Well-being, Independence and the future: Healthy ageing in Wales

1. Well-being, Independence and the future:Healthy ageing in Wales Bob Woods Professor of Clinical Psychology of Older People Dementia Services Development Centre Bangor University

2. Overview • We live and age in unprecedented times • Dementia – the big challenge to independence? • Depression – strong link with dependency • The well-being paradox – your money or your health? • Ageing as growth and development?

3. Global Population Growth • Two centuries of sustained growth in the percentage of the population age 60 and older

4. Regional Growth • The pace of population ageing for different regions of the world

5. Wales – 1871

6. Wales - 1931

7. Wales - 1991

8. Wales - 2001

9. Wales - 2009

10. Wales - 2012

11. Wales – 2033?

12. An older population - UK

13. An older older population - UK

15. What do these changes mean? • More people with physical health difficulties

16. Physical health and older people • Arthritis – 47% females; 32% males 65+ • Cardiovascular disease – 31% females; 37% males • Hypertension – 64% females; 62% men • Limiting long-term illness • 40% aged 65-74 • 60% aged 75-84 • Over half rate their health as good or fairly good

17. Physical health and older people - 2 • Functional limitations in 3 or more areas • Aged 65-69, 2% females, 4% males • Aged 85+, 19% females, 17% males • Hearing impairment – 34% females, 48% males 65+ (USA) • Falls in previous 12 months • 23% females, 18% males 65-69 • 43% females, 43% males • Medication – more frequent use of benzodiazepines

18. What do these changes mean? • More people with physical health difficulties • More people living with dementia

19. Prevalence of dementia in older people (UK Dementia Report, 2007)

20. How old are people with dementia?(Prevalence figures for Gwynedd 2011 – UK Dementia Report)

21. Ageing population predicted to increase number of people with age-related conditions such as dementia • 37,000 people in Wales with dementia in 2007 • 50,000 people in Wales with dementia in 2021 • Number of people with dementia predicted to increase by 33% by the year 2021 • Gwynedd from 1,719 to 2325 • Anglesey from 905 to 1,223 • Conwy from 2,062 to 2,793

22. But some good news! (Lancet, July 2013) • UK estimate down from 884,000 to 670,000 (2011) • Wales estimate 35,000 cf. 40,000 • Figures from CFAS-Wales (Anglesey, Gwynedd, Neath, Port Talbot) in 2014

23. Why are the dementias so challenging? • Fluctuation, variation and change • Different perspectives on need for care • Interaction with physical health conditions and medication • Role of personality, biography and attempts to cope and make sense of the condition • Relocations can be damaging • Major issue for general hospitals • Providing person-centred care – easy to say, difficult to deliver • Availability of family care?

24. Care homes and dementia • Estimates suggest that 37% of people with dementia live in care homes • 27% of 65-74’s • 61% of over 90s • As many as 75% of care home residents have dementia (not reflected in proportion of places registered for dementia care – approximately one third)

25. What do these changes mean? • More people with physical health difficulties • More people living with dementia • More people at risk of depressed mood

26. Depression in later life • Prevalence (Lindesay et al, 1989): • 4.3% severe depression • 13.5% mild/moderate depression • More common in older people? Not in older people at home, but high rates in care homes and in older people in receipt of services and in people with dementia

27. Risk factors for depression • Representative sample of over 14,000 people aged 75 and over (Osborn et al., 2003). • Risk factors: • Life events • Two or more physical illnesses • Not having a confiding relationship

28. Depression in care homes • High rates - 40% or more • Not simply a response to environment (although it may not help) • Lack of activity? Involvement in preferred activities critical • Sense of control key factor? (But, control not wanted by all) • Mann et al (2000) - rates of depression related to staff awareness of physical health issues (e.g. sensory and mobility problems)

29. Despite it all:the well-being paradox • “in the face of age-related increases of somatic and socio-economic risks, the ageing self has reserve capacities that prevent considerable changes in aging satisfaction” Staudinger et al., 1995

30. Compensatory models of adjustment • Selective optimization with compensation (Baltes & Baltes, 1990) e.g. musician, typists • Selection – reduce the range • Optimization – practice more • Compensation – find a different way • Encapsulation – Bingo! Areas important / special to the person show growth and maintenance of function

31. Self-resources • Environmental mastery • Resilience (Windle et al., 2010) • Self-esteem • Self-efficacy • Locus of control • Hardiness

32. European Study of Ageing Well – UK data • 1847 people aged 50-90 in England, Wales & Scotland • Part of 6 nation European study, led from UWB (Burholt, Wenger, Woods) • Analysis of effects of ‘resilience’ undertaken by Gill Windle

33. Does money bring happiness?Age 50-59

34. Moderating effects of resilience on relationship of health and life satisfaction (Windle et al., 2010) N=1847Windle, G., Woods, R. T., & Markland, D. A. (2010). Living with ill health in older age: the role of a resilient personality. Journal of Happiness Studies, 11, 763-777.

35. European Study of Ageing Well – UK data • Resilience important factor in linking good health, material resources, social support, independent function, and activity participation with life satisfaction • For 80-90 age group, volunteering and maintaining independent functioning were most important sources of well-being

36. Ageing as growth & development? • You CAN teach old dogs new tricks! • Learning German - Naylor & Harwood, (1975) • Open University students (Cohen, 1996) • Creativity - quality v. quantity • Swansong phenomenon • Examples of productivity in late life

37. Creativity in late life • Michelangelo (1475-1564) worked on St Peters in his 80’s, and was working on this emotionally intense Rondanini Pieta a few days before he died at the age of 89

38. Creativity in later life • Titian (1485-1576) was painting up to his death at the age of 91 • Pieta (1573-1576) – his final work – was intended for his own tomb

39. Increasing well-being in dementia • Quality of life not related to degree of cognitive impairment in people with dementia • Evidence that a number of therapeutic programmes lead to increased well-being in people with dementia • Life story books • Creative arts • Cognitive stimulation

40. ‘Exhibition of Engage Cymru Project at PlasMaesincla’ “Plas Maesincla residents in Caernarfon visited an exhibition before creating their own artwork ranging from paintings to pottery. The artwork is seen as a way to develop an interest and improve quality of life. Work created by the residents will be on show at the Gwynedd Museum and Art Gallery in Bangor later in the year. “ http://news.bbc.co.uk/1/hi/wales/north_west/8531176.stm

41. New project funded by AHRC(Gill Windle, DSDC, Bangor U)

42. Conclusion • Dementia and depression are the major threats to independence • Resilience can moderate the effects of poor health on well-being • Later life can continue to be a time of growth and development, and a contribution made • Thank you!