Quality of life for older people
Last updated: 22/11/2013
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Cornwall and the Isles of Scilly’s population continues to grow
and like the rest of the UK, it also continues to grow older, with
increases in all age groups over sixty years according to the 2011
It is a welcome fact that people are living longer, healthier
lives. It should be a cause for celebration that today in England
life expectancy is over 75 years, compared to a century ago when
life expectancy was around 50 years. The challenge is to
consistently adopt a positive approach to ageing and develop
appropriate strategies to ensure an improved quality of life for
all older adults in our community, particularly targeting those
that may need additional support to maintain and enhance the
quality of their life.
Why is it important?
The total number of those aged 65 or over in Cornwall is
expected to increase by 74% between 2007 and 2031. This group are
sometimes thought of as the baby boom generation, but they also
include many people who have migrated to Cornwall in their
pre-retirement years. The most recent population projections
highlight that although the older population is increasing, the
rate of increase is in line with what we have seen in the last 20
to 30 years.
One approach is that this is a cause for concern and that public
services in particular will be faced with the burden of the cost of
providing more and more services for the dependent and frail
elderly. At the other end of the spectrum is the view that the 'new
old' are likely to be wealthier, better educated and healthier than
their forebears and have higher expectations in terms of their
quality of life.
It is not just about adding years to life but also the quality
of those extra years. Healthy life expectancy is a real challenge
to social justice. There are groups in our population who not only
live shorter lives but also have less healthy years when compared
to more affluent groups. The gap in life expectancy between the
most affluent and poorest parts of Cornwall is on average 5.7 years
for men and 5.2 years for women. The gap in healthy life expectancy
between these groups is on average 6.1 years for men and 4.8 years
Therefore, the challenge is how we not only minimise the risk of
long term conditions as they age, but also tackle key
determinants of health such as access to good food, physical
activity, warm and healthy homes and tackling loneliness and
isolation. These issues of healthy ageing are particularly
important in dispersed rural communities where there are challenges
over transportation links, access to healthcare closer to home,
choice over care providers and the importance of maintaining social
networks is key.
Building good expectations and more resilience earlier in the
ageing process can pay long-term dividends for independence,
personal choice and a sense of physical, mental and emotional
wellbeing. Attitudes about ageing and retirement are changing with
many people working longer (through choice or necessity) and there
is an opportunity to support more people into this healthy ageing
approach. There are clear benefits for the individual, family and
friends and the community as a whole.
Where are we now?
Quality of life for older people can over a wide range of areas
and will partly depend on the viewpoint, for example, looking at a
range of clinical indicators of ill health such as emergency
admissions from falls or looking more widely at what everyday life
is like for example, participation in social or educational
activity, quality of housing or patterns of diet and activity.
Ageing is not necessarily a burden, and it does not necessarily
decrease a person's ability to contribute to society: older people
can make valuable and important contributions to society, and enjoy
a high quality of life. The aim must be to promote healthy
behaviours amongst older people and provide the necessary
opportunities for regular physical activity, healthy diets,
fulfilling social relations, participation in meaningful activities
and financial security.
Older People’s Wellbeing Monitor for Wales pulls together
statistics and research from a range of different sources and
reports on a variety of wellbeing indicators. The themes are:
- Dignity and social inclusion
- Independence and material wellbeing
- Health and care
- Self-fulfillment and active ageing
The detail of the indicator for quality of life for Older People
in the England Public Health Outcomes Framework is still to be
defined but the example from Wales provides some useful context for
Quality of life for older people is in part connected to the
support available to them. The national population dependency ratio
show how many young people (aged under 14) and older people (aged
over 65) depend on working age adults (through economic activity).
This indicator is expressed as a ratio and in 2008 Cornwall had a
dependency ration of 72 dependent people compared to 100 working
age people. This is expected to rise to 75:100 by 2031.
What is being done?
