Age

Inequalities in later life can be the result of disadvantage over time. Poor education, work opportunities, lack of social connectiveness and other factors may accumulate and have long-term consequences for the income, health
and wellbeing of people when they reach later life. This accumulation can have an impact through multiple long-term conditions, housing circumstances and lower income in retirement.

Adolescence is a time of rapid development, psychologically, biologically and socially. The things that shape the lives of young people continue into adulthood and have a huge impact on our society.

Adolescence is a time of increasing independence which can also mean increased exposure to risks. The World Health Organisation highlights adolescents are at particular risk of:

• Road traffic accidents as pedestrians, cyclists or young drivers – strong road safety laws and enforcing laws prohibiting drink or drug driving.
• Drowning – teaching swimming is vital.
• interpersonal violence, including sexual violence and bullying – prevention support in schools, life skills programmes, limiting access to alcohol and weapons, and empathetic care for survivors.
• Mental health including depression and suicide – psychosocial and resilience support for young people, strengthening relationships with parents, good quality home environments, and prompt intervention when problems arise.
• Alcohol, tobacco drug use – public health prevention with young people, families and communities, and to limit access.
• Sexually transmitted infections and HIV/AIDS – information for young people on prevention, testing and counselling.
• Early pregnancy and childbirth – comprehensive education, access to contraception and high quality maternity care.
• Nutrition and activity – access to healthy food, iron supplements where needed, and access to exercise that builds cardiorespiratory and muscular fitness and bone health.

The Health Foundation has been surveying young people since 2017, and has found four assets that the young people say were important to a successful transition to adulthood:

Skills and qualifications: ‘How right my skills are for the career I want’ Educational level is important to later health outcomes, though the implications of a skills mismatch between young people’s achievements and employers’ demands are less clear.

Personal connections: ‘The confidence and connections to navigate the adult world’ Social networks, personal connections and neighbourhood resources are important, as is social capital, in improving health outcomes.

Financial and practical support: ‘Having the support to achieve what I want from life’ Financial and practical assistance do improve education outcomes and socio-economic status for young people, but research on the direct impact on their health outcomes in early adulthood is limited.

Emotional support: ‘People I can lean on emotionally’ Friends, family and romantic partners are critically important to young people’s sense of wellbeing and connectedness. However, most of the research is set within the context of mental health problems, development of self-esteem, identity development and the role of peers in helping each other to manage situations such as college. There is little research on how emotional support can help emerging adults achieve their life goals or lead to better health outcomes.

As our population ages, there will be increased need for informal care, but there also a need for older people to stay in the workforce longer – Workers aged in their 50s and early 60s are more likely than any other age group to be juggling caring responsibilities and working. In 2016 to 2017, 65% of men and 60% of women aged 52 to 64 years who were carers were also in work

• ‘sandwich caring’ or ‘dual caring’ – those who care for both sick, disabled or older relatives and dependent children – and those who fall under this category are usually referred to as ‘the sandwich generation’ – with teenagers and elderly parents with increasing physical and emotional need at the same time and as middle-aged people begin to face ageing issues of their own, the needs of those around them are increasing.
• Sandwich carers are more likely to report symptoms of mental ill-health, feel less satisfied with life, and struggle financially compared with the general population.
• One in four report health problems, relationship troubles and isolation among the difficulties also related to their caring role.
• Six out of ten sandwich carers who spend more than 20 hours providing adult care are out of paid work. They report a lack of leisure time, and 41% who look after a relative within their home say they are unable to work at all, or as much as they would like.
• Carers UK’s research found that trying to find the right care for an older relative was harder and more stressful than finding good quality childcare
• More than 72% of the sandwich generation are aged between 35 and 54 years, while 62% are women- in the general population, 38% are aged 35 to 54 years and 51% are women.

• Latest census showed 257,300 aged 65 or over in SNEE – almost 1 in 4
• More than 72,000 live alone
• 1 in 5 aged 65 and over in SNEE are estimated to have a limiting long term illness that limits day-to-day activities a lot
• 27% aged 65 and over in SNEE predicted to have a fall
• 1 in 5 in SNEE aged 65 and over unable to manage at least one activity on their own
• 7% of SNEE population aged 65 and over predicted to have dementia

Research published in 2021 by the Centre for Ageing Better on Ethnic health inequalities in later life: The persistence of disadvantage from 1993 -2017 found:

1.The health status of different ethnic groups begin to diverge at around 30 years of age, when the gap in health between ethnic minority and White majority groups gets gradually larger, particularly pronounced in later life.

