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Introduction

Increases in healthy life expectancy are not keeping pace with rising life expectancy, and nearly 70% of us aged 75 or over live with at least one long-term condition.

Age UK is working to ensure we can enhance our expectations of good health and wellbeing as we get older, by pressing for the right support and services to feel well, both physically and mentally, for as long as possible. 

Health, wellbeing & prevention

Efforts to improve public health must be seen as just as important to older age groups as to other age groups. Preventing poor health and health crises in older people should be an essential objective for health and care services.

Healthy living in later life - healthy eating, being physically active, not smoking and drinking alcohol in moderation - can prevent or delay the onset of serious conditions such as heart disease and to some extent dementia.

It can also prevent the further deterioration of health problems and increase people’s general feeling of wellbeing. In spite of this, health promotion is disproportionately targeted at younger ages.

Given the huge diversity of needs and circumstances in the 12 million people aged 65 to over 100 years, society needs to find a positive, proactive approach to older people’s health.

One based not on assumptions about what a person cannot do, but what they can. For a large number of older people, there is no reason at all to doubt that they can still do everything they’ve always done, and many new things beside.

Resources

No one should have no one report - Working to end loneliness amongst older people, (December 2016)  (PDF 636 KB)

Age UK Response - Reporting and acting on child abuse and neglect (October 2016)  (PDF 446 KB)

Age UK Response – NICE quality standard on falls prevention among older people (August 2016) (PDF 262 KB)

Age UK Response - NICE quality standard on mental wellbeing and independence for older people (July 2016) (PDF 264 KB)

Age UK Response - NICE Community engagement - improving health and wellbeing (May 2016) (PDF 224 KB)

Age UK Response - APPG on Dementia Inquiry into dementia and co-morbidities (October 2015) (PDF 316 KB)

Age UK Response - Consultation on refreshing the Public Health Outcomes Framework (October 2015) (PDF 262 KB)

Age UK Response - APPG on Primary Care and Public Health Inquiry into behaviour change, information and signposting (October 2015) (PDF 357 KB)

Response to NICE consultation on older people's independence and mental wellbeing - draft guideline, July 2015 (PDF 357 KB)

Cabinet Office: A Public Service Ombudsman, June 2015 (PDF 276 KB)

Promising approaches to reducing loneliness and isolation in later life, January 2015 (PDF 1 MB)

What is preventing progress? A report by the Richmond Group of Charities, November 2014 (PDF 708 KB)

Living well with health needs

Our risk of living with one or more long-term conditions, such as dementia or arthritis, increases with age. For some of us, our physical ‘reserves’ can be lower than they used to be, meaning a relatively minor event can have a huge impact on our health and wellbeing.

For many older people who rely on multiple services and professionals just to manage daily living, it is vitally important that health, care and other services are coordinated and joined-up around their needs and circumstances.

Yet too many older people living with long-term conditions and/or frailty are not getting the personalised, integrated care and support they need to lead full lives at home and to sustain their independence for as long as possible.

Age UK is working to bring together voluntary organisations and health and care services in local areas to provide people in this position with an innovative combination of medical and non-medical support.

Resources

Age UK Response - NICE quality standard on Multimorbidity (February 2017) (PDF 323 KB)

Age UK Response - Managing medicines for adults receiving social care in the community (November 2016) (PDF 323 KB)

Age UK Response - Mental wellbeing NICE quality standard (March 2016) (PDF 242 KB)

Age UK Response - APPG on Dementia Inquiry into dementia and co-morbidities (October 2015) (PDF 316 KB)

Age UK response - Consultation on draft scope of NICE clinical guideline on dementia, Aug 2015 (PDF 320 KB)

I’m still me: a narrative for coordinated support for older people, Dec 2014 (PDF 1 MB)

Age friendly health services

Older people must be able to access health services that do not discriminate and are equipped to provide safe, high quality care that's relevant to them; and be treated by people that fully understand their needs and aspirations.

