Supporting an Ageing Population

Our updates to this topic are informed by the North Wales Population Needs Assessment.

A rise in the elderly population, particularly if not matched by health improvements, will place ever-greater pressure on the public finances, as a relatively smaller working-age population supports growing spending on health, social care and pensions.

Across the UK around 55% of welfare spending is paid to pensioners

The prevalence of long-term health conditions increases with age, and such conditions account for about 70% of health and social care spending.

A growth in older population groups usually means a decline in the working age population relative to the number of pensioners. A lower proportion of people in work means lower tax revenues overall, and can put strain on the local economy and on the resources needed to provide social care.^[1]

The proportion of people aged over 65 has increased in Conwy from 24.3% in 2010 to 27.9% in 2020. The proportion of people aged over 65 has increased in Denbighshire from 20.9% in 2010 to 24.3% in 2020. ^[2]

The number of people aged 85 and over has increased by 18.8%in Conwy and -0.1% in Denbighshire since 2010. This is mainly due to demographic changes, such as the ageing of the ‘Baby Boomer’ generation and increasing life expectancy. The North Wales coast and rural areas are also popular areas for people to move to after retirement. ^[3]

Our Population Needs Assessment tells us that the number of people aged 65 and over receiving services will continue to increase. The number of people aged 65 and over who receive community based services in North Wales is expected to increase from 7,800 in 2015 to 13,300 in 2035. This is at the same time as the number of people aged 16-64, the available workforce, is decreasing. The number estimated to receive care in future is linked to health and not just age. Conwy has a higher proportion of older people, but as they are healthier, their care needs are lower.

The proportion struggling with daily activities (such as personal care and mobility around the home that are basic to daily living, such as taking medications, eating, bathing, dressing, toileting etc), is predicted to increase slightly. The numbers increase significantly, however, due to the changes in the population structure with an increase in the amount aged 65+.

As cited in the Population Needs Assessment, there were 35 and 25 people aged between 30-64 living in Conwy County Borough and Denbighshire respectively with young onset dementia. The total population aged over 65 in 2017 with dementia was 2,400 in Conwy County Borough and 1,500 in Denbighshire. For more detailed information about the types of dementia please see North Wales Population Needs Assessment.

In North Wales, around 14% of people aged 65 and over provide unpaid care.

Housing can have a significant impact on healthy ageing. The majority of older people live in mainstream housing rather than specialist housing. Many mainstream homes are contributing to poorer health in older people due to them being cold and damp or having hazards that risk trips and falls. Upgrading and refurbishing housing would significantly reduce these risks around falls (such as fewer trip hazards) and create a significant saving to the NHS and social care.

The environment helps determine how active older people can be in society. The built environment and outdoors spaces can determine the long-term health and wellbeing of those who use them regularly, reduce the risk of falls, promote physical activity and reduce social isolation. This can include access to green spaces, the design of public buildings and spaces (including our high streets) and transport. Making these accessible to older people can ensure they are able to continue to participate in society. Key changes to making the environment more age-friendly, include things such as:

maintaining pavements,
providing public benches,
improving traffic related safety by lowering speed limits,
having appropriate signal timings for pedestrians and cars,
signal-controlled crossings
central pedestrian refuges.
more accessible public transport by having short distances between bus stops, sheltered bus stops, good signage and seating in well-maintained areas.
Ensuring communities are dementia friendly and incorporate dementia friendly measurers into new developments.

Creating these environments requires collaboration across partners coproduced with older people.

Covid-19

The Older People’s Commissioner for Wales published a report focusing on the impact of Covid-19 on older people in Wales (Leave No-one Behind – Action for an age friendly recovery, 2020). Key statistics for Wales published in the report found that:

94% of people who have died from Covid-19 have been over the age of 60.
There were 694 care home resident deaths due to Covid-19.
53,430 people aged over 70 were required to shield in Wales.
Over 50% of people aged over 70 say access to shopping, medication and other essentials had been affected.
41% of people over 75 do not have access to the internet, with many services moving online during the pandemic, digital exclusion has been a major issue.

Although these statistics are for Wales as a whole, they will reflect a general picture of the impact on older people in the North Wales region. BCUHB statistics for North Wales have demonstrated that the biggest impact on well-being has been social isolation due to shielding guidance. 1 in 3 older people have reported that they have less energy. 1 in 4 older people are unable to walk as far as before the pandemic and 1 in 5 feel less steady on their feet (BCUHB Infographic, 2021).

