FUTURE HEALTH NEEDS IN LATER LIFE Rachel Winder

FUTURE HEALTH NEEDS IN LATER LIFE Rachel Winder, Research Fellow Epidemiology and Public Health University of Exeter Medical School

HEALTH CARE QUALITY FOR AN ACTIVE LATER LIFE Improving quality of prevention and treatment through information: England 2005 to 2012 David Melzer, Behrooz Tavakoly, Rachel Winder, Suzanne Richards, Luke Mounce, Christian Gericke and Iain Lang University of Exeter Medical School

Purpose 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?

Selected topics – 50 charts � � � � 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 1: 2: 3: 4: Population, disease prevalence Health risks Quality of treatment for common conditions Older people’s experiences

Smoking - kicking the habit Source data: General Lifestyle Survey, ONS 2011 51 Smoking trends in men and women aged 50+ years, England, 1974 - 2009

Major reductions in coronary heart disease death rates Source: Scarborough et al, 201040 Age-specific death rates from coronary heart disease (CHD) in men aged 35+ years, UK, 1968 to 2008 Image from medicinenet. com Heart disease - success

Causes of death Source: ONS, 2011 Mortality by major cause, in men and women (all ages), England Wales, 19112010

Life expectancy at birth Source: Social Trends 40: 2010 edition, ONS Life expectancy at birth in men and women, UK, 1901 to 2021.

Life expectancy doing well, but could do better? 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 http: //stats. oecd. org/Index. aspx? Data. Set. Code =HEALTH_STAT

Obesity epidemic Image from The Guardian, Feb 2013 Source data: Scarborough et al, 2010 (British Heart Foundation) Prevalence of obesity* in men and women age 55+ years, England, 1994 -2008 (*Based on body mass index of >30 kg/m 2)

Diabetes – an epidemic unfolding Source data: HSE, 200958 Percentage of respondents with doctor diagnosed diabetes (all types) in men and women aged 55+ years, England, 1994 -2009

Alcohol Hazardous and harmful alcohol consumption Source data: Adult Psychiatric Morbidity in England, 2007 Results of a Household Survey Hazardous and harmful drinking in men and women in the past year aged 55+ years, England, 2007

Risk of loneliness Social isolation and loneliness 25. 0 20. 0 50 -64 65 -74 75+ Percentage Total 15. 0 10. 0 5. 0 0. 0 18. 5% 12. 6% 8. 8% 16. 5% 20. 3% 18. 6% 11. 1% 10. 9% Feels isolated Feels lonely Percentage of people aged 50+ years not living with a spouse/ partner who replied “Often”, as opposed to “Sometimes” or “Hardly ever”, when asked if they felt isolated or lonely. ELSA, 2010

Common mental health disorders in the community Source data: Adult Psychiatric Morbidity in England, 2007: Results of a household survey 16. Copyright © 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved Prevalence of common mental health disorders in the past week in men and women aged 55 + years, England, 2007

Winter excess death Source data: ONS, 2011 Trends in excess winter deaths in 65+ age groups, England Wales, 1991 to 2011 (EWM = winter deaths minus average non-winter deaths. EWM Index = (EWM / average non-winter deaths) x 100.

Burden of disease: 60+ years old – much is potentially avoidable Tobacco use 15. 5% Physical inactivity 5. 3% Low fruit/ vegetables 1. 7% Overweight/ obesity 8. 7% Other 45. 7% High cholesterol 4. 2% High blood pressure 12. 3% High blood glucose 6. 6% Source data: World Health Organisation: http: //whqlibdoc. who. int/hq/2012/WHO_DCO_WHD_2012. 2_eng. pdf? ua=1 Proportion of ‘Disability Adjusted Life Years’ (DALYS) in High-income countries caused by specific risk factors in adults aged 60+ years

Social inequalities – shorter lives with more disability Source data: Health Statistics Quarterly 50, summer 2011, ONS 48 Life Expectancy with Disability and Disability Free Life Expectancy for men and women at age 65 years, by Index of Multiple Deprivation (IMD) 2007 quintile, England, 2006– 08

Mobility, arthritis and pain Source data: HSE 2005. Copyright © 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved Prevalence of mobility problems in men and women aged 65 +years, England, 2005

Pain or discomfort Source data: HSE 2005, 2006 and 2008 data (aggregated 3 year’s data). ESDS, © Copyright 2003 -2012 http: //www. esds. ac. uk/finding. Data/hse. Titles. asp Universities of Essex and Manchester. All rights reserved. Self-reported prevalence of pain in men and women aged 50+ years, England, 2005, 2006 & 2008