Older people are the largest users of health services, representing two thirds of NHS users. 65% of all admissions to hospitals are people over 65 and because, on average, they stay longer they make up around 70% of bed days.

While in hospital, older people are more likely to be moved multiple times, impacting on the length of stay and their experience of care, and can be faced with the attitude that they 'should not be there'.

The Government has acknowledged that 'it is vulnerable older people for whom the NHS is not providing effective services, with confusion and fragmentation over how care is provided'.

The numbers of people with dementia is predicted to rise from 800,000 to 1 million by 2025. These factors present some challenges that the NHS has for a long time failed to address, making significant changes ever more urgent.

Resources

Hidden in plain sight - the unmet mental health needs of older people, October 2016 (PDF 891 KB)

Age UK response to NICE Multimorbidity clinical assessment and management (May 2016) (PDF 184 KB)

Delivering the Forward View: the CCG Improvement and Assessment Framework (February 2016) (PDF 195 KB)

Setting the mandate to NHS England for 2016 to 2017, November 2015 (PDF 230 KB)

Age UK/BGS Research - Frailty: Language and Perceptions, Jul 2015 (PDF 776 KB)

Age UK response - Consultation on the NHS Constitution, Mar 2015 (PDF 296 KB)

Age UK/Royal College of Surgeons research - Access All Ages 2 - Unequal access to surgery, Jul 2014 (PDF 1 MB)

Dignity and quality in health care

At all times, older people using health services must be treated and cared for with dignity and respect.

65% of all admissions to hospitals are people over 65 and because, on average, they stay longer they make up around 70% of bed days. The NHS Constitution is very clear when it states: 'You have the right to be treated with dignity and respect, in accordance with your human rights'. However, only 31% of the general public feel older people are treated with dignity and respect in hospitals.

There have been countless reports and media stories in recent years that have exposed shocking failures in the care of older people, notably the Care and Compassion? report in 2011 by the Parliamentary and Health Services Ombudsman.

There needs to be a cultural change among the NHS providers in the way care is delivered to older people. Staff must be recruited and trained to uphold the right values of care, be empowered to challenge poor care and expect to be treated with respect themselves.

We broadly agree with the Government’s response to the Francis Inquiry, however we would have liked to see a much broader focus with specific initiatives on the critical issue of empowering older people and their carers and bringing about cultural change within the system.

Dignity in Care Commission

We established a Commission on Improving Dignity in Care in July 2011 in response to the Health Service Ombudsman’s report Care and Compassion that exposed shocking failures in the care of older people. The Dignity in Care Commission was a joint initiative from Age UK, the NHS Confederation and the Local Government Association and sought to understand why poor care persists and to put forward solutions.

The Commission produced a report, Delivering Dignity, in summer 2012. The report contained 37 recommendations impacting on many different aspects of policy and practice, and it concluded there must be a “major cultural shift” in the way the system thinks about dignity.

The Malnutrition Task Force was established on the back of this report, to take forward the recommendations concerning dehydration and malnourishment.

Find out more about Age UK's work on improving dignity in care

Resources

Response to Freedom to Speak Up Review, June 2015 (PDF 276 KB)

End of life care

Everyone has the right to expect services and support that help them to achieve a dignified and pain-free death, with choice in how they are cared for in their final months and days, regardless of where they live or their diagnosis.

91% of people who die in England and Wales are aged 65 or over; 39% are aged 85 and over; but only between 9% and 15% of people gaining access to specialist palliative care services are 85 or over.

Research suggests that between 50 and 70% of people would prefer to die at home. However, only 18% of deaths in people over 65 occur at home, compared to 31% of people aged 15-64.

The first national survey of bereaved people found that 'in the hospital setting, patients who died at 80 years or older were rated lowest [for dignity and respect] compared with both the under 65 and 65 to 79 years age groups'.

Everyone has the right to expect services and support that help to achieve a ‘good death’ and to choice in how they are cared for in their final months and days. This should include access to high quality palliative care services (including pain management) which supports physical, psychological and spiritual needs, respects personal choice (including where advance directives are made) and maintains dignity.

