an assessment of the health and social care needs of older people

east.ayrshire.gov.uk

an assessment of the health and social care needs of older people

AN ASSESSMENT OF THE

HEALTH AND SOCIAL CARE NEEDS OF

OLDER PEOPLE

Version No:

Prepared by

Effective from

Review Date

Lead reviewer

Dissemination

Arrangements

20 (200213)

Marlene McMillan, Andrew Pulford, Zhan

McIntyre, Lynda Hamilton, Maggie Watts

10/09/2012

Carol Davidson

Executive Director of Public Health

Joint Strategy Group for Older People

Officer Locality Groups (Adult/older people)

Complete draft OPNA Page 1 of 131 20 February 2013


Executive summary

Chapter 1 of this joint services needs assessment provides an

introduction and overview of the current policy context, both national

and local including legislation that are of relevance to older adults.

Chapter 2 focuses on the demography with prospective commentary on

what has been described as “the demographic challenge” - rapid ageing

of our population and its consequences for population health in the

future. Future projections for changes to the population profiles for

Ayrshire and Arran and East, North and South Ayrshire are provided

(where possible and/or useful) up to 2035.

Demographic changes in the Scottish and local populations are highly

complex. The exact nature of them relies on the success of policy

responses in relation to the ageing population, which in turn is

dependent on policies relating to the working age population and of

young families.

For example, Chapter 2 presents data to show that the ageing

population will have implications not only in relation to demands on

health and public services but also on potential labour shortages in the

future for staffing these services. Understanding the demographic

challenge allows agencies to plan for the future impact on services and

respond proactively with appropriate policies and service

developments. The health service needs to work together with its

social, cultural and economic partners who can influence population

retention locally and where young people can live, work and raise a

family in environments that allows this to be balanced and achievable.

The fact that people are living longer is in itself a major achievement.

However, this needs to be achieved for everyone. Mortality, life

expectancy and healthy life expectancy are all improving but there are

significant variations in health status across Ayrshire and Arran as there

are in Scotland, and the key determining factor is deprivation 1 .

Life circumstances, including a range of cross-cutting factors that have a

material impact on the health and well-being of individuals are

discussed in Chapter 3. In particular information on income, housing

circumstances, profile of disrepair, housing options for older people,

marital status, household composition, free personal nursing care,

supported and sheltered accommodation, care at home clients, fuel

poverty, fear of crime and internet use are covered.

Chapter 4 examines lifestyle factors that are known to affect the

chances of having the best possible health. In particular this section

examines levels of smoking, alcohol misuse, healthy weight, diet and

nutrition and physical activity and exercise.

Health Status is explored in Chapter 5 and in particular the issues of life

expectancy, healthy life expectancy at birth and at age 65, all cause

mortality, specific morbidities common in older age such as coronary

heart disease and stroke, winter mortality, self-reported health status,

long term conditions, visual and hearing impairment, oral health,

mental health, sexual health and bone health are all included.

Chapter 6 presents information on the use of health and social services.

Within this chapter is information on emergency hospital admissions,

the use of primary care, models of supply and demand for informal

care, estimates of households requiring regular help and care, profile of

unpaid carers, the percentage of people spending the last 6 months of

life at home or in a community setting and the impact polypharmacy

has on admission rates.

Chapter 7 raises a number of important issues, where little local data

relating to needs are available, poverty, social exclusion, multiple

deprivation, gender and ethnicity and health inequalities.

N.B. This needs assessment can be used as a reference document by

clicking on the links to access the information required to underpin and

inform planning and commissioning of services for older people.

Complete draft OPNA Page 2 of 131 20 February 2013


Contents

Chapter 1: Introduction and overview

1.1 The policy context

1.2 Health and social care specific legislation

1.3 National policy

1.4 Local frameworks and policies

Chapter 2: Demography

2.1 Ayrshire and Arran population

2.2 Population projections for Ayrshire and Arran

2.3 Demographic change

2.4 Population projections for Scotland

2.5 Projected population changes for Ayrshire and Arran

2.5.1 Projected Population Changes for East Ayrshire 2010 to

2035

2.5.2 Projected population changes for North Ayrshire 2010 to

2035

2.5.3 Projected population changes for South Ayrshire 2010 to

2035

2.6 Population ageing in Ayrshire and Arran

2.7 Dependency ratios

2.8 Older people and deprivation

Chapter 3: Life circumstances

3.1 Income

3.2 Housing

3.3 Marital status

3.3.1 Housing quality

3.3.2 Housing options for older people – equipment and

adaptations

3.3.3 Housing options for older people – sheltered housing

3.3.4 Housing options for older people - care homes

3.3.5 Housing options for older people – home care

3.3.6 Free personal and nursing care

3.4 Societal and environmental factors

3.4.1 Internet use

3.4.2 Crime and fear of crime

3.4.3 Fuel poverty

3.4.4 Climate change

Chapter 4: Lifestyle factors

4.1 Smoking

4.1.1 Smoking prevalence

4.1.2 Smoking-related mortality

4.1.3 Smoking cessation services

4.2 Alcohol and drugs misuse

4.2.1 Alcohol

4.2.1.1. Alcohol consumption

4.2.1.2 Primary care

4.2.1.3 Acute care

4.2.1.4 Specialist addiction services

4.2.1.5 Alcohol-related brain damage

4.2.2 Drugs

4.3 Healthy weight

4.4 Diet and nutrition

4.5 Physical activity and exercise

Chapter 5: Health status

5.1 Life expectancy

5.2 Mortality

5.3 Self-reported health status

Complete draft OPNA Page 3 of 131 20 February 2013


5.4 Long-term conditions

5.5 The occurrence of specific health problems common in older

age

5.6 Sensory impairment

5.7 Oral health

5.8 Sexual health and blood-borne viruses

5.9 Bone health

5.10 Screening and immunisation

5.11 Mental health and wellbeing

Chapter 6: Use of health and social services

6.1 Primary care consultation rates in Scotland

6.2 Emergency hospital admissions

6.2.1 Multiple emergency admissions

6.2.2 Risk of emergency admission to hospital in the following

year

6.3 Older adults with high support needs

6.3.1 Supply and demand of informal care

6.3.2 Older adults with learning disability

6.3.3 Potential supply and demand for informal care

6.4 Carers

6.5 Palliative care and end of life care

6.5.1 Choosing place of death/spending last months at home

6.6 Polypharmacy - pharmacy needs of older people

7.2.4 Cancer incidence and mortality

7.2.5 First hospital admission for alcohol and alcohol

mortality

7.2.6 Mental wellbeing

7.2.7 Incidence and mortality of falls amongst older people

7.3 Ethnic background and equality

7.4 Gender inequality

7.5 Rural inequality

7.6 Expenditure poor older adults

7.7 Sensory impairment and older adults

7.8 Early intervention and prevention

Chapter 7: Equity and healthy ageing

7.1 Poverty, social exclusion and multiple deprivation

7.2 Impact of health inequalities

7.2.1 Healthy life expectancy

7.2.2 Premature mortality

7.2.3 First hospital admission for coronary heart disease

Complete draft OPNA Page 4 of 131 20 February 2013


List of Figures and Tables

Figures

Figure 1: Estimated population 2010 by age group and gender in Ayrshire and Arran

Figure 2: Estimated population 2010 by local authority and age group

Figure 3: Projected population by age group 2010-2035 in Ayrshire and Arran

Figure 4: Percentage of population over state pension age 2010 to 2035

Figure 5: Five-year average number of birth and death registrations in Ayrshire and

Arran, 1991-2010

Figure 5a: Five-year average ratio of deaths to births by NHS Board and Local

Authority area, 1991-2010

Figure 6: Population pyramid of Scotland, 2010

Figure 7: Population pyramid of Scotland, 2035

Figure 8: Age and gender composition 2010 for Ayrshire and Arran

Figure 9: Age and gender composition 2035 for Ayrshire and Arran

Figure 10: Age and gender composition, 2010 of East Ayrshire

Figures 11: Age and gender composition 2035 of East Ayrshire

Figure 12: Age and gender composition 2010 of North Ayrshire

Figures 13: Age and gender composition 2035 of North Ayrshire

Figure 14: Age and gender composition 2010 of South Ayrshire

Figure 15: Age and gender composition 2035 of South Ayrshire

Figure 16: Projected population by older groups in 2010, 2020 and 2030 in Ayrshire

and Arran

Figure 17: Projected median age of population; East, North and South Ayrshire and

Ayrshire and Arran

Figure 18: Projected dependency ratios for East, North and South Ayrshire and

Scotland 2010 – 2035

Figure 19: Projected old age dependency ratios for East, North and South Ayrshire

and Scotland 2010 - 2035

Figure 20: Projected female population by broad age group 2010-2035 in Ayrshire

and Arran

Figure 21: Projected male population by broad age group 2010-2035 in Ayrshire and

Arran

Figure 22: Number of people over 65 years of age living in Ayrshire and Arran by

deprivation quintile

Figure 23: Number of people aged over 65 years living in East Ayrshire by

deprivation

Figures 24: Number of people aged over 65 years living in North Ayrshire by

deprivation quintile

Figure 25: Number of people aged over 65 years living in South Ayrshire by

deprivation quintile

Figure 26: Rate of Pension Credit claimants, 2008 and 2011

Figure 27: Rate of Attendance Allowance claimants, 2008 and 2011

Figure 28: DLA Claimants by older age bands 2008-11, East Ayrshire

Figure 29: DLA Claimants by older age bands 2008-11, North Ayrshire

Figure 30: DLA Claimants by older age bands 2008-11, South Ayrshire

Figure 31: Single pensioner household by tenure 2009-10

Figure 32: Marital status in East Ayrshire from 35 to 75 + 2009-10

Figure 33: Marital status in North Ayrshire from 35 to 75 + 2009-10

Figure 34: Marital status in South Ayrshire from 35 to 75 + 2009-10

Figure 35: Trends in care home places for older people 1999/00 – 2010/11

Figure 36: Home care clients by age group, 2011

Figure 37: Breakdown of hours home care for clients aged 65+, 2009-2011

Figure 38: Percentage of households in fuel poverty in East, North and South

Ayrshire by age

Figure 39: Estimated number and percentage of smokers in the adult population of

Ayrshire and Arran by age and sex, 2003/04

Figure 40: Percentage of adults in Scotland that smoke by age group

Complete draft OPNA Page 5 of 131 20 February 2013


Figure 41: Smoking status of patients in Ayrshire and Arran at 1 Jan 2009 as a % of

all patients with smoking status recorded by GPs, by age group

Figure 42: Age of clients using local smoking cessation services in Ayrshire and Arran,

2009

Figure 43: Crude rates of all alcohol-related acute hospital discharges (SMR01) for all

persons aged 10 years or over by 5-year age band in Ayrshire and Arran (2000, 2004,

2008)

Figure 44: Alcohol assessments by specialist addictions services (2005/06-2008/09);

age at referral (banded)

Figure 45: General acute inpatient and day case discharges with a diagnosis of

alcohol-related brain damage in any position: five-year average age standardised

rate per 100,000 population, by health board 2001/02r-2010/11p

Figure 46: Crude rates of all drug-related acute hospital discharges (SMR01) for all

persons aged 10 years or over by 5-year age band in Ayrshire and Arran (2000, 2004,

2008)

Figure 47: Expectation of life at birth (LE), by sex for East, North and South Ayrshire,

split by level of deprivation

Figure 48: Male Life expectancy and healthy life expectancy at birth in years

Figure 49: Female Life expectancy and healthy life expectancy at birth in years

Figure 50: Age-standardised death rates for all causes, NHS Ayrshire & Arran and

Scotland, 2006 to 2010

Figure 51: Age-standardised death rates for all causes, East Ayrshire and Scotland

Figure 52: Age-standardised death rates for all causes North Ayrshire and Scotland

Figure 53: Age-standardised death rates for all causes South Ayrshire and Scotland

Figure 54: Seasonal increase in mortality in the winter, by age-group and NHS Board

area of usual residence, 2001/02 to 2010/11; Ayrshire and Arran; 5 year average

Figure 55: Increased Winter mortality index, by age-group and NHS Board5 area of

usual residence, 2001/02 to 2010/11; Ayrshire and Arran; 5 year average

Figure 56: Self-assessed general health, 2008, 2009 and 2010 combined, by age

Figure 57: Prevalence of long-term conditions, 2008, 2009 and 2010 combined, by

age

Figure 58: Heart disease deaths in Ayrshire & Arran, with age-sex standardised

mortality rates per 100,000 population by age band and year of death registration

Figure 59: Heart disease deaths in Ayrshire & Arran, with age-sex standardised

mortality rates per 100,000 population by age 65-74 years and year of death

registration

Figure 60: Heart disease deaths in Ayrshire & Arran, with age-sex standardised

mortality rates per 100,000 population by age 75 years and over and year of death

registration

Figure 61: Heart disease deaths in Ayrshire & Arran, with age-sex standardised

mortality rates per 100,000 population by age band, local authority of residence and

year of death registration

Figure 62: Incidence of coronary heart disease; Ayrshire & Arran and Scotland,


Figure 72: Age-specific incidence rates of cancer (all types) registrations in Ayrshire

and Arran, by five year age band between 2006 and 2010

Figure 73: Number of cancer (all types) deaths in Ayrshire and Arran, by five year

age band between 2006 and 2010

Figure 74: Age-specific incidence rates of cancer (all types) deaths in Ayrshire and

Arran, by five year age band between 2006 and 2010

Figure 75: Age-specific rate per 10,000 population of COPD admissions by sex and

age group for Ayrshire and Arran; for years ending 31 March 1998 – 2007

Figure 76: Percentage with 20 or more natural teeth, and percentage with no

natural teeth, 2008, 2009, 2010, by age band

Figure 77: The number of fall related hospital discharges by gender, age group and

year, 1997-2009, in Ayrshire and Arran

Figure 78: The crude rate per 100,000 population of fall related hospital discharges

by gender, age group and year, 1997-2009, in Ayrshire and Arran

Figure 79: The number of fractures of the neck of femur as a result of a fall by

gender, age group and year (1997-2009) in Ayrshire and Arran

Figure 80: The crude rate per 100,000 population of fractures of the neck of femur

as a result of a fall by gender, age group and year (1997-2009) in Ayrshire and Arran

Figure 81: Breast screening uptake by NHS Board of residence: Scotland, 1st April

2004 to 31st March 2011; Percentage uptake (three year rolling periods), females

aged 50-70 years

Figure 82: Seasonal influenza immunisation uptake among people aged over 65

years

Figure 83: Mean WEMWBS scores, 2008, 2009 and 2010 combined, by age and sex;

Scotland

Figure 84: Good average and poor WEMWBS scores, 2008, 2009 and 2010

combined, by age and sex; Scotland

Figure 85: GHQ12 scores for men, 2008, 2009 and 2010 combined, by age

Figure 86: GHQ12 scores for women, 2008, 2009 and 2010 combined, by age

Figure 87: All male mental illness discharges by age on discharge; rate per 100,000

population; Scotland

Figure 88: All female mental illness discharges by age on discharge; rate per 100,000

population; Scotland

Figure 89: Mental illness specialties in Scottish hospitals: percentage of male

discharges by age and length of stay: year ending 31 March 2011; Scotland

Figure 90: Mental illness specialties in Scottish hospitals: percentage of female

discharges by age and length of stay: year ending 31 March 2011

Figure 91: Mental illness specialties in Scottish hospitals: percentage of male

residents by age and length of stay: year ending 31 March 2011

Figure 92: Mental illness specialties in Scottish hospitals: percentage of female

residents by age and length of stay: year ending 31 March 2011

Figure 93: Ayrshire percentage of those over 65 with dementia, 2007 and 2021 in

East, North and South

Figure 94: Percentage of all males and females with dementia, 2007 and 2021 in

East, North and South Ayrshire

Figure 95: Estimated number of consultations, with corresponding rates per 1,000

for financial years 2003/04 by gender and age group

Figure 96: Estimated number of consultations, with corresponding rates per 1,000

for financial years 2010/11; by gender and age group

Figure 97: Admission rates per 100,000 population of all emergency admissions for

all Ayrshire & Arran residents by financial year and age group

Figure 98: Admission rates per 100,000 population of all emergency admissions for

Ayrshire & Arran Residents aged 65 years and over by financial year, age group, &

deprivation category

Figure 99: Patient rates per 100,000 population for patients with 3+ emergency

admissions for all Ayrshire & Arran residents by financial year & age group

Figure 100: Patient rates per 100,000 population for patients with one or more

emergency admissions per year for Ayrshire & Arran residents aged 65 years and

over by financial year

Figure 101: Patient rates per 100,000 population for patients with 3+ emergency

admissions for Ayrshire & Arran residents aged 65 years and over by financial year &

all deprivation category

Figure 102: Number of patients (65 years and over) at risk of emergency admission

to hospital in the following year; by risk category; Ayrshire and Arran

Figure 103: Percentage of patients (65 years and over) at risk of emergency

admission to hospital in the following year; by risk category; Ayrshire and Arran

Complete draft OPNA Page 7 of 131 20 February 2013


Figure 104: Percentage of patients (65 years and over) classed as being at “high risk”

of emergency admission to hospital in the following year; by health board and CHP

area

Figure 105: Projected potential informal care to older people by people aged 50 – 64

Figure 106: Projected potential informal care to older adults by people aged 50- 64

in East Ayrshire

Figure 107: Projected potential informal care to older adults by people aged 50- 64

in North Ayrshire

Figure 108: Projected potential informal care to older adults by people aged 50- 64

in South Ayrshire

Figure 109: Percentage of people spending last 6 months of life spent at home or in a

community setting

Figure 110: Proportion of individuals in relative poverty before housing costs by area

of residence: Scotland 2008/09 to 2009/10

Figure 111: Percentage of adults in relative poverty (before housing costs) by gender

and by single-adult household composition, Scotland 2010/11

Figure 112: Percentage of people in relative poverty (before housing costs) by ethnic

group: Scotland 2007/08 to 2010/11

Tables

Table 1: Births and Deaths in East, North and South Ayrshire

Table 2: Average migration in and out of East, North and South Ayrshire 2008-10

Table 3: Housing tenure for pensioner households

Table 4: Profile of disrepair and average cost of works of pensioner properties

Table 5: Households that have or require adaptation to dwelling (2008/10) and

projections (2033)

Table 6: Profile of aids and adaptations in East Ayrshire for all tenures, 2009/10 -

2011/12

Table 7: Average number and spend on equipment and adaptations 2009/10 –

2011/12

Table 8: Profile of spend of private sector housing grant 2007/08 – 2009/10

Table 9: Profile of spend in mainstream South Ayrshire Council properties 2008 -

2010

Table 10: Supported accommodation schemes in East Ayrshire

Table 11: Sheltered accommodation complexes in North Ayrshire

Table 12: Sheltered housing complexes in South Ayrshire

Table 13: Older people supported in care homes, 2010/11

Table 14: East Ayrshire care homes inspection grades (latest inspection)

Table 15: North Ayrshire care homes inspection grades (latest inspection)

Table 16: South Ayrshire care homes Inspection rates (latest inspection)

Table 17: Home care client age groups

Table 18: Older people receiving intensive home care (10+ hours per week)

Table 19: Free personal and nursing care (FPNC) provided to clients

Table 20: Internet use of people aged 60+

Table 21: Perception of personal safety in East, North and South Ayrshire

Table 22: Proportion of pensioner households living in ‘poor’ NHER rated housing

and in fuel poverty

Complete draft OPNA Page 8 of 131 20 February 2013


Table 23: Smoking status of patients in Ayrshire and Arran at 1 Jan 2009 as a % of all

patients with smoking status recorded by GPs, by age group and CHP area

Table 24: Estimated smoking-attributable mortality by age and sex, NHS board,

2000–2004

Table 25: Estimated usual weekly alcohol consumption, 2008, 2009 and 2010

combined, by age

Table 26: Estimated alcohol consumption on heaviest drinking day in last week,

2008, 2009 and 2010 combined, by age

Table 27: Adherence to weekly and daily drinking advice, 2008, 2009 and 2010

combined, by age and sex

Table 28: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history

of alcohol abuse or alcohol dependency – diagnosis appearing first on GP record, by

age group and deprivation category

Table 29: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history

of drug abuse or drug dependency – appearing anywhere on GP record, by age group

and deprivation category (51 of 59 local practices)

Table 30: Adult body mass index (BMI), 2008, 2009 and 2010 combined, by age and

sex

Table 31: Body Mass Index (BMI) of patients in Ayrshire and Arran at 1 Jan 1999,

2004, 2009 – counts of all patients with BMI recorded by GPs, by age group and CHP

area (51 of 59 local practices)

Table 32: Prevalence of fruit and vegetable consumption, 2008, 2009 and 2010

combined, by age and sex

Table 33: Summary physical activity levels, 2008, 2009 and 2010 combined, by age

and sex

Table 34: Participation in different activities in the past 4 weeks, 2008, 2009 and

2010 combined, by age and sex

Table 35: Expectation of life at birth (LE), by sex in East, North and South Ayrshire

2006-2010

Table 36: Life expectancy at age 65, in East, North and South Ayrshire, Ayrshire &

Arran and Scotland, 2008-2010

Table 37: Rate of reported long term conditions per 1000 adults, 2008, 2009 and

2010 combined, by age and sex, Scotland

Table 38: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of coronary heart disease (CHD)

Table 39: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of stroke by age group and deprivation category

Table 40: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of cancer by age group and deprivation category

Table 41: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of diabetes type by age group and deprivation category

Table 42: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of diabetes type 2 by age group and deprivation category

Table 43: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of COPD by age group and deprivation category

Table 44: Number and approximate rates per 100,000 population of patients with

Parkinson's disease in Ayrshire and Arran GP practice survey by age, gender and

location (June 2006)

Table 45: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of hearing impairment or visual impairment by gender, age group, and

deprivation category

Table 46: Number of natural teeth, and percentage with no natural teeth, 2008,

2009, 2010, by age and sex

Table 47: Average length of stay for fractures of the neck of femur by age group in

Ayrshire and Arran in 2009

Table 48: Percentage, at 1 Jan 2009, of patients in Ayrshire and Arran with a history

of depression or stress/anxiety by age group, sex and deprivation category

Table 49: Mental illness discharges of MALE patients by age and main diagnosis on

discharge; rate per 100,000 population: year ending 31 March 2011; Scotland

Table 50: Mental illness discharges of FEMALE patients by age and main diagnosis

on discharge; rate per 100,000 population: year ending 31 March 2011; Scotland

Table 51: Estimates of households with someone requiring regular help and care

and carers

Table 52: Profile of unpaid carers in Ayrshire and Arran

Complete draft OPNA Page 9 of 131 20 February 2013


Chapter 1: Introduction and Overview

A range of national policies has been developed to address the rapid

changes in age composition of our population, its consequences for

public health in the future, the likely increases in demand for public

services and the consequent pressure on public spending. Across the

UK, public expenditure related to older people has been estimated to

rise from 20.1% of GDP in 2007-08 to 26.6% in 2057 1 .

Whilst many older people continue to live active lives without recourse

to care and assistance from local authorities and health agencies, there

will always be some who need help to live fulfilling lives. The Scottish

Government has a longstanding policy of ‘shifting the balance of care’.

This means supporting people to remain at home independently for as

long as possible rather than in care homes and hospitals 5 .

This was set out in the Scottish Government’s Reshaping Care for Older

People Programme for Change 4 .

The Office for Budget Responsibility 2 stated that:

the public finances are likely to come under pressure over the longer

term, primarily as a result of an ageing population.”

The demographic dividend of the last six decades has begun to diminish

as the large cohorts of baby boomers have started to retire in 2010 and

policies to maintain independence and quality of life are essential.

However, the future health status of the population will depend on

policies to tackle current health, social, economic and educational

inequalities 3 .

The policy response by the Scottish Government is a programme of

change with the publication of Reshaping Care for Older People 4 . The

NHS and local authorities need to work together to make sure that they

can provide services that work for older people, that are affordable and

that encourage older adults to lead healthy, active independent lives.

The Ayrshire and Arran Joint Strategy for Older People group have

requested an Assessment of older people’s needs to inform the Older

People’s Strategy. It is intended that this Needs Assessment provides a

comprehensive profile of the health and social needs of older people

now and projected into the future.

This chapter sets out the context for the needs assessment by outlining

the range of national and local policy documents, agreements and

structures already in place across Ayrshire.

1.2 Health and social care specific legislation

Social Work (Scotland) Act 1968 6

This is the primary Act detailing the general social work function of the

local authority. A number of subsequent Acts have inserted

amendments in respect of revised or additional duties.

Chronically Sick and Disabled Persons (Scotland) Act 1972 6

This act requires local authorities to assess the needs of disabled

persons and to provide assistance and services.

Disabled Persons (Services, Consultation and Representatives) Act 1986 6

This Act permits authorised representatives to be appointed for a

disabled person. It also requires that, for a person with a mental

disorder who has been in hospital for a continuous period of at least six

months, both the health and local authority should be notified and

carry out an assessment of the individual’s needs.

NHS and Community Care Act 1990 6

The 1990 Act led to the insertion of s12A into the Social Work

(Scotland) Act 1968 creating a duty to assess the needs of any individual

1.1 The policy context

who it appears may require community care services that the local

authority has a duty or power to provide or secure.

Complete draft OPNA Page 10 of 131 20 February 2013


Carers (Recognition of Services) Act 1995 6

This places a duty on local authorities to consider the needs of unpaid

carers.

Community Care (Direct Payments) Act 1996 6

This created the opportunity for a local authority, as an alternative to

the provision of care, to make a direct payment to an individual to

enable them to arrange their own support for assessed needs.

Adults with Incapacity (Scotland) Act 2000 6

This allows for support and intervention for individuals who are deemed

to have incapacity. It sets out the provisions for intervention orders and

guardianship orders.

Community Care and Health (Scotland) Act 2002 6

This Act details a range of provisions in respect of community care

services.

Mental Health (Care and Treatment) (Scotland) Act 2003 6

This replaces the Mental Health Act 1984. It places a duty on local

authorities to meet the needs of ‘mentally disordered’ individuals as

including the provision of care in the community and aftercare services.

It provides where necessary for the detention of individuals in hospital

where this is defined as necessary. The Act also sets out the

requirement to appoint mental health officers to discharge the duties

required by the Act.

Adult Support and Protection (Scotland) Act 2007 6

This Act provides greater protection to those thought or known to be at

risk of harm through new powers to investigate and intervene in

situations where concern exists.

Social Care (Self-directed Support) (Scotland) Bill

http://www.scottish.parliament.uk/parliamentarybusiness/Bills/48001.aspx

If enacted, the Bill will:

Introduce the language and terminology of self-directed support

into statute

Provide a consistent, clear framework in law

Impose firm duties on local authorities to provide the various

options available to citizens – making it clear that it is the citizen’s

choice as to how much choice and control they want to have

Widen eligibility to those who have been excluded up to this point,

such as carers

Consolidate, modernise and clarify existing laws on direct payments

The personalisation agenda of self directed support is linked closely

with the British Association of Social Workers code of ethics that

demonstrates the commitment to five basic values:

Human dignity and worth

Social justice

Service to humanity

Integrity

Competence

The principles underpinning ‘Personalisation’ are outlined in a

discussion paper by Chetty et al., 2012 7

1.3 National policy

The strategic direction of travel in Ayrshire and Arran is driven by a

number of key national and local policy documents outlined below.

Community Care: A Joint Future (2000)

http://www.scotland.gov.uk/Resource/Doc/1095/0013865.pdf

This report outlined recommendations to secure better outcomes for

people through improved joint working between health and social care,

including developing arrangements for managing and financing joint

services.

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Partnership for Care (2003)

http://www.scotland.gov.uk/Publications/2003/02/16476/18730

This white paper included proposals to increase patient-centred care

and established the mandate to create the Community Health

Partnerships to bridge the gap between primary and secondary

healthcare and between health and social care.

Reshaping Care for Older People: A Programme for Change (2011) 4

The Scottish Government’ vision that ‘Older people are valued as an

asset, their voices are heard and they are supported to enjoy full and

positive lives in their own home or in a homely setting’ was a key driver

of the re-shaping care agenda.

The ‘Programme for Change’, published in 2011 set out the reasons for

change in the approach to care for older people and what has been

seen as the key actions required to achieve this change. Some of the

key messages which need to frame the development and delivery of the

Reshaping Care programme include:

1. Older people are an asset not a burden

2. We need a shift on philosophy, attitudes and approaches

3. We are adding healthy years to life

4. Supporting and caring for older people is not just a health or

social work responsibility

5. Services should be outcome focussed

6. We need to accelerate the pace of sharing good practice

7. It is important to align partnership resources to achieve our goals

8. Additional funding is needed for care

The Programme for Change also outlined the main messages from

stakeholders about the preferences of older people:

1. People want to stay in their own homes for as long as possible

2. People want a greater degree of personalisation and choice

3. People want more joined up working – less needless bureaucracy

4. People want to avoid prolonged hospital stays

5. People want greater support for unpaid carers

6. People want funding and support for pensioner networks of

community groups

7. People want a consistency of paid workers

8. People want regular health and well being check ups

9. People want more specialist services for people with dementia

10. People want appropriate housing and timely installation of

equipment and adaptations

11. People want information.

The Programme for Change also outlined a commitment to continue

Change Funding of £70 million for 2012/13 and in the region of £300

million over the period 2011/12 to 2014/15 to stimulate shifts in the

totality of the budget from institutional care to home and community

based care and enable subsequent de-commissioning of acute sector

provision. A summary of the Change Fund guidance is outlined below:

Commissioning Social Care

www.audit-scotland.gov.uk/docs/health/2012/nr_120301_social_care.pdf

After a substantial review of how effectively the public sector

commissions social care services, Audit Scotland made several

recommendations for Councils along with NHS boards and other

relevant commissioning partners:

The need to develop commissioning strategies

The need to manage the risks of contracting services from voluntary

and private providers

Implement self-directed support in a way that service-users will get

information, advice and support and processes are in place to

monitor the outcomes of the support

The need to work very closely together.

