Health of Older People DPH Annual Report 2012 Dr Carolyn Harper, - - PowerPoint PPT Presentation

Health of Older People DPH Annual Report 2012

Dr Carolyn Harper, Director of Public Health

Public Health Annual Scientific Conference 12th June 2013

Overview

• Public health model
• Demographics &

Benefits to society

• Public health challenges

& examples

Public Health Model

• Improving health and reducing inequalities
• Improving health through early detection
• Improving health through high quality services
• Improving health through research
• Protecting health

DEMOGRAPHICS

Where Older People Live

• One third of over 65 year olds live alone1
• ~ 5% will eventually need care home residence1
• 75% of people being cared for are aged 75 years or
• ver2

1 Census 2011 2Survey of carers of older people in Northern Ireland, DHSSPS

65+ Population as % of total, by ward, 2011

85+ Population as % of total, by ward, 2011

Source: NISRA, 2011 (2010-based population projections)

Children under 16 and adults over 65, actual and projected, 1971-2035 2028

Population Pyramids NI (1971-2045)

Source: NISRA

2008

1.78m

2045

(projected)

2.06m

Life expectancy at birth

Expectation of Life at Birth, by Sex (1890-92 to 2056-58) 45 50 55 60 65 70 75 80 85 90

1900-02 1905-07 1910-12 1915-17 1920-22 1925-27 1930-32 1936-38 1940-42 1945-47 1950-52 1955-57 1960-62 1965-67 1970-72 1975-77 1980-82 1985-87 1990-92 1995-97 2005-07 2010-11 2015-16 2020-21 2025-26 2030-31 2036-41 2041-46 2046-51 2051-56 2056-58 Year of Birth Expected Years of Life

Males Females

Projected Estimated

Source: NISRA

10 12 14 16 18 20 22 1980-82 1990-92 2000-02 2008-10 Life Expectance at Age 65 Year Male Female

Life expectancy @ 65 years

Men can expect to live until 82 but in good health until 60.5 years Women can expect to live until 85 but good health until 62.5 years

Source: NISRA

6.00 6.50 7.00 7.50 8.00 8.50 9.00 9.50 10.00 10.50 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 Number of years Year

Males in Northern Ireland: Disability Free Life Expectancy at age 65 showing confidence intervals, 2000-02 to 2008-10

6.00 6.50 7.00 7.50 8.00 8.50 9.00 9.50 10.00 10.50 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 Number of years Year

Females in Northern Ireland: Disability Free Life Expectancy at age 65 showing confidence intervals, 2000-02 to 2008-10

Benefits of an ageing population

• Ageing one of humanity’s great achievements
• Offer great experience and knowledge
• Volunteering and caring contribution
• Contribute to the region’s economy
• 2011/12 – 78% of over 75+yr olds said their health was

good

1 Survey of carers of older people in Northern Ireland, DHSSPS

Economic Contribution: £27bn UK 2012

Source: MGM ‘Rethinking Retirement’ Report 2012

Also challenges for public health…

• Wider determinants of health
• Personal risk factors for poor heath
• Meeting the health & wellbeing needs of older

people by protecting people from illness, through early detection and high quality services

WIDER DETERMINANTS

NI Multiple Deprivation Measure, 60+ yrs, 2010

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 2001 2006 2011

Northern Ireland: Dwelling unfitness (% unfit) by age group of Household Reference Person, 2001, 2006, 2011

Under 60 years 60 - 74 years 75+ years All ages

Source: Poverty in Northern Ireland: 2010/2011, DSD

Pensioner Poverty – NI

Fuel Poverty – NI 2011

Source: Northern Ireland household condition survey, 2011

Proportion of people living in fuel poverty, by age group 66%

Social Disadvantage & Exclusion

• Linked to pensioner poverty
• 64% pensioners say they don’t have enough money1
• 65% of elderly people fear of crime1
• Declining health & loss of independence

1 NI pensioners parliament report 2012

Caring Responsibilities

• Elderly living alone more likely to require some form
• f caring support ears or
• ver
• 16 % of 65-74yr olds and 10% of 75+ age group

provided informal care (16% of males and 8% of females in 75+ group)2

1 Census 2011 2Survey of carers of older people in Northern Ireland, DHSSPS

Examples of what we’re doing

• Carers Programmes ‘It’s all about me’
• Arts-based programmes ‘Engage with Age’ & with Arts

Care

• ‘Be safe be well’ & home safety assessments
• Individualised Health and wellbeing plans
• Maximising access to benefits (MARA) – region wide

1300 households

Tackling fuel poverty

• Northern Exposure Project on home energy efficiency
• Benefit maximisation services
• Keep warm packs
• Fuel stamps
• Severe-weather response plans

RISK FACTORS FOR POOR HEALTH

Smoking

Smoking prevalence by age and sex (2010/2011)

Source: Northern Ireland household condition survey 2010/2011

Alcohol

Source: Northern Ireland household condition survey 2010/2011

Respondents drinking above the weekly limits by age and sex (2010/2011)

