BGS Scotland

Health Numbers: A Statistical View of the Health of Older People in Scotland

The next 20 years will see an ageing population, a continuing shift in the pattern of disease towards long-term conditions, and growing numbers of older people with multiple conditions and complex needs, and the impact of this on them and their immediate carers. There will be more older family carers — many of whom will have their own health needs. These demographic changes and associated shifts in the pattern of ill-health will increase the demands on the whole healthcare system.

About this guide

Welcome to the first edition of BGS Scotland’s Health numbers: a statistical view of the health of older people in Scotland. This document aims to promote and inform debate about how Scotland responds to its ageing population by providing a concise but precise overview of the major health problems that face many of Scotland’s older people.

Please mention the guide if you quote from it.

Professor Paul Knight
BGS President Elect BGS

Dr Donald Farquhar
Chair, BGS Scotland


About the BGS

The British Geriatrics Society (BGS) was founded in 1947 for “the relief of suffering and distress amongst the aged and infirm by the improvement of standards of medical care for such persons, the holding of meetings and the publication and distribution of the results of research”. It has branches throughout the UK. The BGS has more than 2,500 members, including doctors practicing geriatric medicine, old age psychiatrists, GPs, nurses, therapists and scientists. For more information on the BGS visit www.bgs.org.uk or contact Tom Thorpe MCIPR, Press, PR & Parliamentary Affairs Officer on 07779 269 182 or tomthorpe@bgs.org.uk

Older People in Scotland

  • There are 5.2 million people in Scotland and just over a million aged 65 and over.
  • The number of people in Scotland aged 65 and over will increase 21% by 2016, and 62% by 2031.
  • There will be a 38% rise in people aged 85 by 2016 and a 144% rise by 2031.
  • By 2031 there will be more very old people and a proportionately smaller, younger, employed, tax-paying population. There will be an additional 25% demand for health and social care services by 2031.
  • With the ageing population, the number of carers is expected to grow to an estimated one million by 2037. Three out of five people in Scotland will become carers at some point in their lives.
  • Two in five people in Scotland live with a long-term condition.  Many of these are older people.

Expenditure on services for older people

  • In Scotland, around £4.5 billion was spent on health and social care for people aged over 65 in 2006/2007.  This will rise to £7.5 billion by 2031.
  • A large proportion of this was spent on hospitals and care homes, with emergency admissions to hospital alone accounting for £1.4 billion. If services continue to be provided in the same way it is estimated that this figure will increase by £1.1 billion by 2016, and by £3.5 billion (74%) by 2031.
  • Care is provided to approximately 90,000 older people now – and we will need to provide services to a further 23,000 people by 2016.

Use of healthcare services by older people

  • Older patients report very positive experiences dealing with medical, nursing and other healthcare professionals.

Discrimination against older people

  • In 1969, American doctor Robert Butler introduced the term ‘ageism’, defined as ‘a process of systematic stereotyping, prejudicial attitudes and direct or direct discrimination against people because they are old’.  While the Equalities Act in 2012 will make discrimination on the grounds of age illegal, we need to change attitudes and culture as well.
  • A 2009 British Geriatrics Society survey of 200 doctors found that more than half would be worried about how the NHS would treat them in old age. Almost 75% said older people were less likely to be referred for essential treatments.
  • Surveys of older people have found that 63% agree that age discrimination exists in the daily lives of older people; 71% agree that symptoms of poor health in older people are often untreated and dismissed as being a result of ‘old age’; and 71% of older people agree that politicians do not see the needs of older people.

Statistics on specific health conditions that affect older people

Nutrition

  • The Scottish Care Commission conducted a survey of care homes in Scotland and their nutritional standards. It found that 51% of 303 care homes met the national care standards; 85% had a written food and nutrition policy; and 71% screened people for under-nutrition.

Incontinence

  • A third of women and one in seven men aged 65 and over suffer from incontinence.   That translates into just under 172,000 Scots.

Diabetes

  • Half of all people with diabetes in the United Kingdom are over 65.  This equates to around 110,000 of the 228,000 people in Scotland who have the condition.
  • A quarter of people aged over 75 have the condition.

Respiratory disease

  • Pneumonia is a major cause of death in people over 75, with 6% of deaths being attributed directly to this cause.

Depression and mental illness

  • In Scotland, around 10% of people aged 75 and over have a depressive disorder. Of these, more than 30% have severe depression. At one-year outcome, the presence of minor depression at baseline carries a sevenfold risk of the person developing major depression.

The Royal College of Psychiatrists estimates that 85% of older people with depression receive no help at all from the NHS.

Dementia

  • In 2010, approximately 71,000 people had dementia in Scotland.   Around 97% of these were aged 65 and over.  The number of people with dementia is expected to rise to 127,000 by 2031.  At present only around half of people with dementia are currently recorded on primary care registers in Scotland.  A recent Glasgow survey showed that 89% of people in care homes had cognitive impairment, but that only half had been given a formal diagnosis and none was taking cholinesterase inhibitors.

Delirium

  • Delirium (or acute confusion) is common in the elderly. It affects one in three people in Scottish medical units.

Stroke

  • Stroke is the third commonest cause of death in Scotland and the most common cause of severe physical disability in adults.
  • Around 15,000 people annually in Scotland have a stroke . Of these, more than 80% are aged 65 years and over.
  • Hospital care for these patients accounts for 7% of all NHS beds and 5% of the entire NHS budget.

Epilepsy

  • The number of people with epilepsy is expected to rise by 13% from 2007 to 2027, with just under half of sufferers people aged 60 and over.

Health of care home residents

  • Care home residents have ongoing and increasingly complex needs. ,  A recent national census of 751 care homes revealed that 72% of residents were immobile or required mobility assistance; 86% had one or more diagnoses explaining the need for personal care;  54% had care needs related to dementia, stroke or Parkinson’s disease; and 24% had the ‘unholy trinity’ of confusion, immobility and incontinence.
  • Depression affects 40% of older people in care homes.

Cold weather and older people

  • The latest official figures for winter deaths date from 2008/09, when 3, 510 excess winter deaths were recorded in Scotland.  This represents a 37% increase from the previous year.  Excess winter mortality is calculated as deaths occurring in the winter against the average of non-winter deaths in other months.
  • 90% of those in this category were aged 65 and over.
  • Studies have shown that UK excess winter mortality rate is 19% for England, 17% for Wales and 16% for Scotland  —  much higher than colder countries Finland (10%) or Denmark (12%).
  • Around a third of excess winter deaths are caused by respiratory illness.  Cold air can impair the protective function of the respiratory tract, leading to increased broncho-constriction and mucus production, and reduced mucus clearance.  Influenza in older people contributes to about 3% of excess winter deaths in non-epidemic years.
  • After a ‘cold snap’, there is a two-day lag before there is an increase in deaths from heart disease, a five-day lag for deaths from stroke, and a 12-day lag for both deaths and admissions for chronic obstructive pulmonary disease (COPD).