Older people (health and wellbeing needs in South Tyneside)

Overview

This refresh of the older peoples JSNAA (2024), builds on the previous version undertaken in 2016, explaining why the population is ageing and why this matters.

Whilst for some, ageing can be a heathy and fulfilling time, for others who are at increased at risk this can be a very difficult period in their life.

This refresh builds on the age friendly community's approach. An age-friendly community is a place that allows people to age well and live a good later life. Somewhere that people can stay living in their homes, participate in the activities they value, and contribute to their communities, for as long as possible.

When does old age begin?

In the UK, 65 years of age has traditionally been taken as the marker for the start of older age, most likely because it was the official retirement age for men and the age at which they could draw their State Pension.
However, this is no longer the case. In March 2023, it was confirmed that the State Pension age would rise to 67 years as planned between 2026 to 2028 and that a review within two years of the next Parliament will reconsider a rise to age 68 years.
Generally, people are also living longer healthier lives than they traditionally were. In 2018, a man aged 65 could expect to live for another 18.6 years, while a woman could expect to live for 21 more years. So, on average, at age 65 years, women still have a quarter of their lives left to live and men just over one fifth.
In terms of employment, whilst there is no formal definition of an 'older worker'. The term is commonly used to refer to those over 50 years of age. Many organisations will therefore include those over 50 as being eligible for their services or when referring to their staff.

What is population ageing?

At a population level, ageing is measured by an increase in the number and proportion of those aged 65 years and over, and an increase in median age (the age at which half the population is younger and half older).
On both measures, the population has aged and is projected to continue to age. In 2018, there were 11.9 million residents in Great Britain aged 65 years and over, representing 18% of the total population. This compared with the middle of the 20th century (1950) when there were 5.3 million people of this age, accounting for 10.8% of the population.
Looking ahead to the middle of this century, there are projected to be 17.7 million people aged 65 years and over (24.8% of the population). The oldest old are the fastest-growing age group, with the numbers of those aged 85 years and over projected to double from 1.6 million in 2018 to 3.6 million by 2050 (5% of the population). [2]

Why does an ageing population matter?

Measuring population ageing is important because it has multiple economic, public service and societal impacts. It brings challenges but also opportunities.
From an economic and societal point of view, people can continue to contribute for longer. Either by longer working lives, volunteering, and possibly providing care for family members. For individuals it might mean the opportunity to spend more time with family and friends and to pursue personal interests with more time for leisure activities.
When considering the challenges, more older people mean increased demand for health and adult social services and increased public spending on State Pensions. The key to shifting the balance from challenge towards opportunity, both at a societal level and at an individual level, is for older people to be able to live healthy lives for as long as possible.

Contribution of older people

In 2017 the economic value of the employment, informal care, informal childcare, and volunteering of people aged 50+ in the UK amounted to £796 billion a year.

Key issues

The State of Ageing Report (2022) highlights there are almost 11 million people aged 65 and over, 19% of the total population. In 10 years', time, this will have increased to almost 13 million people or 22% of the population.
This comprehensive review of national data on ageing makes clear, that a financially secure and healthy later life is becoming increasingly unlikely for millions of people. With the population ageing rapidly, the number of people at risk is growing at an alarming rate. The latest data shows a sharp increase in pensioner poverty, meaning that almost 1 in 5 people were living in poverty in the 2019 / 20 period.
There has also seen a recent reduction in life expectancy (of 0.3 years for women and 0.4 years for men). Meanwhile, the number of years we can expect to spend in good health, without a disabling illness, continues to decline; this is now 62.4 years for men and 60.9 years for women.
The geography of older age in the UK is already highly skewed away from large urban areas and will become more so. A large proportion of people migrate away from cities before they reach older age. The result is that metropolitan areas largely maintain their current demographic, ageing only slowly, while some areas, particularly rural, semi-rural and coastal areas in the periphery, age much faster.
In a period when the state pension age has risen to 66, the employment rates among people approaching retirement age have fallen to their lowest levels since 2016 and the number of older people renting rather than owning their homes has reached an all-time high.
These factors have major implications for people's financial security and for the quality of their homes as they age. The number of people in mid and later life who live alone - many without the traditional family structures our approach to ageing has historically relied on - has been increasing steadily, with 1.3 million men aged 65 and over living alone today, up 67% between 2000 and 2019.
This has implications for housing and for health and social care. These trends confirm that England is becoming a more challenging country to grow old in. We can see in our data that the pandemic has, of course, contributed to many of these problems - but they are ultimately longer-term issues that have been developing for some time. And they will not go away as we return to life as it was before COVID without concerted action.

