People Living with Frailty

• 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

As we get older our bodies gradually lose their in-built reserves, leaving us vulnerable to dramatic, sudden changes in health that can be triggered by seemingly small events such as a minor infection or a change in medication or environment.

• The British Geriatric Society define it as a state of increased vulnerability to poor resolution after a stressor event, and a state associated with low energy, slow walking speed, poor strength, and in medicine, frailty is the term used that defines the group of older people who are at highest risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long-term care.
• The number of people living with frailty in Suffolk and North East Essex is expected to double in the next 20 years, and evidence suggests that in middle aged and older adults, frailty is significantly associated with multimorbidity in those with four or more long term conditions.
• the growth that we can expect to see in the number of people with two or more long term conditions in the next 15 years, and the fact that this will have a disproportionately bigger effect on the poorest women and men in our population, who are twice as likely to have type 2 diabetes , twice as likely to have a respiratory illness and even more likely to have depression than the wealthiest

Previous increases in the proportion of older people have been primarily driven by improvements in life expectancy and declining fertility, however, progress on life expectancy has stalled, and we are now living a longer period of our lives in poor health or with disability.

This isn’t evenly distributed across our society though, with people living in the most affluent areas having nearly twice as many years of disability free life ahead when they are 65 as those in the most disadvantage, and that also manifests more significantly in certain conditions

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.

The need for appropriate work as the retirement age has increased and there is actually a strong evidence base showing that work is generally good for physical and mental health and well-being, with worklessness is associated with poorer physical and mental health and well-being.

That work has to be appropriate and be flexible, because so many more people are living with health conditions or disability at that time in life because many of us, particularly in the most disadvantaged communities, cross into that stage of life where we are living with a disability or long term health condition and still working, and this starts from about the age of 50 onwards.

Health is the leading reason for people over the age of 50 that are considered as of working age, for being out of work, and with the rising cost of living, many will need to continue to work beyond the state retirement age just to be able to live, yet older workers are more likely to be unemployed and to be experiencing work that they find excessively demanding or don’t have control over.

The group of people in the pre-retirement age category are also more likely than any other age group to be juggling caring responsibilities and working

• Older people may also be particularly vulnerable: cold temperatures increase the risk of strokes and circulatory problems, lung problems, and hospital admissions.
• Cold temperatures lower strength and stability leading to an increase in the likelihood of falls and accidental injuries

• There are 1.2 million carers aged 65 and over in England
• 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, The number of carers aged 85 and over grew by 128% in just ten years
• 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

Multimorbidity increases costs more than ageing.

Frailty is linked to long-term conditions in middle-aged and older adults. Common comorbid conditions include:

• multiple sclerosis,
• chronic fatigue syndrome,
• chronic obstructive pulmonary disease,
• connective tissue disease
• diabetes.

In 20 years we will have 10 times more people with two or more co-morbidities

Sight

prevalence of eye health conditions and sight loss increases with age. As the UK population is ageing, it is predicted that the number of people living with sight loss will double by 2050.

Age related macular degeneration is the most common cause of registerable sight loss in older people.

• The overall prevalence of all causes of visual impairment in those aged 65-74 years and over with visual acuity (VA) of less than 6/18 (moderate or severe) is 5.6%, and 12.4% for those aged over 75.

Of those aged 75 and over, approximately half have cataracts or refractive error (i.e. correctable sight loss) and if these are excluded, the prevalence estimate of those with ‘registrable’ eye conditions is 6.4% in this age group.

Around 60 per cent of people living with sight loss are women. Women have a higher life expectancy and have a higher age-specific prevalence of some of the leading causes of sight loss in older age.

Research by The Clothworkers Foundation (2013) found older people with significant visual impairment struggle with:

Performing even simple tasks – identifying different tablets, reading sell by dates on food, completing forms.

Getting out and about – crossing the street when you cannot see the traffic or the edge of the kerb; finding your way around without the aid of maps of familiar landmarks.

Poor balance – and greater risk of falls.

Inability to read or watch TV – especially for those living alone.

Social situations – difficulty recognising familiar faces, feeling uncomfortable or unsure of themselves, which can mean not connecting with friends and becoming increasingly house-bound, lonely and depressed.

What we can do:

Early identification and treatment of visual impairments – some conditions, such as cataracts, can be corrected or treated. Others, such as dry AMD, have no treatment or cure, but early diagnosis makes adapting to gradual loss of sight far less daunting, and people can be supported properly to learn to cope as their vision changes.

Integrating visual impairment better – into health and social care provision.

Simple adaptations to living conditions—large print books, or better lighting, so people can continue to enjoy activities.