Dementia - a major challenge Source data: Alzheimer’s Society 2007 Reproduced with permission from Alzheimer's Society. © Alzheimer's Society, 2007 The consensus estimates of the population prevalence of late onset dementia in men and women aged 65 +years, UK, 2007

Dementia recorded by GPs Dementia – comparison (Prince et al 2013 The global prevalence of dementia: A systematic review and metaanalysis) 85 -90 yrs: Prince et al (Western Europe): 17. 4%; our data: ~10% 90+ yrs: Prince et al (Western Europe): 33. 4%; our data: ~14%

Multi-morbidity – huge increase in recorded disease, especially in oldest in general practice Work supported by Age UK Prevalence of number of chronic diseases (of 18) by age group, from 2003/4 to 2011/12

Geriatric syndromes - counting up bed sores, other skin ulcers, anaemia, delirium, incontinence, dizziness or vertigo, falls, fractures, osteoporosis, polymyalgia and temporal arteritis Work supported by Age UK

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Quality indicators (Acove) BMJ, 2008 Diabetes mellitus All diabetic persons aged 50 or older should have an annual examination of his/her feet Urinary incontinence If a person aged 50 or older has new urinary incontinence that persists for over 1 month or urinary incontinence at the time of a new evaluation, then a dipstick urinalysis and/or mid-stream urine sample should be obtained Osteoarthritis If oral pharmacological therapy is initiated to treat osteoarthritis among people aged 50 or older, then paracetamol should be the first drug used, unless there is a contraindication to use

Osteoarthritis – no recommendation of physiotherapy or exercise programme (2010) Image from http: //www. cedars-sinai. edu 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 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

Falls – no assessment of strength, balance or walking (2009) Image from BBC News Source data: ELSA 2009 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

ACOVE achievement : low for ‘geriatric’ conditions 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

Cancer – a disease of ageing Source data: Cancer Research UK http: //info. cancerresearchuk. org/cancerstats/incidence/age. Date accessed: 21 st March 2012 Average number of all cancers (excluding non-melanoma skin cancer) per year by age group, UK, 2006 -8

Cancer survival – international comparison Source data: Table 14, Web appendix, Coleman et. al. 2010134 Age-specific relative survival estimates (%) at five years for colorectal cancer for ages 55 -99, international comparisons, 2005– 2007

Image from healthcare informatics. com UK - best at care co-ordination 2011 Sicker people’s experiences of poor care coordination – international comparison Similar pattern for medical errors Source: Commonwealth Fund International Health Policy Survey, 2011 http: //www. commonwealthfund. org/Surveys/2011/Nov/2011 -International-Survey. aspx Percentage of patients self-reporting gaps in coordination of services in the past two years, all adults, international comparisons, 2011

Sicker people’s experiences of medical errors – international comparison Source: Commonwealth Fund International Health Policy Survey, 2011 http: //www. commonwealthfund. org/Surveys/2011/Nov/2011 -International-Survey. aspx Percentage of patients self-reporting medical, medication or laboratory test errors, all adults, international comparison, 2011 Image from the Louvre / http: //dbdouble. blogspot. co. uk/ UK – lowest percentage reporting medical errors 2011

Percentage of population aged 65 and over EU-27 2010 2035 Source: Office for National Statistics, Eurostat Population Ageing in the United Kingdom, its Constituent Countries and the European Union March 2012

Achievements and challenges: Including: � � Continuing challenges of dementia, mobility problems, falls, winter excess deaths Evolving challenges: ◦ Obesity (physical inactivity) /diabetes prevention ◦ Social isolation, loneliness, mental health � We could do better on quality of treatment ◦ Especially for the disabling syndromes of older people ◦ Cancer in later life (awareness, early diagnosis, treatment as chosen)

Later life is no barrier to happiness! Happiness in later life - age makes little difference Source data: Cooper et al (2010) Level of happiness reported by age group, England, 2007

Acknowledgements We are indebted to all who have been involved in the preparation and review of this report at various stages, in particular: Exeter Ageing Research Group Members: Prof Paul Dieppe: Professor of Medical Education and Consultant Rheumatologist, PCMD Prof William Henley: Professor of Medical Statistics, PCMD & Pen. CLAHRC Colleague advisors: Dr Susan Bedford: Dr Richard Byng: Prof John Campbell: Dr Phil Evans: Dr Slav Pajovic: Dr Jonathan Powell: 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 & Pen. CLAHRC 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 Public 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 Pen. CLAHRC Patient and Public Involvement Team Members: Dr Andy Gibson: Research Fellow, Patient and Public Involvement, PCMD & Pen. CLAHRC Ms Lynn Tatnell: Service user Mr Jim Harris: Service user Ms Kath Maguire: Service user