In terms of health

9.1 million people in England are projected to be living with major illness by 2040, 2.5 million more than in 2019. This is an increase from almost 1 in 6 to nearly 1 in 5 of the adult population.
The number of people living with major illness is projected to increase by 37% - over a third - by 2040, nine times the rate at which the working-age population (20 to 69 year olds) is expected to grow (4%).
National Institute for Health and Care Excellence (NICE) guidelines and medical research are all optimised for single diseases but that is not the lived reality for the great majority of older adults who often transfer very rapidly from having no significant disease states to several simultaneously. The increasing specialisation of the medical profession runs counter to optimising treatment for older citizens and patients. We must address this seriously as a profession.
Up to four out of ten people over the age of 65 experience mental health problems. Depression is both the most common and most treatable mental illness in old age, affecting one in five older people in the community. This figure doubles in the presence of physical illness and trebles in hospitals and care homes. Nor should we forget that older people also experience severe mental illnesses.

Age Friendly Communities

In March 2022, South Tyneside agree to work towards becoming a World Health Organization (WHO) Age Friendly Community.
This approach encourages local authority areas to undertake a baseline assessment, then develop a strategy and action plan against eight key themes.
Therefore, the key issues in this JSNAA (2023) are being considered through the lens of the eight-age friendly community themes:

Outdoor Spaces and Public Buildings

The outside environment and public buildings have a major impact on the mobility, independence, and quality of life of older people and affect their ability to "age in place". The recurring topics internationally are quality of life, access, and safety.

Transport

Transportation, including accessibility and affordable public transport, is a key factor influencing active ageing. Being able to move about an area (urban, rural and connections) determines social and civic participation and access to community and health services.

Housing

Housing is essential to safety and well-being. There is a link between appropriate housing and access to community and social services in influencing the independence and quality of life of older people. Housing and support that allow older people to age comfortably and safely within their community are universally valued.
Yet almost 1 in 5 homes headed by someone aged 60 or older is in a condition that endangers the health of the people who live there.
The number of people in mid and later life who live alone - many without the traditional family structures our approach to ageing has historically relied on - has been increasing steadily, with 1.3 million men aged 65 and over living alone today, up 67% between 2000 and 2019.
Almost 9,000 people died in England and Wales last year because their homes were too cold.

Social Participation

Social participation and social support are strongly connected to good health and well-being throughout life. Participating in leisure, social, cultural, and spiritual activities in the community, as well as with the family, allows older people to continue to exercise their independence, to enjoy respect and esteem.

Respect and Inclusion

The respect and inclusion of older people can depend on culture, gender, health status and economic status. The extent to which older people participate in social, civic, and economic life of where they live is closely linked to their experience of inclusion.

Civic Participation

Older people do not stop contributing to their communities on retirement. Many continue to provide unpaid and voluntary work for their families and communities. Age Friendly provides options for older people to continue to contribute to their communities through paid employment or voluntary work, if they so choose, and be engaged in the political process.

Communication and Information

Staying connected with events and people and getting timely, practical information to manage life and meet personal needs is vital for active aging. Age Friendly communities have relevant information that is readily accessible to older people with varying capacities and resources.

Communities and Health

Health and support services are essential for maintaining health and independence in the community. Civil society can provide a role in supporting the health of the community. The WHO checklist focuses on the aspects within the scope of Age Friendly.

