• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Incidence, Prevalence and Trends

Population changes

Over the next 30 years the group of people aged 65 and older will increase in absolute numbers and as a proportion of the whole population (16% to 23.3%). The changes are large. Figure 1 gives the historical backdrop to population changes from 1901 with an estimated projection to 2031. The special situation of the "oldest old" (defined as people aged 85 and older) has been highlighted as the fastest growing age group in the UK. ¹ The greater proportion of women is especially pronounced among the oldest old (65 men per 100 women by 2031). ¹

The effects on the numbers of disabled people are important because three out of four of the oldest old have limiting long standing illness, but most (four out of five of the oldest old) still live in their own home. ¹ This indicates the importance of home support and the financial consequences for (expensive) institutional care if this input is disturbed.

Only a small proportion of older people in the UK (4%) are from non-White ethnic minority groups but their health experience tends to be worse.

Figure 1. Absolute numbers (thousands) and proportions of older people (65+) and the oldest old (85+), 1901-2031

Taken (and slightly adapted) from Table 1 of 'The demographic characteristics of the oldest old in the United Kingdom', Cecilia Tomassini, Population and Demographic Division, Office for National Statistics External Link

Life expectancy and healthy life expectancy

Life expectancy is an important measure of the health of populations but does not address the potential for poor health quality in late life. Onset of disability and dependence marks an important transition in older age. The concept of "compression of morbidity" relates to a desired situation of increasing life expectancy while reducing late life disability. ² There is evidence this is being achieved in the US ³ by ways that are not completely understood, but include improved educational attainment ³ and better mid- and late-life health habits. ⁴

However, the situation is less clear in the UK. ^{5 6} The Health Survey for England gives insight into trends but the self assessment questions used in this cross sectional survey vary over time and between population groups. ⁷ The results from the English Longitudinal Study of Ageing (started in 2001) should improve our understanding of how much healthy life expectancy is increasing in the UK. ⁸ Present data (Figure 2) are a concern because life expectancy at birth has increased by five years and three years for men and women, respectively, but healthy life expectancy is falling behind at less than three years and 1.5 years, respectively.

Figure 2. Life Expectancy, Healthy Life Expectancy in self-perceived good or fairly good general health (HLE (1)), and Healthy Life Expectancy free from limiting long-standing illness (HLE (2)): 1981, 1991, 2001

(1) General Household Survey (GHS) question used to calculate good and fairly good general health rates: "Over the last 12 months would you say your health has on the whole been good, fairly good, or not good?"

(2) General Household Survey (GHS) question used to calculate free from limiting long-standing illness rates: "Do you have any long-standing illness, disability or infirmity?" By long-standing I mean anything that has troubled you over a period of time or that is likely to affect you over a period of time. If 'Yes': a) What is the matter with you? b) Does this illness or disability (do any of these illnesses or disabilities) limit your activities in any way? Source for Life Expectancy: Government Actuary's Department; Source for Healthy Life Expectancy: Office for National Statistics.

Disability estimates

The Office of Population Censuses and Surveys (OPCS), based on fieldwork conducted in 1986, reported that there was an estimated 4.3 million disabled people older than 60 in the UK. ⁹ This represented 70% of all disabled people and 46% of all older people. ⁹ The Medical Research Council (MRC) Cognitive Functioning and Ageing Study began in 1991. Using a restrictive definition for disability it reported an estimate of 1.3 million disabled people older than 65 in England and Wales or 15.7% of people older than 65. ¹⁰ These two population surveys illustrate how disability estimates vary depending on the case definition tool used, although the MRC survey was largely consistent with the 1991 General Household Survey. ⁷

Both the MRC and the OPCS surveys show that disability of all grades of severity is strongly related to increasing age, reflecting the rising prevalence of common disabling conditions, such as stroke, arthritis, cardiorespiratory disease, fractured hip, and peripheral vascular disease (see Table 1 in: External Link ). Both surveys also show that most disabled older people, even those categorised as severely disabled, live in their own home but rely on formal and informal support. However, changes in funding policy can increase or reduce the number of disabled older people able to live at home. ¹⁰ Older people with cognitive impairment and physical disability are the hardest group to support at home and over half live in institutional care. ¹⁰

The prevalence of aspects of cognitive and physical functioning of older people from the first wave report of the English Longitudinal Study of Ageing is given in Table 1. ⁸

Table 1. Estimates for the prevalence of physical and cognitive function for older people

Source: English Longitudinal Study of Ageing (1st wave) report. ⁸

*Fair or poor were the two lowest of five possible categories

Falls

Between 35% and 40% of people aged 65 or older living at home will have a fall each year. ¹¹ The rates are higher for people older than 75 and for people in institutional care. ¹² Falls are classified as environmental (i.e. trips and slips), and spontaneous or unexplained (i.e. predominantly related to personal falls risk factors). Spontaneous falls are more likely to be followed by psychological and behavioural changes referred to as fear of further falls. A hip fracture is one of the most serious complications of a fall in an older person. There are about 86 000 hip fractures in the UK each year: 70% occur in people aged 75 and older and 87% occur in women. ¹³ The rise in the oldest old population is expected to increase the annual numbers of hip fractures.

Delirium

Delirium is the most frequent complication of hospital admission for older people. ¹⁴ It develops in up to half of older patients postoperatively; especially after hip fracture. ¹⁴ A systematic review reported delirium occurrence rates of between 11% and 42% for medical inpatients. ¹⁵

Urinary incontinence

The prevalence of urinary incontinence in people aged 65 and older living at home is 10–20% in women ^{15 16} and 7–10% in men. ¹⁵ The prevalence in people living in residential and nursing homes is 25% and 19-40%, respectively. ^{15 16 17}