The Healthcare Quality Strategy for NHS Scotland. (2010)

http://www.scotland.gov.uk/Publications/2010/05/10102307/8

Complete draft OPNA Page 12 of 131 20 February 2013


The quality strategy was developed following the progress made with

the implementation of Better Health Better Care (Scottish Government,

2007). Implementation of the Quality Strategy will enhance the

integrated approach to service planning and delivery. It sets out the

commitment of the NHS in Scotland to ensure all patients are at the

centre of their care, that the care is clinically effective, safe and timely.

Patients will be encouraged to be partners in their own care and when

consulted on what they wanted and needed from health services they

indicated:

Caring and compassionate staff and services

Clear communication and explanation about conditions and

treatment

Effective collaboration between clinicians, patients and others

A clean and safe care environment

Continuity of care and clinical excellence.

Age, Home and Community: A Strategy for Housing for Scotland’s Older

People: 2012 - 2021 5

The Age, Home and Community document published by the Scottish

Government sets out the vision for housing services for older people in

terms of the shifting the balance of care agenda.

The strategy highlights the importance of and support for:

Advice and information for older people about the housing options

and support available to them

Piloting a housing options approach for older people

Encouraging accreditation under the Scottish National Standards for

Information and Advice Providers

Delivering adaptations in a efficient and effective way

Developing a national register of accessible housing

Establishing and promoting ‘Trusted Trader’ schemes

Encouraging ‘downsizing schemes’

New guidance for the redevelopment of sheltered and very

sheltered housing

Making it easier for older people to access equity in their home

Mainstreaming telecare

Reviewing building and design standards to meet the needs of older

people.

Intermediate Care Framework (Consultation document)

http://www.scotland.gov.uk/Publications/2012/07/1181

Maximising Recovery and Promoting Independence: Intermediate Care’s

contribution to Reshaping Care. Scottish Government, April 2012.

Intermediate care encompasses a range of functions that focus on

prevention, rehabilitation, enablement and recovery. This is one core

element of reshaping health care and support services for older people

and will be developed by the (yet to be established) Health and Social

Care Partnerships. The framework outlines the need for multiprofessional,

multi-agency coordination to prevent unnecessary acute

hospital admission, premature admission to long term care, support

with timely discharge from hospital, promotion of faster recovery from

illness, support of anticipatory care planning and self management of

long term conditions. This is in line with expressed needs from

consultation where older people stated that they want to stay in their

own homes as long as possible.

Generic legislation

Human Rights Act 1998

This sets out the rights everyone can expect to have protected by law

including:

The right to life

The right to freedom from torture, inhuman and degrading

treatment

Complete draft OPNA Page 13 of 131 20 February 2013


The right to liberty

The right to a fair trial

The right to privacy

The right to freedom of conscience

The right to freedom of expression

The right to freedom of assembly

The right to marriage and the family

The right to enjoy the previous rights and freedoms without

discrimination

Equality Act 2010 6

This Act consolidates a range of laws that protected and enhanced the

rights of people from minority groups as well as placing a duty on public

authorities to promote equality of opportunity.

1.4 Local frameworks and policies

• NHS Ayrshire and Arran

Carer Information Strategy 2008 – 2011

A Carer Information Strategy was prepared by NHS Ayrshire and Arran

that complies with legislative requirements set out in the Community

Care and Health (Scotland) Act 2002.

Research carried out for the Carer Information Strategy suggested that

there are around 37,318 carers in Ayrshire:

East Ayrshire – 12,454

North Ayrshire – 13,479

South Ayrshire – 11,385

The purpose of the Carer Information Strategy was to ensure that:

Carers are given the support and information they require to carry

out their caring role

Carers are given the opportunity to be actively involved in the

development, implementation and evaluation of the Strategy and

related services

Getting Better...Together - Care Counts

The Care Counts document explains NHS Ayrshire and Arran’s vision for

the future of the local health service over a ten year period from 2012.

It sets down the notion that a ‘hospital’ based model of care is no

longer sustainable or appropriate to meet the health needs of the

population, and advocates the adoption of a community-focused health

and social care service.

This document explains that the public health priorities across Ayrshire

and Arran are:

Alcohol

Tobacco

Obesity

Mental Health

These priorities are still current in relation to improving the health of

older people across the area.

• East Ayrshire

East Ayrshire Single Outcome Agreement

The Single Outcome Agreement 2011 - 2014 in East Ayrshire is

recognised by the local Community Planning Partnership (CPP) as a

management tool to:

Further improve the quality of life across our communities

Deliver better outcomes for local people

Secure opportunities for reducing bureaucracy

Make more efficient use of resources

Make a difference by removing barriers to improved service delivery

Complete draft OPNA Page 14 of 131 20 February 2013


Identify areas for improvement.

Included in East Ayrshire’s Single Outcome Agreement is a commitment

to shifting the balance of care, illustrated by the Local Outcome:

That ‘Older people, vulnerable adults and their carers are supported,

included and empowered to live the healthiest life possible’

East Ayrshire Change Plan 2012/13

The indicative Change Fund allocation for East Ayrshire in 2012/13 is

£1.887M.

East Ayrshire’s Change Plan for 2012/13 focused on the following areas:

Falls prevention and management

Community based clinical pharmacy

Voluntary sector

Primary care

Dementia

Out of Hours Services

Supported Accommodation Strategy for Older People in East Ayrshire

(2006)

This strategy sets out the way in which ‘supported accommodation’ is

operated. Access to supported accommodation is based on an

assessment of the level of dependency (low, medium and high) of the

individual as well as how urgently they need the support (urgent,

significant, moderate or aspirational).

• North Ayrshire

language of ‘shifting the balance of care’, there is a clear commitment

to helping people to be supported in their own home.

‘North Ayrshire Outcome 6d – more vulnerable people are supported

within their own community’

North Ayrshire’s SOA will be reviewed and updated in 2013 and will

include direct references to the rebalancing care agenda.

North Ayrshire Change Plan 2012/13

The indicative Change Fund allocation for North Ayrshire in 2012/13 is

£2.24M

North Ayrshire’s Change Plan for 2012/13 focuses on the following

areas:

Supporting people with dementia

Care Homes

Anticipatory Care and End of Life Training

Care at Home – including out of hours

Intermediate Care and Enablement

Community Ward

Older People Review Team

Local Operational Teams (LOTs)

Older People’s Housing Strategy

North Ayrshire Joint Commissioning Strategy for Older People 2009 -

2012

The Joint Commissioning Strategy for Older People 2009 – 2012 was

developed by the North Ayrshire Community Health Partnership. The

main vision outlined in the strategy was to:

North Ayrshire - A Better Life A Single Outcome Agreement for North

Ayrshire 2009 - 2012

‘Enable older people to remain at home for as long as it is practical and

The Single Outcome Agreement 2009 – 2012 replaced the Community safe, give person centred care and provide a range of services and

Plan 2006 – 2016 and the North Ayrshire Community Plan 2008 – 11. support appropriate to meeting their needs and achieving good

Although the agreement slightly pre-dates the mainstreaming of the

outcomes’.

Complete draft OPNA Page 15 of 131 20 February 2013


Key proposals within the strategy include:

Need for joint needs assessment, and partnership working

Refocus care in the community rather than relying on hospital beds

or care home placements

Agree level of in-patient care to be retained

Consider number and use of assessment and rehabilitation beds

Agree amount of resource release for investing in community health

and care infrastructure

Consider short to medium term purchase of care home places to

reduce number of delayed discharges

Agree joint investment strategies

Link more closely with Rapid Response Team

Develop respite facility for people with dementia

Increase use of assistive technology

Introduce closer liaison between community based social care and

health and hospital to reduce numbers admitted inappropriately to

hospital by accessing joint provision and out of hours services

Increase range and type of community rehabilitation, anticipatory

and preventative care.

North Ayrshire Local Housing Strategy 2011 - 2016

The North Ayrshire Local Housing Strategy 2011 – 2016 provides a

strategic vision for housing. In relation to meeting the needs of older

people the strategy provides commitments of:

Ensuring all new homes are built to a standard that allows

households to remain living in them throughout their lives

Working with local Registered Social Landlords (RSLs) to ensure

equality of opportunity in terms of accessing equipment and

adaptations as well as matching adapted empty rental properties to

people with similar needs

Ensuring there are housing support measures available that

promote independent living through development of a Housing

Support Strategy. The North Ayrshire Local Housing Strategy 2011 –

2016 was approved through the Scottish Government Peer Review

process.

• South Ayrshire

South Ayrshire Single Outcome Agreement 2009 - 12

The Single Outcome Agreement 2009 – 2012 replaced the Community

Plan ‘A Better Future Together 2006 – 2010’. As with North Ayrshire,

although the SOA document predates the ‘re-balancing care’ policy

drive, there is a clear commitment to helping older people remain as

independent as possible within their own homes:

‘South Ayrshire Strategic Objective 9c’ – increase and maintain the

independence of older people and people with long-term conditions and

disabilities.

South Ayrshire’s SOA will be reviewed and updated in 2013 and will

include direct references to the rebalancing care agenda.

South Ayrshire Council Change Plan 2012/13

The indicative Change Fund allocation for South Ayrshire in 2012/13 is

£2.21M.

South Ayrshire’s Change Plan focused on the following areas:

Community Capacity Building

Targeted Housing Adaptations

Dementia related activity

Telehealthcare development and capital

Mobile attendants

Enablement

Community Wards

Complete draft OPNA Page 16 of 131 20 February 2013


South Ayrshire Local Housing Strategy 2011 - 2016

The South Ayrshire Local Housing Strategy 2011 – 2016 provides a

strategic vision for housing. In relation to meeting the needs of older

people the strategy provides a clear commitment to:

A Strategy for Housing Options for Older People

Improved access to advice and information for older people

Agreeing a South Ayrshire amenity standard.

The South Ayrshire Local Housing Strategy was approved through the

Scottish Government Peer Review Process in September 2011.

undertake the various tasks that a client may not be able to do because

of an injury or illness, help and support are provided to that client to

help them regain confidence and skills to undertake the tasks for

themselves.

In East Ayrshire the Transformation Plan developed in (2011/12)

included proposals within the work streams to integrate rehabilitation

and enablement services. Community-based integrated health and

social care service models with a focus on re-ablement, alternatives to

hospital admission and accelerated discharge teams have been

proposed to deliver this change.

In North Ayrshire, re-ablement is offered to clients for up to 12 weeks.

This involves agreeing a support plan to help learn or relearn skills and

also provide support to help the client achieve their desired outcome. If

after the 12 week period is over more support or care is required, this

will be arranged.

In South Ayrshire, the re-ablement model has been piloted in several

areas and has proved very successful in producing positive outcomes

for clients and reducing costs for the community care team. Due to the

success of the pilot schemes, re-enablement is being rolled out across

the whole area over 2012/13.

Housing Options for Older People – Re-ablement

The re-ablement model of care has been introduced across Ayrshire in

various ways. Re-ablement represents a significant departure from the

existing ‘care at home’ model. Rather than providing a home-carer to

Complete draft OPNA Page 17 of 131 20 February 2013


Popualtion (000s)

Chapter 2: Demography

2.1 Ayrshire and Arran population

The most recent population estimates available at the time of writing

the joint needs assessment are for 2010. These estimate a slight

decline in the Ayrshire and Arran population from 368,149 at the time

of the 2001 National Census to 366,860 in 2010. The estimates use

the census figures and make calculations allowing for major

population changes such as births, deaths, inward and outward

migration from geographic areas.

Figure 1: Estimated population 2010 by age group and gender in

Ayrshire and Arran

60

50

40

30

20

Males

Females

Figure 1 provides a profile of the age and gender distribution, in broad

age bands, of the estimated Ayrshire and Arran population in 2010.

The gender balance shifts from a higher proportion of males in the

youngest age group (in the majority of years there are slightly more

boys born than girls), to a higher proportion of women in the older age

groups. These population changes are due predominantly to

differences in male and female mortality rather than to migration

factors. In the 75 years and over age group, 37.5 percent of the

population are male with females accounting for 62.5 percent. These

gender imbalances are not new and reflect the national picture. Those

persons aged 65 years and over account for 19% of the Ayrshire and

Arran population.

East, North and South Ayrshire Populations

The population estimates in Figure 2 for 2010 indicate that North

Ayrshire is the most populated locality with 135,180 people residing

there; this represents 37 percent of the Ayrshire and Arran population,

the East Ayrshire population of 120,240 accounts for 33 percent and

South Ayrshire, with the smallest population of 111,520, accounting

for 30 percent.

10

0

0-15 16-29 30-49 50-64 65-74 75 and

over

Age band (years)

Source: http://www.groscotland.gov.uk/statistics/theme/population/estimates/mid-year/2010/tables.html

Between 2009 and 2010 the population of East Ayrshire and South

Ayrshire changed little; North Ayrshire saw a decrease of 0.2 percent.

The total population in all three localities has fallen overall since 1984.

In Scotland 23.1 percent of the population are aged 60 years and over.

In East Ayrshire the figure is 24.5 percent (29,495 people), in North

Ayrshire 25.9 percent (34,995) and in South Ayrshire those aged over

60 years account for 28.7 per cent of the population (31,998).

Complete draft OPNA Page 18 of 131 20 February 2013


Population (000s)

Figure 2: Estimated population 2010 by local authority and age group

40

35

30

25

20

15

10

5

0

0-15 16-29 30-49 50-64 65-74 75-84 85-90+

Age band (years)

Source: http://www.groscotland.gov.uk/statistics/theme/population/estimates/mid-year/2010/tables.html

2.2 Population Projections for Ayrshire and Arran

East Ayrshire

North Ayrshire

South Ayrshire

Population projections are calculations based on current trends of four

demographic variables - the fertility (births) rate, the mortality

(deaths) rate, immigration and emigration. Projections are reasonably

accurate and reliable given that the cohorts are already born.

Projections have limitations and tend to be less reliable for areas with

small populations, local and regional population projections are set in

a national context. The key demographic trends in Scotland are a

result of many years of high fertility rates (‘baby booms’) followed by

low fertility rates and sustained increases in life expectancy that are

rising at a faster rate than healthy life expectancy. There is little that

changes the predicted population trends other than extraordinary

migration or mortality 3. However, it is argued that extraordinary

migration in Scotland may not change the current projected balance

between young and old because migrants often adopt the fertility

pattern of their country of residence 8 . Population projections are

therefore important in understanding the likely future impacts of

these demographic changes for the public sector and how they will

affect demand on services. As a result these data are valuable for

informing a whole range of policies that contribute directly and

indirectly to securing the population’s health.

It is clear from Figure 3 that the population structure of Ayrshire and

Arran is projected to change quite markedly over the period from 2010

to 2035. Whilst the overall population is projected to decline (to just

under 356,000 in 2035), this is not evenly distributed across age

groups. The 16 years and under population group will decline by 7.8

percent, 16 to 29 years old group by 13.1 percent, 30 to 49 years old

group by 14.8 percent and 50 to 64 years old group by 23 percent.

Conversely, the 65 to 79 years old population group will increase by 33

percent and the 80 years and over group by 105 percent accounting

for 10 percent of the total population.

Figure 3: Projected population by age group 2010-2035 in Ayrshire and

Arran

100%

80%

60%

40%

20%

0%

2010 2015 2020 2025 2030 2035

0-15 16-29 30-49 50-64 65-79 80+

Source: http://www.gro-

scotland.gov.uk/statistics/theme/population/projections/sub-national/2010-

based/index.html

Complete draft OPNA Page 19 of 131 20 February 2013


Percentage of population

The 65 years and over population group accounted for 19 percent of

the total Ayrshire and Arran population in 2010 and are projected to

account for 30 percent of the total population by 2035. This translates

into an increase in the number of people aged over 65 from the

current 69,720 to 106,800, a rise of just over 37,000 individuals. The

rise in the number ofolder old’ i.e. those over the age of 80 is

anticipated to rise from 17,598 in 2010 to 36,070 in 2035, a rise of

18,472.

It is known that the age of retirement will increase over coming years

and this will require a focus on workplace policies to maintain the

health and wellbeing of an ageing workforce. Pensionable age is 65

years of age for men, 60 for women until 2010; between 2016 and

2018 pensionable age for women increases to 65. Between 2018 and

2020, State Pension age will increase to 66 years for both sexes, rising

to 67 by 2026 9 .

Figure 4 shows that the largest increase of people over the state

pension age between 2010 and 2035 is projected to be 17 percent in

North Ayrshire, almost doubling the percentage of pensioners in the

population. In South Ayrshire it is half of this increase at 8.5 percent

with East Ayrshire projected to increase by 15 percent.

Figure 4: Percentage of population over state pension age 2010 to

2035

50

45

40

35

30

25

20

15

10

5

0

East Ayrshire North Ayrshire South Ayrshire Scotland

2010 2025 2035

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/index.html

Complete draft OPNA Page 20 of 131 20 February 2013


2.3 Demographic change

The population changes outlined above will have a profound impact on

the demand for health, social and long-term care services. It is likely

that this will increase substantially over the next few decades. The

geographic distribution of this change in terms of urban and rural

living may add complexity to meeting demand; Scottish projections

show that there will be a higher percentage (21%) of people aged over

60 living in rural areas compared to the percentage (17%) living in

urban areas 1 .

Reasons for population change

Population change is determined by the interaction of four

demographic variables outlined in section 2.2. Natural change is the

difference between the number of births and deaths. There has been

a long-term linear decline in mortality as is detailed for Ayrshire and

Arran in Figure 5 and for each local authority in Table 1. Meanwhile,

births have also decreased, although this trend has levelled off in

recent years.

Figure 5a provides further detail of this relationship as a ratio of

deaths to births at NHS Board and Local Authority level. It should be

noted that the ratio of deaths to births can be observed to have

reduced in recent years, in line with the national trend. However,

while nationally births currently outnumber deaths (indicating a

natural growth in population); locally, deaths continue to outnumber

births (indicating a natural decrease in population). This is particularly

evident in South Ayrshire where there are currently about 1.34 deaths

for every birth. East and North Ayrshire remain above the Scottish

average but are both approaching a ratio of one death to every birth.

Figure 5: Five-year average number of birth and death registrations in

Ayrshire and Arran, 1991-2010

6,000

5,000

4,000

3,000

2,000

1,000

0

Source: National Records for Scotland

Table 1: Births and deaths in East, North and South Ayrshire

Births % change Deaths

Year 2009 2010 2009-2010 2009 2010

% change

2009-2010

East Ayrshire 1,362 1,334 -2.1% 1,328 1,270 -4.3%

North Ayrshire 1,498 1,450 -3.2% 1,608 1,484 -7.7%

South Ayrshire 1,054 1,035 -1.8% 1,379 1,439 4.1%

Ayrshire and

Arran

All births

All deaths

3,914 3,819 -2.4% 4,315 4,193 -2.8%

Scotland 59,046 58,719 -0.4% 53,856 53,967 0.2%

Source: www.gro-scotland.gov.uk/statistics/at-a-glance/council-areas-map.html

Complete draft OPNA Page 21 of 131 20 February 2013


Figure 5a: Five-year average ratio of deaths to births by NHS Board

and Local Authority area, 1991-2010

1.6

1.4

1.2

1

0.8

0.6

0.4

Source: National Records for Scotland

Fertility

Scotland Ayrshire & Arran East Ayrshire

North Ayrshire

South Ayrshire

The fertility rate is a key driver to demographic change, along with

migration (in- and out-) and life expectancy. These variables impact on

the size of the population and the dependency ratio. The dependency

ratio measures the number of dependent people (above and below

working age) compared to the number of people of working age.

Of the four demographic variables it is fertility that has the biggest

impact on the ageing of the population 8 . The birth rate has increased

in Scotland since 1995, peaking in 2008 with 60,000 births. This

dropped by 2.1 percent in 2010 and currently Scotland has the lowest

birth rate of the UK countries 1 . There have been two large ‘baby

boom’ cohorts that increased the number of people of working age for

the labour market. The first was in 1946-1950, peaking in 1947 at

110,000 births and the second in the 1960s 10 . This ‘demographic

dividend’ is now beginning to diminish as the baby boomer

generations start to retire from 2010 onwards. This will result in a

substantial decrease in the size of the working age population 3 .

Scotland’s fertility rate is now below the level required to replace its

population 1 . The replacement level of fertility is approximately 2.1

live births per woman with a level above 1.5 considered to be in the

‘safety zone’ (net immigration can still compensate for lower

fertility) 11 .

The Total Fertility Rate (TFR) per 1000 women of reproductive age for

East, North and South Ayrshire in 2010 is 1.90, 1.88 and 1.78

respectively, placing a reliance on in-migration to compensate.

Migration

Net migration is the balance between immigration and emigration and

it is projected that, without net immigration, Scotland’s population will

decrease over the longer term 12 . Migration flows are difficult to

predict as they are influenced by social, cultural and economic factors

that are not accounted for in the assumptions. An out-migration of

young people from Scotland due to the current economic downturn is

possible but difficult to predict or project.

Complete draft OPNA Page 22 of 131 20 February 2013


Table 2 indicates in-and out-migration for East, North and South

Ayrshire. In-migration exceeded out-migration in East and South

Ayrshire. North Ayrshire experienced more out-migration than inmigration.

However, in all three areas the 16 to 29 year olds age group

accounted for the largest in-migrants and out-migrants (National

Records for Scotland, 2011). Long term migration assumptions predict

that East, North and South Ayrshire will experience more outmigration

than in-migration over the medium to long term,

contributing to the fall in population seen in the projections.

Table 2: Average migration (in and out) of East, North and South

Ayrshire 2008-10

All Ages In Out Net

East Ayrshire 3,439 3,215 224

North Ayrshire 3,787 3,852 -65

South Ayrshire 3,659 3,403 256

Ayrshire and

Arran

10,885 10,470 415

Source: http://www.gro-scotland.gov.uk/statistics/theme/population/index.html

Demographic data are essential in determining current and future

public health needs. These also assist in highlighting the differences

shown at local authority level and can be utilised in joint service

planning between NHS Ayrshire & Arran and each local authority and,

in particular, for the health and social care of older people in our

communities.

Complete draft OPNA Page 23 of 131 20 February 2013


Ten year age bands

Ten year Age bands

2.4 Population projections for Scotland

Population pyramids provide a quick reference profile of the

population structure; the bars to the left of the central axis shows

populations for males in ten year age bands, the bars to the right are

female populations. The population pyramids for Scotland summarise

the anticipated changes in the population structure between 2010 and

2035 (Figures 6 and 7).

As can be seen, the shape of the ‘pyramid’ changes in a number of

ways over the twenty five year period. There are fewer people aged

between 0 to 20 in 2035, the high numbers of people aged 20-30 in

2010 are reflected in the bulge in the numbers aged 45-55 in 2035 and

the high number of those in the mid 40s in 2010 become the increased

number of people aged around 70 in 2035. There is a much less steep

gradient in older age in 2035 with higher numbers extending into later

years.

Figure 6: Population Pyramid of Scotland, 2010

Figure 7: Population Pyramid of Scotland, 2035

90+

80-89

70-79

60-69

50-59

40-49

30-39

20-29

10-19

0-9

Male

Female

90+

80-89

70-79

60-69

50-59

40-49

30-39

20-29

10-19

0-9

Male

Female

20 15 10 5 0 5 10 15 20

2010 percentage of population Scotland

20 15 10 5 0 5 10 15 20

2035 percentage of population Scotland

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/scotland/populationpyramids.html

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/scotland/populationpyramids.html

Complete draft OPNA Page 24 of 131 20 February 2013


Ten year age bands

Ten year age bands

2.5 Projected population changes for Ayrshire and Arran

2010 to 2035

Figures 8 and 9 compare the age and gender structure of Ayrshire and

Arran in 2010 with the projected changes estimated for 2035. The

difference between the figures indicates slow population growth with

low birth rates and declining mortality. The 50 to 59 year olds in 2010

are the 75 to 84 year olds in 2035.

Figure 9 Shows substantial change to a more rectangular shape with a

shift from those aged 40-49 constituting the largest proportion of the

population, to those aged 60-69.

Figure 8: Age and gender composition 2010 for Ayrshire and Arran

Figure 9: Age and gender composition 2035 for Ayrshire and Arran

90 +

80 - 89

70 - 79

60 - 69

50 - 59

Male (%)

Female (%)

90 +

80 - 89

70 - 79

60 - 69

50 - 59

Male (%)

Female (%)

40 - 49

40 - 49

30 - 39

30 - 39

20 - 29

20 - 29

10 to 19

10 to19

0 - 9

0 - 9

20 15 10 5 0 5 10 15 20

2010 Percentage of population

20 15 10 5 0 5 10 15 20

2035 Percentage of population

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Complete draft OPNA Page 25 of 131 20 February 2013


Ten year age bands

Ten year age bands

2.5.1 Projected Population Changes for East Ayrshire 2010 to 2035

Figures 10 and 11 compare the age and gender structure of East

Ayrshire in 2010 with the projected changes estimated for 2035. The

differences between these figures show an ageing population with a

slight increase in the gender imbalance towards females in the older

age groups by 2035.

Figure 10: Age and gender composition, 2010 of East Ayrshire

of the population in East Ayrshire in 2010 and in 2035 it is estimated

that this will increase to eight percent of the total male population.

The population pyramid for East Ayrshire 2035 shows a similar pattern

to the pyramid for Ayrshire and Arran 2035. The largest population are

aged 60 to 69 years - those born between 1966 and 1975.

Figures 11: Age and gender composition 2035 of East Ayrshire

90 +

80 - 89

Male (%)

Female (%)

90 +

80 - 89

Male (%)

Female (%)

70 - 79

60 - 69

50 - 59

40 - 49

30 - 39

20 - 29

10 to 19

0 - 9

70 - 79

60 - 69

50 - 59

40 - 49

30 - 39

20 - 29

10 to 19

0 - 9

20 15 10 5 0 5 10 15 20

2010 Percentage of population East Ayrshire

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

The projections indicate that male life expectancy is increasing. For

example all males aged 80 to over 90 years old make up three percent

20 15 10 5 0 5 10 15 20

2035 Percentage of population East Ayrshire

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Females aged 80 to over 90 years old currently account for five

percent of the East Ayrshire population and this is projected to double

by 2035.

Complete draft OPNA Page 26 of 131 20 February 2013


Ten year age bands

Ten year age bands

2.5.2 Projected population changes for North Ayrshire 2010 to

2035

Figures 12 and 13 compare the age and gender structure of North

Ayrshire in 2010 with the projected changes estimated for 2035. The

differences between these figures show an ageing population with

more females in the 60 to 79 age group by 2035.

Figure 12: Age and gender composition 2010 of North Ayrshire

90 +

80 - 89

70 - 79

60 - 69

50 - 59

40 - 49

30 - 39

20 - 29

10 to 19

0 - 9

20 15 10 5 0 5 10 15 20

2010 Percentage of population North Ayrshire

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Male (%)

Female (%)

Figure 12 shows the rectangular profile indicating the low birth rates,

ageing population and increased life expectancy, although the excess

of females over males appears more clearly in those aged over 60.

Figures 13: Age and gender composition 2035 of North Ayrshire

90 +

80 - 89

70 - 79

60 - 69

50 - 59

40 - 49

30 - 39

20 - 29

10 to 19

0 - 9

15 10 5 0 5 10 15 20

2035 Percentage of population North Ayrshire

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Male (%)

Female (%)

Complete draft OPNA Page 27 of 131 20 February 2013


Ten year age bands

Ten year age bands

2.5.3 Projected population changes for South Ayrshire 2010 to

2035

Figures 14 and 15 compare the age and gender structure of South

Ayrshire in 2010 with the projected changes estimated for 2035. The

differences between these figures show an ageing population with

lower birth rates over the period than in East or North Ayrshire.

In Figure 14 the male and female populations aged between 40 to 49

is the largest and the 1960s baby boom has contributed to a

proportion of this. The large male and female populations aged 60 to

69 years old are a result of the post war baby boom.

Figure 14: Age and gender composition 2010 of South Ayrshire

90 +

80 - 89

70 - 79

60 - 69

50 - 59

40 - 49

30 - 39

20 - 29

10 to 19

0 - 9

20 15 10 5 0 5 10 15 20

2010 Percentage of population South Ayrshire

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Male (%)

Female (%)

Figure 15 shows large male and female populations aged 70 to 79 are

a result of the 1960s baby boom. Those aged 60 to 69 were born

during the last baby boom of the 1980s. The pyramid is ‘top heavy’

demonstrating the higher proportion of people in the older age groups

compared to those in the younger age groups in the future in South

Ayrshire.

Figure 15: Age and gender composition 2035 of South Ayrshire

90 +

80 - 89

70 - 79

60 - 69

50 - 59

40 - 49

30 - 39

20 - 29

10 to 19

0 - 9

15 10 5 0 5 10 15 20

2035 Percentage of population South Ayrshire

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Male (%)

Female (%)

Complete draft OPNA Page 28 of 131 20 February 2013


Median age

2.6 Population ageing in Ayrshire and Arran

Ageing of the population includes an increasing number of older adults

as well as increases in the median age of the population. Figure 16 has

projections for the older adult age groups. It is estimated that between

2010 to 2030 there will be significant percentage increases in these

population age groups; 21 percent in the 65 – 69 age group, 22

percent in the 70-74 age group, 24 percent in the 75-79 age group, 43

percent in the 80-84 age group and 61 percent increase in the over 90

age group.

Figure 17 shows a clear trend in an increasing median age in East,

North and South Ayrshire. This is due to reduction in mortality rates

combined with low fertility rates. The largest projected increase in

median age is in North Ayrshire; in 2000 it was 38 years and in 2035 it

is projected to be 46 years, an increase of 8 years. The median age in

South Ayrshire is estimated to be 48 years in 2035 however it was 41

years in 2000. In East Ayrshire the median age is 38 and this is

projected to rise to 45 years by 2035.

