Care of the Elderly: Medical and social care of highly dependent older people

The number of older people in the population in the United Kingdom greatly increased last century, with a rapid acceleration over the last three decades. The total population is projected to continue to increase for the next 30 years or so, rising to about 62.2 million in 2026, after which deaths will exceed births. Within this period it is estimated that the number of persons aged over 75 will increase from 3.9 million to 6.3 million; with those aged over 85 expected to double and at the same time the numbers aged over 90 will have tripled. These changes in population structure have resulted from changes in life expectancy; over the last 150 years the average life expectancy at birth has risen from 40 years to over 70 years. The average life expectancy for men is now 73 years and that for women is 79 years. Ageing is associated with an increased perception of poor health, and disability itself increases with age. Pessimists have argued that an ageing population will be accompanied by a pandemic of degenerative diseases and chronic mental disorders, while optimists believe that the adoption of healthier lifestyles will result in a compression of morbidity into an increasingly brief period before death. Others are of the opinion that in reality there will be a firm balance between the two. The Department of Health recently commissioned work on disability-free life expectancy, a measure of health and morbidity (disability) as a proportion of life expectancy. In addition to finding a national increase in incidence of medium levels of disability, there is a suggestion that the incidence of severe disability has decreased. The evidence from this work and the results of the General Household Survey also show that, from a population perspective, women spend a greater proportion of their life with disability than men. More older women than men report problems with simple activities of daily living. In the population aged 75 and over, nearly 20% of women and 10% men cannot cut their own toenails; 10% of men and nearly 30% of women cannot walk outside; and approximately 20% of women and 10% of men cannot bath themselves. Cognitive impairment/dementia occurs in up to 20% of people aged over 80. Higher levels of both physical disability (dependency) and dementia have been found in both the residential and nursing home sector. Although the ratio of older women to older men is expected to decrease during the next 20 years, the proportion of older people living alone is expected to increase because of the increasing divorce rate, and other changes in family life. Changes in future patterns of care will also be affected by the overall level of employment, shifts in employment patterns, changes in productivity, and immigration, as well as the availability of those with appropriate skills. The socio-economic status of older people will influence their health status as well as their ability to continue to live in their own homes. According to the Institute of Actuaries the number of disabled people will increase from 6.5 million in 1995 to 8.8 million in 2031; the Institute of Public Policy Research estimate that by 2031 3.3 million people needing either regular or continuous care will require 9.7 billion hours of care provided by either the state or family and friends/ carers.