Older people
Whilst it is well-known that our population is ageing it is less often discussed that more people are dying. Numbers of people dying each year declined over 30 years between the mid 1970s and the middle of the last decade (2000-9). However it is now predicted that numbers of deaths will start to rise over the next twenty years from about 503,000 deaths per year in England and Wales in 2006 to about 586,000 in 2030 (Gomes and Higginson, 2008).
There is a disconnect between what people say about where they want to die, and where they actually die. About 70% of people say they want to die at home. In fact about 60% die in hospital, whilst numbers of home deaths have been declining and are below 20% (End of Life Care Strategy, 2008).
Figure: The gap between the numbers of people dying and numbers of people dying at home (with acknowledgements to Gomes and Higginson, 2008)
Of those who die each year, almost two thirds are aged over 75 (End of Life Care Strategy, 2008). Whilst people are living longer before they die, the period of ill-health at the end of life is also increasing. More people are living with multiple long-term conditions. For example 29% of people aged 85 and over with cancer, circulatory or respiratory disease also have dementia (NCPC, 2006). There are currently 822,000 people with dementia in the UK and it is predicted that this will pass the 1 million mark before 2025 (Alzheimer's Research Trust, 2010)
The combined pressures of more deaths, more older people and greater numbers of people living with multiple conditions at the end of life mean that pressure on health and social care capacity will increase. The King’s Fund estimated before the election that NHS spending would have to rise by 1% each year simply to keep pace with demographic change. Discussion of “real terms funding” must take account of that reality.
With an aging population and as death rates increase, there is insufficient capacity to allow for further deaths in hospitals or hospices. This will demand greater capacity in care homes and other supported housing as well as planning for more home deaths. New services will be required to ensure that people receive good end of life care, whatever setting they are in.
What we’re doing
Our MDS collection shows that people aged over 85 receive disproportionately less access to specialist palliative care than people in other age groups. We are working to ensure that older people are able to access high quality palliative care when they need it. As well as looking at individual conditions such as dementia that tend to affect this group, we’re also helping services to be more prepared for the rising number of people with multiple conditions.
Some of our top priorities in this area are:
- Ensuring older people’s voices are heard in planning services
- The implications of multiple conditions and frailty
- Improving access for people with dementia
- Supporting the housing sector (including care homes, extra care and sheltered housing) in providing end of life care for older people
- Removing age discrimination and health inequalities
- Ensuring that the personalisation agenda works to the benefit of older people and their carers
How we work
Our work on these issues is informed by our Older People’s Group, a cross cutting group of professionals informed by people with personal experience. This group looks at key issues affecting older people rather than specific diagnoses.
The Older People’s Group also oversees the work of the Dementia Group. This is an important link given the prevalence of the condition among older people (one in 14 people over 65 years of age and one in six people over 80 years of age has a form of dementia).
References
Barbara Gomes and Irene J. Higginson (2008), Where people die (1974-2030): past trends, future projections and implications for care, Palliative Medicine, 22; 33
NCPC (2006), Exploring Palliative Care for People with Dementia. London: NCPC
Dementia 2010 Report Health Economics Research Centre at the University of Oxford for the Alzheimer's Research Trust