Those at Risk

As an individual ages their risk factors generally increase. However, there are some specific groups / communities where the risks are even higher:

1. Older people in poverty

Almost 1 in 5 people of pension age were living in relative poverty in 2019 / 20, following a sharp increase (of 200,000 people) over the previous year. This extends a worrying trend which first emerged in the middle of the last decade and means more than 2 million people of state pension age in the UK were living in poverty in 2019 / 20.
This comes after a long period of widening wealth and income inequalities among people in their 50s and 60s. The net (non-pension) wealth of the richest 20% of people in this age group doubled between 2002 and 2018, while that of the poorest 20% fell by 30%.
The number of people aged 50 to 64 who are not engaged with the labour market in any way (that is, they are neither working nor looking for work) has risen by 228,000 since the start of the pandemic, and the employment rate in this group has fallen by 1.8 percentage points.
The UK state pension is one of the worst in Europe providing just 58% of previous earnings from work - below the OECD average of 62%.11 Those people who have to rely on the pension as a main or only source of income face a bleak financial future.

2. The Digital Divide

This digital inequality can be particularly seen for those in mid to later life, with ONS data (2020) highlighting that prior to the pandemic, 32% of those who had never or not recently used the internet were aged between 50 and 69 (over 1 million individuals).

3. Loneliness and social isolation

Older people are especially vulnerable to loneliness and social isolation, and it can have a serious effect on health.
Hundreds of thousands of elderly people are lonely and cut off from society in this country, especially those over the age of 75.
According to Age UK, more than 2 million people in England over the age of 75 live alone, and more than a million older people say they go over a month without speaking to a friend, neighbour or family member.
People can become socially isolated for a variety of reasons, such as getting older or weaker, no longer being the hub of their family, leaving the workplace, the deaths of spouses and friends, or through disability or illness.

4. Carers

16% of people aged 65+ in the UK are unpaid carers, equivalent to 2 million people, while 13% of people aged 80+ in the UK are also unpaid carers, equivalent to 440,000 people.

5. Ethnic Minorities

Black, Asian and Minority Ethnic people aged 50 to 70 are more likely to be in the poorest fifth of the population in England compared with White people, and that Black people are living on an average of £100 less a week compared to White people.
Despite this, the research also shows that Black men and women in their 50s and 60s are more likely to be working - with White people in this age group three times more likely to have retired - suggesting people from these groups are more likely to be in low paid jobs and/or to have less access to other sources of income, such as pension savings and assets.

6. LGBTQ+

As the ageing population continues to grow, the diversity of those requiring support has also increased. We now know that LGBTQ+ people in later life report poorer health than the general population and have worse experiences of care. This is irrespective of whether they're accessing cancer, palliative / end-of-life,3 dementia and / or mental health services.
There is also concern around older LGBT people in relationships in relation to visiting, Power of Attorney or Next of Kin and that their rights will not be respected.

7. Learning Disabilities

People with learning disabilities are more likely to develop dementia as they grow older according to the Social Care Institute for Excellence. They may develop dementia at a younger age than non-learning-disabled people and they may also experience deterioration from dementia at a faster rate than the general population.

8. Mental Health

It is now widely accepted that the mental health needs of older people have historically been under-recognised and under-treated. Although the proportion of those affected is broadly in line with other age groups, older people have not been able to access the same level of support.

9. Domestic Abuse

Older people are often overlooked in discussions about domestic abuse. But domestic abuse can happen at any age. Crime Survey figures show that in 2019 over 189,000 women in the UK between the ages of 16 and 74 reported that they had experienced domestic abuse. The total figure for all ages is likely to be much higher because until October 2021, following a successful campaign by Age UK, domestic abuse data was not collected on individuals aged 75 and over. We also know that older people may face barriers to reporting abuse and there are likely to be many cases of domestic abuse that have not been officially recorded.

Level of need

Whilst there are many relevant facts and figures related to ageing across the UK, it is important that this JSNAA focuses on the local picture.

In South Tyneside the population projections for over 65s in 2018 were 19.9% and 24.9% by 2042. In 2021 there were 30,847 over 65 (20.9%) and 3843 over 85s (2.6%) [21].

South Tyneside Older People's Health and Wellbeing Profile indicates that our ageing population is experiencing greater inequality. Socio economic differences are growing and they have a very significant impact on older people's experience of life, especially as it affects their health and wellbeing.