Figure 16: Projected population by older groups in 2010, 2020 and

2030 in Ayrshire and Arran

Figure 17: Projected median age of population; East, North and South

Ayrshire and Ayrshire and Arran

30,000

25,000

20,000

15,000

10,000

2010

2020

2030

50

45

40

35

30

25

20

East Ayrshire

North Ayrshire

South Ayrshire

Ayrshire &

Arran

5,000

0

65 - 69 70-74 75-79 80-84 85-89 90+

Age bands

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

15

10

5

0

2000 2010 2015 2020 2025 2030 2035

Source: GROS Bespoke Mid year population estimates 1982 2000 and 2010

Population Projections for Scottish Areas combined

Complete draft OPNA Page 29 of 131 20 February 2013


Dependency Ratio

2.7 Dependency Ratios

Age-dependency ratios are a measure of the age structure of the

population and the projections of the ratios into the future is a

function of the mortality, fertility and net migration.

Dependency ratios summarise how many young people (under 16

years of age) and older people (over the state retirement age) depend

on people of working age (16 to state retirement age). Areas that

have a high dependency ratio have more people who are not of

working age and therefore fewer who are working and paying taxes to

sustain public services. The higher the number then the greater the

high level of dependent people 14, 15 .

For example, a dependency ratio of 50% equates to one dependent

person for every two people of working age, a dependency ratio of

75% equates to three dependent people for every four people of

working age.

Solutions to higher dependency ratios include raising the retirement

age in line with increasing life expectancy, encouraging in-migration

and discouraging out-migration of people aged 20 to 30 years old

(OECD 2007).

Figure 18 demonstrates that the dependency ratios are predicted to

rise across Ayrshire and Arran between 2010 and 2035.

Figure 18: Projected dependency ratios for East, North and South

Ayrshire and Scotland 2010 - 2035

90.0

80.0

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Old Age Dependency Ratio

Scotland East Ayrshire North

Ayrshire

South

Ayrshire

2010

2025

2035

The projected old age dependency ratios (the number of people over

retirement age divided by the working age population only) for East,

North and South Ayrshire and Scotland are presented in Figure 19.

These demonstrate that the population structure in Ayrshire and Arran

is ageing faster than that of Scotland. Between 2010 and 2035 there

will be an increase in the dependency ratio of 17 percent in Scotland.

However, in East, North and South Ayrshire this increase is projected

to be 26, 30 and 28 percent respectively. Taking the 0 to 15 year olds

out of the calculation reduces the ratio.

Complete draft OPNA Page 30 of 131 20 February 2013


Old-Age Dependency Ratio

Figure 19: Projected old age dependency ratios for East, North and

South Ayrshire and Scotland 2010 - 2035

90.0

80.0

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

Scotland East Ayrshire North

Ayrshire

South

Ayrshire

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

2010

2025

2035

2010 and this is estimated to decrease slightly to 15.5 percent by

2035. The female working age population, i.e. those aged 16 to 60

years old, account for 55.7 percent in 2010 and this is estimated to

decrease to 46.3 percent by 2035. The largest change is in the older

female age groups with the over 60 year olds making up 28 percent in

2010, this being estimated to increase to 38 percent by 2035. It also

demonstrates that the policy solution to decreasing the dependency

ratio by increasing the State Pension age to 66 years increases the

female working age population by 8 percent compared with the

situation without Pension Reform.

Figure 20: Projected female population by broad age group 2010-2035

in Ayrshire and Arran

100

80

60

40

Over State

Pension Age

16 to State

Pension age

0 to 15

It is therefore vitally important that planning for health improvement,

health and health and social care services in the future addresses the

demographic changes that are predicted for the population in NHS

Ayrshire and Arran over the coming 20 years.

20

0

2010 2035 without

Pension Reform

2035 with Pension

Reform

Policy Responses to the Dependency Ratio

Figures 20 and 21 demonstrate the projected structural changes in the

Ayrshire and Arran population between 2010 and 2035. In Figure 20,

females aged 0 to 15 years make up 16.2 percent of the population in

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Complete draft OPNA Page 31 of 131 20 February 2013


Figure 21 shows that males aged 0 to 15 years make up 18.4 percent

of the population in 2010 and this is estimated to decrease slightly to

17.9 percent by 2035. The male working age population, those aged 16

to 65 years old, account for 64.3 percent in 2010 and this is estimated

to decrease to 55.5 percent by 2035. The largest change is in the older

male age groups with the over 65 year olds making up 17.1 percent in

2010, this being estimated to increase to 27.2 percent by 2035. It also

demonstrates that the policy solution to decreasing dependency ratio

by increasing the State Pension age to 66 years has less effect on the

male working age population as it will only increase by 1 percent.

Figure 21: Projected male population by broad age group 2010-2035 in

Ayrshire and Arran

100%

80%

60%

40%

20%

Over State

Pension Age

16 to State

Pension Age

0 to 15

The predicted changes in the population of Ayrshire and Arran as

highlighted above will impact on the proportion of people of working

age compared to those who are of non-working age. This information

assists in determining the current and future needs of the population,

in service planning and in focusing on upstream policies aimed

towards keeping people well so that the quality of life in older age is

optimised and people can live as independently as possible.

2.8 Older people and deprivation

The Scottish Index of Multiple Deprivation 2009 allows for mapping of

areas into populations living in the most and least deprived geographic

areas. SIMD quintiles provide an estimate of the deprivation

experienced by the population living in any defined geographic area.

This means that the 20% most deprived areas are geographically

identifiable and service providers can look at ways to improve access

and encourage uptake and use of local services that contribute to

improving health and reducing health inequalities.

Figure 22 indicates the number of people over 65 years of age, by five

year age bands, living in the most to least deprived quintiles of

Ayrshire and Arran.

0%

2010 2035 without

Pension Reform

2035 with Pension

Reform

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Complete draft OPNA Page 32 of 131 20 February 2013


Population aged over 65 years old

Population aged over 65 years old

Figure 22: Number of people over 65 years of age living in Ayrshire and

Arran by deprivation quintile

Figure 23: Number of people aged over 65 years living in East Ayrshire

by deprivation

20000

18000

16000

14000

12000

10000

8000

6000

4000

2000

0

Quintile1 Quintile 2 Quintile 3 Quintile 4 Quintile 5

most deprived

least deprived

90+

85-89

80-84

75-79

70-74

65-69

7000

6000

5000

4000

3000

2000

1000

0

Quintile 1

Most

Deprived

Quintile 2 Quintile 3 Quintile 4 Quintile 5

Least

Deprived

Ages

90+

85-89

80-84

75-79

70-74

65-69

Source: GRO Scotland and SIMD 2009

Source: GRO Scotland and SIMD 2009

Figure 23 indicates that almost 60 percent of those over 65 years of

age live in quintiles 1 and 2 in East Ayrshire. Twenty-nine percent of

those over 65 years of age live in the most deprived quintile with 12

percent living in the least deprived quintile.

Figure 24 presents the data for North Ayrshire indicating that 54

percent of those over 65 years of age live in quintiles 1 and 2. Twentyeight

percent live in the most deprived quintile with only 10 percent of

those aged over 65 living in the least deprived quintile.

Complete draft OPNA Page 33 of 131 20 February 2013


Population aged over 65 years old

Population aged over 65 years old

Figures 24: Number of people aged over 65 years living in North

Ayrshire by deprivation quintile

Figure 25: Number of people aged over 65 years living in South

Ayrshire by deprivation quintile

8000

7000

6000

5000

4000

3000

Ages

90+

85-89

80-84

75-79

70-74

8000

7000

6000

5000

4000

3000

Ages

90+

85-89

80-84

75-79

70-74

2000

65-69

2000

65-69

1000

1000

0

Quintile 1

Most

Deprived

Quintile 2 Quintile 3 Quintile 4 Quintile 5

Least

Deprived

0

Quintile 1

Most

Deprived

Quintile 2 Quintile 3 Quintile 4 Quintile 5

Least

Deprived

Source: GRO Scotland and SIMD 2009

Source: GRO Scotland and SIMD 2009

The profile for older people and deprivation in South Ayrshire shown

in Figure 25 is markedly different to that of East and North with only

40 percent of the population aged over 65 living in quintiles 1 and 2.

Twelve percent of those over 65 years of age live in the most deprived

quintile whereas 27 percent are living in the least deprived quintile.

Complete draft OPNA Page 34 of 131 20 February 2013


Chapter 3: Life Circumstances

3.1 Income

rented housing and are more likely to be in contact with advice and

rights services. (http://www.poverty.org.uk/66/index.shtml)

Figure 26: Rate of Pension Credit claimants, 2008 and 2011

Household income and expenditure

The Department of Work & Pensions (DWP) reports that the

proportion of pensioners living in low income households has fallen in

recent years with the introduction of the minimum income guarantee

although the risk of low income rises with age. Single female

pensioners are more likely to have a lower income than single male

pensioners or pensioner couples. Once people are over the age of 75

they are more likely to live in a low income household than younger

pensioners. This is partly explained by the fact that the proportion of

pensioners living alone rises with age

(http://www.dwp.gov.uk/research-and-statistics/).

Pension Credits

Pension Credits are a means tested welfare benefit for people over the

state retirement age designed to guarantee those qualifying with a

minimum level of income. Pension Credits are therefore an indicator

of low income in older people. Figure 26 presents the rate per 1000

population over pensionable age of Pension Credit claimants for East,

North and South Ayrshire in two separate years, 2008 and 2011. These

data are collected quarterly with little variation across the year so it is

the third quarter of each year for each age band that is presented.

East Ayrshire has the highest rate of claimants in most of the age

bands. The Poverty Site estimates that around a third of pensioner

households entitled to claim the credit do not. It is highlighted that

take up of Pension Credits is much higher in those who live in social

Age 90 plus -…

Age 90 plus -…

Age 85-89 - 2011

Age 85-89 - 2008

Age 80-84 - 2011

Age 80-84 - 2008

Age 75-79 - 2011

Age 75-79 - 2008

Age 70-74 - 2011

Age 70-74 - 2008

Age 65-69 - 2011

Age 65-69 - 2008

Source: www.sns.gov.uk

Attendance Allowance

0 200 400 600 800

Rate per 1000 by age band

East Ayrshire North Ayrshire South Ayrshire

Attendance Allowance is a tax-free non-means tested benefit for

people over the age of 65 who require personal care because they are

physically or mentally disabled. It could be argued that it is a proxy

indicator of a higher dependency level of care needs within the

community. However not all people apply for or have equal access to

benefits so it could underestimate need.

Complete draft OPNA Page 35 of 131 20 February 2013


Figure 27 presents the rate per 1000 of Attendance Allowance

claimants for East, North and South Ayrshire in two separate years,

2008 and 2011. These data are collected quarterly with little variation

across the year so it is the third quarter of each year for each age band

that is presented. East Ayrshire has the highest rate of claimants in

almost all the age bands.

Figure 27: Rate of Attendance Allowance claimants, 2008 and 2011

Age 90 plus - 2011

Age 90 plus 2008

Age 85-89 - 2011

Age 85-89 - 2008

Age 80-84 - 2011

Age 80-84 - 2008

Age 75-79 - 2011

Age 75-79 - 2008

Age 70-74 2011

Age 70-74 - 2008

Age 65-69 - 2011

Age 65-69 - 2008

Source: www.sns.gov.uk

Disability –related benefits

0 200 400 600 800 1000

Rate per 1000 by age band

East Ayrshire North Ayrshire South Ayrshire

to over 90 years of age in East, North and South Ayrshire. These data

provide some indication of the levels of dependency within the

population and show that for the vast majority of age bands, the level

of claimants has increased over a short time period.

The highest claimant count in all three areas is among those aged

between 65 to 69 years. The smallest claimant count is amongst those

aged 90 plus however this has increased from zero to around 20 per

1000 in two years and is likely to continue to increase as the

population ages.

Figure 28: DLA Claimants by older age bands 2008-11, East Ayrshire

Age 90+ - 2011

Age 90+ - 2008

Age 85-89 - 2011

Age 85-89 - 2008

Age 80-84 - 2011

Age 80-84 - 2008

Age 75-79 - 2011

Age 75-79 - 2008

Age 70-74 2011

Age 70-74 - 2008

Age 65-69 - 2011

Age 65-69 - 2008

0 50 100 150 200

Rate per 1000 by age band

Source: www.sns.gov.uk

Figure 29: DLA Claimants by older age bands 2008-11, North Ayrshire

Figures 28, 29 and 30 present the rates per 1000 by age band of

Disability Living Allowance (DLA) claimants for 2008 and 2011 from 65

Complete draft OPNA Page 36 of 131 20 February 2013


Age 90+ - 2011

Age 90+ - 2008

Age 85-89 - 2011

Age 85-89 - 2008

Age 80-84 - 2011

Age 80-84 - 2008

Age 75-79 - 2011

Age 75-79 - 2008

Age 70-74 2011

Age 70-74 - 2008

Age 65-69 - 2011

Age 65-69 - 2008

0 50 100 150 200

Rate per 1000 by age band

Source: www.sns.gov.uk

Age 90+ - 2011

Age 90+ - 2008

Age 85-89 - 2011

Age 85-89 - 2008

Age 80-84 - 2011

Age 80-84 - 2008

Age 75-79 - 2011

Age 75-79 - 2008

Age 70-74 2011

Age 70-74 - 2008

Age 65-69 - 2011

Age 65-69 - 2008

0 50 100 150

Rate per 100 by age band

Source: www.sns.gov.uk

The prevalence of disability increases with age and is significantly

higher in those aged over 74 years old. Disability related benefits

provide an indicator of dependency amongst older people however

not all older people who are entitled to these benefits apply for them.

People aged less than 65 years with care and/or mobility needs are

entitled to (DLA); this continues into retirement if the needs continue,

so more is paid to the ‘younger old’. Attendance Allowance is a similar

benefit and paid to those aged over 65 years and is highest in those

aged 75 years (the ‘old old’). Payment of these benefits decrease in

the ‘oldest old’ population (those aged 85 years and above) and are

very low in the ‘very old’ population (those aged over 90) 16 .

Figure 30: DLA Claimants by older age bands 2008-11, South Ayrshire

These national patterns of benefit uptake are reflected in East, North

and South Ayrshire. What is not clear from the data is the extent to

which the benefits offset the additional costs of disability for older

people and whether they actually prevent them moving into poverty,

therefore impacting on health, wellbeing and independent living 16 .

Complete draft OPNA Page 37 of 131 20 February 2013


3.2 Housing

This section explores issues relating to housing options and housing

quality across Ayrshire.

It covers a wide range of issues including:

Housing tenure

Household characteristics

Housing quality

Housing options

o Equipment and adaptations

o Sheltered and supported accommodation

o Care homes

o Home care

Housing options suitable for older people are vital to achieve the wider

agenda to shift the balance of care. There is a strong relationship

between housing and health since housing in a poor state of repair can

increase the risk of accidents, serious injury and death amongst its

occupants. Poor energy-efficiency and thermal conditions can impact

on health status in relation to a range of conditions such as influenza,

heart disease, stroke and respiratory illness; and a lack of modern

facilities can impact on living conditions, physical and mental health.

Housing tenure

Housing tenure refers to the ownership of the housing in which people

live. In Scotland, there are two main tenure types:

Private

o Ownership – either outright or with a mortgage

o Renting – from a private landlord

Social

o Renting – from a Local Authority or other Registered Social

Landlord (RSL)

The key points to highlight, in terms of tenure and health and

wellbeing implications for older people is the household expenditure

associated with paying and maintaining a home.

The Scottish House Condition Survey (2008/10) provides information

relating to housing issues for older people across Ayrshire. It uses the

term ‘pensioner household’ for those households where there are two

adults, at least one of whom is of pensionable age and no children, or

one adult of pensionable age and no children.

The private sector is the predominant tenure for pensioners across all

areas. However, a higher proportion of pensioner households live in

the private sector in South Ayrshire compared to East and North

Ayrshire (Table 3 and Figure 31).

Table 3: Housing tenure for pensioner households

Pensioner Households

as a proportion of all

households (%)

Pensioner Households

(Estimated number)

Pensioner Households

in ‘Private’ tenure (%)

Pensioner Households

in ‘Private’ tenure

(Estimated number)

Pensioner Households

in ‘Social’ tenure (%)

Pensioner Households

in ‘Social’ tenure

(Estimated number)

Source: SHCS (2008/10) (Table 2.9)

East

North South Ayrshire

Ayrshire Ayrshire Ayrshire and Arran

30% 30% 38% 32%

16,117 18,602 19,580 54,299

63% 63% 79% 69%

10,207 11,781 15,458 37,446

37% 37% 21% 31%

5,909 6,821 4,122 16,852

Complete draft OPNA Page 38 of 131 20 February 2013


Percentage of the population

Household characteristics

Figure 31 shows that very few single pensioners live in the private

rented sector. Fifty nine percent of single pensioner households in

East and South Ayrshire are owner occupied - below the Scottish figure

of 61 percent with North Ayrshire above this at 66 percent. This may

reflect the high level of social housing transferred into the private

market via the right to buy policy of the recent past. Social rented

housing by single pensioner is higher than the Scottish figure of 33

percent in East and South Ayrshire where it is 36 percent whereas

North Ayrshire is lower at 25 percent. The percentage of single

pensioner households in East, North and South Ayrshire is 14, 16 and

18 respectively.

Figure 31: Single pensioner household by tenure 2009-10

South

Ayrshire

North

Ayrshire

East

Ayrshire

Other

Private rented

Social rented

Owner occupied

3.3 Marital Status

Marital status in older adults provides an indication of whether or not

people are likely to be living alone and what type of support may be

available to them. Figures 32, 33 and 34 all present a fairly similar

pattern with the greatest likelihood of being widowed/bereaved civil

partner in the over 75 year age groups.

Figure 32: Marital status in East Ayrshire from 35 to 75 + 2009-10

80

70

60

50

40

30

20

10

0

Single, never Married / Civil

married / civil partnership

partnership

Divorced /

Separated

Widowed /

Bereaved civil

partner

Source: www.scotland.gov.uk/Topics/Statistics/16002/LA0910Excel

35 to 44

45 to 59

60 to 74

75 plus

0 20 40 60 80

Source: http://www.scotland.gov.uk/Publications/2011/08/17093111/23

Complete draft OPNA Page 39 of 131 20 February 2013


Percentage of population

Percentage of popualtion

Figure 33: Marital status in North Ayrshire from 35 to 75 + 2009-10

80

70

60

50

40

30

20

10

0

Single, never

married / civil

partnership

Married /

Civil

partnership

Divorced /

Separated

Widowed /

Bereaved civil

partner

Source: www.scotland.gov.uk/Topics/Statistics/16002/LA0910Excel

35 to 44

45 to 59

60 to 74

75 plus

Figure 34: Marital status in South Ayrshire from 35 to 75 + 2009-10

3.3.1 Housing quality

Housing quality can have a significant impact on health and well-being.

Analysis of the SHCS (2008/10) shows that housing quality is closely

related to housing tenure; people living in the private rented sector

are at a higher risk of living in poor quality housing (Woods and Bain

2001).

Table 4 shows the proportion of pensioner households who live in a

dwelling that has some element of disrepair. This category ranges from

very minor and trivial disrepair such as the need for new paint on the

window sills to more serious problems such as major repair works to

the roof. However it provides a high level overview of the level and

challenge of constantly repairing and maintaining housing stock over

time – which can be applied to the whole population and the totality

of the housing. The majority of pensioners live in a dwelling that has at

least some level of disrepair which may require a considerable amount

of resources to maintain and improve their properties.

80

70

60

50

40

30

20

10

0

Single, never

married / civil

partnership

Married /

Civil

partnership

Divorced /

Separated

Widowed /

Bereaved civil

partner

Source: www.scotland.gov.uk/Topics/Statistics/16002/LA0910Excel

35 to 44

45 to 59

60 to 74

75 plus

Table 4: Profile of disrepair and average cost of works of pensioner

properties

East

Ayrshire

North

Ayrshire

South

Ayrshire

Ayrshire

and

Arran

/ total

Pensioner Households who living in 90% 90% 82% 87%

a dwelling with any disrepair (%)

Pensioner Households who living in 14,505 16,742 15,973 47,220

a dwelling with any disrepair

(estimate)

Annual spend on work to dwellings £11M £9M £24M £44M

by pensioner households (total)

Spend on work to dwellings by £2,200 £2,500 £3,500 -

pensioner households (median)

Source: SHCS (2008/10) Table 2.9 and 7.7

Complete draft OPNA Page 40 of 131 20 February 2013


3.3.2 Housing options for older people – equipment and adaptations

The majority of older people live in their own homes. As such, the

provision of equipment and adaptations has been, and will continue to

be, a vital part of helping older people remain in their own homes as

they age. There is a wide range of options that can help transform a

home that has become inaccessible and dangerous because of changes

in the resident’s health and mobility, into a safe and independent

living space.

Guidance produced by the Scottish Government (2009) reiterates that

Local Authorities have a duty to provide equipment and adaptations to

people if an Occupational Therapist (OT) determines they have an

‘assessed need’. Equipment and adaptations are provided when a

person’s house no longer meets their physical needs, and are installed

to enable the individual to remain in their own home for as long as

possible. Private sector aids and adaptations are funded from the

Scheme of Assistance (formerly Private Sector Housing Grant) which is

administered by the Local Authority. The Housing (Scotland) Act 2006

placed a statutory duty on Local Authorities to fund 80% (rising to

100% if in receipt of qualifying benefits) of grants for disabled

adaptations.

Table 5 indicates that 10 – 20 percent of households across Ayrshire

had one or more adaptations, and a further 5 – 7 percent still requires

an adaptation in their dwelling. The last two rows of Table 5 shows

the estimated number of households that will require adaptations in

2033 if current conditions remain unchanged. This figure does not take

into account the ageing of the population – which will almost certainly

increase the requirement for adaptations.

Table 5: Households that have or require adaptation to dwelling

(2008/10) and projections (2033)

East North South

Households where one or

more adaption is present in

dwelling (%)

Households where one or

more adaption is present in

dwelling (Estimates)

Household where an

adaptation is required to the

dwelling (%)

Household where an

adaptation is required to the

dwelling (Estimate)

Estimate of households

requiring adaptations at 2033

Ayrshire

Ayrshire Ayrshire Ayrshire and Arran

19% 11% 20% 16%

10,207 6,821 10,305 27,333

5% 7% 6% 6%

2,686 4,340 3,092 10,118

2,950 4,677 3,323 10,950

% Increase in households 10% 8% 8% 8%

Source: Scottish House Condition Survey (2008/10) Tables 5.11 and 5.15 and GRO(S)

Household Projections for Scotland 2008 based Tables 5 and 11

Each local authority has a slightly different approach to the provision

and recording of aids and adaptations. As a result, information for

each of the local authorities is given separately.

In East Ayrshire, the average annual spend on aids and adaptations

over the period 2009/10 – 2011/12 was £507,683, with the total spend

reaching £1,523,049 over that period. The highest level of funding has

been for the provision of showers, which accounted for around 62%

(£950,502) of the total spend over that three year period (Table 6)

Complete draft OPNA Page 41 of 131 20 February 2013


The next highest grant allocation was used for the provision of stair

lifts, which accounted for around 23% (£353,908) of the total spend

over that same three year period.

Table 6: Profile of aids and adaptations in East Ayrshire for all tenures,

2009/10 - 2011/12

Number Number Number Average

2009/10 2010/11 2011/12

Shower 107 102 207 139

External Handrails 144 124 69 112

Stair lift 43 19 62 41

Door Adaptations 16 22 15 18

Ramps 14 8 13 12

Source: East Ayrshire Council Housing Spending Figures

In North Ayrshire, the average annual spend on aids and adaptations

was just under £1.5M a year. The highest number of funding has been

for the provision of shower / wet rooms.

While each local authority has a slightly different approach to the

provision and recording of aids and adaptations, the highest level of

funding has tended to be for the provision of showers or wet rooms.

Other equipment and adaptations that had high levels of funding

include the provision of ramps and banisters and stair lifts.

Table 7: Average number and spend on equipment and adaptations

2009/10 – 2011/12

East Ayrshire North Ayrshire South Ayrshire

Year No Costs No Costs No Costs

2009/10 324 £474,290 924 £1,482,530 - £1,160,287

2010/11 102 £325,806 767 £1,285,885 - £1,118,581

2011/12

366 £722,951 1,135 £1,107,601 216

£687,841

(private sector

figures only)

Average 322 £507,683 942 £1,292,006 - £988,903

Source – Adaptation Information from each Local Authority

In South Ayrshire, as with East and North Ayrshire, the highest level of

funding in the private sector has been used for the provision of

showers which accounted for 48% of total grant funding in 2009 or

£416,849 (Table 8). The second highest grant allocation is used for the

provision of stair-lifts, which accounted for 17% of total grant funding

in 2009 at £148,461. Improving access through the provision of

external ramps accounted for the third highest level of expenditure

across all three years and totalled £45,356 in 2009/2010 or 5% of total

funding.

Complete draft OPNA Page 42 of 131 20 February 2013


Table 8: Profile of spend of private sector housing grant 2007/08 –

2009/10

2007/08 2008/09 2009/10 Average

Access

£5,950.00 £1,808.60 £15,994.95 £7,917.85

Improvement

Auto WC £3,245.00 £1,753.38 £11,817.40 £5,605.26

Dampness £1,891.75 £11,020.47 - £6,456.11

Extension £77,837.96 £114,281.79 £81,017.02 £91,045.59

External steps - £1,035.18 - £1,035.18

Formation of £23,464.93 £10,261.5 £31,722.40 £21,816.28

bathroom

Formation of £15,500 £15,500 £20,000.00 £17,000.00

bedroom

Formation of - £9,094.47 £20,468.5 £14,781.49

shower room

Provision of

£3,328.40 - £6775.00 £5,051.70

bathroom

Provision of various £20,000.0 - - £20,000.00

rooms

Ramp £33,313.89 £33,789.79 £45,356.95 £37,486.88

Shower £219,560.94 £413,857.35 £416,849.50 £350,089.26

Shower & access - £3,963.78 £3,963.78 £3,963.78

steps

Shower & platform £14,574.00 £14,574.00 - £14,574.00

lift

Stair lift £152,353.71 £136,985.37 £14,8461.30 £145,933.46

Stair lift & shower £37,015.17 £77,032.97 £35,839.19 £49,962.44

Stair lift & WC - £13,112.51 £5,318.00 £9,215.26

Stair lift & wetroom - - £7,475.00 £7,475.00

Tracking hoist £17,430.98 £25,344.80 £2,545.61 £15,107.13

Wet Room £9,894 - £5,739.00 £7,816.50

Windows - - £2,039.18 £2,039.18

Total £629,410.73 £881,607.36 £845,387.83 -

Source: Information Provided by SAC Building Standards Section: Dec 2010

Table 9 provides a breakdown of all adaptations carried out to

mainstream (rather than sheltered) South Ayrshire Council properties

over the past three years (2008 - 2010). This table does not include the

costs for stair-lift installation or costs relating to the provision of

equipment. This information is held and recorded separately by Social

Work and cannot be broken down by housing tenure. The total cost of

stair-lift provision from 2008-2010 amounted to £205,940.

Table 9: Profile of spend in mainstream South Ayrshire Council

properties 2008 - 2010

2008 2009 2010 Average

Automatic WC £3,498.60 - £400.49 £1,949.55

Banisters £18,067.78 £8,632.44 £7,365.74 £11,355.32

Door alterations £3,037.37 £1,575.81 £3,045.28 £2,552.82

Intercoms - - £160.01 £160.01

General £5,820.96 £769.06 £890.30 £2,493.44

Handrails £24,601.87 £24,956.80 £14,515.54 £21,358.07

Lever Taps £1,907.06 £927.51 £387.23 £1,073.93

Ramps £30,211.25 £41,160.63 £15,854.22 £29,075.37

Sensory adaptations £2,197.29 £663.06 £325.64 £1,062.00

Showers £97,231.79 £94,138.50 £28,517.23 £73,295.84

Steps £282.23 £86.24 £2,997.79 £1,122.09

Wash hand basin £162.86 - £271.39 £217.13

Wet Floor shower £160,578.10 £142,653.20 £187,302.80 £163,511.37

Total £347,597.16 £314,900.19 £262,033.66 £308,177.00

Source: Information Provided by Housing Occupational Therapists: Dec 2010

The level and allocation of funding follows a similar pattern to private

sector adaptations. The provision of wet floor showers accounts for

the total highest level of funding across the three years at £490,534,

followed by showers at £219,887, ramps at £87,226 and handrails at

£64,074.

Complete draft OPNA Page 43 of 131 20 February 2013


3.3.3 Housing options for older people – sheltered housing

North Ayrshire Council has undertaken a considerable amount of

research and strategy development in relation to housing options for

older people in recent months. This has resulted in the development

of the ‘North Ayrshire Older Persons Housing Strategy’, which was

submitted for partner approval in the summer of 2012. It offers

considerable insight into the housing needs and aspirations of older

people in the area.

The key ‘wants’ in terms of service improvement that older people

identified as part of this research included:

More involvement in strategic decisions and the development of

the services that affect them

Improved communication between the local authority, NHS and

partners

Improved information and advice on the housing and care options

available to them

Localised care and support to help them remain independent and

in their own home

Increased low level preventative support to reduce the risks of falls

and injury in the home

Improved social events and activities within sheltered housing

complexes.

East Ayrshire has 40 supported accommodation schemes throughout

the area, 30 of which are linked to the East Ayrshire Risk Management

Centre (RMC) and the remaining 10 not linked to this facility,

highlighted in Table 10.