Diagnosis, place of residence, care setting or individual circumstances should not act as a barrier to receiving high quality end of life care.

Resources

Age UK response: Care of the Dying Adult - comments form (September 2015) (PDF 178 KB)

Age UK response to Health Select Committee Inquiry on end of life care, Dec 2014 (PDF, 215KB)

NHS

In October 2014, NHS England published its Five Year Forward View (FYFV), a vision document for the future of the NHS.

The FYFV primarily set out to achieve two things:

  1. describe the direction in which the NHS will need to move to maintain and improve the quality of care, based on making what are currently innovative approaches more like the norm
  2. set out the financial realities to achieve this 

In the FYFV, Simon Stevens, NHS England chief executive and chief architect of the vision, challenges the traditional way of working. The NHS today largely operates as collections of hospitals remote from primary care (GPs), an approach largely unchanged since the NHS was founded in 1948.

Instead, the FYFV proposes 'Multispecialty Community Providers' – in simple terms, teams of health professionals with a range of skills working together across traditional boundaries.

Where, for example, an older person living with multiple conditions will usually have their health needs managed almost independently of each other, this approach would formally join-up their care and provide it closer to where they live.

'Primary and Acute Care' systems are also proposed, a way of bringing hospitals and primary care more closely together, even suggesting that a local hospital could hold a contract to provide GP services for a local area.

This would be quite a big departure from the traditional way of working, in which GPs are often fiercely independent, their relationship with a local hospital being primarily about referring people for specialist services and diagnostics.

On paper, this approach is good news for older people. Age UK has long raised the issues of the lack of joined-up care and little systematic focus on prevention, i.e. a proactive approach to improving people’s health so they are at lower risk of serious problems later on.

For a person faltering with multiple long-term conditions and frailty, an approach that starts with preventing ill health, encourages care that is close to home, and in all cases works in a joined-up way should be very welcome.

Age UK will continue to work closely with colleagues across the NHS as the ideas in the FYFV are rolled out.

NHS Five Year Forward View (PDF 536 KB)

The Malnutrition Task Force

The Malnutrition Task Force (MTF) is committed to working across the community and care settings to tackle avoidable and preventable malnutrition and dehydration in older people. 

Why was the MTF set up?

Malnutrition is a real issue in the UK. Over 1 million people over the age of 65 are malnourished or at risk of malnourishment and the cost of the condition is estimated to be in the region of billions of pounds a year. 

However, despite being a widespread problem, the condition is often poorly understood or not dealt with properly across care settings, including hospitals and care homes.  

Age UK jointly established the MTF in 2012 to help us take forward recommendations concerning dehydration and malnourishment in care settings that appeared in Delivering Dignity (see Recommendation 24), the report from the Commission on Improving Dignity in Care.

Who is part of the MTF?

Age UK is one of the founding members and current sponsors of the MTF. Others include apetito, BAPEN, Nutricia and RVS.

It is chaired by Age UK’s Chairman, Dianne Jeffrey CBE DL. 

What does the MTF do?

The Malnutrition Prevention Programme

The Prevention Programme was an innovative scheme set up by the MTF to combat malnutrition at a local level. It featured local health stakeholders – including NHS trusts, hospitals, GP practices, care homes and community groups - coming together to tackle the problem.

The Programme was piloted in five areas across England - Salford, Gateshead, Purbeck, Kent and Lambeth and Southwark. The evaluation results from these pilots will be disseminated nationally in the first half of 2016.

Guides

The first phase of MTF work saw an expert ‘task and finish’ group being set up to review evidence and identify practices that work at tackling malnutrition. On the back of this, guides were produced aimed at different care settings, outlining ‘best practice’ and implementation models to tackle malnutrition. These have received widespread professional praise.

Visit the Malnutrition Task Force website for more information

Further information

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For more information: Call Age UK Customer Relations: 0800 169 8787

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