The Office for National Statistics found over 50% of the over 60s were worried about their wellbeing. Of these, 70% were worried about the future, 54% were stressed/anxious and 43% felt bored. They found the over 60s coped by staying in touch with family/friends, gardening, reading and exercise. The data showed they were more likely to help neighbours, less worried about finances, more worried about getting essentials and less optimistic about how long the pandemic would last. Banerjee (2020) also claims older people are more vulnerable to mental health problems during a pandemic and recommends that consideration is made for the mental health of this group, with increased risk of health anxiety, panic, depression and feeling of isolation, particularly those living in institutions.

Hoffman, Webster and Bynum (2020) discuss the implications of isolation on the older population. They claim reduced physical activities, lack of social contact, and cancellation of appointments, can lead to increases in disability, risk of injury, reduced cognitive function and mental health issues. Campbell (2020) also finds social isolation can impact physical and mental health, with reduced physical activity, limited access to resources, loneliness and even grief. Cox (2020) claims the higher risks for older people are further exacerbated by inequalities, including chronic illness, poverty and race, making individuals with long-term conditions, low socio-economic status and Black, Asian and Minority Ethnic (BAME) people even more vulnerable.

The Centre for Ageing Better (2020) claim that although many more of the over 55s have moved online, the digital divide has widened during the pandemic, with more services moving to online only. It is important to ensure that older people aren’t digitally excluded moving forward. Boulton et al (2020) in a review of remote interventions for loneliness, highlighted methods that can reduce loneliness, including telephone befriending, video communication, online discussion groups and mixed method approaches. They claim that the most successful involved the building of close relationships, shared experiences or characteristics and some pastoral care. In a rapid review, Noone et al (2020) contradict this, suggesting evidence that video consultations reduced loneliness, symptoms of depression and/or quality of life were inconclusive and more high quality evidence was needed.

Third sector organisations supporting older people across the region have reported two major concerns, the first being digital exclusion and the need to find alternatives for those who don’t want or aren’t able to move activities online. The second concern has been raised regularly by older people of Do Not Resuscitate (DNR) notices being automatically applied to older people in hospital during the pandemic.

A rapid review was undertaken in October 2020 by the North Wales Regional Partnership Board. The rapid review summarises available research about the impact of Covid-19 on people who receive care and support services, this included a section on older people. The Population Needs Assessment Rapid Review 2020 contains further information about the impact of Covid-19 on the population.

[1] Political challenges relating to an ageing population: Key issues for the 2015 Parliament, Commons Library Research Paper, May 2015

[2] Numbers have been rounded so may not sum. Source: Mid-year population estimates, Office for National Statistics

[3] Mid-year population estimates, Office for National Statistics

The increase in the number of people aged over 65 is mainly due to two factors; firstly improvements in mortality rates mean people are living longer; and secondly the ageing on of the large ‘baby boom’ cohort born after the Second World War.

Conwy County Borough and Denbighshire have had high proportions of older people in their population for some years, in part due to the region’s attractiveness as a retirement location – which brings migrants from other parts of the UK into the area. The numbers of people in the older age groups started to rise significantly in Conwy County Borough the 2000s, possibly due to retirement related-migration. From the late 2000s the increase in the number of people aged 65+ is also due to the large number of ‘baby boomers’ (the generation who were part of a period of very high birth rates after World War 2) entered the post-retirement age group.

The net out-migration of young people at ages 18-29, and which has been happening in both Conwy County Borough and Denbighshire for some years, compounds the skew towards older age groups within our population.

The proportion of the population in Conwy estimated to be aged over 65 is predicted to increase from 27.9% (32,950) in 2020, to 35.4% (43,500) in 2040 (both the highest proportion and percentage increase on 2020 values across North Wales). The proportion of over 65s in Denbighshire is predicted to increase from 24.3% (23,500) in 2020 to 30.9% (30,400) in 2040.^[1]

The proportion of older people in the population is projected to continue to increase to 2040. At the same time the proportion of people aged 16-64, the available workforce, is expected to continue to decrease. The changes are predicted to begin levelling off by 2040. This change to the population structure provides opportunities and challenges for the delivery of care and support services.

The change in population structure shows a similar pattern in every county in North Wales, although the counties with the highest proportion of people aged 65 and over are expected to be Conwy, Anglesey and Denbighshire

As cited in our region’s Population Needs Assessment, research suggests that

Much of the costs of old age have arisen because growth in total life expectancy has outpaced growth in healthy life expectancy (i.e. the number of years we can expect to live in good health). Policies that improve preventative healthcare, and help people to remain active and healthy in later life, could help increase the proportion of life spent in good health and reduce costs. A healthier old-age population would also allow greater numbers to remain in the labour market for longer, thereby mitigating the impact of an ageing population on the dependency ratio.