Out of the 40 supported accommodation schemes, East Ayrshire

Council operate 21, Hanover Housing operate 8, Bield operate 6, Trust

operate 3 and Atrium and West of Scotland Housing operate 1 each.

East Ayrshire Council is in the process of reviewing their approach to

supported accommodation for older people to ensure that it is

providing the best possible service. In the meantime, supported

accommodation applicants to Council schemes are asked to complete

a questionnaire that is assessed by the social work team. Applicants

are categorised into requiring low, medium or high needs

accommodation as well as the priority that should be awarded to the

application. Bield, Hanover and Trust operate their own common

housing register for the supported accommodation schemes.

Table 10: Supported accommodation schemes in East Ayrshire

Local Sub-Area

Number of support

Number of units

accommodation schemes

Cumnock 13 303

Doon Valley 3 56

Kilmarnock and Loudon 24 444

Town

Auchinleck 2 53

Catrine 1 21

Crookedholm 1 10

Crosshouse 1 23

Cumnock 7 160

Dalmellington 2 37

Darvel 1 8

Drongan 1 33

Galston 3 68

Kilmarnock 13 264

Kilmaurs 2 24

Mauchline 1 22

Muirkirk 1 14

Newmilns 1 10

Patna 1 19

Stewarton 2 37

Complete draft OPNA Page 44 of 131 20 February 2013


East Ayrshire total 40 803

Ratio of 65+ population (20,852) to units available (803) 2012 1:26

Ratio of 65+ (30,328) to units available (803) 2030 1:38

Source: East Ayrshire Council Housing Team

The last two rows in Table 10 shows the ratio of the population aged

over 65 to number of units currently available in 2012 and in 2030 – if

provision were to remain exactly the same. If the provision of units

remains the same into the future, the pressure on supported

accommodation will increase significantly. If no change is made to the

level of provision of supported units, the ratio would increase from 1

unit for every 26 people aged over 65 to 1 unit for every 38 people

aged over 65.

As part of the overall review of sheltered housing in North Ayrshire,

the complexes were categorised into four categories from 1 – High

Demand to 4 – Very Low Demand. North Ayrshire Council have

proposed to invest around £800,000 per year for the next five years

(around £4M) in improving selected complexes to meet the needs and

aspirations of older people in the 21 st century.

There are 43 sheltered housing complexes across North Ayrshire,

shown in Table 11 below. Out of the 43 complexes, North Ayrshire

Council operate 28, Isle of Arran Homes operate 6, Hanover operate 3,

Blackwood Homes and Irvine Housing Association operate 2 each, and

Bield, McCarthy and Stone and Peverel Retirement operate 1 each.

(Ref Draft North Ayrshire Older Peoples Housing Strategy 2012 p. 10)

Table 11: Sheltered accommodation complexes in North Ayrshire

Sub Housing Market Area Number of Sheltered Housing Number of Units

Complexes

Arran 6 63

Garnock Valley 8 148

Irvine/Kilwinning 12 254

North Coast 7 221

The Three Towns 10 227

Local Area

Ardrossan 3 80

Arran 6 63

Beith 2 41

Dalry 3 59

Irvine 8 170

Kilbirnie 3 48

Kilwinning 4 84

Largs 5 189

Saltcoats 4 96

Stevenston 3 51

West Kilbride 2 32

North Ayrshire total 43 913

Ratio of 65+ population (25,275 )to units available (913) 2012 1:27

Ratio of 65+ population (37,130) to units available (913) 2030 1:41

Source: North Ayrshire Council

Complete draft OPNA Page 45 of 131 20 February 2013


The last two rows in Table 11 above show the ratio of the population

aged over 65 to number of units available in 2012 and in 2030 – if

provision were to remain exactly the same.

With the same proviso in place about the limitations of this figure, it

shows that if the level of provision were to remain the same, the ratio

would increase from 1 unit for every 27 people aged over 65, to 1 unit

for every 41 people aged over 65.

South Ayrshire Council has also recently undertaken a review of

housing options for older people across the area, which identified a

range of units suitable for further investment to establish a range of

‘extra-care’ housing options.

There are 46 sheltered housing units, as shown in Table 12. In total

there are 1,471 units of sheltered housing (Council, RSL and privately

owned), which includes 234 amenity standard flats located in Riverside

Place in Ayr.

Out of the 46 complexes, South Ayrshire Council operate 21, Hanover

Housing Association operate 8, Peveral Retirement and Trust Housing

Association operate 5 each, West of Scotland Housing operate 3,

Blackwood Homes operate 2, while Bield Housing Association and

Sandfirs Investment Ltd operate 1 each.

Out of these complexes, one has been specifically designed for people

with dementia.

Table 12: Sheltered housing complexes in South Ayrshire

Local Area

Number of sheltered housing

complexes

Ayr 18 747

Prestwick 5 166

Troon 14 377

Maybole 1 24

Girvan 3 84

Rural North 5 73

Rural South - 0

South Ayrshire Total 46 1471

Number of

sheltered housing

units

Ratio of 65+ population (24,059 )to units available (1,471) 1:16

2012

Ratio of 65+ population (33,528) to units available (1,471) 1:22

2030

Source:-South Ayrshire Council Internal Systems and RSL stock returns: Jan 2011

(please note these figures contain Riverside Flats in Ayr).

3.3.4 Housing options for older people - care homes

A care home is a residential setting where a number of older people

live usually in individual rooms, and have access to on-site care

services. A home registered simply as a care home will provide

personal care only - that is help with washing, dressing and giving

medication. Some care homes are registered to meet a specific care

need, for example dementia or terminal illness.

Table 13 shows the number of people and rate per 1,000 population

who were supported in care homes in 2010/11. The rate is similar

across each of the Ayrshires.

Complete draft OPNA Page 46 of 131 20 February 2013


Percentage Change in Care Home

Places compared to 1999/2000

Table 13: Older people supported in care homes, 2010/11

East

Ayrshire

North

Ayrshire

South

Ayrshire

Clients aged 65+ 735.5 883.5 833

Total population 21,157 25,314 23,787

aged 65+

Rate per 1,000

population

34.8 34.9 35

Source: Health and Social Care Data – (Tab 9)

The number of places has changed in recent years (Figure 35). In all

cases, the number of care home places has decreased, although this

change has been sporadic rather than a demonstrating any trend.

Figure 35: Trends in care home places for older people, 1999/00 –

2010/11

105%

100%

95%

90%

85%

80%

75%

70%

65%

60%

East Ayrshire

North

Ayrshire

South

Ayrshire

SCOTLAND

Care homes are regulated by the Care Inspectorate, with a focus on

four areas:

Quality of care

Quality of environment

Quality of staffing

Quality of management and leadership

Scores can range from 1 – 6:

1 - Unsatisfactory

2 - Weak

3 – Adequate

4 – Good

5 – Very good

6 – Excellent

In East Ayrshire, there are around 21 care homes, offering around

914 beds. The smallest care home has 10 spaces and the largest has

80 spaces. The rates charged range from £435 per week to £1,000 per

week.

Table 14 shows the grades reported for East Ayrshire’s care homes at

the latest inspections. The majority of care homes have an adequate

grading or higher. An interdisciplinary team from the Council and NHS

has been established to work with care home that are

underperforming.

Source: Health and social care data

Complete draft OPNA Page 47 of 131 20 February 2013


Table 14: East Ayrshire care homes inspection grades (latest

inspection)

Quality of

Care

Quality of

Environment

Quality of

Staffing

Grade

1 1 - - -

2 2 1 2 3

3 8 8 4 4

4 2 1 3 -

5 4 4 3 3

6 1 - - -

Source: East Ayrshire Council

Quality of

Management

and

Leadership

In North Ayrshire, there are 21 care homes, offering 906 spaces. The

smallest care homes have 15 spaces and the largest has 92 spaces.

The rates charged range from £487.20 per week for residential care to

£568.96 for nursing and residential care.

Table 15 shows the grades reported for North Ayrshire’s care homes at

the latest inspections. The majority of care homes have an adequate

grading or higher. However, due to concerns about quality of some

care home services, North Ayrshire Council and NHS have invested in

Care Home Support Team, made up of CPNs, District Nurses, Social

Workers, and a Clinical Improvement Practitioner.

Table 15: North Ayrshire care homes inspection grades (latest

inspection)

Quality of

Care

Quality of

Environment

Quality of

Staffing

Quality of

Management

and

Leadership

Grade

1 1 - -

2 2 1 2 3

3 11 11 6 7

4 2 2 8 6

5 4 7 5 4

6 1 - - 1

Source: North Ayrshire Performance Information

In South Ayrshire, there are 26 care homes offering just over 1,000

spaces. The smallest care homes have 14 spaces and the largest has

80 spaces. One property offers specialist care for people with

dementia. The rates charged range from £462.20 to £639.75 for the

specialist dementia room.

At the last inspections returned for South Ayrshire’s Care Homes

(Table 16) shows the grades at last inspection. The majority of care

homes have an adequate grading or higher.

Complete draft OPNA Page 48 of 131 20 February 2013


Table 16: South Ayrshire care homes inspection grades (latest

inspection)

Quality

of Care

Quality of

Environment

Quality of

Staffing

Quality of

Management

and

Leadership

Grade

1 1 - - 1

2 - 1 1 -

3 5 4 3 4

4 8 5 2 2

5 12 3 1 -

6 - 1 -

Source: South Ayrshire Council Performance Information

3.3.5 Housing options for older people – home care

Home care is care provided for an individual in their home to enable

them to maintain their independence. It involves regular visits from a

home care worker and may include:

Personal care

Shopping

Meals on wheels / frozen meals delivery

Collecting pensions and prescriptions / paying bills

Laundry – washing and ironing in home or laundrette

General cleaning.

Access to home care is not restricted by age, as shown in Table 17

below, but it does tend to be people over the age of 65 who use the

service.

Table 17: Home care client by age group and geography, 2009-2011

East

Ayrshire

North

Ayrshire

South

Ayrshire

Ayrshire

and Arran

2009

0-64 471 162 527 1,160

65 - 74 294 262 295 851

75-84 714 628 627 1,969

85+ 580 602 724 1,906

2010

0-64 423 117 551 1,091

65 - 74 268 249 306 823

75-84 700 537 650 1,887

85+ 527 517 709 1,753

2011

0-64 350 101 665 1,116

65 - 74 261 243 323 827

75-84 661 552 693 1,906

85+ 562 531 756 1,849

Source: Health and Social Care Data - Tab 8

Figure 36 shows the age profile of home care clients in 2011 alone. It

shows that South Ayrshire had the largest amount of clients across all

age groups.

Complete draft OPNA Page 49 of 131 20 February 2013


Number of Home Care Clients 2011

Number of Home Care Hours

Figure 36: Home care clients by age group, 2011

3000

2500

2000

756

1500 562

693

531

1000

661

323

552

500 261

665

350

243

0

101

East Ayshire North Ayrshire South Ayrshire

Source: Health and Social Care Data – (Tab 8)

85+

75-84

65 - 74

0-64

Figure 37: Breakdown of hours home care for clients aged 65+, 2009-

2011

2000

1800

1600

1400

1200

1000

800

600

400

200

0

2009 2010 2011 2009 2010 2011 2009 2010 2011

East Ayrshire North Ayrshire South Ayrshire

10+ Hrs

4-10 Hrs

Under 4 Hrs

However, it is important to highlight that not every service user needs

the same level of care. Figure 37 shows the breakdown of the number

of hours each client received between 2009 and 2011. Although there

is a little year on year and geographical differentiation, around a third

of clients receive less than 4 hours per week, around a third between 4

and 10 hours and around a third receives over 10 hours.

Table 18 shows the number of people aged 65+ and the rate per 1,000

people receiving more than 10 hours a week of support.

South Ayrshire has by far the highest rate of people with intensive

care.

Source: Health and Social Care Data - Tab 8

Table 18 : Older people receiving intensive home care (10+ hours per

week)

East

Ayrshire

North

Ayrshire

South

Ayrshire

Ayrshire

and Arran

Clients aged 302 412 622 1,336

65+

Rate per 1,000

population

14.3 16.3 26.1

Source: Health and Social Care Data – (Tab 8)

Complete draft OPNA Page 50 of 131 20 February 2013


3.3.6 Free personal and nursing care

Free personal and nursing care (FPNC) was introduced in Scotland on 1

July 2002. Prior to 1 July 2002, people could be charged for personal

care services provided in their own home and many residents in Care

Homes had to fully fund their care from their own income and savings.

Now people in care homes aged 65+ and assessed as self-funders can

receive a weekly payment towards their personal care. This weekly

‘FPNC’ payment was set at £153 from April 2009. Furthermore, people

aged 65+ can no longer be charged for personal care services provided

in their own home due to the introduction of Free Personal Care (FPC).

Table 19 shows the number of FPNC for people in Care Homes and FPC

for people receiving Care at Home from 2007/08 – 2010/11. South

Ayrshire has the highest level of clients across Ayrshire. The number of

clients has increased more or less consistently over the past three

years.

The rate per 1,000 for FPNC and FPC are also shown in the last row of

Table 19. The most surprising difference is that the rate of FPC in

North Ayrshire is quite a bit lower than that in East and South Ayrshire.

Table 19: Free personal and nursing care (FPNC) provided to clients

East Ayrshire North Ayrshire South Ayrshire

FPNC - Care Home Number of Clients

2007-08 180 260 360

2008-09 180 290 340

2009-10 180 310 340

2010-11 180 330 380

FPC - Care At Home Number of Clients

2007-08 1,400 1,230 1,440

2008-09 1,500 1,410 1,540

2009-10 1,460 1,350 1,650

2010-11 1,500 1,310 1,730

FPNC - Care Home Expenditure £000's

2007-08 1,848 2,855 4,043

2008-09 1,985 3,091 3,937

2009-10 1,988 3,399 4,178

FPC - Care at Home Expenditure £000's

2007-08 8,702 4,952 11,142

2008-09 8,792 8,223 12,066

2009-10 8,716 9,216 12,871

Provision of FPNC 2009 - 10 Care Home

Rate per 1,000 population 9 12 15

Provision of FPC 2009 - 10 Home Care

Rate per 1,000 population 70 54 70

Source: Health and Social Care Data – Tab 12

Complete draft OPNA Page 51 of 131 20 February 2013


3.4 Societal and environmental factors

A range of wider societal and environmental factors will impinge on

the lives of the population and is likely to affect more vulnerable

people to a greater degree.

3.4.1 Internet use

The internet can be used to access and provide a whole range of

services, as well as providing a useful communication tools and source

of information.

There is a view within society that older people tend not to use the

internet as much as younger people, which to some extent is reflected

in statistics such as the Scottish Household Survey.

However, there this picture is varied and many older people are happy

to explore online services. Furthermore, research undertaken for the

Joseph Rowntree Foundation 17 revealed that even those who did not

use the internet recognised the benefits that it might bring.

Table 20 below shows information taken from the Scottish Household

Survey 2007/08, and shows that around 20,000 people over 60 across

Ayrshire use the internet.

Table 20: Internet Use of People Aged 60+

East

Ayrshire

North

Ayrshire

South

Ayrshire

Internet user (%) 29 38 46

Internet user (estimate) 4,674 7,069 9,007

Does not use the Internet at all (%) 71 62 54

Does not use the Internet at all

(estimate)

11,443 11,533 10,573

Source SG 2010 Table 9.3

3.4.2 Crime and fear of crime

Hirschfield 18 highlighted that there is a complex relationship between

crime, the fear of crime and health. Hirschfield (2004: 2) suggested

that crime and fear of crime were known to cause symptoms such as

stress, sleeping difficulties, loss of appetite, depression, loss of

confidence and health harming ‘coping mechanisms’ such as smoking

and alcohol. The fear of crime can alter people’s lifestyles and may

affect them in ways that lessen their quality of life and impact upon

their physical and psychological health. Robinson and Keithley 19

explain that crime poses substantial risks to the health of victims and

consequently, generates additional demand on health services.

Complete draft OPNA Page 52 of 131 20 February 2013


Table 21: Perception of personal safety in East, North and South

Ayrshire

East

Ayrshire

North

Ayrshire

South

Ayrshire

Walking Alone – people aged 65+

Very or fairly safe (%) 68 66 68

Very or fairly safe

10,959 12,277 13,314

(estimate)

Very or a bit unsafe (%) 31 31 31

Very or a bit unsafe

4,996 5,767 6,070

(estimate)

Don’t know (%) 1 3 1

Don’t know (Estimate) 161 558 196

Very or fairly safe (%) 98 97 95

Very or fairly safe

15,794 18,044 18,601

(estimate)

Very or a bit unsafe (%) 2 3 5

Very or a bit unsafe

322 558 979

(estimate)

Don’t know (%) - - -

Don’t know (estimate) - - -

Source SG 2011 Table 4.20

3.4.3 Fuel poverty

According to the Scottish Fuel Poverty Statement, “a household is in

fuel poverty if, in order to maintain a satisfactory heating regime, it

would be required to spend more than 10% of its income (including

Housing Benefit or Income Support for Mortgage Interest) on all

household fuel use 20 . Adequate warmth is defined as 21 o C/23 o C in the

main living areas and 18 o C in other areas.

Fuel poverty has a negative impact on health and can exacerbate ill

health in older people. Older people spend more time in their homes

than the general population and lower temperatures can increase

respiratory disease, high blood pressure, coronary thrombosis and

other diseases of the circulatory system 20 . There are three

contributory factors to fuel poverty:

Energy efficiency / performance of the property

Income of household

Price of energy

The National Home Energy Rating Scheme (NHER) is both a UK

accreditation scheme for energy assessors and a rating scale for the

energy efficiency of housing. The NHER scale runs from 0 to 20, with

20 being the highest level of energy efficiency. A dwelling with an

NHER rating of 20 achieves zero CO₂ emissions along with zero net

running costs. Currently, an average dwelling would score between

4.5 and 5.5 on the NHER scale. Table 22 shows the proportion of

pensioner households with a ‘poor’ National Housing Energy Rating

(NHER) score that is between 0 and 5, as well as the proportion of

pensioner households living in fuel poverty.

Complete draft OPNA Page 53 of 131 20 February 2013


Percentage of households

Table 22: Proportion of pensioner households living in ‘poor’ NHER

rated housing and in fuel poverty

Pensioner households

living in dwelling with

NHER* Score of 0 – 5

(%)

Pensioner households

living in dwelling with

NHER Rating of 0 – 5

(Estimated number)

Pensioner households

in fuel poverty (%)

Pensioner households

in fuel poverty

(Estimated number)

East

Ayrshire

Source: SHCS (2008/10) Tables 8.5 and 8.14

North

Ayrshire

South

Ayrshire

Ayrshire

and

Arran

17% 22% 30% 23%

2,740 4,092 5,874 12,706

41% 53% 50% 48%

6,608 9,859 9,790 26,257

Around half of pensioner households across Ayrshire are living in fuel

poverty, which has implications for the health and well-being of these

households.

Fuel poverty in East, North and South Ayrshire

and in East Ayrshire it was lowest at 40.2. The increases in utility bills

over the last decade appear to have had disproportionately negative

impact on the levels of fuel poverty in the older age group.

Local partnership coordination related to housing improvement

measures and energy efficiency, such as insulation and double glazing,

particularly in the social rented housing is of importance in addressing

the issues. Local policies implementation could for example, focus on

age rather than or as well as on geography related to SIMD.

Figure 38: Percentage of households in fuel poverty in East, North and

South Ayrshire by age

55

50

45

40

35

30

25

20

15

10

5

0

East Ayrshire North Ayrshire South Ayrshire

Figure 38 presents data that demonstrate that householders over the

age of 60 are more than twice as likely to experience fuel poverty than

those householders under the age of 60. In 2008-10 North Ayrshire

had the highest percentage of householders over the age of 60 in fuel

poverty at 52.8 percent, the figure for South Ayrshire was 50 percent

Under 60 years old

Source: http://www.sns.gov.uk/default.aspx

Over 60 years old

Complete draft OPNA Page 54 of 131 20 February 2013


3.4.4 Climate change

A report written by the Intergovernmental Panel on Climate Change

(IPCC) (2007) confirmed that climate change is expected to increase

the incidence of extreme weather events. The Climate Change

(Scotland) Act 2009 places a duty on public bodies to consider ways to

deliver a reduction in carbon emissions and operate in the most

sustainable way. It also places an obligation on public bodies to

consider the impact of climate change and ways of mitigating and

adapting to the negative impacts of climate change as far as possible.

Increased rates of food poisoning

Increased exposure to UV radiation

Reduction in cold-related health problems, including falls and

deaths (estimated to be a drop of around 20–32% of excess

winter deaths – a reduction of about 1% of overall mortality

rates by 2050, with concomitant fall in cold related hospital

admissions).

Various research projects and findings have started to emerge,

although it will be some time before a full understanding of what the

impacts of climate change will be for older people and the health, care

and housing services they will require.

What is important to recognise is that the risks associated with the

impacts of climate change are not distributed equally throughout

society, but are likely to have a more significant impact on already

vulnerable households, including vulnerable older people.

A recent SPICe briefing 21 outlines a range of potential impacts on

health and wellbeing. These include:

Increases in heat-related deaths and illness in summer

(estimates around 100 extra heat related deaths per year)

Marine and fresh water pathogens

Health problems due to air pollution

The many health impacts of flooding

Increased respiratory conditions associated with algal and

fungal growth in housing

Complete draft OPNA Page 55 of 131 20 February 2013


Chapter 4: Lifestyle factors

It is not only life circumstances that impact on people’s health. Life

circumstances and the social, economic and cultural environment can

affect and/or influence the lifestyle choices people make and these

have a major impact on health across the life course.

Increasing the number of people with better lifestyles is crucial for the

longer-term health of older people; “it is never too early and never too

late” to improve lifestyle behaviours. However, it the risk taking

behaviours, such as smoking and alcohol misuse in young and middle

adulthood that have a negative effect in later life. Public health

interventions, such as smoking cessation and alcohol brief

interventions early in life as well as later in life will increase the

chances of a longer, healthier and more independent old age 22.

4.1 Smoking

4.1.1 Smoking prevalence

Smoking tobacco is recognised as the single largest preventable cause

of ill health and early death in Scotland. Smoking has been evidenced

as a contributing factor in heart disease, stroke, cancer, and lung

disease. It is also recognised as a major contributor to health

inequalities 23 .

Figure 39 presents the smoking prevalence estimates for Ayrshire and

Arran from 2003/04.The Scotland-level findings from the Scottish

Health Survey 2009 are shown in Figure 40. All these data show that

the percentage of smokers within the adult population is highest

among those in their 20s and 30s before dropping steadily with each

successive age band.

Similar findings were observed from data extracted in 2009 from NHS

Ayrshire & Arran’s electronic recording system for General Practice

(then GPASS), with 20% of patients aged 65-74 years and 11% of

patients aged 75 years and over being recorded as smokers (Figure 39

and Table 21). Around 30% of patients aged 65 and over were

recorded as ex-smokers. Over 90% of cases were found to have

smoking status recorded which indicates that this should be a fairly

accurate estimate of the population prevalence.

Figure 39: Estimated number and percentage of smokers in the adult

population of Ayrshire and Arran by age and sex, 2003/04

%

45

40

35

30

25

20

15

10

5

0

16-24 25-34 35-44 45-54 55-64 65-74 75+

Males Females All

Source: An Atlas of Tobacco Smoking in Scotland (2007)

Figure 40: Percentage of adults in Scotland that smoke by age group

Complete draft OPNA Page 56 of 131 20 February 2013


%

27

23

33 32

28

25

27 26

20

17

10 11

26

23

Source: Scottish Government. Scotland’s People – Annual Report: results from 2009

Scottish Household Survey. 2010.

Figure 41: Smoking status of patients in Ayrshire and Arran at 1 Jan

2009 as a % of all patients with smoking status recorded by GPs, by

age group

100%

80%

60%

40%

20%

0%

40

30

20

10

0

16-24 25-34 35-44 45-59 60-74 75 plus All

62%

8%

Male

31% 30%

Female

53% 47%

18% 32%

20%

57%

32%

11%

15-34 yrs 35-64 yrs 65-74 yrs 75+ yrs

% smoker % ex-smoker % non smoker

Source: All general practices in Ayrshire and Arran utilising GPASS, representing 51

of 59 local practices

Table 23: Smoking status of patients in Ayrshire and Arran at 1 Jan

2009 as a % of all patients with smoking status recorded by GPs, by

age group and CHP area

Age group CHP area % smoker % ex-smoker % non

smoker

East 29.6% 7.0% 63.4%

15-34 yrs North 31.9% 7.5% 60.6%

South 30.6% 8.6% 60.8%

All 15-34 yrs 30.8% 7.6% 61.6%

East 30.4% 18.0% 51.7%

35-64 yrs North 31.3% 16.5% 52.2%

South 27.4% 18.4% 54.3%

All 35-64 yrs 29.9% 17.5% 52.6%

East 22.4% 33.8% 43.8%

65-74 yrs North 20.4% 30.2% 49.4%

South 18.2% 33.4% 48.4%

All 65-74 yrs 20.4% 32.2% 47.4%

East 13.2% 34.6% 52.1%

75+ yrs North 11.1% 28.7% 60.2%

South 9.4% 34.1% 56.5%

All 75+ yrs 11.2% 32.2% 56.6%

Source: All general practices in Ayrshire and Arran utilising GPASS,

representing 51 of 59 local practices

4.1.2 Smoking-related mortality

Tobacco smoking is a significant factor in the mortality of older people.

Based on estimates from 2000-04, it is believed that 25% of deaths

among males aged 70 years and over, and 20% of deaths among

females aged 70 years and over, can be attributed to smoking (Table

24).

Complete draft OPNA Page 57 of 131 20 February 2013


Number of clients

The proportion of deaths which are estimated to be smokingattributable

among adults aged 35-69 years is higher than for those

aged 70 years and over. This is likely to be a factor in the decreased

prevalence of smoking among older people which is partly due to the

fact that smoking related illnesses are a major cause of premature

mortality.

Table 24: Estimated smoking-attributable mortality by age and sex,

NHS board, 2000–2004

Ayrshire

& Arran

Source: Reference 24 .

Males Males (70+) Females Females All persons

(35-69)

(35-69) (70+)

n % n % n % n % n %

938 27 1,669 25 672 28 1,923 2

0

4.1.3 Smoking cessation services

5,202 23

Smoking cessation services are delivered in Ayrshire and Arran through

two main providers; Fresh Air-shire Smoking Cessation and Prevention

Service and Community Pharmacies. Local smoking cessation services

were used by 293 older people in Ayrshire and Arran during 2009

(Figure 42).

Figure 42: Age of clients using local smoking cessation services in

Ayrshire and Arran, 2009

800

700

600

500

400

300

200

100

0

34

under

16

Source: NHS Ayrshire & Arran Smoking Cessation Service

4.2 Alcohol and drugs misuse

4.2.1 Alcohol

310

572

Alcohol is the most commonly used drug in Scotland today.

Consumption of alcohol is associated with a wide range of medical

conditions, including cirrhosis of the liver, acute and chronic

pancreatitis, brain damage, cancers, stroke, mental health problems

and heart disease. In addition, alcohol features as a major contributor

to accidents, domestic abuse, violence, and anti-social behaviour, and

can have a major detrimental effect on families. Like smoking, it is

recognised as a major contributor to health inequalities.

752

654

454

254

16-24 25-34 35-44 45-54 55-64 65-74 75+

39

Complete draft OPNA Page 58 of 131 20 February 2013


Alcohol can present specific health risks to older people as tolerance

to alcohol reduces with age due to a number of factors including:

a reduced ratio of body water to fat (less water for the alcohol to

be diluted in);

decreased hepatic blood flow (liver will receive more damage);

inefficiency of liver enzymes (alcohol will not be broken down as

efficiently);

altered responsiveness of the brain (alcohol will have a faster

effect on the brain) 25 .

In addition, the use of prescribed medicines is more prevalent among

older people. This increases the risk of adverse interactions with

alcohol as it is contraindicated for use with many of the medicines

commonly used by older people 26 .

A range of life changes and significant life events associated with the

ageing process have been identified as factors which can lead to

problematic alcohol consumption among older people 25 . These

include emotional and social changes such as bereavement or loss of

occupation; medical problems such as physical disabilities or chronic

pain; and practical problems such as altered financial circumstances or

reduced coping skills. However, the identification of alcohol problems

among older people can be problematic 26 .

Due to stigma around problematic alcohol use, older people may be

likely to under-report their alcohol consumption and professionals

involved in their care and wellbeing may be reluctant to broach

alcohol issues. Furthermore, screening instruments that are validated

for the general adult population may be less effective when used with

older people.

Due to older people’s higher sensitivity to alcohol, commonly used

questions about the frequency and level of consumption should be

used with care. Similarly, the threshold of dependency is lower for

older drinkers and screening tools such as CAGE have been found to

have a lower validity among older people.

4.2.1.1 Alcohol consumption

No current local data on alcohol consumption was available at the

time of writing. The Scottish Health Survey (2008, 2009 and 2010

combined) does however provide Scottish-level estimates of alcohol

consumption for older people.

Older people were found to consume substantially less alcohol than

Scottish working age adults. While over one quarter of adults aged 16-

64 years reported consuming over the maximum weekly

recommended amount of alcohol (14 units of alcohol for females; 21

units of alcohol for males), this reduced steadily through each

subsequent age band to 6% of those aged 85 years and over (Table

25). Similarly, 45% of adults aged 16-64 years reported consuming

over the maximum daily recommended amount of alcohol (3 units of

alcohol for females; 4 units of alcohol for males); compared with 6%

aged 85 years and over (Table 25). However, it should be noted that

when weekly and daily limits were taken together, a significant

minority of older people reported drinking in excess of the

government guidelines (Table 26). For all age bands, males reported

higher alcohol consumption than females.

