal problems including osteoporosis and osteoarthritis are a major cause of disability and the leading cause of death caused by injury in people aged over 75 in the UK. One-third to one-half of people aged over 65 will fall each year.

Falls are the largest reason for emergency admissions to hospital in people aged 65 and over in Dudley.  Emergency admissions for both accidental falls and diseases of the musculoskeletal system and connective tissue among people aged 65 and over have been increasing over the last decade and there are significant inequalities in hospitalisation within the borough with emergency admissions higher in the most deprived parts of the borough. Risk factors for musculoskeletal diseases and falls include poor nutrition including calcium deficiency, poor balance that can be addressed by weight bearing physical activity, drinking alcohol, some combinations of medicines, hazards in the home and social isolation.

Dementia

Nationally, around 1 in 14 people aged 65 and over were living with dementia in 2015. The proportion of people with dementia increases with age, so that whilst 3% of people aged between 70 and 74 have dementia, 30% of those between 90 and 95 have dementia. The most common cause of dementia is Alzheimer’s disease, which accounts for 62% of dementia cases. Twelve percent of people with dementia have vascular dementia and 10% have both Alzheimer’s and vascular dementia. There are also a number of other less common causes of dementia. The severity of dementia can be divided into mild, moderate and severe; around half of those with dementia have mild dementia whilst one in ten have severe dementia.

Nationally, a third of people with dementia live in care homes, half live with someone in their own home and one in six live alone at home. Nationally, around 670,000 carers look after someone with dementia in the UK, and they often face very challenging and stressful situations that can be detrimental to their own health.

In 2015 it was estimated that 4,300 people aged 65 and over in Dudley have dementia, with this predicted to increase to almost 7,000 people by 2030. The number of people with a recorded diagnosis of dementia was less than this at 2,392, reflecting the under diagnosis of the disease. The rate of emergency hospital admissions among people with dementia aged 65 and over in Dudley in 2013/14 was estimated to be 3,300 per 100,000 population, which is significantly higher than the national average. There was a significant increase in emergency admissions among people with dementia in Dudley between 2012/13 and 2013/14, if this trend continues it may indicate that support services are struggling to meet the needs of this population.

Risk factors for dementia include hypertension, type 2 diabetes, depression, lack of physical activity, tobacco smoking, obesity, unhealthy diet, excessive alcohol consumption and social isolation.

Ageing Well in Dudley

Older people’s ability to contribute to the community in Dudley depends on them being healthy. Public services and communities therefore need to be prepared to both unleash the potential of an ageing population and to enable older people to stay healthy for as long as possible. In order to do this, we need to deliver an integrated healthy ageing programme(6), which supports older people to age well so they can continue to play an active role in the community and stay independent for as long as possible.

In order for older people to age well, we want Dudley to be a place where people of all ages are able to actively participate in community activities. Everyone should be treated with respect regardless of their age and it should be easy to stay connected to people around us and those we love. We should be able to stay healthy and active even at the oldest ages, and when we can no longer look after ourselves we should be supported to live with dignity and enjoyment, whether supported by informal carers or health and social care services.

Older people tell us there are many barriers to healthy ageing such as changes in where and how extended families live, poorly designed buildings, lack of financial security, fear of crime and lack of transport that prevents older people accessing the places they want to visit. But many barriers result simply from the way we think about ageing and the way we view and treat older people.

In Dudley there are strong foundations on which we can build our work on healthy ageing. The borough has a flourishing voluntary and community sector which both provides older people with a wide range of opportunities to get involved and use their skills as well as providing help for older people who need extra support to live independently and with dignity. The Clinical Commissioning Group is working with partners to develop a new model of care that better meets the needs of local people than existing services. Two central elements of this are developing services for people with long term health problems and providing better care for frail elderly people, both of which intend to lead to improved services and outcomes for older people. The West Midlands Combined Authority promises to deliver transport and housing developments that can help older people be connected to family and friends; and finally, the borough has an abundance of green space, nature reserves and parks in which older people can enjoy their leisure time.

Our goals for healthy ageing

Research that has asked people about their aspirations for older age has found that as we age we want to continue be useful, healthy, and physically, mentally and socially active; and in order to age well, older people tell us that they need good health, financial security and social connections. In light of this we have set four goals for healthy ageing in Dudley and the rest of this report will address each of these in turn, setting out the current position in Dudley and what more we can do if we are to enable people in Dudley to age well.

Our four goals for healthy ageing are:

1. Increase social connectedness

2. Develop age-friendly environments

3. Support healthy behaviours

4. Develop high quality support services

 

What is our definition of older people?

In this report, the definition of older people that we are using is people aged 60 and over. However it has not always been possible to obtain routine statistics or information from studies that relate specifically to this age group.

Some information, data or studies that we quote in the report relates to people aged 65 and over, which is considered to be the usual retirement age and therefore the beginning of a new way of life for many older people.

Some information in the report relates to people aged 50 and over. This is because some healthy ageing initiatives focus on the period of time before retirement, when people can prepare for retirement and set healthy behaviours that can continue into older age. In addition, some information about older people, work and the economy classifies this age group to be older adults, and we wanted to be able to include this information in the report.

In the report, when we are quoting data, we will always specify what age group it relates to.

How our healthy ageing goals contribute to addressing the five main diseases affecting older people

References

  1. Age UK (2016) Later Life in the UK. Available at: http://www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true (Accessed: 21 September 2016).
  2. Centre for Better Ageing (2015) Later Life in 2015: An analysis of the views and experiences of people aged 50 and over. Available at: https://www.ageing-better.org.uk/wp-content/uploads/2015/12/Later-life-in-2015-Ipsos-MORI-Ageing-Better.pdf (Accessed: 21 September 2016).
  3. Carol Jagger (2015) Trends in life expectancy and healthy life expectancy. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/464275/gs-15-13-future-ageing-trends-life-expectancy-er12.pdf (Accessed: 21 September 2016).
  4. World Health Organisation (WHO) (2014) Policies and priority interventions for healthy ageing. Available at: http://www.euro.who.int/en/health-topics/Life-stages/healthy-ageing/publications/2012/policies-and-priority-interventions-for-healthy-ageing (Accessed: 21 September 2016).
  5. Office For National Statistics, O.F.N. (2016) Spike in number of deaths in 2015 driven by increased mortality in over 75s. Available at: https://www.ons.gov.uk/news/news/spikeinnumberofdeathsin2015drivenbyincreasedmortalityinover75s (Accessed: 21 September 2016).
  6. Public Health England (2016) Healthy Ageing in the West Midlands: Findings of the West Midlands Healthy Ageing and Frailty Project. Available at: http://wm-adass.org.uk/wp-content/uploads/2016/05/HealthyageingFINAL160316-2.pdf (Accessed: 21 September 2016)

© Copyright 2016 - Graphics Studio, Dudley Council