Prevention

Poor health is not inevitable as we get older. Focusing on prevention can ensure that the number of years lived in good health is maximised. Health behaviours are crucial to health in our later years, a healthy diet; regular physical activity, safe alcohol use and avoiding tobacco use all contribute to reducing the risk of ill health as we age. Continuing these positive health behaviours throughout our older years is also important. It is crucial that people are able to access a range of services that support them to adopt healthy behaviours.

Healthy ageing

At the Wales level, while estimates vary significantly, prior to the COVID-19 pandemic, life expectancy increases in Wales looked set to continue, although the rate of increase has slowed over the past decade. However, this increase in life expectancy has not translated in to a higher ‘healthy life expectancy’ (the years someone spends in good health), which has decreased slightly in the past decade. This trend is driven, in part, by inequalities faced by those living in the most deprived areas in Wales, who are most likely to report ill health. Ageing populations are also more associated with higher levels of chronic health conditions and ill health. However, older people tend to provide unpaid care and make valuable contributions to local communities.^[2]

Current projections estimate that to meet demand, expenditure on health will grow from 7.3 per cent of GDP in 2014-15 to 8.3 per cent in 2064-65 and from 1.1 to 2.2 per cent of GDP on long term care up during the same period.98 Projections show that within Wales and the UK as a whole, the old age dependency ratio, which gives an approximation of the number of people being supported by the working age population, will drop considerably over time until 2037.99 This means that the number of those most likely to require publically funded services will increase relative to the number of economically active people that are able to provide tax revenue. ^[3]

A longer life presents key opportunities for older people, families and wider society. Older people have a significant amount to offer to society including knowledge, skills and expertise. Ageing can present many opportunities for learning new things, change career or offering unpaid care to older or younger family members. Doing this successfully though requires people to have good health.

Our health and wellbeing in later life cannot be looked at in isolation. Poorer health in later years is strongly determined by factors throughout the course of our lives. Interventions targeted throughout pregnancy, early years, childhood and adolescence are crucial in determining our health.

The impact of the baby boomer generations on the population structure will start to diminish from the mid-2040s onward.

The “Inequality in a Future Wales” report states:^[4]

“An ageing population will disrupt how health and social care, employment and education, and pensions operate, and these systems will need to adapt if they are to function in the long-term. Future challenges need to be tackled with the needs of all generations in mind or risk disadvantaging one at the expense of another and/or falling short of achieving ambitions. A ‘care-led recovery’ puts childcare and the care needs of older people on an equal footing with ‘green jobs’ in benefitting health, the environment and the economy.”

[1] Mid-year 2020 population estimates, Office for National Statistics; and 2018-based population projections, Welsh Government

[2] Welsh Government (2021). Future Trends Report Wales. https://gov.wales/sites/default/files/publications/2021-12/future-trends-report-wales-2021-narrative-summary.pdf

[3] Welsh Government (2021). Future Trends Report Wales. https://gov.wales/sites/default/files/publications/2021-12/future-trends-report-wales-2021-narrative-summary.pdf

[4] Dr Sara MacBride-Stewart & Dr Alison Parken (2021). Inequality in a Future Wales: Areas for action in work, climate and demographic change. The findings are summarised within a Summary Report and ‘Bite-size’ version with Easy Read and BSL versions available also. For those who are interested in the more detailed analysis you can access the full technical report.

Reducing loneliness and isolation is one of the main challenges identified in consultation and engagement work undertaken for the North Wales Population Assessment and is a priority for Welsh Government’s Ageing Well in Wales Programme. Having strong social networks of family and friends and having a sense of belonging to the local community is important in order to reduce social isolation and loneliness for people who need care and support and carers who need support.

Improving access to services for the local population can help local authorities contribute to better public health by reducing differences in life expectancy and healthy life expectancy between communities, by improving those of people in more disadvantaged communities.

People identified those with disabilities, including learning difficulties, and older people as people they feel should be supported, in particular to reduce feelings of isolation and loneliness. They thought that there could be ways of building generational links through younger volunteering to support older people.

The need to support healthy lifestyles was also raised, particularly in respect of tackling obesity crisis, through increased leisure opportunities, partnership working and by building on our active travel network.

Poor housing has been highlighted by people as having a causal relationship with lower life expectancy.

The North Wales Population Needs Assessment contains a wealth of engagement feedback from service users, service providers and other respondents.

Years of austerity has adversely affected the social determinants that impact on health in the short, medium and long term and will affect the lives of our children born and growing up under its effects. To what extent are all our communities resilient to negative factors affecting their well-being?

This topic does not give sufficient consideration to climate and eco consideration needed (mitigation and adaptation).

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Conwy & Denbighshire Public Services Board

Supporting an Ageing Population

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