Complete draft OPNA Page 59 of 131 20 February 2013


Table 25: Estimated usual weekly alcohol consumption, 2008, 2009

and 2010 combined, by age

Alcohol units per

Age Total

week

16-64 65- 70- 75- 80- 85+

65+

69 74 79 84

% % % % % % %

All adults

Drank over 14/21 26 21 14 11 9 6 14

units per week

Mean units per week 13.5 10.8 7.9 6.3 5.2 3.5 7.7

Bases (weighted):

All adults 16675 1249 1097 910 591 375 4222

Source: SheS 2008-10 combined

Table 26: Estimated alcohol consumption on heaviest drinking day in

last week, 2008, 2009 and 2010 combined, by age

Alcohol units per

day

Age Total

65+

Consumed over 3/4

units

Consumed over 6/8

units

16-64 65- 70- 75- 80- 85+

69 74 79 84

% % % % % % %

All adults

45 27 20 12 6 5 17

26 9 4 2 1 1 4

Mean units per day 5.3 2.8 2.1 1.4 1.1 0.7 1.9

Bases (weighted):

All adults 16586 1251 1098 911 591 376 4226

Source: SheS 2008-10 combined

Table 27: Adherence to weekly and daily drinking advice, 2008, 2009

and 2010 combined, by age and sex

Adherence to

Age

weekly and

daily drinking

advice

Never drunk

alcohol

16-

64

65-69 70-74 75-79 80-84 85+

Total

65+

% % % % % % %

Men

4 3 4 5 7 11 5

Ex drinker 5 10 12 13 15 15 12

Drinks within 37 43 50 57 59 59 51

guidelines a

government

Drinks

outwith

government

guidelines b 53 45 34 26 19 15 33

Never drunk

alcohol

Women

6 10 12 20 21 27 16

Ex drinker 6 11 11 10 12 13 11

Drinks within 43 55 58 57 61 56 57

guidelines a

government

Drinks

outwith

government

guidelines b 45 24 18 12 6 5 15

Complete draft OPNA Page 60 of 131 20 February 2013


Never drunk

alcohol

All adults

5 7 9 14 15 22 11

Ex drinker 6 10 12 11 13 13 12

Drinks within 40 49 54 57 60 57 55

guidelines a

government

Drinks 49 34 26 18 11 8 23

guidelines b

outwith

government

Bases (weighted):

Men 8041 581 502 375 235 116 1809

Women 8425 667 594 534 355 259 2409

All adults 1646 1248 1096 909 590 375 4218

6

a Drank no more than 4 units (men) or 3 units (women) on heaviest drinking day,

and drank no more than 21 units (men) or 14 units (women) in usual week.

b Drank more than 4 units (men) or 3 units (women) on heaviest drinking day,

and/or drank more than 21 units (men) or 14 units (women) in usual week.

Source: SheS 2008-10 combined

4.2.1.2 Primary care

The data in Table 26 show numbers of patients with a diagnosis of

alcohol abuse or alcohol dependency. Counts are mutually exclusive,

based respectively on a first-time diagnosis of abuse with no preceding

diagnosis of dependency, and a first-time diagnosis of dependency

with no preceding diagnosis of abuse. It should be noted that patients

do not necessarily have a current alcohol problem, only that the GP

has recorded an alcohol problem at some point in their history of

contact with the patient.

Alcohol abuse was found to reduce with age among females and

recorded in less than 1% of cases for females aged 65 years and over.

Among males, however, alcohol abuse was recorded most commonly

among those aged 65-74 years (2.7%)

Alcohol dependency was found to be highest for both males and

females aged between 65-74 years (2.57% and 1.12% respectively) but

reduced among patients aged 75 years and over.

Again, there was a clear deprivation gradient with the proportion of

patients recorded as having a primary diagnosis for alcohol abuse or

dependency being observed to rise consistently with deprivation.

Complete draft OPNA Page 61 of 131 20 February 2013


Older People’s Needs Assessment

Table 28: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of alcohol abuse or alcohol dependency – diagnosis appearing

first on GP record, by age group and deprivation category

Age group of Deprivation category Female patients Male patients

patients

Alcohol abuse* Alcohol dependency* Alcohol abuse* Alcohol dependency*

n % n % n % n %

SIMD 1 188 1.73% 53 0.49% 321 2.96% 138 1.27%

SIMD 2 172 1.47% 41 0.35% 234 2.00% 88 0.75%

15-34 yrs SIMD 3 91 1.25% 9 0.12% 101 1.39% 38 0.52%

SIMD 4 35 0.66% 0 0.00% 53 1.00% 15 0.28%

SIMD 5 28 0.62% 2 0.04% 31 0.69% 6 0.13%

All 15-34 yrs 522 1.29% 106 0.26% 746 1.85% 290 0.72%

SIMD 1 299 1.79% 304 1.82% 777 4.65% 712 4.26%

SIMD 2 224 1.18% 217 1.15% 556 2.94% 572 3.02%

35-64 yrs SIMD 3 122 0.93% 104 0.79% 305 2.31% 241 1.83%

SIMD 4 66 0.56% 67 0.57% 136 1.16% 128 1.09%

SIMD 5 40 0.40% 25 0.25% 90 0.90% 68 0.68%

All 35-64 yrs 758 1.05% 727 1.01% 1,889 2.63% 1,737 2.42%

SIMD 1 54 1.50% 49 1.36% 165 4.59% 134 3.73%

SIMD 2 48 1.17% 70 1.70% 126 3.06% 133 3.23%

65-74 yrs SIMD 3 19 0.69% 31 1.13% 62 2.26% 56 2.04%

SIMD 4 16 0.60% 10 0.38% 39 1.47% 45 1.70%

SIMD 5 9 0.42% 12 0.56% 19 0.89% 27 1.26%

All 65-74 yrs 146 0.94% 173 1.12% 419 2.70% 399 2.57%

SIMD 1 27 1.18% 12 0.53% 68 2.98% 41 1.80%

SIMD 2 28 1.01% 24 0.86% 49 1.76% 41 1.47%

75+ yrs SIMD 3 19 1.03% 13 0.71% 24 1.31% 15 0.82%

SIMD 4 10 0.56% 9 0.50% 19 1.06% 11 0.61%

SIMD 5 6 0.45% 2 0.15% 10 0.75% 13 0.98%

All 75+ yrs 91 0.90% 60 0.59% 171 1.68% 122 1.20%

Source: GPASS

Complete draft OPNA Page 62 of 131 20 February 2013


Crude rates per 100,000 population

Number of referrals

4.2.1.3 Acute care

Figure 43 shows the pattern of crude rates of alcohol-related acute

hospital discharges in Ayrshire and Arran between 2000 and 2008

for patients aged 10 years and above (shown by 5-year age bands).

Although the rate of alcohol-related discharges has historically

peaked among people aged in their fifties, there has been an

upwards trend of discharge rates among older people over the past

decade. In particular, large increases have been observed among

those aged 65 to 74 years.

Figure 43: Crude rates of all alcohol-related acute hospital

discharges (SMR01) for all persons aged 10 years or over by

5-year age band in Ayrshire and Arran (2000, 2004, 2008)

2000

1800

1600

1400

1200

1000

800

600

400

200

0

4.2.1.4 Specialist addiction services

The majority of alcohol assessments made by NHS Ayrshire & Arran

Specialist Addiction Services are made for people aged 35-54 years

(Figure 44). People aged 65 and over accounted for 3.9% of alcohol

assessments made between 2005/06 and 2008/09, equating to 198

assessments over this time period.

Figure 44: Alcohol assessments by specialist addictions services

(2005/06-2008/09); age at referral (banded)

500

450

400

350

300

250

200

150

100

50

0

15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 and over

Source: SMR01

2000 2004 2008

Source: SAMS database

2005/06 2006/07 2007/08 2008/09

Complete draft OPNA Page 63 of 131 20 February 2013


4.2.1.5 Alcohol-related brain damage

Alcohol-related brain damage (ARBD) refers to the effects of

changes to the structure and function of the brain resulting from

the long-term consumption of alcohol, including the toxic effects

of alcohol on brain cells, impairment caused by vitamin and

nutritional deficiencies, and disturbances to the blood supply to

the brain.

People who have an ARBD condition can acquire a number of

cognitive problems, including confusion, difficulty in processing

new information, and confabulation to compensate for gaps in

memory. They may suffer from apathy and depression. They may

also sustain physical harms, such as damage to their livers, their

vision, and their gait, and can experience numbness or pain in their

hands, feet, and legs. Since requires high levels of alcohol

consumption over a considerable period of time it is relatively rare

among younger adults but its prevalence increases with age.

Persons aged 65 years and over have a significantly higher rate of

hospital discharges with a diagnosis of ARBD than those aged 35-

64 years (Figure 45). In addition the rate of discharges among

persons aged 65 years and over has increased both nationally and

within Ayrshire and Arran.

Figure 45: General acute inpatient and day case discharges with a

diagnosis of alcohol-related brain damage in any position: five-year

average age standardised rate per 100,000 population, by health

board 2001/02 r -2010/11 p

40.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

0.0

35-64 years 65 years and over 35-64 years 65 years and over

SCOTLAND

Source: ISD Scotland (SMR01)

AYRSHIRE & ARRAN

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

Complete draft OPNA Page 64 of 131 20 February 2013


4.2.2 Drugs

Illicit drug use is not common among older people in Scotland, with

0.2% of adults aged 60 years and over reporting having used illicit

drugs during the last year, and 0.1% in previous month (SCJS

2010/11). This compares with reported rates of two percent among

people aged 15 to 64 years of age.

Few older people in Ayrshire and Arran are recorded as having a GP

diagnosis for drug abuse or dependency (Table 29). Similarly, low

rates of drug-related discharges have been observed in Ayrshire and

Arran (Figure 46). However, it is worth noting that there had been

an increase in drug-related discharges among patients aged 30-54

years over the last decade. The patterns of drug use among this

cohort may have implications on the care and treatment of older

people in future years.

As presented in Table 29, drug assessments of older people by

specialist addiction services in Ayrshire and Arran have been very

rare in recent years.

Less information is available on the adverse effects of licit drugs on

the older population. As people age, they tend to develop health

conditions that require continuing medication (e.g. osteoarthritis,

diabetes), and are also more vulnerable to infection and the

development of acute conditions. Drugs are used frequently in the

management of health problems in older people and several drugs

maybe prescribed for any individual.

Complete draft OPNA Page 65 of 131 20 February 2013


Older People’s Needs Assessment

Table 29: Percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of drug abuse or drug dependency – appearing anywhere on

GP record, by age group and deprivation category (51 of 59 local practices)

Age group of Deprivation category Female patients (%) Male patients (%)

patients

Drug abuse* Drug dependency* Drug abuse* Drug dependency*

n % n % n % n %

SIMD 1 226 2.12% 278 2.61% 317 2.92% 416 3.83%

SIMD 2 148 1.31% 161 1.43% 244 2.08% 288 2.46%

15-34 yrs SIMD 3 54 0.80% 55 0.82% 91 1.25% 107 1.48%

SIMD 4 18 0.37% 13 0.27% 39 0.74% 31 0.59%

SIMD 5 15 0.37% 4 0.10% 18 0.40% 17 0.38%

All 15-34 yrs 468 1.21% 520 1.35% 719 1.78% 874 2.16%

SIMD 1 222 1.36% 273 1.67% 391 2.34% 538 3.22%

SIMD 2 159 0.82% 156 0.81% 287 1.52% 362 1.91%

35-64 yrs SIMD 3 67 0.50% 64 0.48% 119 0.90% 154 1.17%

SIMD 4 41 0.35% 38 0.32% 50 0.43% 51 0.44%

SIMD 5 38 0.37% 10 0.10% 28 0.28% 22 0.22%

All 35-64 yrs 531 0.73% 551 0.76% 889 1.24% 1,135 1.58%

SIMD 1 23 0.57% 24 0.59% 9 0.25% 12 0.33%

SIMD 2 19 0.39% 21 0.43% 8 0.19% 11 0.27%

65-74 yrs SIMD 3 12 0.38% 11 0.35% 2 0.07% 5 0.18%

SIMD 4 2 0.07% 5 0.16% 3 0.11% 7 0.26%

SIMD 5 4 0.18% 2 0.09% 1 0.05% 2 0.09%

All 65-74 yrs 60 0.34% 63 0.36% 23 0.15% 37 0.24%

SIMD 1 52 1.36% 7 0.18% 15 0.66% 1 0.04%

SIMD 2 13 0.27% 9 0.19% 10 0.36% 5 0.18%

75+ yrs SIMD 3 24 0.80% 9 0.30% 7 0.38% 0 0.00%

SIMD 4 2 0.07% 5 0.18% 1 0.06% 0 0.00%

SIMD 5 4 0.22% 4 0.22% 0 0.00% 0 0.00%

All 75+ yrs 96 0.58% 34 0.21% 1 0.33% 6 0.06%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing 51 of 59 local practices

Complete draft OPNA Page 66 of 131 20 February 2013


Crude rates per 100,000 population

Figure 46: Crude rates of all drug-related acute hospital discharges

(SMR01) for all persons aged 10 years or over by 5-year age band in

Ayrshire and Arran (2000, 2004, 2008)

1200

1000

800

hospitalised, and more generally in contact with health care

services, than non-overweight people 27 .

The Body Mass Index (BMI) is used to measure general obesity.

BMI is defined as:

BMI = Body weight (kg)

Height (m)²

600

400

200

0

Source: SMR01

4.3 Healthy weight

2000 2004 2008

Obesity is defined as “a condition characterised by excessive body

fat”. Body fat can either be stored predominantly around the waist

or around the hips. Obesity has been linked to an increased risk of

coronary heart disease, diabetes, cancer, kidney failure, arthritis,

back pain and psychological damage, and decreased life

expectancy. As a result, obese people are more likely to be

A BMI of between 18.5 and 25 kg/m² is considered to be a healthy

weight. Scotland-level data drawn from the Scottish Health Survey

2008-10 found that 25% of people aged over 65 years were

between 18.5 and 25 kg/m² compared with 35% of people aged 16-

64 years (Table 30). The proportion of older people who reported

being a healthy weight did however increase with each age band. A

BMI of between 25 and 30 kg/m² is considered to be overweight,

while a BMI of >30 kg/m² is considered to be obese. Forty-two per

cent of people aged 65 and over were recorded as being

overweight compared with 36% of people aged 16-64 years. Thirty

per cent of people aged 65 years and over were recorded as being

obese compared with 24% of those aged 16-64 years. A BMI of


Table 30: Adult body mass index (BMI), 2008, 2009 and 2010

combined, by age and sex

BMI (kg/m 2 ) Age Total 65+

16-64 65-69 70-74 75-79 80-84 85+

% % % % % % %

Men

Less than 18.5 2 - 1 1 1 1 1

18.5 to less than 25 32 21 20 22 27 34 22

25 to less than 30 40 44 46 47 53 51 47

30 to less than 40 25 33 32 29 19 14 29

40+ 1 2 2 1 0 - 1

Mean 27.3 28.7 28.5 28.1 27.2 26.3 28.2

Women

Less than 18.5 2 1 1 2 4 2 2

18.5 to less than 25 38 24 28 26 32 34 28

25 to less than 30 32 39 38 38 38 42 39

30 to less than 40 23 33 30 30 24 21 30

40+ 4 3 2 4 2 1 2

Mean 27.3 28.6 28.2 28.4 27.1 26.8 28.1

All adults

Less than 18.5 2 1 1 1 3 2 1

18.5 to less than 25 35 23 24 25 30 34 25

25 to less than 30 36 41 42 42 44 45 42

30 to less than 40 24 33 31 30 22 19 30

40+ 3 2 2 2 1 0 2

Mean 27.3 28.6 28.3 28.2 27.1 26.6 28.1

Bases (weighted):

Men 7325 504 434 303 159 83 1483

Women 7242 556 488 395 254 141 1835

All adults 14567 1060 922 699 413 223 3318

b 30 and over = obese.

a 25 and over = overweight (including obese).

Source: SHeS 2008-10

Primary Care

Data on BMI is also collected at a local level through GP electronic

recording systems (Table 32). Data from 2009 showed similar

proportions to the findings from the Scottish Health Survey.

Looking at the GP data between 1999 and 2009 it can be seen that

the proportion of patients aged 65-74 years with a BMI


Table 31: Body Mass Index (BMI) of patients in Ayrshire and Arran at 1 Jan 1999, 2004, 2009 – counts of all patients with BMI recorded by GPs,

by age group and CHP area (51 of 59 local practices)

Age group of patients 1999 2004 2009

BMI BMI BMI BMI

BMI BMI BMI BMI

BMI BMI BMI BMI

00-25 25-30 30-40 40+

00-25 25-30 30-40 40+

00-25 25-30 30-40 40+

15-34 yrs n 20,297 7,157 2,592 216 23,426 7,879 3,776 489 27,280 10,300 6,180 969

% 67.1% 23.7% 8.6% 0.7% 65.9% 22.2% 10.6% 1.4% 61.0% 23.0% 13.8% 2.2%

35-64 yrs n 25,132 21,555 10,121 947 40,464 34,305 18,565 2,279 43,307 42,611 28,588 4,285

% 43.5% 37.3% 17.5% 1.6% 42.3% 35.9% 19.4% 2.4% 36.5% 35.9% 24.1% 3.6%

65-74 yrs n 4,922 5,302 2,142 141 8,254 9,976 5,179 401 9,059 12,158 7,760 772

% 39.4% 42.4% 17.1% 1.1% 34.7% 41.9% 21.8% 1.7% 30.5% 40.9% 26.1% 2.6%

75+ yrs n 2,267 1,779 638 32 7,192 6,184 2,491 122 9,983 8,676 4,151 235

% 48.1% 37.7% 13.5% 0.7% 45.0% 38.7% 15.6% 0.8% 43.3% 37.6% 18.0% 1.0%

BMI not recorded 162,325 (60.7%) 109,630 (39.1%) 66,602 (23.5%)

Source: All general practices in Ayrshire and Arran utilising GPASS, representing 51 of 59 local practices

Complete draft OPNA Page 69 of 131 20 February 2013


4.4 Diet and nutrition

The Scottish Government recommends that adults consume at least five

portions of fruit and vegetables per day 28 . Data on diet and nutrition is

collected at a national level through the Scottish Health Survey (Table

33). Eighteen per cent of respondents aged 65 years and over reported

consuming five or more portions of fruit and vegetables per day,

compared with 22% of respondents aged 16-64 years. The proportion

of older respondents meeting the recommended five portions per day

was highest among those aged 65-69 years and lowest among

respondents aged 85 years and over. No difference was observed

between males and females in relation to fruit and vegetable

consumption.

Table 32: Prevalence of fruit and vegetable consumption, 2008, 2009

and 2010 combined, by age and sex

16-64 65-69 70-74 75-79 80-84 85+ Total

65+

% % % % % % %

None 10 6 6 4 6 6 5

Less than 1

4 4 5 4 5 3 4

portion

1 portion 18 15 16 18 16 18 16

2 portions 17 17 18 20 21 22 19

3 portions 16 16 19 16 17 18 17

4 portions 12 14 12 17 14 15 14

5 portions or more 22 27 24 21 21 18 23

Mean portions 3.2 3.5 3.4 3.3 3.3 3.2 3.4

Source: SHeS 2008-10 combined

Bases (weighted):

All adults 16984 1253 1099 914 591 380 4237

4.5 Physical activity and exercise

Scottish Government guidance in recent years has been to recommend

that adults participate in 30 or more minutes of moderate or vigorous

activity on at least 5 days a week.

Fourteen per cent of respondents aged 65 years and over reported

meeting the recommended weekly physical activity levels, compared

with 44% of respondents aged 16-64 years. The proportion of older

people reduced with each increasing age band from 22% of those aged

65-69 years to 3% of those aged 85 years and over.

A higher proportion of older males than females indicated they met the

physical activity recommendations. When asked about specific forms of

activity, a higher proportion of males reported engaging in these

activities than females, with the exception of heavy housework

(Table 34).

Complete draft OPNA Page 70 of 131 20 February 2013


Table 33: Summary physical activity levels, 2008, 2009 and 2010

combined, by age and sex

Summary activity

Age Total 65+

level a 16-64 65-69 70-74 75-79 80-84 85+

% % % % % % %

Men

Meets 50 24 19 14 10 6 17

recommendations

Some activity 27 30 28 26 18 10 26

Low activity 23 46 53 60 72 84 57

Women

Meets 38 21 15 9 4 2 12

recommendations

Some activity 36 35 30 23 18 7 26

Low activity 25 44 56 68 78 91 62

All adults

Meets 44 22 17 11 7 3 14

recommendations

Some activity 32 33 29 24 18 8 26

Low activity 24 45 55 65 76 89 60

Bases (weighted):

Men 8324 584 504 377 236 116 1816

Women 8651 668 595 534 355 262 2414

All adults 16976 1252 1099 911 590 378 4230

a Meets recommendations: 30 minutes or more on at least 5 days a week; Some

activity= 30 minutes or more on 1 to 4 days a week; Low activity= fewer than 30

minutes of moderate or vigorous activity a week.

Source: SHeS 2008-10

Table 34: Participation in different activities in the past 4 weeks, 2008,

2009 and 2010 combined, by age and sex

Age

16-64 65-69 70-74 75-79 80-84 85+

Total

65+

% % % % % % %

Heavy Housework

Male 51 48 42 39 27 18 40

Female 69 60 52 40 25 12 44

Heavy Manual/Gardening/ DIY

Male 27 28 23 20 11 9 22

Female 10 12 8 5 3 1 7

Walking (brisk/fast pace)

Male 45 22 18 13 9 5 16

Female 37 22 15 11 7 3 13

Sports and Exercise

Male 58 37 35 29 25 12 31

Female 50 34 29 19 15 7 24

Any physical activities

Male 88 73 68 59 48 33 63

Female 87 73 65 52 38 20 56

Bases (weighted):

Male 8317 583 503 376 236 117 1815

Female 8647 667 593 532 355 262 2410

Source: SHeS 2008-10

Complete draft OPNA Page 71 of 131 20 February 2013


Chapter 5: Health Status

Health status refers to the experience of wellbeing and disease in the

population.

5.1 Life expectancy

Life expectancy is a broad indicator of overall health, an estimate of

the number of years a newborn child would live if it was to experience

current local mortality rates for all of its life. Life expectancy at birth in

Ayrshire and Arran has increased, the average life expectancy for

males in 1992-94 was 71.9 years and by 2008-10 it had increased to

75.5 years. The average life expectancy at birth for females in Ayrshire

and Arran in 1992-94 was 77.3 years and by 2008-10 it was 80 years.

Improved projections of life expectancy allow us to see the size of the

elderly population and plan ahead for this.

Table 35: Expectation of Life at Birth (LE), by Sex in East, North and

South Ayrshire 2006-2010

(where MD=most deprived 15% and LD=least deprived 85%)

Area Males Females

LE Lower

95% CI

Upper

95% CI

LE Lower

95% CI

Upper

95% CI

East Ayrshire LD 75.7 75.2 76.3 79.5 79.0 80.1

East Ayrshire MD 70.3 68.9 71.7 75.9 74.7 77.1

East Ayrshire 75.0 74.5 75.5 79.0 78.6 79.5

North Ayrshire LD 75.2 74.7 75.8 80.1 79.6 80.5

North Ayrshire MD 69.2 67.8 70.5 75.7 74.5 76.9

North Ayrshire 74.3 73.8 74.8 79.4 79.0 79.8

South Ayrshire LD 77.3 76.8 77.9 81.4 81.0 81.9

South Ayrshire MD 68.9 67.4 70.5 78.2 76.9 79.5

South Ayrshire 76.1 75.5 76.6 81.0 80.6 81.5

Source: http://www.gro-scotland.gov.uk/statistics/theme/lifeexpectancy/scotland/index.html

Table 35 shows the differences in life expectancy at birth between the

most and least deprived areas in East, North and South Ayrshire.

Females living in the least deprived areas of South Ayrshire have the

highest life expectancy overall at 81.4 years. Males from the most

deprived area of South Ayrshire have the lowest life expectancy in

Ayrshire and Arran at 68.9 years. The gap in LE between males from

the least and most deprived areas of South Ayrshire is 8.4 years and

this is the largest inequality gap when compared to North Ayrshire at

six years and East Ayrshire at 5.4 years. However, the numbers of

males in the most deprived areas of South Ayrshire are small and

therefore these values are not as robust as the numbers of males for

Ayrshire and Arran. Females living in the most deprived areas of North

Ayrshire have the lowest life expectancy in Ayrshire and Arran at 75.7

years. Females living in the least deprived areas of North Ayrshire have

a higher life expectancy (80.1 years) compared to those living in the

least deprived areas of East Ayrshire (79.5 years).

The estimated life expectancy for males and females at the age of 65 is

presented in Table 36 along with the ranking of Ayrshire & Arran

among the 14 NHS Board areas and the ranks for East, North and

South out of 32 Scottish local authorities.

Table 36: Life Expectancy at age 65, in East, North and South Ayrshire,

Ayrshire & Arran and Scotland, 2008-2010

Males - Years Rank Females - Years Rank

Ayrshire & Arran 16.7 11 19.1 12

East Ayrshire 16.3 25 18.9 25

North Ayrshire 16.7 21 18.7 28

South Ayrshire 16.9 18 19.7 14

Scotland 16.8 - 19.3 -

Source: http://www.gro-scotland.gov.uk/statistics/theme/life-expectancy/scottishareas/2008-2010/tables.html

Complete draft OPNA Page 72 of 131 20 February 2013


Figure 47 shows the marked differences in life expectancy between

males and females across East, North and South Ayrshire. The

confidence interval between males and females from the most and

least deprived areas shown in Table 36 indicate only a small

difference. Again the life expectancy of males from the most deprived

area of South Ayrshire is less robust than in the other areas because of

the small numbers involved.

Figure 47: Expectation of Life at Birth (LE), by Sex for East, North and

South Ayrshire, split by level of deprivation

East Ayrshire

LD

East Ayrshire

MD

North Ayrshire

LD

North Ayrshire

MD

South Ayrshire

LD

South Ayrshire

MD

60 65 70 75 80 85

Age

Source: http://www.scotpho.org.uk/population-dynamics/healthy-lifeexpectancy/data/community-health-partnerships

Expectation of

Life at birth

Females

Expectation of

Life at birth

Males

Healthy Life Expectancy compared with Life Expectancy

Figures 48 and 49 present male and female life expectancy (LE) and

healthy life expectancy (HLE) at birth in years for the five year period

1999 to 2003. Males in South Ayrshire have the highest LE and

shortest period in ‘not healthy’ health at 6.31 years. Females have a

longer life expectancy than males and as is shown in Figure 50, have a

longer period of life in ‘not healthy’ health. Females in South Ayrshire

have the highest LE and the shortest period in ‘not healthy’ health at

7.42 years. Females in North Ayrshire experience 8.81 years in ‘not

healthy’ health, the longest period and in East Ayrshire the number of

years is 8.44 just below the Scottish figure of 8.45 years.

Figure 48: Male Life expectancy and Healthy Life Expectancy at birth in

years

Male Life Expectancy

72.50 72.63

65.09 65.20

Male Healthy Life Expectancy

74.20

67.89

73.29

East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP Scotland

66.26

Source: http://www.scotpho.org.uk/population-dynamics/healthy-lifeexpectancy/data/community-health-partnerships

Complete draft OPNA Page 73 of 131 20 February 2013


Figure 49: Female Life expectancy and Healthy Life Expectancy at birth

in years

77.27

Female Life Expectancy

68.83 69.45

Female Healthy Life Expectancy

78.26 78.89 78.69

71.47

70.24

5.2 Mortality

As with most of the West of Scotland age standardised mortality rates

in Ayrshire & Arran have been above the Scottish ratio. Over the past

five years they have been reducing at a faster rate than Scotland

leading to a merging of values in 2010.

South Ayrshire has the lowest rates until 2010 when East Ayrshire was

lower, North Ayrshire has seen a steeper decline.

East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP

Scotland

Females East and North Ayrshire have seen steeper declines than

South Ayrshire.

Source: http://www.scotpho.org.uk/population-dynamics/healthy-lifeexpectancy/data/community-health-partnerships

Having estimates on the levels of morbidity at an average age (for

males of 65 and females of 70 in Ayrshire and Arran) provides a guide

to whom and when the demand for health and social care will increase

for groups within the population. Taking into account the differences

in life expectancy between those older people living in the most and

least deprived areas adds to the profile. Knowing where older people

live in relation to deprivation will increase the information for the

planning of services to meet the needs where they are likely to be

higher.

Figure 50: Age-standardised death rates for all causes, NHS Ayrshire &

Arran and Scotland, 2006 to 2010

1000

900

800

700

600

500

400

300

200

100

0

2006 2007 2008 2009 2010

Males Scotland

Males A&A

Females Scotland

Females A&A

Source: http://www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/agestandardised-rates.html

Complete draft OPNA Page 74 of 131 20 February 2013


Figure 51: Age-standardised death rates for all causes, East Ayrshire

and Scotland

Figure 53: Age-standardised death rates for all causes South Ayrshire

and Scotland

1000

900

Males

Scotland

1000

900

Males Scotland

800

700

600

500

400

300

200

100

0

Males

East

Ayrshire

Females

Scotland

Females

East

Ayrshire

800

700

600

500

400

300

200

100

0

Males South

Ayrshire

Females

Scotland

Females South

Ayrshire

2006 2007 2008 2009 2010

2006 2007 2008 2009 2010

Source: http://www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/agestandardised-rates.html

Figure 52: Age-standardised death rates for all causes North Ayrshire

and Scotland

1000

900

800

700

600

500

400

300

200

100

0

2006 2007 2008 2009 2010

Males

Scotland

Males

North

Ayrshire

Females

Scotland

Females

North

Ayrshire

Source: http://www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/agestandardised-rates.html

Winter Mortality

There is no single cause of 'additional' deaths in winter (NRS 2011).