There are a wide range of opportunities for older people to take
part in activities that support their everyday health, wellbeing
and happiness. Many of these will focus on existing networks of
family, friends or work colleagues. The voluntary and community
sector also play a vital role in providing local networks and
social connections to provide opportunities for enhancing health
and wellbeing as well as signposting more specialist support where
For example, Age UK offers a range of practical advice and
support around better health and wellbeing. It identifies
10 top tips for healthier ageing, which mirror many of the same
key messages for the rest of the adult population, namely:
- Eat a healthy diet
- Don’t smoke
- Engage socially with others
- Have a positive attitude about ageing
- Get regular health check ups
- Protect your eyes
- Avoid excessive sun exposure
- Get sufficient good quality sleep
- Pay attention to your pension, and get expert financial
For those that need more support, there is a wide range of
services to address particular circumstances or needs.
- The Winter Wellness programme aims to keep people warm and well
over the winter period and offers practical support to help those
most at risk. Read more on the winter deaths page.
The National Carers Strategy, Recognised, Valued and Supported,
highlights the need for carers (unpaid) to be better supported by
statutory agencies in recognition of the demands presented through
caring. People must also be supported in the management of their
own conditions through advice and support on appropriate self care.
Long Term Conditions (LTC) Quality Improvement Productivity and
Prevention (QIPP) Programme uses risk stratification of people
(knowing what level of support is needed), self care support for
those individuals and the development of integrated neighbourhood
teams to coordinate agencies who provide support.
- The increasing use of technology, such as
telehealth is being further tested in Cornwall as on of the
national test-beds for this innovation. This will help to develop
the evidence base around who can benefit most from the use of
remote technology in monitoring and managing health
- The Acute GP Service is working closely with
the Royal Cornwall Hospitals Trust to ensure that only those older
people who really need a stay in hospital are admitted, providing
rapid support and intervention to people to help them stay at
- Peninsula Community Health have also been
commissioned to expand the Acute Care At Home Service across
Cornwall and the Isles of Scilly, providing an alternative to acute
admission for any person aged over 18 who meets the criteria for
- Health and Social Care Partnership Working
has helped to develop an Early Intervention Service across six
locations in Cornwall to provide rapid intermediate care services
for people aged over 18 who are at risk of health or social care
breakdown. The Multi Disciplinary Team identify and care for
vulnerable people in their locality through a key worker system, to
prevent unnecessary admission as well as supporting safe and timely
discharge from hospital. The teams will see the combining of a
range of previously distinct care services into integrated
- Falls Prevention: an update on local activity to reduce the incidence
and impact of falls
- Case Management of Care Home Residents: An innovative project
using a nurse practitioner to reduce avoidable hospital admissions
and to improve the quality of care for frail older people been
successful in a pilot with 16 care homes. This model which supports
patients by coordinating care between independent care homes and
health services, to stay out of hospital will now expand to cover
all care homes in Cornwall.
What else is needed?
A continued focus on the everyday health, wellbeing and
happiness of older people is needed to ensure that every
opportunity can be taken to positively influence their healthy
ageing. The emphasis must be on prevention and early intervention
where possible and targeting those in most need or in the most
challenging circumstances. Investment in this approach should
provide long-term benefits for the individual, their family and
friends, the community and the economy.
Where they are required, specific programmes addressing more
complex health and care needs like those set out above must
continue to be delivered with the needs of vulnerable older people
at the centre of how services develop.
The effects of the recession must also be closely monitored, for
example, the impact on wider community based care currently
provided by the voluntary sector. Helping older people to manage
the financial and emotional challenge of the economic climate is
likely to remain a key challenge for some time.
Currently there is significant change taking place across the
public sector and there needs to be a continued partnership
approach to managing opportunities for better health and wellbeing
as well as providing the right care and support for people locally.
The Health and Wellbeing Boards for Cornwall and the Isles of
Scilly will have a leading role in shaping commissioning around
better outcomes for older people.
Progress will also be monitored in other related public health
outcomes framework indicators such as falls prevention, long term
conditions and preventable winter deaths.
Both the NHS and Social Care Outcomes framework includes a
measure of the health-related quality of life for people with long
term conditions as measured by quality of life surveys.