Suffolk Healthy Ageing Needs Assessment 4 th February 2019

1. Suffolk Healthy Ageing Needs Assessment4th February 2019 Jeptepkeny Ronoh Nowreen Azim Alison Matthews

2. Overview • Suffolk Healthy Ageing Needs Assessment • Objectives • Definition and scope • Findings • Age, sex and constitutional factors • Lifestyle • Social and community networks • Care and health conditions • Socio-economic and environmental conditions • Services in Suffolk • Evidence review • Conclusion and recommendations

3. Healthy ageing considers the ability of people of all ages to live a healthy, safe, and socially inclusive lifestyle • “… the process of optimising opportunities for physical, social and mental health to enable older people to take an active part in society without discrimination and to enjoy an independent and good quality of life…”

5. Suffolk’s population is forecast to increase by 10% over the next 20 years, ALL the increase is in over 65s, so the proportion of older people within the population increases by 50% 54% increase in people aged 65+ Suffolk Population '000's Suffolk Coastal and Babergh will see up to 10% increases in the number of older people. 2017 People >65 as a proportion of Suffolk’s population 2037 Source: ONS sub-national population projections mid-year 2014

6. Life expectancy Life expectancy has increased over the last decade, but healthy life expectancy has fallen. Healthy life expectancy is lower than Suffolk’s closest statistical neighbours.

7. Deprivation, health & life expectancy A child born in the least deprived part of Suffolk will live on average longer than a child born in the most deprived part of Suffolk • Deprivation increases the risk of ill health and disability at a younger age, so: • People are less likely to remain independent and in work. • They are more likely to experience economic disadvantage and suffer mental ill health.

8. Lifestyle: Physical Activity Physical activity decreases as people get older Nationally, only 1 in 10 males aged over 75 and 1 in 20 females aged over 75 meet the recommended guidelines for physical activity women people with a limiting illness or disability people from lower socio-economic classes the unemployed Suffolk people who are less physically active:

9. Lifestyle: Obesity REDUCES QUALITY OF LIFE INCREASES RISK OF DIABETES, CARDIOVASCULAR DISEASES, & CANCER ASSOCIATED WITH UNEMPLOYMENT AFFECTS SELF-ESTEEM & MENTAL HEALTH

10. Lifestyle: Diet and Nutrition Suffolk adults eat more fruit & vegetables than national & regional averages Diets rich in fruits, vegetables & nuts can reduce mortality in older people BUT…

11. Lifestyle: Smoking Smoking rates vary across Suffolk 1 in 5 in Forest Health & Ipswich 1 in 12 in Babergh

12. Lifestyle: Alcohol Alcohol consumption appears to increase with age Higher-risk drinking is declining for all ages except the over 50s Consumption is higher among more affluent groups 75% of residential alcohol treatment facilities in England have age limits Alcohol-related deaths might be prevented if access to treatment was not age-restricted

13. Lifestyle: Loneliness & isolation

14. Mental health • Loneliness is linked to dementia • Loneliness, social isolation, and lack of community bonding are also linked to depression Older people with mental ill health may find accessing health care challenging due to loneliness, stigmatisation and poor mobility. This leads to poor quality of life.

15. Care homes There has been a marked increase in A&E attendances and emergency admissions from care home residents aged over 85 in both IESCCG and WSCCG over the last two years. Main reasons for attendance or admission: • Pneumonia • UTI • Fall

16. Carers

17. Frailty • ELECTRONIC FRAILTY INDEX • Used in general practice • Routine frailty identification & action • Could improve detection & management of frailty

18. Dementia • 4%dementiaprevalence in Suffolk (people 65+) • 4xhigherdementia prevalence in people with learning disabilities aged 65+ • 61.9%WSCCG’s rate of dementia diagnosis (65+) is significantly lower than the national average (67.9%) • 3.5xvariation in dementia diagnosis rates between Suffolk GP Practices. Probably not due to clinical variation & may cause health inequalities • 2.5xincrease in people aged 85+ with dementia in 20 years to 2035 • Highestincreases in dementia expected in the over 65’s in Mid Suffolk • 7xincrease in dementia prevalence in BME groups compared to • 2xrise in the rest of the population • Suffolk Dementia Action Alliances include Debenham Project, Hadleigh & Sudbury Dementia Action Alliance • Age-Friendly Cities encourage active ageing by optimizing opportunities for health, participation and security. This should enhance people’s quality of life as they age. We are exploring how we could use the approach to make Suffolk an age-friendly county

19. Healthconditions: Cancer • The highest increases in disease prevalence over the next 20 years will be in cancers, cerebrovascular disease, COPD, IHD, falls and diabetes. • More people aged 65+ live with or survive cancer. Cancer services need to be appropriate for older people. • Older people may be undertreated and are less likely to receive more intensive cancer therapy than younger people. • Prevention across the life course can reduce the risk of cancer. • Lifestyle interventions can prevent cancer occurring and also recurring.