Very few are caused by hypothermia. Most are from respiratory and

circulatory diseases such as pneumonia, coronary heart disease and

stroke. In only a small proportion of deaths are influenza recorded as

the underlying cause. The seasonal increase in mortality in the winter

is defined as the difference between the number of deaths in the fourmonth

'winter' period (December to March, inclusive) and the average

number of deaths in the two four-month periods which precede

winter (August to November, inclusive) and follow winter (April to July,

inclusive).

Source: http://www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/agestandardised-rates.html

Complete draft OPNA Page 75 of 131 20 February 2013


Figure 54 presents the seasonal increase in winter mortality in

Ayrshire and Arran between 2001/02 and 2010/11 as a five year

average. The seasonal increase in winter mortality for persons aged 0-

64 years and 65-74 years has been fairly stable over this time period,

but has risen for persons aged 75-84 years and 85 years and over.

Figure 54: Seasonal Increase in Mortality in the Winter, by age-group

and NHS Board area of usual residence, 2001/02 to 2010/11; Ayrshire

and Arran; 5 year average

120

100

80

60

40

20

0

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

Source: National Records of Scotland

0-64 65-74 75-84 85+

The Increased Winter Mortality (IWM) Index is the unrounded number

of 'additional' winter deaths divided by the unrounded average

number of deaths in a four month 'non-winter' period, expressed as a

percentage.

Figure 55 presents the IWM Index scores for Scotland and Ayrshire and

Arran between 2001/02 and 2010/11 as a five year average. At

national level the IWM Index score can be seen to rise steadily both

with increasing age band and across the time period. A similar pattern

in relation to age can be observed within Ayrshire and Arran. For

persons aged 75 years and over there has been an increase over the

time period, while for younger older people (65-74 years) there has

been a slight decrease 29 .

Figure 55: Increased Winter Mortality index, by age-group and NHS

Board5 area of usual residence, 2001/02 to 2010/11; Ayrshire and

Arran; 5 year average

Source: National Records of Scotland

.

25

20

15

10

5

0

0-64 65-74 75-84 85+ 0-64 65-74 75-84 85+

Scotland

Ayrshire and Arran

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

Complete draft OPNA Page 76 of 131 20 February 2013


5.3 Self-reported health status

Many of the reports on health status are based on self reported

general health and the presence of long standing illness. Some may

argue that a person’s judgement about their own health is too

subjective and therefore has little validity. However, studies have

shown that people’s perceptions of their own health can be good

predictors of future health care use and of mortality rates 30, 31 .

The Scottish Health Survey asks respondents to rate their health status

on a scale from “very good” to “very bad” (Figure 56). The proportion

of respondents who reported being in “very good” health declined

with each increasing age band, while the proportion who reported

“fair” or “bad” health increased. Little difference was observed

between male and female respondents. Logistic regression analysis

was conducted to identify associated risk factors for reporting

poor/very poor general health among respondents aged 65 years and

over. Increasing deprivation status and being a current or ex-smoker

were found to significantly increase the odds of reporting poor/very

poor general health. Consumption of alcohol above the weekly

recommended limits was found to significantly reduce the odds of

reporting poor/very poor general health, however, this finding is likely

to be related to the fact that people in poor health who have been

advised not to drink were included in the reference category along

with people who drink within the recommended limits.

Figure 56: Self-assessed general health, 2008, 2009 and 2010

combined, by age – Scotland.

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Source: SheS 2008-10

16-64 65-69 70-74 75-79 80-84 85+

Very good Good Fair Bad Very bad

Complete draft OPNA Page 77 of 131 20 February 2013


5.4 Long-term conditions

Evidence has shown that long-term conditions affect the lives of

the one in three people - or six in 10 adults but this burden of

illness is particularly increased among older people, affecting

around two -thirds of those aged over 75, 45 percent of whom have

more than one long-term condition. The local available data

(Scotland’s Census OnLine) estimates that the average age of a

person in Ayrshire & Arran with a limiting illness is 59 years (North

58; East 58 and South 61 years) whereas Scotland as a whole is 58

years.

Long-term or limiting conditions clearly have a significant impact

and represent a challenge for the NHS and local authorities. The

problem is estimated to grow due to increasing obesity, more

sedentary lifestyles, particularly within an ageing population.

This is likely to place increasing long-term demands on health care

systems. Not only will chronic conditions be the leading cause of

disability, if not successfully prevented or managed they will

become the most expensive problems faced by our health care and

local authority systems.

As the population ages, caring for people with long-term conditions

and limiting illness such as, heart disease, asthma and diabetes is

likely to require increased service responses from the NHS, local

authority, voluntary sector as well as informal carers. Patients with

long-term conditions are known to use a significant proportion of

all appointments with GPs and outpatient clinics and of inpatient

hospital bed days as described previously 32 .

Current policy on long-term conditions seeks to reduce this burden

through prevention, early intervention and developing services that

enable people to remain living independently in their own homes.

It also seeks to empower patients, give them information about

their condition, how to manage it better and offer them choice

about where and how they are treated and achieve the outcomes

they want for themselves. A local example of this is the Co-creating

Health Initiative which aims to embed self-management support

into patient pathways for people with chronic obstructive

pulmonary disease (COPD) and enabling it to become a core

element of developing relationships between patients and

clinicians. Phase 1 focused on COPD, however during Phase 2 there

are plans to extend to include other long-term conditions.

The Scottish Health Survey asks whether respondents had any longterm

physical or mental conditions or disabilities that had affected,

or were likely to affect, them for at least twelve months. Those

who reported having such a condition were asked to say whether it

limited their daily activities in any way. This enabled conditions to

be further classified as either 'limiting' or 'non-limiting'. As the

question did not specify that conditions had to be doctordiagnosed,

responses were subject to some distortion due to

variation in individuals' perceptions.

Long-term conditions were reported by one-third (33%) of men

aged 16-64 years and two-thirds (66%) aged 65 years and over

(Figure 57). Prevalence was slightly higher in younger women

(37%) than younger men, but similar in older women (67%)

compared to older men. The prevalence of long-term conditions

increased with age above 65 years in a similar manner for both

Complete draft OPNA Page 78 of 131 20 February 2013


sexes, from 62% in adults aged 65-69 years to 73% in those 85

years and over.

Figure 57: Prevalence of long-term conditions, 2008, 2009 and

2010 combined, by age

80

70

60

50

40

30

20

10

0

16-64 65-69 70-74 75-79 80-84 85+

Source: SheS 2008-10

The reported rates of selected long term conditions are presented

in Table 38. The three most common categories of conditions in

men and women aged 65 and over were musculoskeletal

conditions (280 per 1,000 in men, 370 per 1,000 in women);

conditions of the heart and circulatory system (298 per 1,000 in

men, 266 per 1,000 in women); and endocrine and metabolic

disorders (124 per 1,000 in men, 137 per 1,000 in women).

Although musculoskeletal conditions were also the most common

condition for those aged 16-64, the corresponding rates were much

lower (117 per 1,000 in men, 126 per 1,000 in women). Heart and

circulatory system conditions were the next most common in men

aged 16-64 (69 per 1,000) while mental disorders were the next

most common condition among younger women (78 per 1,000).

Mental disorders and skin complaints were the only conditions to

have higher rates among men and women aged 16-64 than in the

65 and over age group. In addition, nervous disorders were more

common in younger than older women.

Among those aged 65 and over, heart and circulatory conditions,

musculoskeletal conditions, ear and eye problems, and skin

conditions increased with age (though heart conditions in men and

skin conditions in women declined in the oldest age group). In

contrast, mental disorders and endocrine and metabolic conditions

decreased with age (though mental disorders in women increased

again in the 85 and over group).

Respiratory conditions decreased with age in women, while there

was no effect of age in men; thus these conditions were more

common in the 'young old' women and in the 'older old' men.

While heart and circulatory disease, ear conditions, and genitourinary

disorders were more common in men than women,

musculoskeletal problems and mental disorders were generally

more common in women. The prevalence of neoplasms, infections,

and conditions of the digestive system and blood and related

organs did not vary by age or sex.

Complete draft OPNA Page 79 of 131 20 February 2013


Table 37: Rate of reported long term conditions per 1000 adults,

2008, 2009 and 2010 combined, by age and sex, Scotland

Condition Group

Age Total

( ICD 10 chapters) a 16- 65- 70- 75- 80- 85+ 65+

64 69 74 79 84

Rate per 1000

Men

XIII Musculoskeletal 117 266 286 289 304 269 280

system

IX Heart & circulatory 69 257 309 318 356 280 298

system

IV Endocrine & 47 134 132 125 107 72 124

metabolic

X Respiratory system 66 113 114 79 123 98 107

XI Digestive system 32 43 60 68 93 56 60

VII Eye complaints 12 29 31 55 84 105 47

VIII Ear complaints 8 26 46 49 101 135 53

II Neoplasms & benign 8 39 50 64 66 56 52

growths

VI Nervous System 36 53 39 36 52 27 44

V Mental disorders 53 35 12 23 5 19 21

XIV Genito-urinary 11 50 38 54 47 92 50

system

Women

XIII Musculoskeletal 126 319 322 403 433 441 370

system

IX Heart & circulatory 57 243 273 273 271 289 266

system

IV Endocrine & 64 155 125 161 111 100 137

metabolic

X Respiratory system 70 103 99 105 65 40 90

XI Digestive system 42 78 77 63 59 82 72

VII Eye complaints 7 22 34 49 76 151 53

VIII Ear complaints 10 26 31 36 54 85 40

II Neoplasms & benign 13 39 41 46 23 31 38

growths

VI Nervous System 48 57 37 36 45 23 42

V Mental disorders 78 47 36 37 18 28 36

XIV Genito-urinary

system

15 18 24 18 38 23 20

All adults

XIII Musculoskeletal 122 295 305 356 382 388 330

system

IX Heart & circulatory 63 249 289 292 305 286 280

system

IV Endocrine & 56 145 128 146 109 91 131

metabolic

X Respiratory system 68 107 106 94 88 58 97

XI Digestive system 37 62 69 65 73 74 67

VII Eye complaints 10 25 33 51 79 137 50

VIII Ear complaints 9 26 38 42 73 101 46

II Neoplasms & benign 11 39 45 53 40 38 44

growths

VI Nervous System 42 55 38 36 47 25 43

V Mental disorders 66 42 25 32 13 25 30

XIV Genito-urinary

system

All adults 1699

1

Source: SheS 2008-10

13 33 30 32 41 45 30

Bases (weighted):

Men 8332 584 503 378 235 118 1818

Women 8659 669 596 537 356 263 2421

1253 1100 914 591 381 4239

Complete draft OPNA Page 80 of 131 20 February 2013


5.5 The occurrence of specific health problems common in older

age

Coronary heart disease

The prevalence of coronary heart disease (CHD) rises quickly after

65 years, with 19% of patients aged 65-74 years and 26% of

patients aged 75 years and over having a history of CHD (Table 39).

Male patients and those from more deprived areas were

consistently observed to have a higher rate of CHD history.

Mortality rates for all heart disease have reduced in Ayrshire and

Arran over the last decade for older people as in the general

population (Figure 62). Among those aged 65-74 years the rate of

heart disease deaths decreased from 2,130 per 100,000 population

in 2001 to 1,081 per 100,000 population in 2010. Over the same

time period the rate of heart disease deaths among those aged 75

years and over decreased from 6,631 per 100,000 population in

2001 to 4,268 per 100,000 population in 2010. Heart disease death

rates among males we observed to be consistently higher than

among females (Figures 59 and 60). Little variation was observed

between CHP areas (Figure 64 and 65). East Ayrshire appeared to

have slightly higher death rates than North or South for part of the

time period, however, this seems to have reduced in recent years.

Table 38: Counts and percentages, at 1 Jan 2009, of patients in

Ayrshire and Arran with a history of coronary heart disease (CHD)

Deprivation

category

All Male Female

n % n % n %

SIMD 1 3 0.01% 2 0.02% 1 0.01%

SIMD 2 4 0.02% 0 0.00% 4 0.04%

SIMD 3 3 0.02% 0 0.00% 3 0.04%

15-34 yrs SIMD 4 0 0.00% 0 0.00% 0 0.00%

SIMD 5 1 0.01% 1 0.02% 0 0.00%

All 15-34 yrs 13 0.02% 5 0.01% 8 0.02%

SIMD 1 1637 4.96% 1,019 6.10% 618 3.78%

SIMD 2 1531 4.01% 977 5.16% 554 2.87%

SIMD 3 788 2.97% 539 4.09% 249 1.86%

35-64 yrs SIMD 4 600 2.54% 439 3.75% 161 1.36%

SIMD 5 531 2.63% 391 3.93% 140 1.37%

All 35-64 yrs 5162 3.58% 3,419 4.75% 1,743 2.41%

SIMD 1 1756 22.93% 983 27.35% 773 19.03%

SIMD 2 1791 19.98% 1,006 24.42% 785 16.20%

SIMD 3 1034 17.63% 619 22.56% 415 13.30%

65-74 yrs SIMD 4 868 15.25% 561 21.14% 307 10.11%

SIMD 5 605 14.01% 424 19.84% 181 8.30%

All 65-74 yrs 6127 18.57% 3,640 23.47% 2,487 14.22%

SIMD 1 1759 28.81% 773 33.84% 986 25.80%

SIMD 2 2101 27.83% 967 34.76% 1,134 23.79%

SIMD 3 1267 26.19% 593 32.28% 674 22.46%

75+ yrs SIMD 4 1097 23.90% 546 30.49% 551 19.69%

SIMD 5 715 22.61% 368 27.77% 347 18.88%

All 75+ yrs 7021 26.39% 3,287 32.37% 3,734 22.70%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing

51 of 59 local practices

Complete draft OPNA Page 81 of 131 20 February 2013


Figure 58: Heart disease deaths in Ayrshire & Arran, with age-sex

standardised mortality rates per 100,000 population by age band

and year of death registration

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

ALL 65-74 75+

Source: Registrar General for Scotland, Death Records

Figure 59: Heart disease deaths in Ayrshire & Arran, with age-sex

standardised mortality rates per 100,000 population by age 65-74

years and year of death registration

3,000

2,500

2,000

1,500

1,000

500

0

Source: Registrar General for Scotland, Death Records

Figure 60: Heart disease deaths in Ayrshire & Arran, with age-sex

standardised mortality rates per 100,000 population by age 75

years and over and year of death registration

10,000

8,000

6,000

4,000

2,000

0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Males Females Both Sexes

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Males Females Both Sexes

Source: Registrar General for Scotland, Death Records

Complete draft OPNA Page 82 of 131 20 February 2013


Standardised rate per 100,000 pop'n

Figure 61: Heart disease deaths in Ayrshire & Arran, with age-sex

standardised mortality rates per 100,000 population by age band,

local authority of residence and year of death registration

3,500

3,000

2,500

2,000

1,500

1,000

500

0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

EAST 65-74 EAST 75+ NORTH 65-74

NORTH 75+ SOUTH 65-74 SOUTH 75+

Figure 62: Incidence of Coronary Heart Disease; Ayrshire & Arran

and Scotland,


Crude prevalent rate per 100 pop'n

Crude prevalent rate per 100 pop'n

Figure 63: Coronary Heart Disease Estimated Prevalence by age sex

for Ayrshire & Arran compared to Scotland

Figure 64: Coronary heart Disease Estimated Prevalence for Males

by CHP

20

18

16

14

12

10

8

6

4

2

0

Male A&A

Male

Scotland

Female A&A

Female

Scotland

Both_Sexes

A&A

Both Sexes

Scotland

20

18

16

14

12

10

8

6

4

2

0

East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP Scotland

Males aged 45-64 Males aged 65-74

Aged 45-64 years

Aged 65-74 years

Source: http://www.isdscotland.org/Health-Topics/Heart-Disease/

Figure 63 presents the estimated prevalent rate per 100 of the

population by age group and sex and compares Ayrshire and Arran

rates with the Scotland rates. As shown the rates for Ayrshire and

Arran are very similar to Scotland, being slightly less than one

percent difference for each group presented.

Figure 64 shows that East Ayrshire has the highest prevalence of

CHD for males aged 45-64 at 6.33 per 100 and for males aged 65-74

at 17.99 per 100. The rate per 100 for males aged 45-64 in North

and South Ayrshire is 5.67 and 5.41 respectively however Scotland

has a lower rate at 5.29. The pattern for 65 -74 year old males in

North (16.96 per 100) and South Ayrshire and Scotland is similar to

the 45-64 year olds however South Ayrshire has a lower rate than

Scotland at 16.77 and 16.85 respectively.

Source: http://www.isdscotland.org/Health-Topics/Heart-Disease/

Figure 65 shows that East Ayrshire has the highest prevalence of

CHD for females aged 45-64 at 2.90 per 100 and for females aged

65-74 at 9.56 per 100. The lowest rate for females aged 45-64 is the

Scotland rate at 2.28, the South Ayrshire rate is 2.31 per 100 and

the North Ayrshire rate is 2.57 per 100. North Ayrshire has the

lowest CHD prevalence rate for women aged 65 -74 years old at

8.07, the Scotland rate is 8.26 and the rate for females in South

Ayrshire in this age group is 8.64 per 100.

Complete draft OPNA Page 84 of 131 20 February 2013


Crude prevalent rate per100 pop'n

Figure 65: Coronary Heart Disease Estimated Prevalence for

Females by CHP

12

10

East Ayrshire CHP

South Ayrshire CHP

North Ayrshire CHP

Scotland

prevention with upstream public health programmes when adults

are young are likely to have the largest long-term benefits keeping

people disability free into old age. However health promotion

interventions relating to lifestyle behaviour in older people has

been shown also to be beneficial for leading a more independent

and disability free life. http://www.ageuk.org.uk/scotland/health-wellbeing/

8

6

4

2

0

Females aged 45-64 Females aged 65-74

Source: http://www.isdscotland.org/Health-Topics/Heart-Disease/

Cerebrovascular disease

Cerebrovascular disease has also be seen to be much more

prevalent among older people as can be observed from Ayrshire

and Arran GP records (Table 39). At 1 January 2009, 7% of patients

aged 65-74 years and 13% of patients aged 75 years and over were

recorded as having a history of stroke. As with cardiovascular

disease, male patients and those from more deprived areas were

consistently observed to have a higher rate of stroke history.

It should be noted that numbers of cases for small geographical

areas are less robust than rates for larger geographical areas, so the

most reliable estimate of prevalence here is the one for Scotland

and then NHS Ayrshire and Arran.

Source: www.isdscotland.org/Health-Topics/Heart-Disease/Topic-

Areas/Prevalence/ (Table PV1)

It is clear from these data that the prevalence of coronary heart

and cerebrovascular disease increases significantly after the age of

65. The public health evidence shows that lifestyle interventions to

reduce the level of risk factors associated with these two

conditions; alcohol, tobacco, obesity and physical activity, are

effective at all ages. Investment in early intervention and

Complete draft OPNA Page 85 of 131 20 February 2013


Table 39: Number and percentages, at 1 Jan 2009, of patients in

Ayrshire and Arran with a history of stroke – appearing anywhere

on GP record, by age group and deprivation category

Deprivation

category

All Male Female

n % n % n %

SIMD 1 8 0.04% 5 0.05% 3 0.03%

SIMD 2 15 0.07% 7 0.06% 8 0.07%

SIMD 3 7 0.05% 6 0.08% 1 0.01%

15-34 yrs SIMD 4 5 0.05% 0 0.00% 5 0.10%

SIMD 5 5 0.06% 4 0.09% 1 0.02%

All 15-34 yrs 42 0.05% 23 0.06% 19 0.05%

SIMD 1 577 1.75% 293 1.75% 284 1.74%

SIMD 2 608 1.59% 330 1.74% 278 1.44%

SIMD 3 342 1.29% 186 1.41% 156 1.17%

35-64 yrs SIMD 4 244 1.03% 147 1.25% 97 0.82%

SIMD 5 182 0.90% 122 1.23% 60 0.59%

All 35-64 yrs 1980 1.37% 1,089 1.51% 891 1.23%

SIMD 1 626 8.18% 338 9.40% 288 7.09%

SIMD 2 702 7.83% 395 9.59% 307 6.34%

SIMD 3 394 6.72% 241 8.78% 153 4.90%

65-74 yrs SIMD 4 323 5.68% 186 7.01% 137 4.51%

SIMD 5 229 5.30% 137 6.41% 92 4.22%

All 65-74 yrs 2304 6.98% 1,316 8.49% 988 5.65%

SIMD 1 892 14.61% 378 16.55% 514 13.45%

SIMD 2 987 13.07% 442 15.89% 545 11.43%

SIMD 3 614 12.69% 253 13.77% 361 12.03%

75+ yrs SIMD 4 572 12.46% 285 15.91% 287 10.26%

SIMD 5 416 13.15% 207 15.62% 209 11.37%

All 75+ yrs 3531 13.27% 1,582 15.58% 1,949 11.85%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing

51 of 59 local practices

Mortality rates for cerebrovascular disease have reduced in

Ayrshire and Arran over the last decade for older people as in the

general population (Figure 70). Among those aged 65-74 years the

rate of cerebrovascular disease deaths decreased from 412 per

100,000 population in 2001 to 173 per 100,000 population in 2010.

During the same time period mortality rates for cerebrovascular

disease reduced among those aged 75 years and over from 2,326 to

1,026 per 100,000 population.

Cerebrovascular mortality rates were observed to be higher among

males than females for persons aged 65-74 years (Figure 67) but

not between males and females aged 75 years and over (Figure 68).

The mortality rate for females aged 75 years and over was in fact

slightly higher than for males between 2007 and 2010. Again, little

difference in mortality rates were observed between CHP areas

(Figure 69). A slightly higher rate was observed for persons aged 75

and over in North Ayrshire between 2006 and 2009, however, this

gap had narrowed by 2010.

Complete draft OPNA Page 86 of 131 20 February 2013


Figure 66: Cerebrovascular disease deaths in Ayrshire & Arran,

with age-sex standardised mortality rates per 100,000 population

by age band and year of death registration

3,000

2,500

2,000

1,500

1,000

500

0

Source: Registrar General for Scotland, Death Records

Figure 67: Cerebrovascular disease deaths in Ayrshire & Arran,

with age-sex standardised mortality rates per 100,000 population

by age 65-74 years and year of death registration

600

500

400

300

200

100

0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

All ages 65-74 75+

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Males Females Both Sexes

Source: Registrar General for Scotland, Death Records

Figure 68: Cerebrovascular disease deaths in Ayrshire & Arran,

with age-sex standardised mortality rates per 100,000 population

by age 75 years and over and year of death registration

3,000

2,500

2,000

1,500

1,000

500

0

Source: Registrar General for Scotland, Death Records

Figure 69: Cerebrovascular disease deaths in Ayrshire & Arran,

with age-sex standardised mortality rates per 100,000 population

by age band, local authority of residence and year of death

registration

3,000

2,500

2,000

1,500

1,000

500

0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Males Females Both Sexes

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

EAST 65-74 EAST 75+ NORTH 65-74

NORTH 75+ SOUTH 65-74 SOUTH 75+

Source: Registrar General for Scotland, Death Records

Complete draft OPNA Page 87 of 131 20 February 2013


Standardised rate per 100,000 pop'n

Figure 70: Incidence of Cerebrovascular Disease; Ayrshire & Arran

and Scotland,


Table 40: Number and percentages, at 1 Jan 2009, of patients in

Ayrshire and Arran with a history of cancer by age group and

deprivation category

Deprivation All Male Female

category

n % n % n %

SIMD 1 57 0.26% 30 0.28% 27 0.25%

SIMD 2 61 0.27% 25 0.21% 36 0.32%

SIMD 3 41 0.29% 14 0.19% 27 0.40%

15-34 yrs SIMD 4 23 0.23% 12 0.23% 11 0.22%

SIMD 5 26 0.30% 15 0.33% 11 0.27%

All 15-34 yrs 211 0.27% 97 0.24% 114 0.30%

SIMD 1 765 2.32% 271 1.62% 494 3.02%

SIMD 2 894 2.34% 299 1.58% 595 3.09%

SIMD 3 620 2.34% 200 1.52% 420 3.14%

35-64 yrs SIMD 4 620 2.63% 211 1.80% 409 3.44%

SIMD 5 528 2.62% 200 2.01% 328 3.21%

All 35-64 yrs 3498 2.42% 1,202 1.67% 2,296 3.17%

SIMD 1 651 8.50% 288 8.01% 363 8.93%

SIMD 2 740 8.25% 315 7.65% 425 8.77%

SIMD 3 521 8.88% 224 8.16% 297 9.52%

65-74 yrs SIMD 4 517 9.08% 217 8.18% 300 9.88%

SIMD 5 368 8.52% 160 7.49% 208 9.53%

All 65-74 yrs 2842 8.61% 1,228 7.92% 1,614 9.23%

SIMD 1 692 11.33% 297 13.00% 395 10.33%

SIMD 2 859 11.38% 345 12.40% 514 10.78%

SIMD 3 535 11.06% 250 13.61% 285 9.50%

75+ yrs SIMD 4 561 12.22% 260 14.52% 301 10.76%

SIMD 5 397 12.55% 192 14.49% 205 11.15%

All 75+ yrs 3090 11.62% 1,366 13.45% 1,724 10.48%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing

51 of 59 local practices

Figure 71: Number of cancer (all types) registrations in Ayrshire

and Arran, by five year age band between 2006 and 2010

1,800

1,600

1,400

1,200

1,000

800

600

400

200

-

Source: Scottish Cancer Registry, ISD Scotland

Figure 72: Age-specific incidence rates of cancer (all types)

registrations in Ayrshire and Arran, by five year age band between

2006 and 2010

3,000

2,500

2,000

1,500

1,000

500

0

Ayrshire and Arran

Source: Scottish Cancer Registry, ISD Scotland

SCOTLAND

Complete draft OPNA Page 89 of 131 20 February 2013


The number and rate of cancer deaths is also higher among older

people in Ayrshire and Arran during the same time period (Figures

73 and 74). Again, the reduction in the absolute number of deaths

after 80 years is not mirrored in the rate. There is little difference

between the rate for cancer deaths in Ayrshire and Arran and for

Scotland.

Figure 73: Number of cancer (all types) deaths in Ayrshire and

Arran, by five year age band between 2006 and 2010

1,200

1,000

Figure 74: Age-specific incidence rates of cancer (all types) deaths

in Ayrshire and Arran, by five year age band between 2006 and

2010

2,500

2,000

1,500

1,000

500

0

800

600

400

Ayrshire and Arran

Source: Scottish Cancer Registry, ISD Scotland

SCOTLAND

200

-

Source: Scottish Cancer Registry, ISD Scotland

Diabetes

Using data taken from Ayrshire and Arran GP records, it can be

observed that age, gender and deprivation category do not appear

to be associated with the prevalence of type 1 diabetes (Table 42).

However, for type 2 diabetes higher prevalence rates were

observed for older people, males and patients living in more

deprived areas (Table 43). Twelve per cent of patients aged 65-74

years had a diagnosis of type 2 diabetes on their GP record and 11%

of patients aged over 75 years, compared with less than 1% for

type 1 diabetes in either age band.

Complete draft OPNA Page 90 of 131 20 February 2013


Table 41: Number and percentages, at 1 Jan 2009, of patients in

Ayrshire and Arran with a history of diabetes type by age group and

deprivation category

Deprivation

category

All Male Female

n % n % n %

SIMD 1 118 0.55% 56 0.52% 62 0.58%

SIMD 2 144 0.63% 81 0.69% 63 0.56%

SIMD 3 104 0.74% 54 0.74% 50 0.74%

15-34 yrs SIMD 4 59 0.58% 38 0.72% 21 0.43%

SIMD 5 50 0.58% 29 0.64% 21 0.51%

All 15-34 yrs 488 0.62% 264 0.65% 224 0.58%

SIMD 1 287 0.87% 177 1.06% 110 0.67%

SIMD 2 267 0.70% 149 0.79% 118 0.61%

SIMD 3 198 0.75% 106 0.80% 92 0.69%

35-64 yrs SIMD 4 143 0.61% 77 0.66% 66 0.56%

SIMD 5 123 0.61% 81 0.81% 42 0.41%

All 35-64 yrs 1033 0.72% 598 0.83% 435 0.60%

SIMD 1 66 0.86% 35 0.97% 31 0.76%

SIMD 2 59 0.66% 30 0.73% 29 0.60%

SIMD 3 48 0.82% 28 1.02% 20 0.64%

65-74 yrs SIMD 4 18 0.32% 13 0.49% 5 0.16%

SIMD 5 25 0.58% 16 0.75% 9 0.41%

All 65-74 yrs 220 0.67% 123 0.79% 97 0.55%

SIMD 1 29 0.47% 9 0.39% 20 0.52%

SIMD 2 26 0.34% 13 0.47% 13 0.27%

SIMD 3 20 0.41% 9 0.49% 11 0.37%

75+ yrs SIMD 4 23 0.50% 9 0.50% 14 0.50%

SIMD 5 7 0.22% 3 0.23% 4 0.22%

All 75+ yrs 107 0.40% 43 0.42% 64 0.39%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing

51 of 59 local practices

Table 42: Number and percentages, at 1 Jan 2009, of patients in

Ayrshire and Arran with a history of diabetes type 2 by age group

and deprivation category

Deprivation

category

All Male Female

n % n % n %

SIMD 1 47 0.22% 27 0.25% 20 0.19%

SIMD 2 31 0.13% 12 0.10% 19 0.17%

SIMD 3 11 0.08% 8 0.11% 3 0.04%

15-34 yrs SIMD 4 12 0.12% 7 0.13% 5 0.10%

SIMD 5 11 0.13% 8 0.18% 3 0.07%

All 15-34 yrs 113 0.14% 63 0.16% 50 0.13%

SIMD 1 1658 5.02% 921 5.52% 737 4.51%

SIMD 2 1583 4.14% 937 4.95% 646 3.35%

SIMD 3 990 3.73% 588 4.46% 402 3.01%

35-64 yrs SIMD 4 737 3.12% 464 3.96% 273 2.30%

SIMD 5 571 2.83% 361 3.63% 210 2.06%

All 35-64 yrs 5632 3.90% 3,329 4.63% 2,303 3.18%

SIMD 1 1102 14.39% 556 15.47% 546 13.44%

SIMD 2 1173 13.08% 623 15.12% 550 11.35%

SIMD 3 683 11.65% 401 14.61% 282 9.04%

65-74 yrs SIMD 4 571 10.03% 329 12.40% 242 7.97%

SIMD 5 402 9.31% 251 11.75% 151 6.92%

All 65-74 yrs 3983 12.07% 2,196 14.16% 1,787 10.22%

SIMD 1 828 13.56% 372 16.29% 456 11.93%

SIMD 2 889 11.78% 392 14.09% 497 10.43%

SIMD 3 559 11.55% 273 14.86% 286 9.53%

75+ yrs SIMD 4 436 9.50% 212 11.84% 224 8.01%

SIMD 5 286 9.04% 151 11.40% 135 7.34%

All 75+ yrs 3031 11.39% 1,419 13.97% 1,612 9.80%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing

51 of 59 local practices

Complete draft OPNA Page 91 of 131 20 February 2013


Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is now the preferred

term for the conditions in patients with airflow obstruction who

were previously diagnosed as having chronic bronchitis or

emphysema. The disease is almost always caused by smoking,

however, other factors - particularly occupational exposures - may

also contribute to the development of COPD. The airflow

obstruction is usually progressive, not fully reversible and does not

change markedly over several months. COPD becomes more

common with age, increasing to a peak among those aged 75 years

and over (Figure 75 and Table 43). The rate of admissions also

increased over the time period of 1997-2007.

