Key Health Data for the West Midlands 2002
CHAPTER THIRTEEN: OLDER PEOPLE
List of Tables
List of Figures
Main Body
1: The Geography of the West Midlands
2: Life Expectancy and Inequalities
3: Drinking Water Quality
4: Chemical incidents in the West Midlands
5: Landfill Sites
6: IPPC
7: Fires in the West Midlands
8: Road Traffic Accidents
9: Drownings
10: Access to a healthy diet
11: National Health Service Priority Areas
12: Communicable Disease
13: Older People
13.1 Introduction
In last year's KHD we looked at child health, in particular the Sure Start targets and the role of education and social welfare provision for those caring for children. With the publication of the 2001 Census our focus in this year's KHD is on the other end of the age spectrum and older people. This group has already been identified as an important population in terms of healthcare provision with the publication of the National Service Framework (NSF). This chapter details the increase in the older population largely due to rising life expectancy; reporting on the impact this has on the ratio of those in work to those of retirement age. It looks at social care provisions, where data are available from the Performance Assessment Framework and variation in the distribution of benefits. The chapter also reports on a range of health events, such as injuries, strokes, coronary heart disease and deliberate self-harm.
13.1.1. Demography
In 1991 the total population for the West Midlands was 5,265,485 (1991 census), in 2001 this figure was 5,267,337 (2001 Census), an increase of just 1,852 people. Although the population has stayed relatively stable over the last 10 years, the dynamics have changed. In 1991 there was a higher number of people aged between 20-35 than in 2001. The number of older people has increased slightly. (Figure 13.1)
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Figure 13.1. West Midlands populations at the 1991 and 2001 census by 5 year age bands |
With a decrease in the number of people of working age, supporting a growing number of older people is becomes more of an issue.
The dependency ratio can be used to calculate the number of older people who depend on people of working age. This calculation has been applied to the West Midlands local authority (LA) populations.
The calculation used to determine the dependants of old age only is:
((total number of men aged 65 or over + women aged 60 or over)/ (total number of men 15-64 years old + women aged 15-60 years old))* 100.
The dependency ratio represents the number of dependants for every 100 adults of working age.
The maps show that between 1991 and 2001 (figure 13.2 and 13.3) the number of older people dependants per 100 people of working age have increased in the majority of LAs within the West Midlands with the exception of Birmingham, Coventry, Warwick, and Worcester LA.
Bromsgrove, Solihull and South Shropshire have seen the greatest increase of dependents to their area in the 10 years.
In 1991 the greatest number of elderly dependants within the West Midlands were in South Shropshire, Malvern and the County of Herefordshire LAs where there were between 35 and 40 dependants for every 100 working population. By 2001 the number of elderly dependants in the same LAs had risen to 37-44 dependants for every 100 working population. These LAs have remained those with the highest number of dependents in the West Midlands.
Tamworth, Redditch and Telford & Wrekin LAs had the least number of dependants per 100 working people in the West Midlands ranging from 10 to 22. In 2001 these LAs still had the least number of elderly dependants but the figure had risen to between 20 and 23 for every 100 working age people.
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Figure 13.2. Dependency ratio by local authority based on 2001 census populations |
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Figure 13.3. Dependency ratio by local authority based on 1991 census populations |
13.2. Morbidity and mortality in the older population
A brief compendium of statistics relating to some of the more common health problems faced by older people has been presented. Many of these are the subject of policy objectives set out in the National Service Framework for older people (Department of Health, 2001)
Rates of hospital admission and in some cases, deaths, have been used. The data have been presented geographically by ward with Primary Care Trust (PCT) boundaries superimposed over them. Owing to the small numbers involved, five-year rates have been used. Yearly rates both for PCTs and for wards are available on the disk supplied with this publication.
13.2.1. Stroke
Stroke is a major cause of mortality and disability in the older population. Admissions for stroke appear variable; however this is not wholly reflective of the underlying epidemiology, as admission criteria may vary across the region. For example, some providers have community based services in which a proportion of patients with cerebral infarctions are treated. Stroke admissions in this analysis comprise in-patient spells arising from emergency admissions where primary diagnosis was ICD10 I61.0 - I64 inclusive.
There appears to be variation in the proportion of stroke patients who are discharged back to their usual place of residence after their first episode of inpatient care. Again this is not solely a function of epidemiology as this figure will be affected by the types of care pathway that are used by the various providers. The inclusion criteria were as per Figure 13.4.
Emergency Admissions |
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Discharges to normal residence |
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13.2.2. Admissions and deaths from injuries amongst older people
Injuries, particularly from falls, are a major policy concern in the care of older people. Standard 6 of the older people NSF (Department of Health, 2001, p.76) sets out targets to reduce the incidence of falls and the severity of injuries arising from them. Again we see considerable variation across the region in both emergency admissions for injuries and deaths from injuries (see figures 13.6 to 13.7). Admissions in this analysis comprise in-patient spells arising from emergency admissions where primary diagnosis was ICD10 S00.0 - S99.9, or T00.0 - T32.9.