20. Health conditions: Multimorbidity 4+ • Society benefits from older people’s skills & economic contributions. • Multimorbidity increases costs more than ageing. If trends continue, health & care will be unsustainable. • Prevention of ill-health & promotion of healthy ageing from middle age onwards are crucial. • 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. This should inform development of frailty management pathways.

21. Healthconditions: Other Musculoskeletal (MSK) Diabetes 30% increase in adult prevalence of diabetes in Suffolk over the next 20 years Diabetes & 25+ BMI is associated with: liver cancerin men breast cancer in women • Increased prevalence due to: • ageing population • reduced physical activity • lifestyle habits (e.g. smoking) • Preventative interventions promote ageing well & should address: • physical activity • healthy weight and balanced diet • smoking cessation

22. Urgent & emergency care • Emergency hospital admissions for people aged 65 and over have increased nationally and locally. Close to half of all emergency admissions are in those aged 65 and over.

23. Housing+ Excess Winter Deaths • All older people should have access to appropriate, affordable housing options that meet their additional needs • Vulnerable older people may be affected by unsafe, unhealthy & unsuitable homes • 9.1% Suffolk households are fuel poor, higher than the regional average (7.8%) • Mid Suffolk, Babergh & Waveney have the highest proportion of fuel poor households • Forest Health has the highest Excess Winter Deaths Index (EWDI) for people 65+. Waveney has the lowest • WSCCG has the highest EWDI for people 65+. GYWCCG has the lowest • EWDI is highest in people 85+ across the three Suffolk CCGs

24. Work • Employers should adapt working styles & opportunities to meet the needs of an older workforce • Healthy ageing can be improved by interventions to keep older (and younger) people in work for longer • A purpose in life helps older adults retain physical function • People who work later in life keep socially connected & financially secure

25. Work • Ipswich has the highest numbers of people 50+ in employment (2015-17). Babergh & Forest Heath are lowest. • Numbers of 50+ women in employment have fallen in Suffolk Coastal, Babergh, Waveney & Ipswich. • Suffolk Coastal has the highest number of retired people. • Ipswich (with Waveney second), has the highest % of people who are economically inactive because they are “looking after a home or family”, on long-term sick, or disabled.

26. Existing services Existing Services

27. Whatworks? • Address socioeconomic inequalities: • Reduce fuel poverty • Increase employment • Improve the built environment • Minimise inequalities between ethnic groups • Improve mental health and wellbeing: • Tackle social isolation and loneliness • Support carers, especially older carers • Coordinate responses to dementia • Develop more dementia-friendly communities • Support physical health: • Increase physical activity • Improve early identification & management of frailty • Improve care quality for care home residents • Prevent age discrimination • Encourage businesses & employers to support older people and address the challenges they face in work • Develop & adopt technological solutions to support older people • Make Suffolk an Age Friendly County Focuson prevention across the life-course Intervene & prevent as early as possible

28. Recommendations • Prevention across the life course; reducing health inequalities • Early identification and management of frailty • Tackle social isolation and loneliness • Support carers (especially older carers) • Quality of care for care home residents • Tackle age discrimination and support older people in work • Technological solutions to support older people • Establish Suffolk as an age-friendly county • Coordinated response to dementia and development of dementia friendly communities

29. Next steps … • Implementing recommendations • System buy-in • Alliances • Health and Wellbeing Board • Priorities • Research / applied research • Generate evidence • Opportunities for partnership • Centre for Ageing Better • NIHR – School for Public Health Research • Other …

30. Links • Full report: https://www.healthysuffolk.org.uk/uploads/Healthy_Ageing_Needs_Assessment_webFinal160718.pdf • Executive summary: https://www.healthysuffolk.org.uk/uploads/Healthy_Ageing_Executive_Summary_Report_WebFinal130718.pdf