Figure 75: Age-specific rate per 10,000 population of COPD

admissions by sex and age group for Ayrshire and Arran; for years

ending 31 March 1998 – 2007

900

800

700

600

500

400

300

200

100

-

Source: SMR 01

35-44 45-54 55-64 65-74 75-84 85+

1997/98 1998/99 1999/00 2000/01 2001/02

2002/03 2003/04 2004/05 2005/06 2006/07

Table 43: Number and percentages, at 1 Jan 2009, of patients in

Ayrshire and Arran with a history of COPD by age group and

deprivation category

Deprivation

category

All Male Female

n % n % n %

SIMD 1 7 0.03% 3 0.03% 4 0.04%

SIMD 2 6 0.03% 3 0.03% 3 0.03%

SIMD 3 3 0.02% 2 0.03% 1 0.01%

15-34 yrs SIMD 4 0 0.00% 0 0.00% 0 0.00%

SIMD 5 0 0.00% 0 0.00% 0 0.00%

All 15-34 yrs 17 0.02% 9 0.02% 8 0.02%

SIMD 1 1000 3.03% 456 2.73% 544 3.33%

SIMD 2 743 1.94% 329 1.74% 414 2.15%

SIMD 3 341 1.28% 177 1.34% 164 1.23%

35-64 yrs SIMD 4 202 0.86% 96 0.82% 106 0.89%

SIMD 5 135 0.67% 65 0.65% 70 0.69%

All 35-64 yrs 2466 1.71% 1,144 1.59% 1,322 1.82%

SIMD 1 925 12.08% 469 13.05% 456 11.22%

SIMD 2 814 9.08% 399 9.68% 415 8.57%

SIMD 3 420 7.16% 220 8.02% 200 6.41%

65-74 yrs SIMD 4 260 4.57% 127 4.79% 133 4.38%

SIMD 5 158 3.66% 80 3.74% 78 3.57%

All 65-74 yrs 2610 7.91% 1,316 8.49% 1,294 7.40%

SIMD 1 732 11.99% 311 13.62% 421 11.02%

SIMD 2 746 9.88% 322 11.57% 424 8.89%

SIMD 3 412 8.52% 193 10.51% 219 7.30%

75+ yrs SIMD 4 242 5.27% 127 7.09% 115 4.11%

SIMD 5 140 4.43% 72 5.43% 68 3.70%

All 75+ yrs 2294 8.62% 1,037 10.21% 1,257 7.64%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing

51 of 59 local practices

Complete draft OPNA Page 92 of 131 20 February 2013


Parkinson’s disease

Parkinson’s disease is a progressive neurological condition which

affects mobility through tremor, rigidity and slowness of

movement. It occurs mainly among older people 33, 34 .

Data collected from Ayrshire and Arran GP records for a local

neurology needs assessment 35 reflects this pattern with 790

patients aged 65 years and over recorded as having Parkinson’s

disease compared with 82 patients aged 40-64 years and two

patients aged 16-39 years per 100,000 population.

5.6 Sensory impairment

Patient records held within General Practice indicate that

prevalence of sensory impairment increases with age (Table 45).

Hearing impairment was identified as being more common among

older people than visual impairment, and more common among

older males than females. There was little difference in the

prevalence of visual impairment between older male and female

patients. Sensory impairment was also found to be more prevalent

among older patients in more deprived areas.

Table 44: Number and approximate rates per 100,000 population

of patients with Parkinson's disease in Ayrshire and Arran GP

practice survey by age, gender and location (June 2006)

n

Rate per 100,000 population

Population 16+ yrs 618 168

16 – 39 2 2

40 – 64 104 82

65+ 512 790

Male 350 249

Female 268 169

East Ayrshire 215 222

North Ayrshire 217 197

South Ayrshire 186 201

Source: All general practices in Ayrshire and Arran utilising GPASS, representing

52 of 60 local practices

Complete draft OPNA Page 93 of 131 20 February 2013


Table 45: Number and percentages, at 1 Jan 2009, of patients in Ayrshire and Arran with a history of hearing impairment or visual impairment by gender, age

group, and deprivation category

Age band

Female

Male

Deprivation

category Hearing impairment Visual impairment Hearing impairment Visual impairment

n % n % n % n %

SIMD 1 215 2.0% 22 0.2% 256 2.4% 21 0.2%

SIMD 2 196 1.7% 18 0.2% 240 2.0% 32 0.3%

15-34 yrs SIMD 3 84 1.2% 15 0.2% 133 1.8% 16 0.2%

SIMD 4 54 1.1% 7 0.1% 105 2.0% 11 0.2%

SIMD 5 49 1.2% 6 0.1% 89 2.0% 7 0.2%

All 15-34 yrs 609 1.6% 69 0.2% 836 2.1% 88 0.2%

SIMD 1 576 3.5% 71 0.4% 692 4.1% 96 0.6%

SIMD 2 520 2.7% 60 0.3% 653 3.5% 74 0.4%

35-64 yrs SIMD 3 304 2.3% 49 0.4% 420 3.2% 36 0.3%

SIMD 4 270 2.3% 20 0.2% 352 3.0% 39 0.3%

SIMD 5 221 2.2% 14 0.1% 332 3.3% 33 0.3%

All 35-64 yrs 1,915 2.6% 218 0.3% 2,488 3.5% 284 0.4%

SIMD 1 328 8.1% 59 1.5% 403 11.2% 58 1.6%

SIMD 2 290 6.0% 33 0.7% 419 10.2% 45 1.1%

65-74 yrs SIMD 3 173 5.5% 21 0.7% 263 9.6% 16 0.6%

SIMD 4 176 5.8% 21 0.7% 239 9.0% 18 0.7%

SIMD 5 112 5.1% 10 0.5% 177 8.3% 15 0.7%

All 65-74 yrs 1,089 6.2% 145 0.8% 1,517 9.8% 152 1.0%

SIMD 1 562 14.7% 160 4.2% 437 19.1% 83 3.6%

SIMD 2 618 13.0% 171 3.6% 475 17.1% 78 2.8%

75+ yrs SIMD 3 377 12.6% 102 3.4% 297 16.2% 54 2.9%

SIMD 4 351 12.5% 98 3.5% 311 17.4% 40 2.2%

SIMD 5 199 10.8% 40 2.2% 200 15.1% 38 2.9%

All 75+ yrs 2,119 12.9% 580 3.5% 1,731 17.0% 298 2.9%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing 51 of 59 local practices

Complete draft OPNA Page 94 of 131 20 February 2013


5.7 Oral health

Oral health is perceived to deteriorate with age, as can be observed in

Figure 76. However, this is not an unavoidable consequence of ageing

per se. The perception is the consequence of the cumulative effect of

longer exposure to risk factors throughout life. The two most

prevalent oral diseases, dental caries and periodontal disease, are

largely preventable, therefore strategies and action plans to improve

the oral health of older people and the oral care of older people need

to be underpinned by prevention.

Figure 76: Percentage with 20 or more natural teeth, and percentage

with no natural teeth, 2008, 2009, 2010, by age band

100

90

80

70

60

50

40

30

20

10

0

16-24 25-34 35-44 45-54 55-64 65-74 75+

Epidemiological trends in oral health have shown a great deal of

change over the 20 th century. The generations dominated by having

all their teeth extracted at a relatively young age are being replaced by

subsequent generations, born since the 1930s, retaining some of their

teeth but often experiencing high levels of decay, consequently

requiring a high level of maintenance. Changing trends are also

evident in children and younger adults, with reducing rates of dental

disease and restorations 36 but this will not impact on the older people

population for at least another 25 years or more. Prior to this cohort

reaching old age a generation with many teeth, many restorations and

high demands on the oral health care system will become old. This

shift in patterns of disease has a profound impact on the demand

placed on dental services but also on the types of dental treatment

required 37 .

2008 - 20 or more 2009r - 20 or more

2010 - 20 or more 2008 - No natural teeth

2009r - No natural teeth 2010 - No natural teeth

Source: SHeS

Complete draft OPNA Page 95 of 131 20 February 2013


Table 46: Number of natural teeth, and percentage with no natural teeth, 2008, 2009, 2010, by age and sex

All adults

2008

Age

16-24 25-34 35-44 45-54 55-64 65-74 75+

% % % % % % %

No natural teeth 0 1 2 5 15 33 51

Fewer than 10 - 1 2 4 10 13 13

Between 10 and 19 1 3 9 13 23 22 19

20 or more 99 96 88 78 52 32 17

2009r

No natural teeth 0 1 2 6 14 32 51

Fewer than 10 0 0 2 4 8 15 10

Between 10 and 19 1 4 8 15 22 21 19

20 or more 98 95 88 75 56 33 20

2010

No natural teeth 0 0 2 4 16 29 50

Fewer than 10 - 0 2 4 8 14 13

Between 10 and 19 1 2 8 14 23 20 19

20 or more 99 98 89 77 53 37 19

Bases (weighted):

All adults 2008 902 966 1179 1140 981 709 566

All adults 2009 1046 1134 1324 1347 1151 836 666

All adults 2010 1004 1114 1224 1309 1111 805 646

a The 2009 figures have been revised to correct an error in the weighting. They replace the original 2009 report figures. The impact of this revision is minimal.

Source: SHeS

Complete draft OPNA Page 96 of 131 20 February 2013


5.8 Sexual health and blood-borne viruses

Sexual health in older life

Sexual health has been defined as “the integration of somatic,

emotional, intellectual and social aspects of sexual being, in ways that

are positively enriching” (WHO 1975 – see Gott et al for ref) and as

such encompasses more than sexual intercourse and related infections.

While sexually transmitted infections tend to peak among people in

their 20s there are also a number of conditions related to sexual health

which increase with age such as erectile dysfunction among men

vaginal dryness among women.

Although sexual function tends to decline in older age it is a

misperception that sexual activity is solely the preserve of young

people. The second half of the 20 th Century witnessed significant social

changes in relation to sexual health and relationships such as more

open access to a wider range of contraceptive medicines and devices;

increased rates of divorce and remarriage; and civil partnerships and

open same-sex relationships, which are likely to have an impact on the

sexual health of older people. Societal perceptions of old age have also

changed with longer life expectancies and older people enjoying better

In addition better health outcomes and new types of medication such

as Viagra can be seen as a catalyst for changing perceptions of sexuality

in older life.

The increased diversity of sexual health behaviours into older age has

implications for how sexual health services will need to be delivered in

the future. There is some evidence that older patients and their GPs

have reservations about raising sexual health issues. There may also be

issues around awareness of sexual health issues among older people as

they have not traditionally been targeted by health promotion

campaigns.

Blood borne viruses

Whilst considerable attention is given to reducing the risk of long term

conditions such as cardiovascular disease and respiratory disease,

there is less of a focus on the impact of long term illness or disability

related to blood borne viruses such as hepatitis C virus (HCV) or Human

Immunodeficiency Virus (HIV).

Many of the older adults with chronic hepatitis C infection acquired the

disease in earlier life and as such there is a growing number of older

people now living with hepatitis C and HIV. Much of this is due to

improvements in screening, diagnosis and treatment over recent years,

which means that people with hepatitis C and HIV can now hope to live

into later life. An estimated 39,000 people are currently living in

Scotland with chronic (long-term) hepatitis C infection. At present, 50-

60% of people chronically infected with hepatitis C remain undiagnosed

(approximately 22,500). Of the 16,500 who are diagnosed, around 75%

are not currently in specialist care 38 . Chronically infected people are at

increased risk of serious liver disease and cancer. However, even with

improved diagnosis, treatment and care there is still a number of

patients presenting with complications of liver disease, mainly cirrhosis

and hepatocellular cancer and this number is likely to increase.

Nationally, a twofold increase in the annual number of diagnosed

persons developing end-stage liver disease has been observed between

1999 and 2009

Hepatitis C and HIV are now considered to be a long-term chronic

condition. As such, primary care services are an important part of the

care pathway for people living with these long term conditions and

Complete draft OPNA Page 97 of 131 20 February 2013


have an important role in monitoring and minimising co-morbidities of

HIV and its treatment. However, despite decreases in the incidence of

acute hepatitis C, the prevalence of long term chronic hepatitis C is

increasing among older adults. Therefore despite the improvements in

antiviral treatment for hepatitis C and HIV the future burden of HIV and

HCV related disease is likely to be substantial. All national data sources

(hospital admissions for HCV-related end-stage liver disease, liver

transplants and deaths) show that HCV-related liver disease is

continuing to rise. In England alone it is predicted that in 2020, 15,840

individuals will be living with HCV-related cirrhosis or hepatocellular

carcinoma (HCC).

5.9 Bone health

Fall related hospital discharges have been occurring frequently with a

gradual increase throughout the past decade. Figure 77 clearly shows

an ongoing rise in fall-related hospital discharges among older people,

particularly among females aged 75 years and over. A similar trend can

be seen when examining the crude rates per 100,000 population

suggesting that the increased number is not simply related to the aging

population and higher proportion of older females to older males.

Figure 77: The number of fall related hospital discharges by gender,

age group and year, 1997-2009, in Ayrshire and Arran

1,800

1,600

1,400

1,200

1,000

800

600

400

200

0

Source: SMR01

Figure 78: The crude rate per 100,000 population of fall related

hospital discharges by gender, age group and year, 1997-2009, in

Ayrshire and Arran

9,000

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0

35-44 45-54 55-64 65-74 75+ 35-44 45-54 55-64 65-74 75+

MALE

FEMALE

35-44 45-54 55-64 65-74 75+ 35-44 45-54 55-64 65-74 75+

1997

2000

2003

2006

2009

1997

2000

2003

2006

2009

MALE

FEMALE

Source: SMR01

Complete draft OPNA Page 98 of 131 20 February 2013


Fractures of the neck of femur have increased throughout the same

time period (Figures 79 and 80). The over 75 population have

contributed to 75% of the overall number of fractures of the neck of

femur within Ayrshire and Arran over the time period of 1997 to 2009.

The average length of stay in hospitals has also been observed to

increase with age (Table 47)

Figure 79: The number of fractures of the neck of femur as a result of a

fall by gender, age group and year (1997-2009) in Ayrshire and Arran

450

400

350

300

250

200

150

100

50

0

Source: SMR01

30-49 50-64 65-74 75+ 30-49 50-64 65-74 75+

MALE

FEMALE

1997

2000

2003

2006

2009

Figure 80: The crude rate per 100,000 population of fractures of the

neck of femur as a result of a fall by gender, age group and year (1997-

2009) in Ayrshire and Arran

2,500

2,000

1,500

1,000

500

0

Source: SMR01

30-49 50-64 65-74 75+ 30-49 50-64 65-74 75+

MALE

FEMALE

1997

2000

2003

2006

2009

Table 47: Average length of stay for fractures of the neck of femur by

age group in Ayrshire and Arran in 2009

Age Group Average Length of Stay (days) n

30 - 49 8 9

50 - 64 18 40

65 - 74 15 112

75 + 20 555

All ages 19 717

Source: SMR01

Complete draft OPNA Page 99 of 131 20 February 2013


5.10 Screening and immunisation

Breast screening uptake

In Scotland, women aged 50-64 years were invited for a routine screen

once every three years until 2003-04, when the age range for invitation

was extended to include women up to the age of 70 years. Women

over 70 years are still screened three yearly on request. The uptake

rate for breast screening services in Ayrshire and Arran has consistently

been within 1% of the Scottish average in recent years and consistently

halfway between the national minimum standard and target uptake

rates (Figure 81).

Figure 81: Breast screening uptake by NHS Board of Residence:

Scotland, 1st April 2004 to 31st March 2011; Percentage uptake (three

year rolling periods), females aged 50-70 years

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

2004-07 2005-08 2006-09 2007-10 2008-11

Bowel screening uptake

The Scottish Bowel Screening Programme commenced a phased roll

out in June 2007 and by December 2009 all NHS Boards in Scotland

were participating in the Programme. All men and women registered

with a Community Health Index (CHI) number and aged 50-74 years are

invited to participate and be screened every two years. The

programme has an uptake target of 60%.

Data for bowel screening invites issues between 1 st November 2008

and 31 st October 2010 indicates that 53.1 percent of invites were taken

up in Ayrshire and Arran 39 . This was lower than the programme target

but similar to the Scottish average (53.7 percent). Females had a

higher uptake rate than males and people living in less deprived areas

had a higher uptake than those living in more deprived areas.

Influenza immunisation uptake

In Scotland, a seasonal immunisation programme is available for those

most vulnerable to influenza complications. This includes people aged

65 and over as a priority group for vaccination. The national target for

vaccination uptake was 70% of priority groups until 2010/11 when it

was raised to 75%. The uptake rate in Ayrshire and Arran has exceeded

the national target every year since 2005/06, and has been within 2%

of the national average (Figure 82).

Ayrshire & Arran Scotland Target Min std

Source: Scottish Breast Screening Programme (SBSP) Information System - KC62

Returns

Complete draft OPNA Page 100 of 131 20 February 2013


Figure 82: Seasonal influenza immunisation uptake among people

aged over 65 years

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Source: NHS Ayrshire & Arran Immunisation Annual Report

5.11 Mental health and wellbeing

5.11.1 Mental wellbeing

Scotland Ayrshire & Arran Target

Positive mental wellbeing is now measured in the Scottish Health

Survey using the Warwick-Edinburgh Mental Wellbeing Scale

(WEMWBS) 40 . WEMWBS is a 14 item scale of mental well-being

covering subjective well-being and psychological functioning, in which

all items are worded positively and address aspects of positive mental

health. The scale is scored by summing responses to each item

answered on a 1 to 5 Likert scale. The minimum scale score is 14 and

the maximum is 70.

WEMWBS data can be analysed by grouping the survey population into

three groups:

1. those with relatively "good mental wellbeing" (a WEMWBS score of

over one standard deviation above the mean);

2. those with "average mental wellbeing" (a WEMWBS score of within

one standard deviation of the mean); and

3. those with relatively "poor mental wellbeing" (a WEMWBS score of

more than one standard deviation below the mean).

Figures 83 and 84 shows that while the younger age bands of older

people report higher mean WEMBS scores and higher proportion

classified and having “good wellbeing” than those aged 16-64 years,

the mean WEMWBS score decreases with subsequent increases in age

band and the proportion of older people classified as having “poor

wellbeing” increases to about 20% among those aged 80 years and

over.

Figure 83: Mean WEMWBS scores, 2008, 2009 and 2010 combined, by

age and sex; Scotland

52

51

50

49

48

47

46

16-64 65-69 70-74 75-79 80-84 85+

Men Women All adults

Source: SHeS

Complete draft OPNA Page 101 of 131 20 February 2013


Figure 84: Good average and poor WEMWBS scores, 2008, 2009 and

2010 combined, by age and sex; Scotland

100%

80%

15 11 13 15 19 18

2.98, respectively). Age was not significantly associated with the

outcome in men or women once other factors were included in the

model.

5.11.2 Mental health problems

60%

40%

20%

0%

72

69 67

72 67 70

13

20 20

13 15 12

16-64 65-69 70-74 75-79 80-84 85+

% Good wellbeing % Average wellbeing % Poor wellbeing

Disabilities and mental health problems in older adults

The World Health Organisation has estimated that, by 2020, depression

will have become the second largest cause of disabilty in the world

after cardiovascular disease. There is a large literature indicating that

women are twice as likely as men to experience depression, the risk of

all persons with a disability developing depression is higher than the

general population and the rate of depression in women with a

disability is higher than that for men with a disability 41 .

Source: SHeS

Logistic regression models that examined the association between

individual factors and mental wellbeing, found that marital status, the

presence of a limiting long-term condition, and reporting low physical

activity levels were each significantly associated with poor wellbeing.

Compared with married or cohabiting people, the odds ratios for poor

mental wellbeing were 2.22 for men who were single, separated or

divorced, 2.03 for widowers or surviving civil partners, and 1.47 for

widows or surviving civil partners. In women but not men, living in the

most deprived 15% of areas increased the odds of poor mental

wellbeing, but drinking above the weekly limit decreased the odds.

The odds of poor mental wellbeing were 4.16 times higher in men with

a limiting long-term condition than in men with no condition; the

equivalent odds ratio for women was 2.76. Men and women with low

physical activity levels also had higher odds of poor wellbeing than

those who met the activity recommendations (odds ratios of 3.32 and

Many older people have one or more long term conditions and a high

proportion also have ‘co-morbid mental health problems’ with

disproport-ionately higher rates amongst those living in deprived areas.

The combination of multiple long term conditions, mental health

problems and deprivation not only has a negative impact on the health

outcomes for the individual but contributes to maintaining inequalities

in health. The negative effect on health outcomes for individuals,

families and communities increases public sector expenditure in those

areas. The Kings Fund recommend closer integration of mental health

services and health and social care services 42 .

Negative mental health is measured in the Scottish Health Survey using

the General Health Questionnaire (GHQ12) scale. GHQ12 is designed

to detect possible psychiatric morbidity in the general population. The

questionnaire contains twelve questions about the informant’s general

Complete draft OPNA Page 102 of 131 20 February 2013


level of happiness, depression, anxiety and sleep disturbance over the

past four weeks. Responses to these items are scored, with one point

given each time a particular feeling or type of behaviour was reported

to have been experienced ‘more than usual’ or ‘much more than usual’

over the past few weeks. These scores are combined to create an

overall score of between zero and twelve. A score of four or more

(referred to as a ‘high’ GHQ12 score) has been used in this report to

indicate the presence of a possible psychiatric disorder 43 .

GHQ12 scores of 4 or more was higher in those aged 16-64 years

compared with adults 65 and over (13% vs. 9% for younger and older

men and 18% vs. 14% respectively for women) (Figure 85). There was

an increase in prevalence of GHQ12 scores of 4 or more with age for

women, from 11% of those aged 65-69 years to 21% of those aged 85

years and over, whereas the equivalent figures among men did not

vary by age. More women than men across all age groups had a

GHQ12 score of four or more. The prevalence of GHQ12 scores of 1-3

increased with age among both older men and women.

Figure 85: GHQ12 scores for men, 2008, 2009 and 2010 combined, by

age

100%

80%

60%

40%

20%

0%

Source: SHeS

13 9 9 9 10 10

18

23

23 25

34 29

64

73 69 67

56 61

16-64 65-69 70-74 75-79 80-84 85+

0 1-3 4 or more

Figure 86: GHQ12 scores for women, 2008, 2009 and 2010 combined,

by age

100%

80%

60%

18 11 13 16 16 21

21

25

26

29 32

39

40%

20%

58

69 61 55 52

40

0%

16-64 65-69 70-74 75-79 80-84 85+

Source: SHeS

0 1-3 4 or more

Complete draft OPNA Page 103 of 131 20 February 2013


5.11.2.1 Mental health problems commonly treated within

Primary Care

Common mental health problems such as depression and

stress/anxiety are regularly treated within the Primary Care setting.

Table 48 presents the percentage, at 1 st Jan 2009, of patients in

Ayrshire and Arran with a history of depression or stress/anxiety

appearing anywhere on the GP recording system. The highest

proportions of patients with history of a common mental health

problem are aged between 36-64 years, with a slight decrease among

older age bands. A higher proportion was observed among females

and patients living in more deprived areas.

Table 48: Percentage, at 1 Jan 2009, of patients in Ayrshire and Arran

with a history of depression or stress/anxiety by age group, sex and

deprivation category

Deprivation

category

Depression

Stress/anxiety

Male Female Male Female

SIMD 1 7.70% 16.10% 7.30% 11.40%

SIMD 2 5.80% 12.00% 5.30% 9.00%

15-34 yrs SIMD 3 3.90% 9.50% 3.60% 7.00%

SIMD 4 3.50% 7.10% 3.30% 6.20%

SIMD 5 2.60% 5.00% 2.50% 5.30%

All 15-34 yrs 5.30% 11.30% 4.90% 8.50%

SIMD 1 16.20% 28.30% 15.70% 26.80%

SIMD 2 11.50% 21.40% 11.50% 20.00%

35-64 yrs SIMD 3 9.20% 17.60% 9.60% 16.20%

SIMD 4 7.50% 13.80% 8.90% 14.30%

SIMD 5 6.40% 11.50% 7.60% 13.00%

All 35-64 yrs 10.70% 19.50% 11.10% 18.80%

SIMD 1 12.50% 21.80% 12.50% 21.40%

SIMD 2 10.10% 15.50% 9.90% 18.80%

65-74 yrs SIMD 3 8.20% 14.40% 8.50% 16.80%

SIMD 4 6.70% 10.70% 8.40% 12.80%

SIMD 5 6.50% 10.40% 7.30% 11.10%

All 65-74 yrs 9.20% 15.20% 9.60% 16.90%

SIMD 1 9.20% 16.90% 8.00% 16.80%

SIMD 2 6.20% 12.10% 6.50% 13.50%

75+ yrs SIMD 3 6.70% 12.10% 7.20% 12.20%

SIMD 4 5.80% 8.80% 5.90% 9.30%

SIMD 5 4.20% 7.90% 6.00% 7.60%

All 75+ yrs 6.60% 12.10% 6.80% 12.60%

Source: All general practices in Ayrshire and Arran utilising GPASS, representing 51 of

59 local practices

5.11.2.2 Inpatient mental health services

Similarly to the Primary Care data presented in the previous section,

the rate of mental illness discharge from psychiatric hospitals is highest

among persons aged 25-44 years (Figures 87 and 88). There is,

however, less of a reduction in the rates among older people, with the

rates for persons aged 75 years and over actually rises again. This is

largely a result of the inclusion of dementia discharges within this

dataset.

Complete draft OPNA Page 104 of 131 20 February 2013


Figure 87: All male mental illness discharges by age on discharge; rate

per 100,000 population; Scotland

1000

800

600

400

200

0

15-24 25-44 45-64 65-74 75 and

2006/07 2007/08 2008/09 2009/10 2010/11

Figures 89 and 90 present the percentages of mental illness speciality

discharges in Scottish hospitals, and Figures 91 and 92 present the

percentage of residents, by age and length of stay. The discharge data

can be seen to be skewed towards shorter lengths of stay, while the

resident data is skewed toward longer lengths of stay. This indicates

that there is a cohort of older people using inpatient mental health

services for a short length of stay but also a cohort of long-term

residents.

Tables 49 and 50 present mental illness discharges by main diagnosis.

Dementia can be seen here to be the most common diagnosis for

discharge among older people with mood (affective) disorders being

the second most common main diagnosis.

