Recovery JSNA- Older People
Older people are typically extremely resilient and self-sufficient but the COVID-19 pandemic and the associated policy responses have posed them with unique challenges. If you are an older person, staying at home may help to protect you from the virus but, it can lead to other serious problems: for example, loss of function - mobility and balance especially as a result of moving around less; pain from untreated medical conditions that will often have got worse these can last months; and the psychological impact of living with so much stress, uncertainty and isolation, leading to increased loneliness among other problems.
The COVID-19 pandemic has highlighted new and existing challenges within the health and social care system and exacerbated exclusion, inequality and poverty for many who rely on its support. Local authorities have undertaken life-saving work, people’s experience of COVID-19 responses and associated restrictions has too often been lack of control, confinement, isolation, fear and stress. Many people remain distanced from the planning and decision making that affects their choices and everyday lives.
Trends in Life & Healthy Life Expectancy
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Trends in Life & Healthy Life Expectancy
Life expectancy at age 65 shows the average number of years a person would expect to live based on contemporary mortality rates. Healthy life expectancy shows the years a person can expect to live in good health (rather than with a disability or in poor health). Health life expectancy at age 65 provides an important summary measure of the mortality and morbidity in those aged 65 years and over. While it may take a few years for the impact of the pandemic to be seen in these measures it is important to understand the baseline position.
Life Expectancy at Age 65
Life expectancy is a measure of the average number of years a person would expect to live based on current mortality rates.
In Wiltshire life expectancy for both males and females is significantly higher than the England average.
It is also slightly higher than the South West average but not significantly.
Source: Public Health Outcomes Framework (Extracted on 23/04/2021)
Healthy Life Expectancy at Age 65
Healthy life expectancy shows the years a person can expect to live in good health rather than with a disability or in poor health. It is a measure of the average number of years a person would expect to live in good health based on current mortality rates and prevalence of self-reported good health.
In Wiltshire healthy life expectancy for both males and females is significantly higher than the England average. It is also slightly higher than the South West average but not significantly.
Source: Public Health Outcomes Frameworks (extracted on 23/04/2021)
Life Expectancy at Age 65
In Wiltshire life expectancy at age 65 for males is 19.6 years and for females 22.3 years. There has been a steady increase in life expectancy at age 65 over the last 10 years.
Source: Public Health Outcomes Frameworks (extracted on 13/04/2021)
Healthy Life Expectancy at Age 65
In Wiltshire healthy life expectancy at age 65 for males is 12.7 years and for females 13.1 years.
Healthy life expectancy at age 65 has remained at the same level over the last 10 years. There is little gap between the genders, however, females are likely to live a greater proportion of their later life with complications associated with health.
Source: Public Health Outcomes Frameworks (extracted on 13/04/2021)
Main causes of death in those aged 65 and over
Provisional data for 2020 suggests that there was an increase in deaths in those aged 65 and over of around 18% (688 deaths). Around 63% of the increase was related to COVID-19 mortality.
There was also an increase in mortality associated with cancer, dementia, heart disease and other causes. It is expected that deaths in these categories are also likely to remain higher than the levels seen in 2019 for a number of years. If this does persist there is likely to be an impact on life expectancy.
Source: Extracted from Local Primary Care Mortality Data on 30/04/2021
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Impact on Older Peoples Health
The risk associated with a severe COVID-19 infection is known to be higher in older individuals and higher again in those with multiple long-term health conditions (multimorbidity). Levels of multimorbidity have been increasing in recent years as a factor of the ageing population and also increasing negative impacts of lifestyle choices.
A vital weapon in the fight against COVID-19 has been the shielding of clinically extremely vulnerable individuals at high risk, and instructions to clinically vulnerable people at moderate risk to stay at home and avoid face-to-face contact as far as possible. The consequences of this advice for mental health and well-being are not well understood.
Additionally the level of infections requiring hospitalisation has resulted in the postponing of large numbers of routine activity in the NHS which has increased waiting times which increases the risk that patients waiting will deteriorate further requiring more intensive treatment or be more dependent on other services.
Furthermore, COVID-19 pandemic has also had an impact on the mental health and wellbeing of the population in England. During March and May 2020 different population measures revealed that mental health and wellbeing deteriorated for many individuals including older people. Older adults who were recommended to shield were more likely to report higher levels of depression, anxiety and loneliness in June and July 2020 than people of a similar age but not recommended to shield.
For more information about mental health and wellbeing visit: www.wiltshireintelligence.org.uk
Clinically Extremely Vulnerable Older People
In April 2020 NHS England developed a methodology for identifying patients who were clinically extremely vulnerable (CEV) should they catch COVID-19.
There are 4 main groups of patients:
- - Transplant patients
- - Specific Cancer patients
- - Rare Disease patients at higher risk of infections
- - GP Managed (Elderly, COPD, Diabetic, CVD & Other
In Wiltshire there were 8,920 people aged 70 and over that were classed as clinically extremely vulnerable.
- - This was around half of all patients identified as CEV in Wiltshire
- - This is around 111 per 1,000 people aged 75 and over in Wiltshire
These patients were asked to shield during the 1st and 3rd National Lockdowns to protect them being infected.
Clinically Extremely Vulnerable Older People
There were 8,920 people aged 70 and over classed as clinically extremely vulnerable in Wiltshire. This is around 112 per 1,000 population.
In England the rate is slightly higher at around 130 per 1,000 population.
These patients received additional support to help them shield from the risk of infection. Supporting these patients back to independence will be important to reduce dependency.