Emergency admissions following admissions |
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Deaths from injuries
The inclusion criteria for these mortality data were derived from the 'underlying cause' field of the ONS death records.
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13.2.3. Coronary heart disease
Deaths from Coronary Heart Disease (CHD) are falling in England, but it remains the largest single cause of death in the population as a whole (Office of National Statistics, 2002 p.126) and most of the burden of this illness is borne by older people. Gains in quality and quantity of life could be achieved for large numbers with even a modest reduction in prevalence. There appears to be a strong socio-economic gradient of disease burden; consequently, in an area as heterogeneous as the West Midlands, variations in CHD are inevitable. The pattern of emergency admissions, as can be seen from Figure 13.8, is similarly variable.
CHD reduction has been the subject of a number of key policy initiatives. Indeed the first of the government's NSFs was on this subject (Department of Health 2000). Also, the NSF for older people highlights the importance of cardiovascular health, standard 8 being concerned with the promotion of health and active life in older age.
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Revascularisation
A common response to CHD is coronary revascularisation. Last year's Key Health Data, (University of Birmingham 2002, pp.57-59) demonstrated that there was an apparent discrepancy between populations who had high levels of CHD and those who received revascularisation. Access to this intervention is highly variable across all age ranges in the region. However these variations appear amplified when the analysis is limited to older people. This treatment was one of a number highlighted in the interim report of the Older People NSF on age discrimination (Department of Health 2002 (b) p.7).
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13.2 4. Diseases of the nervous system
This analysis has focussed on admissions for dementia and for a range of diseases of the nervous system which cause it, the most common one being Alzheimer's disease. As in stroke, service response is unlikely to be a reliable proxy for incidence of disease owing to differing admissions policies across the region (see figure 13.10).
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13.2.5. Deliberate self-harm
Whilst intentional self-harm and suicide in the elderly is now rarer than amongst younger age groups (Office of National Statistics, 2002, p.127), self-harm acts are more likely to be lethal. The recent National Suicide Prevention Strategy for England highlights the challenges to providing effective interventions for depression in older people (Department of Health, 2002 (b), pp 25-26), a condition which is frequently overlooked.
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13.3. Performance Assessment Framework (PAF) indicators
The Department of Health collects a range of data from councils with social services responsibilities and from the NHS through a series of statistical returns. These data inform policy development and inspection preparations nationally, and are published to aid local planning and comparison.
In this section we have only presented those indicators which relate to older people, aged 65 and older.
The provision of intensive home care services helps many people to remain at home, or to go home following hospital treatment or a period spent in a group home. Most people prefer care in their own homes rather than in a residential home and it comes closest to meeting the aim of helping people to live a normal, independent life.
We can see from table 13.2 that older people in Worcestershire have the lowest rate of intensive home care per 1,000 population. Telford and the Wrekin UA, Sandwell and Walsall are amongst the highest recipients of intensive home care in the region.
Table 13. 2. Performance assessment framework indicators - Households receiving intensive home care |
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Table 13.3. Performance assessment framework indicators - Residential and Nursing care |
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For more information on the PAF and a comprehensive list of indicators visit http://www.doh.gov.uk/paf/#intro
13.4. Influenza
The annual influenza immunisation is the best protection against influenza and although influenza it is not usually life threatening for healthy people the influenza vaccine is highly effective in preventing illness and hospital admissions among people in certain 'high risk' groups, such as those with underlying respiratory, heart or renal disease, diabetes mellitus, those with impaired immune systems and for all those aged 65 and over or in long stay residential care. Influenza is a significant cause of more serious illness and death in these at risk groups.
Strategic health authorities and primary care trusts will be taking an active role in promoting 'influenza immunisation locally this year. This years influenza vaccination campaign began on the 1st October, the campaign involved media coverage and the dissemination of materials and leaflets. The Influenza Immunisation campaign is a reminder not to be complacent about influenza and encourages people aged 65 and over, or those in at risk groups, to book an appointment at the local surgery for a influenza vaccination.
Table 13.5. Campaign data form the October 31s to January 31st 2003 |
References
Department of Health. National Service Framework for Coronary Heart Disease, 2000.
Department of Health. National Service Framework for Older People, 2001.
Department of Health. National Service Framework for Older People Interim Report on Age Discrimination,2002 (a).
Department of Health. National Suicide Prevention Strategy for England, 2002 (b).
Office of National Statistics. Social Trends 32, HMSO London, 2001.
Department of Public Health and Epidemiology. Key Health Data for the West Midlands 2000, Birmingham: University of Birmingham, 2001.
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