 

Hearing

• Age-related hearing loss (or presbycusis), is the single biggest cause of hearing loss
• Hearing loss as a risk factor for dementia – There is strong evidence to show that: mild hearing loss doubles the risk of developing dementia, moderate hearing loss leads to three times the risk, severe hearing loss increases the risk five times.
• Hearing loss can sometimes be misdiagnosed as dementia. It can also speed up the onset of dementia, or make the symptoms of dementia appear worse, and dementia can heighten the impact of hearing loss.
• Higher prevalence of multimorbidity among adults aged 65 and older who suffer from hearing loss, compared with those who do not suffer from hearing loss or with other health conditions
• almost 272,000 aged 65 and over with some hearing loss, around 4,000 of 18-64 and over 20,000 aged 65 and over of which have severe hearing loss

Royal Osteoporosis Society’s survey ‘Life with Osteoporosis 2021: the untold story… ‘ highlighted:

Activity: Many people stop doing everyday tasks because they are anxious about hurting themselves. Lack of energy, tiredness and fatigue which often results from pain means they need to rest regularly.

Work: Giving up work and the increased costs of living with osteoporosis cause stress and financial worries. Over a quarter have had to give up work, and almost one in five have had to take early retirement.

Independence: Over one in four of those who have fractured have had to change their living arrangements in some way in order to cope. Only just over half (56%) said they are getting the right level of support to live independently.

Fears for the future: 92% are concerned about falling or fractures in the future; for many the fear was all-consuming, resulting in hypervigilance and loss of confidence. 4 in 5 were worried about changes to their physical appearance and the pain they might be in. Those living alone worried about how they would manage.
Many were concerned about how effective treatment would be, side effects, and what happens if they stop treatment.

The survey also found:

• Many people with osteoporosis lacked confidence in healthcare professionals. This was exacerbated during the COVID-19 pandemic as patients missed out on face-to-face consultations.
• For many, diagnosis, healthcare and intervention doesn’t happen quickly enough to avoid multiple fractures. Almost 3 in 4 broke a bone (which they suspect was related to their osteoporosis) before their diagnosis and almost 1 in 3 broke more than one before they got a diagnosis. Most people wait up to 6 months before osteoporosis is identified as the cause of their fracture, but 1 in 7 people are not diagnosed with osteoporosis for over 5 years following their first fracture.
• Even once diagnosed, many don’t think their medication is effective or that their condition is monitored well enough to provide confidence that the medication is working:
• Only 48% are confident they’re on the right medication.
• Only 40% think their medication is effective.
• Only 54% feel the benefits and drawbacks of their medication are fully explained to them.
• 57% are worried about the risks of taking their medication for prolonged periods of time.
• 52% are worried about the potential side effects of their medication.

BABCP and Age UK’s IAPT practice guide for older people summarises some of the messages from data and research:

• Depression is estimated to affect 22% of men and 28% of women aged 65 years and above; anxiety disorders are estimated to affect 1 in 20 older people.
• Common symptoms of depression such as hopelessness and apathy may manifest as outcomes of ageing, e.g. ‘at my age it is all downhill from here’, and, ‘I am too old to change’. These commonly expressed thoughts may lead to people being denied access to treatments that are known to be beneficial (e.g. evidence-based psychological therapies).
• Older people with generalised anxiety disorder are more likely to present to primary care with somatic symptoms (e.g. gastrointestinal symptoms, aches and pains) rather than cognitive or emotional symptoms.
• Older people who are depressed are at increased risk of frailty, functional decline, reduced quality of life, cognitive decline, and an increase in mortality not attributed to pre-existing physical health conditions.
• It is estimated that 1 in 4 residents in care homes will have clinical depression, 1 in 5 have an anxiety disorder, and up to 80 per cent of residents experience symptoms of depression.

The report highlights the importance of IAPT services proactively engaging with older people to raise awareness and improve access, and recommends that services are trauma-informed.

Some older people will have had severe mental illness for many years, though some may develop late onset schizophrenia. Research shows contributing factors in developing psychosis in older people include:

•Age-related deterioration of frontal and temporal cortices •Neurochemical changes associated with ageing •Social isolation

•Sensory deficits •Cognitive decline •Medication-related complexities

Hallucinations – in older people may be physical rather than mental-health-related. Physical causes can include:

• Certain eye conditions – may lead to seeing shapes, colours, objects or people
• Hearing loss – may result in hearing sounds
• Grief – seeing the deceased person or mistaking someone else for them
• Parkinson’s Disease – feeling someone nearby or seeing something from the corner of the eye
• Stroke – depending on the area of the brain affected
• Being unwell – infection, poor health or stress
• Medication

It is therefore important to get the right help to identify the cause, and so enable access to the right treatment.

(MindEd For Families)

Ageing in society | Centre for Ageing Better (ageing-better.org.uk)

Productive Healthy Ageing Profile – Inequalities – OHID (phe.org.uk)

Productive Healthy Ageing Profile – Data – OHID (phe.org.uk)

Report_vF_0.pdf (independentage.org)

Ageing-Better-new-Strategy-2022-2025.pdf

Projecting Older People Population Information System (poppi.org.uk)

the-marmot-review-10-years-on-full-report.pdf (instituteofhealthequity.org)

20190718_HANA_Presentation_final.pptx (live.com)

Healthy Ageing Needs Assessment Summary (healthysuffolk.org.uk)

hhna-Infographic.pdf (healthysuffolk.org.uk)