Source: Extracted from (Coronavirus Shielded Patient List open data set, England - NHS Digital) on 27/01/2021
Social Isolation – Users of Social Care Services
Annually a survey of social care users asks about the amount of social contact a client receives is enough. The survey was completed in 2019-20 prior to the implementation of restrictions.
It was found that in Wiltshire there was a reduction in the percentage indicating enough social contact to around 35% which was lower than the national and regional percentage.
Source: Extracted from Public Health Outcomes Frameworks on 22/04/2021
Social Isolation – Carers of Social Care Services Clients
Every 2 years a survey of carers of social care clients asks about the amount of social contact a client receives is enough. The last survey was undertaken in 2018-19 prior to the COVID-19 pandemic.
In Wiltshire there was a further reduction in the percentage of carers indicating enough social contact to around 13% which was lower than the national and regional percentage.
Source: Extracted from Public Health Outcomes Frameworks on 22/04/2021
Care Home Beds
In 2020 there were around 4,800 care home beds which is around 10 per 100 population aged 75 and over. This is broadly similar to the average in England and the South West.
The peak was in 2016 where just over 5,000 number of beds were available.
Source: Healthy Ageing on 28/04/2021
Nursing Home Beds
In 2020 there were around 2,300 nursing home beds which is just under 5 per 100 population aged 75 and over. This is broadly similar to the average in England and the South West.
The number of beds has fallen sharply in the last few years from a peak of just over 2,700 in 2016.
Source: Healthy Ageing on 28/04/2021
Permanent admissions to Care Homes
Avoiding permanent placements in care homes is an indication of delaying dependency, and local health and social care services working together to reduce avoidable admissions. Research suggests where possible people prefer to stay in their own home rather than move into residential care.
In 2019/20 there were around 570 permanent admission to care homes in Wiltshire. This reversed the downward trend seen from 2013-14. Wiltshire is not lower than the England average and broadly similar to the South West average.
Source: Healthy Ageing on 28/04/2021
Flu Vaccine Uptake
Three quarters of the population aged 65 and over (83,100 people) had their flu vaccination in 2019-20.
This is broadly similar to the average in England and the South West and represents a slight increase on uptake in previous years.
Source: Extracted from Public Health Outcomes Frameworks on 22/04/2021
Flu hospital admissions
In the current financial year to date there have been no recorded admissions to hospital for influenza. This is likely to have been caused by a number of factors such as vaccination uptake, ongoing social distancing, reductions in international travel and the wearing of face coverings.
This is a positive development but may lead to increased respiratory infections in the 2021-22 winter as immune systems are less used to dealing with these infections resulting in historically mild infections leading to a more severe illness.
Source: Local HES Data accessed on 26th Mat 2021
Dementia Diagnosis Rate
Timely diagnosis of dementia enables people living with dementia, their carers and healthcare staff to plan accordingly and work together to improve health and care outcomes. The challenge to the NHS was to increase the diagnosis rate to 67%.
In Wiltshire the current diagnosis rate is around 65% which is lower than the England average but higher than the South West.
Source: Extracted from Public Health Outcomes Frameworks on 22/04/2021
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Financial Impact on Older People
Older people have been severely affected by the coronavirus pandemic in terms of their health and mortality, but less focus has been given to the financial impact on older adults. The Institute for Fiscal Studies (IFS) reported that those who were in paid work immediately prior to the pandemic were more likely to see a negative impact on their financial situation than those in retirement.
While many older individuals have financial wealth that they might be able to draw on to help weather income shocks, this is not true of all. There are reports of how they have adjusted to lower incomes: some have drawn on pension saving, borrowed from banks, or borrowed from friends and family. Overall, those who report being adversely affected by the COVID-19 crisis are disproportionately those who were in a less secure position financially before the crisis, heightening concerns about the impact of the crisis on financial inequalities.
Pension Credit Claimants
In August 2020 there were around 8,150 older people in Wiltshire receiving Pension Credit.
The rate of claimants is around 75 per 1,000 population aged 65. This is lower than the rates in England and the South West.
The number of claimants and the rate are continuing to fall.
Extracted from Stat-Xplore on 26/04/2021
Carer Allowance Claimants
In August 2020 there were around 7,100 people in Wiltshire providing care sufficient to qualify for receiving Carers Allowance.
The rate of claimants is around 65 per 1,000 population aged 65. This is lower than the rates in England and the South West.
The number of claimants and the rate have remained broadly similar since May 2018.
Extracted from Stat-Xplore on 26/04/2021
Digital Exclusion
In 2015 the House of Lords noted that everyday activities—such as shopping, using a telephone and banking— increasingly require interaction with technology and the response to the pandemic has increased and broadened the number of areas in everyday life which require an interaction with technology. The national data shows that over a third of those aged 75 and over have never accessed the internet. This has potential implications as services move to more digital delivery.
Improving digital skills for all will help with embedding new models of service delivery.
Source: Extracted from ONS.gov.uk on 23/04/2021
Fuel Poverty
A household is considered to be fuel poor if they have required fuel costs that are above average (the national median level) and, were they to spend that amount, they would be left with a residual income below the official poverty line.
Evidence shows that living in cold homes is associated with poor health outcomes and an increased risk of morbidity and mortality for all age groups.
National data shows that around 9% of older couples and 7% of single older people are living with fuel poverty.
Source: Extracted from Public Health Outcomes Framework on 22/04/2021
It is estimated that in 2018 around 17,500 households were in Fuel Poverty, this is around 8% of households.
Following a reduction in the number of families in fuel poverty in Wiltshire from 2014 the percentage of families is lower than the England and South West averages.
Source: Extracted from Public Health Outcomes Framework on 22/04/2021