2.At any given age after 30, Pakistani and Bangladeshi people experience the highest rates of poor self-rated health; their rates of poor health are equivalent to those of White people who are at least 20 years older.

3.These ethnic health inequalities have persisted, unchanged, for almost 25 years.

4.Ethnic health inequalities result from experiences of racism and racial discrimination, which directly cause physical and mental stress, and indirectly impact through their effect on socioeconomic status.

Recommendations:

1.Close the ethnicity data gap – mandatory reporting on ethnicity, using specific categories (e.g. Pakistani, Bangladeshi, Indian) rather than broad categories (e.g. South Asian); sufficient representation of ethnic minority groups in surveys and ask about their experiences of racism and racial discrimination.

2.Produce and implement a national race equality strategy – which takes into account healthy ageing; includes recovery from the effects of the pandemic; and takes a life-course approach to prevent inequalities in later life.

3.Address inequalities in all policy activity relating to people in and approaching later life.

“patients who were most able to manage their health conditions had 38% fewer emergency admissions than the patients who were least able to. They also had 32% fewer attendances at A&E, were 32% less likely to attend A&E with a minor condition that could be better treated elsewhere and had 18% fewer general practice appointments”

(The Health Foundation)

Close to half of all emergency admissions are in those aged 65+

Evidence suggests that in middle aged and older adults, frailty is significantly associated with multimorbidity in those with four or more long term conditions.

Long term conditions associated with frailty include multiple sclerosis, chronic fatigue syndrome, chronic obstructive pulmonary disease, connective tissue disease and diabetes.

Between 2017 and 2035, the number of people aged 75 over admitted to hospital due to a fall is expected to rise by 70%.

The older population with immobility, incontinence and self-care limitations is predicted to rise significantly

Recently published research by the Alzheimer’s Society found that approximately 40% of people with dementia have depression, but of referrals to IAPT only 0.2% are people with dementia – a lack of expertise in dementia may mean primary care is not referring everyone who could benefit from therapy, or lead to referrals being rejected by some IAPT services.

Recent research by Queen Mary University of London (reported in The Guardian) analysed data from almost 600,000 people over 19 years and found that of the 5,000 with dementia, the suicide
rate was similar to the general population – 2%. But:

• An increased risk of suicide was also seen among those who had a psychiatric
  condition.
• Those who were diagnosed with dementia before the age of 65 were at 2.82 times
  increased risk of suicide compared with those without the condition.
• In the first 3 months of younger people’s diagnosis, the risk was almost 7 times
  greater than those without dementia, though this did later reduce.

• The number of carers over the age of 65 is increasing more rapidly than the general carer population –
• Over 37,000 people aged 65 and over in SNEE are providing unpaid care, over 3,000 of which aged 85 and over
• There are 1.2 million carers aged 65 and over in England
• The number of carers aged 85 and over grew by 128% in just ten years
• Nearly 3 in 5 (59%) carers aged 85 and over are male – Carers over the age of 65 are more likely to be female (52% are female and 48% are male). – the balance shifts as carers get older; 59% of carers aged 85 and over are male.

• Nearly half (45%) of carers aged 75 and over are looking after someone who has dementia
• As carers get older, they are more likely to provide more hours of care
• 6 in 10 (60%) older carers who provide 50 or more hours of care a week say their health is not good, rising to 72% of carers aged 85 and over
• 8 in 10 (81%) carers aged 75 or over say they were looking after a spouse or partner
• Older carers who provide lower levels of care (1 to 19 hours a week) report being in better health than non-carers of the same age – this pattern reverses for older carers providing 20 or more hours of unpaid care a week
• As our population ages, there will be increased need for informal care, but there also a need for older people to stay in the workforce longer – Workers aged in their 50s and early 60s are more likely than any other age group to be juggling caring responsibilities and working. In 2016 to 2017, 65% of men and 60% of women aged 52 to 64 years who were carers were also in work
• Nearly three in five carers in England and Wales are aged 50 years and over, and one in five people aged 50 to 69 years are informal carers – this is the most common age group for having caring responsibilities

Ageism: What’s the harm? | Centre for Ageing Better (ageing-better.org.uk)

Age Discrimination in Health and Social Care – Emilie Roberts – The King’s Fund, 1st June 2000 (kingsfund.org.uk)

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