Quality of life for older people
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 Census.
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 for women.
Therefore, the challenge is how we not only minimise the risk of people developing 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.
The 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 this work.
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 needed.
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 advice
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.
- The 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 conditions.
- 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 home.
- 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 care.
- 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 teams.
- 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.