Obesity

Source: Northern Ireland household condition survey 2010/2011

Obesity levels by age and sex (2010/2011)

Physical activity

Source: Northern Ireland household condition survey 2010/2011

Respondents meeting the recommended weekly physical activity levels by age and sex (2010/2011)

Respondents who feel they can make their life healthier

Long-term conditions

Respondents indicating they have a long-standing illness by age and sex (2010/2011)

Source: Health Survey Northern Ireland 2010/11

0% 2% 4% 6% 8% 10% 12% 14% 16%

Asthma Angina Heart attack Heart murmur Other kind

• f heart

trouble Diabetes (not during pregnancy) Cancer COPD Stroke

Northern Ireland: Prevalence of various medical conditions (told by a doctor that they had the condition) in those persons aged 65+, 2010/11 and 2011/12 Aged 65+ Aged 16+

Source: DHSSPSNI, NI Health Survey 2010/11 and 2011/12 (http://www.dhsspsni.gov.uk/in dex/stats_research/stats-public- health.htm)OPD: Chronic Obstructive Pulmonary Disease Note that a person may have been told that they have more than one condition

Dementia- women

Projected number of women with dementia in Northern Ireland

Source: EURODERM prevalence rates applied to NI populations projections

Projected number of men with dementia in Northern Ireland

Source: EURODERM prevalence rates applied to NI populations projections

Dementia- men

MEETING THE HEALTH & WELLBEING NEEDS OF OLDER PEOPLE

Age specific admission rates

50 100 150 200 250 300 350 400 65-69 70-74 75-79 80-84 85+

Age specific admission rates /1000 population Age group Source: Patient admission system data, 2011

1 in 4 people over 85yrs are admitted every year & 1 in 10 65-69 year olds

Causes of Death

30% 28% 15% 27% Cardiovascular disease Cancer Respiratory Disease Other

500 1,000 1,500 2,000 2,500 3,000 3,500 1960 1970 1980 1990 2000 2010 2011

Northern Ireland - Males: Death rates for major causes, 65-74, 1960 - 2011

Malignant neoplasm Heart Disease IHD

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 1991 1996 2001 2006 2011

Northern Ireland - MALES - Death rates in those aged 65-74 years from avoidable causes, 1991 - 2011

All Causes Causes considered: Preventable Causes considered: Amenable 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 1991 1996 2001 2006 2011

Northern Ireland - FEMALES - Death rates in those aged 65-74 years from avoidable causes, 1991 - 2011

All Causes Causes considered: Preventable Causes considered: Amenable

Cardiovascular – AAA Screening Programme

• By age 65, 1 in every 40 men will have an AAA
• A third will rupture if not treated
• Screening men aged 65 can reduce death rate by ~50%
• Between 1 July 2012 to 26 March 2013 7,088 men

screened

• Uptake in target population 81%
• 75 AAAs detected in this period

Cancer – Bowel Cancer Screening Programme

• >1,000/year people diagnosed with bowel cancer each

year and 400 deaths

• Since April 2012 , screen 60-71 year olds
• As of end of December 2012, 190,000 people invited
• More than 175 people diagnosed with bowel cancer

Respiratory – Excess Winter Deaths

• 10

10 20 30 40 50 60

1974/75 1976/77 1978/79 1980/81 1982/83 1984/85 1986/87 1988/89 1990/91 1992/93 1994/95 1996/97 1998/99 2000/01 2002/03 2004/05 2006/07 2008/09 2010/11 Excess winter deaths index (%) Year 65-74 75-84 85+

Source: NISRA

Flu Vaccination Programme

England Scotland Wales Northern Ireland 2006-07 73.9 75.2 N.A. 75.1 2007-08 73.5 74.3 64 75.7 2008-09 74.1 76.3 60 76.8 2009-10 72.4 75.0 64 77.0 2010-11 72.8 75.3 65.8 74.9 2011-12 74.0 76.2 67.7 77.0 Uptake of flu vaccination in people over 65 years of age in the UK

Where People Die

PLACE OF DEATH N (%) Hospital 7,336 (51%) Nursing home 2,347 (16%) Hospice 517 (4%) All other places 4,328 (30%) Total 14,425 Average number of deaths from any cause in Northern Ireland according to place of death (2007-2011)

Source: Register General Office, 5 year period (2007-2011)

Examples of What We’re Doing

• Implementing Service Frameworks & LTC Policy
• Expanding pulmonary rehab services
• Modernising long term oxygen therapy services
• Expanding palliative care services
• Innovation & research
• Chronic illness case management model
• Treatment of age-related macular degeneration
• Assessing the effectiveness of psychoactive medication review

services in nursing homes (the Fleetwood model)

• Testing new approaches to pain management in older people

Acknowledgements

Editorial Team Katie O’Connor, Tracy Owen, Stephen McKenna, Gillian Johnston, Adele Graham, Joanne Murphy Partner organisations Public health practitioners & researchers

Further Information

PHA website http://www.publichealth.hscni.net/ Report Core Tables Profile of Older People’s health