Examples of this include:

South Tyneside was ranked 23rd most deprived out of 151 upper tier local authorities nationally in the 2019 English Index of Multiple Deprivation. The Borough is more deprived that its Tyne and Wear neighbours and is the 3rd most deprived Borough in the North East region.
During 2018 to 20 in South Tyneside, life expectancy at birth was three years below the national average for men and two years for women (76.4 years for men and 81.2 for women, compared to 79.4 and 83.1 nationally).
Between 2018 and 2020 life expectancy at 65 amongst males in South Tyneside was 17.1 years, significantly lower than the region (17.8) and England (18.7). Amongst females' life expectancy was 19.6 years, similar to the region (20.0) and significantly lower than England (21.1).
At ward level, male life expectancy in the most deprived area (Biddick and All Saints) is 76.5, whereas in the most affluent area (Cleadon and East Boldon) the male life expectancy is 82.6.
From 2018 to 20 in South Tyneside, healthy life expectancy was almost six years below the national average for men and five years lower for women (57.3 for men and 58.9 for women, compared to 63.1 and 63.9 nationally).
South Tyneside residents are more likely than the national average to engage in behaviours which are risk factors for poor health. In 2022 15.2% of South Tyneside adults are smokers, compared to 12.7% of adults nationally.
During 2021 / 22 61.5% of adults living in South Tyneside engage in regular physical activity, compared to 67.3% of adults nationally. 76.3% of adults are classified as overweight or obese, compared to a 63.8% English average.
Second highest % of adults overweight or obese - increasing overtime.
Second highest rates of alcohol related conditions 65+ for women.
In terms of mental health, of 2490 over 65s who presented with frailty they also had anxiety.
Yet South Tyneside has one of the lowest referral rates for over 65s across the ICB, with evidence suggesting unmet need, particularly for 65 to 79 year olds.
The Annual Population Survey shows that between July 2022 and June 2023 6.7% of the population were economically inactive due to retirement in South Tyneside, lower than 14.3% in the North East and 13.0% across England.
Fuel poverty is worse than England average (11.3%). This is based on the percentage of households that experience fuel poverty based on low-income high-cost methodology.
In South Tyneside in the 12 months to July 2023, 989 crimes were reported in over 65s, of which 3% were recorded as serious crime.
In the 2021 census, 22,371 households did not have a car, of which 9421 were over 65 years.
Whilst 70.8% of adult social care service users felt they had control over their daily lives, 30% do not have as much social contact as they would like.
15% adult carers get as much social contact as they would like.
The Borough has higher than average rates of premature deaths, including those from cardio-vascular disease and cancer.
16.8% of people have had an emergency readmission into hospital within 30 days of discharge from hospital.
Excess winter deaths 30.2%, lower than the England average (36.2%).

Unmet Needs

Normative Needs - what experts define as need based on some standard

There is a plethora of National Institute for Health and Care Excellence (NICE) Guidance that is available to support the needs of older people.

Examples of this include:

Locally this overarching JSNAA needs to link to other specific JSNAA topics including:

Felt Need and Expressed Need - What people say they want and request of services

Felt need and expressed need is what people say they want and request of service.

In 2022 South Tyneside undertook a baseline survey and follow up validation events based on the eight themes of the WHO age friendly communities.

1. Outdoor spaces and buildings

Public spaces are easy to visit, green spaces are well looked after, and street lighting is generally good.
Would like more benches, litter bins and toilets.
Want to feel safer when out and about, with better footpath accessibility.

2. Transport

Some choose to drive because public transport can be problematic. Examples include:

Difficulty booking a journey due to digital technology or a disability.
Getting to the bus stop requires more places to sit or shelter.
Journey quality varies because of changes to or their ability to read the timetables.
Difficulties getting on, taking a seat, or knowing when to get off public transport.

3. Housing

The majority would like to stay in their own home as they age but will need help to make it suitable and are not sure what help is available.
A need to make better use of touch points to instigate future proofing.
South Tyneside needs different types of housing in general, such as more family homes and bungalows.

4. Social participation

There is a good range of affordable activities.
Lots of supportive organisations.
Would like more opportunity to contribute to what is going in the area.
More opportunities to mix with others.

5. Respect and inclusion

There are opportunities for younger people and older people to learn from each other.
Not everyone can make their voice heard.
Older people sometimes feel that others talk down to them or address their family / carer not them.

6. Civic participation

There are opportunities to volunteer.
There are educational classes but they to be at different times.
Need more suitable employment opportunities for older people.

7. Communication and information

There is information available, but there could be more.
Information needs to be simple.
Don't over rely on IT for everything.

8. Community and health

Generally, a good sense of community but less pride in the area, than there once was.
Shops generally make older people feel welcome, but there could be a better choice of shops.
Can be hard to find out about entitlements.
Can be hard to book a GP and dental appointment.
Some people don't know how to find out what care is available.

Projected Need and Demand

The overview outlined what is meant by an ageing population and the impact this will have. - By the middle of this century, there are projected to be 17.7 million people aged 65 years and over (24.8% of the population)

The level of need section outlined that in South Tyneside the population projections for over 65s in 2018 were 19.9% and 24.9% by 2042.

Our ageing population is becoming more diverse. By 2026 it is estimated that the older population from black and minority ethnic communities will make up 28.4% of the population compared to 21.2% today.

Our ageing population will be more open to diversity in sexuality with a significant growth in the number of older people who are openly gay, lesbian or bisexual.

Community Assets and Services

There are a wide range of services available to support older people, their families and carers in South Tyneside.

In South Tyneside we use A Better U approach to prevention. The ABU principles stress the importance of personalised, proactive, and fair approach, which aligns with the council commitment to proud values.

Examples of services include:

1. Outdoor spaces and buildings

Blue Space - such as beaches and foreshore
Leisure Facilities
Libraries
Parks and other green space (cemeteries)
Tyne and Wear Archives and Museums (TWAM)

2. Transport

Fix my Street
Nexus
Transport North East

3. Housing

ECO4
Green Doctor
South Tyneside Council Housing Services and other housing association providers
Wise group (HEAT)

4. Social particpation

'Plinth' - the new flatform managed by Inspire, with potential for improved insight and data
Age Concern Tyneside South
60+ Welcoming Places - including community, local authority and commercial

5. Respect and inclusion

Alzheimer's Society
Tyneside Mind
Vision and Hearing
Women's Health in South Tyneside

6. Civic participation

Inspire - Plinth
DWP

7. Communication and inclusion

AskSara
Carers Association
Independence and
Let's Talk

8. Community and health

Dentists
GP Practices
Mental Health Trust
Pharmacists
SSTFT
Life cycle - Talking therapy
Older Person's Mental Health Team
Primary Care Outreach Service
Admiral Nurses

Evidence for Interventions

Additional Needs Assessments Required

Prevention
Dementia
Frailty
Information and advice

With consideration for:

Minority ethnic backgrounds
Sexual Preferences
Environmental factors such as housing, transport and lack of services for those in a coastal locality

Key Contact

Grahame Cassidy, Chief Officer, Age Concern Tyneside South:

Email: grahame.cassidy@ac-ts.org.uk
Phone: 0191 456 6903

Mary Fairfield, Public Health Practitioner:

Email: mary.fairfield@southtynesie.gov.uk
Phone: 0191 424 6518

GOV.UK: Chief medical officer annual report (2023)

References

Last updated: March 2024

Older people (health and wellbeing needs in South Tyneside)

Overview

When does old age begin?

What is population ageing?

Why does an ageing population matter?

Contribution of older people

Key issues

In terms of health

Age Friendly Communities

Outdoor Spaces and Public Buildings

Transport

Housing

Social Participation

Respect and Inclusion

Civic Participation

Communication and Information

Communities and Health

Those at Risk

1. Older people in poverty

2. The Digital Divide

3. Loneliness and social isolation

4. Carers

5. Ethnic Minorities

6. LGBTQ+

7. Learning Disabilities

8. Mental Health

9. Domestic Abuse

Level of need

Unmet Needs

Normative Needs - what experts define as need based on some standard

Felt Need and Expressed Need - What people say they want and request of services

1. Outdoor spaces and buildings

2. Transport

3. Housing

4. Social participation

5. Respect and inclusion

6. Civic participation

7. Communication and information

8. Community and health

Projected Need and Demand

Community Assets and Services

1. Outdoor spaces and buildings

2. Transport

3. Housing

4. Social particpation

5. Respect and inclusion

6. Civic participation

7. Communication and inclusion

8. Community and health

Evidence for Interventions

Additional Needs Assessments Required

Key Contact

References

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