Source: SMR04

Figure 88: All female mental illness discharges by age on discharge;

rate per 100,000 population; Scotland

900

800

700

600

500

400

300

200

100

0

Source: SMR04

15-24 25-44 45-64 65-74 75 and

2006/07 2007/08 2008/09 2009/10 2010/11

Figure 89: Mental illness specialties in Scottish hospitals: percentage of

male discharges by age and length of stay: year ending 31 March 2011;

Scotland

Source: SMR04

Complete draft OPNA Page 105 of 131 20 February 2013

70

60

50

40

30

20

10

0

Under

4

weeks

4-7

weeks

8-25

weeks

26-51

weeks

12-23

months

2-4

years

5-9

years

10

years

All ages

65-74

75 and over


Figure 90: Mental illness specialties in Scottish hospitals: percentage of

female discharges by age and length of stay: year ending 31 March

2011

70

60

50

40

30

20

10

0

Under

4

weeks

4-7

weeks

8-25

weeks

26-51

weeks

12-23

months

2-4

years

5-9

years

10

years

All ages

65-74

75 and over

Figure 92: Mental illness specialties in Scottish hospitals: percentage of

female residents by age and length of stay: year ending 31 March 2011

25

20

15

10

5

0

All ages

65-74

75 and over

Source: SMR04

Figure 91: Mental illness specialties in Scottish hospitals: percentage of

male residents by age and length of stay: year ending 31 March 2011

25

20

15

All ages

65-74

75 and over

Source: SMR04

10

5

0

Under

4

weeks

4-7

weeks

8-25

weeks

26-51

weeks

12-23

months

2-4

years

5-9

years

10

years

Source: SMR04

Complete draft OPNA Page 106 of 131 20 February 2013


Table 49: Mental illness discharges of MALE patients by age and main

diagnosis on discharge; rate per 100,000 population: year ending 31

March 2011; Scotland

all

ages

25-44 45-64 65-74 75 and

over

All diagnoses 415.6 653.9 432.0 394.8 603.2

Dementia 50.9 0.4 12.5 144.0 419.6

Alcohol misuse 78.4 135.8 123.9 48.6 16.2

Drug misuse 23.8 64.9 7.1 0.5 0.5

Schizophrenia 77.9 167.1 83.6 22.7 12.8

Mood (affective)

86.0 120.1 113.2 104.9 72.3

disorders

Bipolar affective

27.8 41.8 42.6 24.1 9.5

disorder

Depressive episode 43.0 61.7 49.0 59.1 44.7

Recurrent depressive 8.9 8.1 12.9 15.9 14.7

disorder

Other psychotic

23.7 40.3 18.2 14.1 21.4

disorders

Disorders of childhood 1.9 2.2 * * *

Neurotic, stress-related 22.3 34.0 23.4 18.6 21.4

and somatoform

disorders

Personality disorders 9.8 23.6 6.7 3.6 *

Mental handicap 1.3 2.2 2.0 * *

Other conditions 39.7 63.2 41.1 37.7 37.6

Source: ISD Scotland SMR04

Table 50: Mental illness discharges of FEMALE patients by age and

main diagnosis on discharge; rate per 100,000 population: year ending

31 March 2011; Scotland

all

ages

25-44 45-64 65-74 75 and

over

All diagnoses 372.1 519.9 376.9 375.6 562.6

Dementia 50.5 * 8.7 101.7 340.7

Alcohol misuse 33.6 61.0 53.0 14.2 4.9

Drug misuse 10.5 27.3 4.4 * *

Schizophrenia 28.2 45.3 42.4 26.4 10.9

Mood (affective)

119.8 163.0 148.1 139.9 118.4

disorders

Bipolar affective disorder 37.7 53.1 58.2 43.0 16.8

Depressive episode 58.7 79.6 62.5 64.2 72.2

Recurrent depressive 15.5 19.3 19.7 25.2 20.8

disorder

Other psychotic

20.1 23.6 21.7 20.1 35.0

disorders

Disorders of childhood 0.9 1.3 * * *

Neurotic, stress-related 28.2 41.2 30.2 30.3 22.8

and somatoform

disorders

Personality disorders 39.2 92.9 25.8 5.5 2.0

Mental handicap 0.8 1.0 1.2 * *

Other conditions 40.3 62.9 40.7 35.5 26.7

Source: ISD Scotland SMR04

Complete draft OPNA Page 107 of 131 20 February 2013


Percentage of over 65 year olds

Percentage of all male and female

population

5.11.2.3 Dementia

The data for dementia relies on a diagnosis therefore it is assumed that

there are levels of undiagnosed dementia within the population.

Figure 93 provides data on the percentage of males and females over

the age of 65 with a diagnosis of dementia. The percentages for 2007 in

East, North and South Ayrshire compared to the projected levels in

2021 does not show a large increases however the numbers of people

over the age of 65 is increasing and therefore the numbers with

dementia will increase. The higher percentage of females with a

diagnosis of dementia compared to males may be because of the

higher proportion of older women than men over the age of 65. The

slight increase in the future for men may be that the proportion of

older men is also increasing in relation to improved life expectancy.

Figure 93: Ayrshire percentage of those over 65 with dementia, 2007 and

2021 in East, North and South

10

9

8

7

6

5

4

3

2

1

0

East Ayrshire North Ayrshire South Ayrshire

2007 Males 65+

2021 Males 65+

2007 Females 65+

2021 Females 65+

Figure 94 demonstrates this last point showing the percentage of

males and females with dementia in East, North and South Ayrshire

populations. Again the prevalence is fairly low with the trend increasing

between the two time periods. This may be explained by the projected

increases in the older population groups and reflects the gender

differences in life expectancy.

Figure 94: Percentage of all males and females with dementia, 2007

and 2021 in East, North and South Ayrshire

10

9

8

7

6

5

4

3

2

1

0

East Ayrshire North Ayrshire South Ayrshire

Source:http://alzheimers.org.uk/site/scripts/download_info.php?fileID=8

2007 All males

2021 All males

2007 All females

2021 All females

Source:http://alzheimers.org.uk/site/scripts/download_info.php?fileID=8

Complete draft OPNA Page 108 of 131 20 February 2013


Chapter 6: Use of health and social services

6.1 Primary care consultation rates in Scotland

Practice Team Information (www.isdscotland.org/pti) collects

information from a sample of Scottish general practices. The pyramids

below present data for male and female GP consultations in 2003-04

and 2010-11. The changes in this short period are small but the

patterns reflect the demographic changes that are occurring in Ayrshire

and Arran. There is a 1.8 percent increase in female consultations for

those aged over 75 years of age with less of an increase for males over

75 years at 1.5 percent.

Figure 95: Estimated number of consultations, with corresponding

rates per 1,000 for financial years 2003/04 by gender and age group

Figure 96: Estimated number of consultations, with corresponding

rates per 1,000 for financial years 2010/11; by gender and age group

75+

65-74

55-64

45-54

35-44

25-34

15-24

5-14

0-4

Males (%)

Females (%)

75+

65-74

55-64

45-54

35-44

25-34

15-24

5-14

0-4

18 16 14 12 10 8 6 4 2 0 2 4 6 8 10 12 14 16 18

Percentage of males and females consulting thier GP 2003-04

Males (%)

Females (%)

18 16 14 12 10 8 6 4 2 0 2 4 6 8 10 12 14 16 18

Percentage of males and females consulting their GP 2010-11

Source: www.isdscotland.org/pti)

Males over the age of 65 accounted for just under a quarter of all

consultations in 2003-04 to just over a quarter in 2010-11. Females

over 65 years old accounted for 23 percent of the consultations in

2003-04 increasing to 24.3 percent in 2010-11

Source: www.isdscotland.org/pti)

Complete draft OPNA Page 109 of 131 20 February 2013


6.2 Emergency hospital admissions

The rate of emergency hospital admissions among persons aged 65

years and over is significantly higher than for younger age groups

(Figure 97). Between 2006/07 and 2010/11 the emergency admission

rate among persons aged 65 years and over in Ayrshire and Arran has

been consistently above 25,000 per 100,000 population, while the rate

for younger age bands has been around 10,000 per 100,000 population

or less.

Figure 97: Admission rates per 100,000 population of all emergency

admissions for all Ayrshire & Arran residents by financial year and age

group

30,000

25,000

20,000

15,000

10,000

5,000

0

2006/07 2007/08 2008/09 2009/10 2010/11p

Source: ISD Scotland (SMR01)

Under 25 25 to 44 45 to 64 65 plus

There is a clear deprivation gradient to emergency admissions among

older people in Ayrshire and Arran (Figure 98). Between 2006/07 and

2010/11 the emergency admission rate in Ayrshire and Arran for

persons aged 65 years and over within the most deprived quintile has

been around 30,000 per 100,000 population, while the rate for those in

the least deprived quintile has been around 20,000 per 100,000

population. The rate of emergency admissions has steadily increased

during the study time period for all deprivation categories.

Figure 98: Admission rates per 100,000 population of all emergency

admissions for Ayrshire & Arran Residents aged 65 years and over by

financial year, age group, & deprivation category

35,000

33,000

31,000

29,000

27,000

25,000

23,000

21,000

19,000

17,000

15,000

Source: ISD Scotland (SMR01)

2006/07 2007/08 2008/09 2009/10 2010/11p

SIMD1 SIMD2 SIMD3

SIMD4 SIMD5 ALL

Complete draft OPNA Page 110 of 131 20 February 2013


6.2.1 Multiple emergency admissions

The rate of multiple emergency hospital admissions during one year is

also significantly higher among persons aged 65 years and over than for

younger age groups (Figure98).

Figure 99: Patient rates per 100,000 population for patients with 3+

emergency admissions for all Ayrshire & Arran residents by financial

year & age group

2500

2000

1500

Figure 100: Patient rates per 100,000 population for patients with one

or more emergency admissions per year for Ayrshire & Arran residents

aged 65 years and over by financial year

14000

12000

10000

8000

6000

4000

2000

0

2006/07 2007/08 2008/09 2009/10 2010/11p

1000

500

0

2006/07 2007/08 2008/09 2009/10 2010/11p

Source: ISD Scotland (SMR01)

Under 25 25 to 44 45 to 64 65 plus

Figure: 100 shows the patient rates per 100,000 population for patients

with one or more emergency admissions per year for Ayrshire & Arran

residents aged 65 years and over between 2006/07 and 2010/11.

Around 12,000 patients per 100,000 population had one emergency

admission per year during the time period, while about 3,500 patients

per 100,000 population had two emergency admissions and 2,000

patients per 100,000 population had three or more emergency

admissions.

Source: ISD Scotland (SMR01)

1 emergency admission 2 emergency admissions

3+ emergency admissions

Differences in emergency admission rates can again be observed when

looking at patients aged 65 years and over with three or more

admissions in one year (Figure 99). Between 2006/07 and 2010/11 the

patient rate per 100,000 population among the most deprived quintile

is roughly double the rate among the least deprived quintile.

Complete draft OPNA Page 111 of 131 20 February 2013


Figure 101: Patient rates per 100,000 population for patients with 3+

emergency admissions for Ayrshire & Arran residents aged 65 years

and over by financial year & all deprivation category

3000

Figure 102: Number of patients (65 years and over) at risk of

emergency admission to hospital in the following year; by risk category;

Ayrshire and Arran

30,000

28,136

2500

25,000

2000

1500

1000

500

0

2006/07 2007/08 2008/09 2009/10 2010/11p

20,000

15,000

10,000

5,000

0

18,956

9,788

5,276

2,951 1,617 854 420 139 13

SIMD 1 SIMD 2 SIMD 3

SIMD 4 SIMD 5 ALL

Source: ISD Scotland (SMR01)

6.2.2 Risk of emergency admission to hospital in the following year

Scottish Patients at Risk of Readmission and Admission (SPARRA) is an

algorithm developed by Information Services Division (ISD) to predict a

patient's risk of being admitted to hospital as an emergency in a

particular year. SPARRA scores can range from 1 to 99% for patients in

the cohort. Patients with a score of 50%, for example, are generally

said to have a 1 in 2 chance of being admitted to hospital in the

prediction year. Figure 102 presents the number of Ayrshire and Arran

patients aged 65 years and over at risk of emergency admission to

hospital in the following year by risk category.

Source: ISD Scotland (SPARRA)

A patient with a SPARRA score of under 10% is classed as being “low

risk”, while a score of over 30% is classed as being at “high risk” and a

score over 90% is classed as “very high risk”. From Figure 102 it can be

seen that the proportion of SPARRA cohort patients is broadly similar

for each risk category at national, health board and CHP area level.

Among the three CHP areas, the highest proportion of patients classed

as being at “high risk” was in East Ayrshire, which was 1% higher than

the Ayrshire and Arran proportion and 2% higher than the national

proportion.

Complete draft OPNA Page 112 of 131 20 February 2013


Figure 103: Percentage of patients (65 years and over) at risk of

emergency admission to hospital in the following year; by risk category;

Ayrshire and Arran

50

45

40

35

30

25

20

15

10

5

0

SCOTLAND

Source: ISD Scotland (SPARRA)

NHS AYRSHIRE

& ARRAN

EAST AYRSHIRE

CHP

NORTH

AYRSHIRE CHP

0-10% 10-20% 20-30% 30-40% 40-50%

SOUTH

AYRSHIRE CHP

50-60% 60-70% 70-80% 80-90% 90% &Over

Figure 104: Percentage of patients (65 years and over) classed as being

at “high risk” of emergency admission to hospital in the following year;

by health board and CHP area

18

17

16

15

14

13

12

11

10

SCOTLAND

NHS

AYRSHIRE &

ARRAN

Source: ISD Scotland (SPARRA)

EAST

AYRSHIRE

CHP

NORTH

AYRSHIRE

CHP

SOUTH

AYRSHIRE

CHP

Complete draft OPNA Page 113 of 131 20 February 2013


6.3 Older adults with high support needs

A recent paper from the Joseph Rowntree Foundation 16 provides an

overview on the demographic issues related to older adults with high

support needs. The intention of the paper is to stimulate and inform

thinking on a better life for older people. It indicates that the

population over the age of 85 (termed the ‘oldest old’) is the fastest

growing age group in the UK. The gender differences become more

defined with adults aged over 90 (termed the ‘very old’) women out

number men by 3:1 and this ratio rises in centenarians to 6.5:1. The

paper highlights the fact that the prevalence of disability rises with age

and is most evident after the age of 74. For example, the prevalence of

severe disability is below 5 percent in those aged under 55 years and is

40 percent in those aged 85 years and over. However not all of the

oldest old have high support needs and other age groups have to be

considered.

6.3.1 Supply and demand of informal care

The population projections of supply and demand to 2041 show that

there are more care-receivers than care-providers in all years and this

has consequences for increasing demands on services 44 .

Responses to the demographic change are complex. For example,

encouraging women to train in order to provide formalised health and

social care will affect the total fertility rate unless policies are

developed to ensure that families can balance work and private life.

6.3.2 Older adults with learning disability

The life expectancy of adults with learning disabilities is increasing and

parents often being the primary carers are aging too. There is evidence

to show that adults with Down’s syndrome have a four times higher

risk of dementia compared to the general population. It is estimated

that over 33 percent of people with Down’s syndrome aged 50 to 59

and over 50 percent aged 60 to 69 will have dementia. It is

recommended that improvements in data relating to older people with

learning disabilities are required in order to meet future needs 16 .

NHS Ayrshire & Arran has worked systematically to ensure that people

with learning disabilities are provided with an annual health check with

their GP and a register has been developed in order to implement this.

The Public Health department has developed a Health Improvement

Plan with an extensive programme of work for people with learning

disabilities. A dementia pathway for adults with learning disabilities has

been developed in Ayrshire & Arran.

6.3.3 Potential supply and demand for informal care

Figures 105, 106, 107 and 108 present a potential care-recipient /careprovider

scenarios where it projects that supply could outstrip demand

in the future. Research shows that family members provide informal

care and the current demographic challenge is difficult to mitigate.

These are merely scenarios of the projected potential supply and

demand of informal care based on crude assumptions that everyone

over 75 would need care and that those aged 50 to 64 would be the

providers. It does however give an indication of the likely deficit of

informal care as a result of the population ageing.

Complete draft OPNA Page 114 of 131 20 February 2013


Population (000s)

Population

Population (000s)

Whilst increasing the female working population with the pension

reforms and increasing the retirement age to 66 has a positive effect

on the dependency ratio, research in England suggests that the greater

reliance on women in the provision of informal care means that this

may create a different problem 44 . As the number of older people

increases the demand for informal care will increase, women will be

working for longer therefore the availability of informal care could

potentially reduce.

Figure 105: Projected potential informal care to older people by people

aged 50 – 64

100,000

90,000

80,000

70,000

60,000

50,000

40,000

30,000

20,000

10,000

0

2010 2015 2020 2025 2030 2035

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

50-64

75+

Figure 106: Projected potential informal care to older adults by people aged

50- 64 in East Ayrshire

30

25

20

15

10

5

0

2010 2015 2020 2025 2030 2035

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Figure 107: Projected potential informal care to older adults by people

aged 50- 64 in North Ayrshire

35

30

25

20

15

10

5

0

2010 2015 2020 2025 2030 2035

50-64

75+

50-64

75+

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

Complete draft OPNA Page 115 of 131 20 February 2013


Population (000s)

Figure 108: Projected potential informal care to older adults by people

aged 50- 64 in South Ayrshire

30

25

20

15

10

5

0

Source: http://www.groscotland.gov.uk/statistics/theme/population/projections/index.html

6.4 Carers

2010 2015 2020 2025 2030 2035

The 2001 Census revealed that carers are often at greater risk of

suffering from ill health, poverty and discrimination. In particular,

carers who provide high levels of unpaid care for sick or disabled

relatives and friends are more than twice as likely to suffer from poor

health compared to people without caring responsibilities.

What is more, older people who take on carer responsibilities are far

more likely to develop health problems than other people in their same

age group.

Research undertaken by Carers UK 45 indicated that the causes of

carers’ poor physical and mental health are due to:

50-64

75+

a lack of information, lack of support – either through the right kind

or the right amount;

worry about finances and the general stresses and strains of caring

full-time with everyday life;

isolation

Carers Scotland 46 reported that there are “many costs associated with

poor health in carers”, such as:

Direct costs in treating the carer’s own health problems;

Potential costs that would result if the carer is less able to care

because of ill-health;

Indirect costs associated with carers being unable to work whilst

caring or after their caring role has ended because of ill health.

Table 51 draws on data from the Scottish Household Survey (SHS)

(2009) to show the estimated number of households that contain at

someone who needs regular help and care across Ayrshire and Arran.

Table 51: Estimates of households with someone requiring regular

help and care and carers

East North South Total

Ayrshire Ayrshire Ayrshire

Total Number of Households 53,722 62,006 51,526 167,254

Households with someone who

needs regular help and care (%)

Households with someone who

needs regular help and care

(estimated number)

Compared to national average

(13%)

Source – SHS 2009

17% 14% 13% 15%

9,133 8,681 6,698 24,512

↑ ↑ ↔ ↑

Complete draft OPNA Page 116 of 131 20 February 2013


The proportion of households in South Ayrshire with someone who

needs regular help and care is around the same as the national

average, with higher proportions of these households in East Ayrshire

and North Ayrshire.

The SHS (2009) suggests that in relation to ‘single pensioner

households’ around a quarter of ‘single pensioner’ households require

regular help and care across Ayrshire (East Ayrshire – 25%; North

Ayrshire - 24%; and South Ayrshire - 23%).

In relation to ‘older smaller’ households, there is a bit more variation

across Ayrshire and Arran with 32% of older smaller households in East

Ayrshire requiring help and care, 22% of these households in North

Ayrshire and 17% of these households in South Ayrshire.

Table 51 draws on data from the SHS (2009) to provide estimates on

households that require care. Just fewer than 25,000 people across

Ayrshire and Arran provide some sort of unpaid care, with each area

having a higher proportion of unpaid carers than the national average.

Around two thirds of those unpaid carers provide care to someone

outwith their household. Proportionally, this is highest in East Ayrshire

and lowest in North Ayrshire. Just under a third of those unpaid carers

provide care to someone within their household. Proportionally, this is

highest in North Ayrshire. A small proportion – around 5% of the

unpaid carers, have a double burden of care – caring for both someone

within and outwith their household.

Table 52: Profile of unpaid carers in Ayrshire and Arran

East

Ayrshire

North

Ayrshire

South

Ayrshire

Ayrshire

and Arran

Someone in the

15.0% 13.2% 14.0% 14.02%

household provides

unpaid care (% of all

households)

Someone in the

8,058 8,185 7,214 23,457

household provides

unpaid care (estimate)

Compared to national

average (12.5%)

↑ ↑ ↑ ↑

Someone in the

household provides

unpaid care outside the

household (%)

Someone in the

household provide

unpaid care outside the

household (estimate)

Compared to national

average (8.9%)

Someone in the

household provides

unpaid care within the

household (%)

Someone in the

household provides

unpaid care within the

household (estimate)

Compared to national

average (3.1%)

10.2% 7.6% 9.1% 8.90%

5,480 4,712 4,689 14,881

↑ ↓ ↑ ↑

3.9% 5.2% 3.8% 4.35%

2,095 3,224 1,958 7,277

↑ ↑ ↑ ↑

Complete draft OPNA Page 117 of 131 20 February 2013


Someone in the

household provides

unpaid care both within

and outside the

household (%)

Someone in the

household provides

unpaid care both within

and outside the

household (estimate)

Compared to national

average (0.5%)

Source SHS 2009 Table 10

6.5 Palliative care and end of life care

0.9% 0.4% 1.1% 0.78%

483 248 567 1,298

↑ ↓ ↑ ↑

The pattern of death in the UK has changed dramatically in the past

100 years. At the end of the 19th century 85 percent of people died at

home, the majority from acute infections. Today 58 percent of the

500,000 deaths each year occur in hospital, mainly from chronic longterm

conditions. Long-term projections by Gomes and Higginson 47

suggest that if current trends continue unchecked, fewer than one in

10 people will die at home by 2030 while deaths in institutions will rise

by over 20 percent. Projections also show that although annual

numbers of deaths fell by 8 percent from 1974 to 2003, they are

expected to rise by 17 percent from 2012 to 2030. People will die

increasingly at older ages, with the percentage of deaths among those

aged 85 and expected to rise from 32 percent in 2003 to 44 percent in

2030 47 .

An NHS Confederation survey suggests 56 per cent of terminally ill

people would prefer to die at home. But only 18 percent achieve this,

with 58 percent dying in hospitals, 17 percent in care homes and 4

percent in hospices. According to the Healthcare Commission more

than half the complaints about hospital care between July 2004 and

2006 related to end-of-life treatment. There is also often poor coordination

between the different services involved in delivering

treatment.

Improving ‘active ageing’ and supporting older people to live in their

own homes independently, reduce isolation and address end of life

care are all important and should be considered when planning and

developing services. The main ways in which this will be achieved are

through improved community services, rapid response nursing teams,

developing specialist palliative outreach services, introducing quality

standards against which PCTs and providers’ performance can be

measured, and giving a more central role to carers. There will be a

new focus on improving the skills of the vast number of generalist staff

who are involved in end-of-life care but have little formal training.

Complete draft OPNA Page 118 of 131 20 February 2013


6.5.1 Choosing place of death/spending last months at home

6.6 Polypharmacy - pharmacy needs of older people

One of the aspirations set out in the reshaping care agenda is to allow

people to remain in their own homes. One of the clearest indications of

how close we are to achieving this aspiration is the proportion of

households able to spend the last six months of life at home or in a

community setting.

Figure 109 shows the proportion of people spending the last six

months of their lives at home or in a community setting. It reveals that

South Ayrshire has the highest proportion of people spending their last

six months at home, but this has decreased since 2007/08. Figures

have increased in both East and North Ayrshire over the past few years.

Figure 109: Percentage of people spending last 6 months of life spent

at home or in a community setting

%

92.0

91.5

91.0

90.5

90.0

89.5

89.0

88.5

On average older people are prescribed more drugs than other age

group within the population. It is estimated that four out of five people

over the age of 75 take prescription medicine that 36 percent are

prescribed four or more medicines, 50 percent of drugs are not taken

as prescribed, many drugs prescribed can cause adverse drug reactions

(ADRs) and this is implicated in 5 to 17 percent of hospital

admissions 48 .

Patients on multiple medicines are at an increased risk of experiencing

drug side effects, this can be related to the number of health

conditions they have. However, admission patterns show that patients

admitted with one drug side effect are more than twice as likely to be

admitted with another 48.

One study in two large general hospitals in Merseyside of 18,820

patients over the age of 16 found that 1,225 (prevalence of 6.5%) with

the ADR leading to the admission of 80 percent of cases. The median

stay in hospital was eight days and this was estimated to account for

four percent of bed capacity. The projected annual cost, to the NHS, of

admissions due to ADRs was £466m (in 2004) and the authors

concluded that most admissions were avoidable 49

The risk of ADRs is higher in frail older people and interactions can

88.0

occur with a very wide range of drugs, which can aggravate side effects

87.5

that are disabling, such as confusion, falls and forgetfulness thus

2005/06 2006/07 2007/08 2008/09 2009/10

increasing contact with health services and the likelihood of

East Ayrshire North Ayrshire South Ayrshire Scotland hospitalisation. Frail older people who experience cognitive decline

and/or those with dementia are likely to have more impact on health

services due to non-adherence to their medication and are at an

Source: Health and Social Care Data - Tab 5

increased risk of hospitalisation 49 .

Complete draft OPNA Page 119 of 131 20 February 2013


Older people should not be denied medication that can benefit them

however, when medication presents risks that can be harmful a review

is required. NHS Grampian has set out a framework with guidance for

reducing polypharmacy, this estimates that 72 percent of all ADRs are

avoidable. The benefit:harm ratio needs to be applied in regular

reviews of medication to minimise drug related complications to older

people. There is also evidence to show that de-prescribing (reducing)

medication in certain cases has little harmful effects. This is highly likely

to reduce the costs to the NHS and improve quality of life for the

patient 50 .

Chapter 7: Equity and healthy ageing

This chapter refers to a number of issues impacting on the health and

social care needs of older people, where only limited local data are

available. These include poverty and social exclusion, multiple

deprivation, gender, ethnicity and health inequalities.

The future population of older adults is not heterogeneous and is likely,

with the ‘baby boomer’ cohort currently coming up to retirement, to

be more diverse than in the past. The needs of older people from

different equality groups will require flexible and sensitive services.

Service providers need to avoid stereotyping of older people and

recognise that the diversity of the ageing population has to be

considered equally to the rest of the population with equal access,

socially, economically and politically, to available resources and

services will assist maximising social inclusion 51, 52 .

Age discrimination in service provision can stem from assumption

about older people being dependent and/or in ill health. Older adults

are often not considered in mainstream national and local policies

7.1 Poverty, social exclusion and multiple deprivation

Old age and poverty are not synonymous. However, there are

arguments that future cohorts of older people, the ‘baby boomers’,

have high current credit debt that may indicate many will be much

poorer than they had expected. Changes now with the Welfare Reform

Act will also have an impact on the pensions of future generations.

Economic disadvantage in old age is known to be associated with

poorer health 53 .

Complete draft OPNA Page 120 of 131 20 February 2013


Relative poverty 1 is often applied as a one dimensional monetary

indicator relating to 60 percent of the median income. Relative

poverty limits full participation in the social, economic, political and

cultural activities that allow individuals to be socially integrated into

society. Relative poverty also brings high costs to society and, in the

context of the social exclusion of older adults, it has the potential to

increase demands on health and social care services and also stifle

economic 54 . Relative poverty can significantly reduce an older person’s

ability to remain independent and in their own home.

Although pensioner poverty has declined in Scotland over the last ten

years 55 there are specific groups within society that are more

vulnerable to poverty and/or social exclusion. The small proportion of

some equality groups in the Ayrshire and Arran population such as

ethnic minorities which forms less than one percent overall adds to the

difficulty of assessing local needs to tailor services. Similarly, lesbian

and gay older people at 5 to 7% of the total population 56 are likely to

be a more hidden population but with a higher potential of lower care

and support from family than the general population 57 . It is noted that

LGBT older people are an under researched group and that service

responses tend to focus on ‘health risks and psychological problems’

rather than on what contributes to this groups wellbeing and quality of

life 52 .

However, where national data are available and reliable, the patterns

of inequality nationally are likely to be reflected at the local level for

these groups.

Currently the most common method of assessing inequality in Scotland

is geographically - based on the Scottish Index of Multiple Deprivation.

Data from the SIMD indicates multiple deprivation, where the health

and wellbeing of communities are being affected by many social and

economic factors. It is possible to estimate the number of older adults

living in the most deprived areas compared to the number living in the

least deprived areas (see Figures 22 to 25). However, this method

‘masks’ the profile and needs of other equality groups apart from

geographic communities, making any focus and targeting of resources

to increase equality and reduce inequality within those geographies

difficult.

Figure 110 shows that the percentage of the Scottish population

experiencing relative poverty is more concentrated in the 15% most

deprived areas compared to those in the 85% least deprived areas.

These data will include older adults. It shows that the gap has

decreased in 2009/10 compared to the preceding year.

1 People are said to be living in relative poverty if their income and resources are so

inadequate as to preclude them from having a standard of living considered

acceptable in the society in which they live. Because of their poverty they may

experience multiple disadvantage through unemployment, low income, poor housing,

inadequate health care and barriers to lifelong learning, culture, sport and recreation.

They are often excluded and marginalised from participating in activities (economic,

social and cultural) that are the norm for other people and their access to

fundamental rights may be restricted (European Commission, Joint Report on Social

Inclusion 2004).

Complete draft OPNA Page 121 of 131 20 February 2013


percentage

Figure 110: Proportion of individuals in relative poverty before housing

costs by area of residence: Scotland 2008/09 to 2009/10

40

30

20

10

0

33

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Social-

Welfare/IncomePoverty

7.2 Impact of health inequalities

There are strong links between poverty and poor health, with

individuals who experience poverty and low incomes having poorer

mental and physical health and wellbeing than those with higher

incomes.

The top four priorities in NHS Ayrshire & Arran for improving

population health are alcohol, tobacco, obesity and mental health

(ATOM), all of which are risk factors for common diseases and

premature death. Individuals, groups and communities living within

29

15 15

% %

2008/09 2009/10

15% most deprived datazones Rest of Scotland

areas of multiple deprivation experience poorer health across the

broad spectrum of health priorities and this has implications for the

ageing population.

Health inequalities i.e. the gap between those living in the most and

least geographically defined areas of deprivation, are outlined below by

comparing the rates of ill health and premature mortality between

those areas at the Scotland level.

7.2.1 Healthy life expectancy

Healthy Life Expectancy (HLE) at the national level in the most deprived

decile was 22.5 years lower for males and 22.1 years lower for females

than the HLE of those living in the least deprived decile 58 .

7.2.2 Premature mortality

Premature mortality from all causes for those aged under 75 years is

3.4 times higher in the most deprived decile compared to the least

deprived decile 58 .

7.2.3 First hospital admission for coronary heart disease

The rate of first ever hospital admission for coronary heart disease is

two and half times higher in the most deprived areas compared to the

least deprived areas. This indicates higher service demand from those

living in the most deprived areas compounded by the earlier onset of

long term conditions and has implications for the increase of services in

these older adults 58 .

Complete draft OPNA Page 122 of 131 20 February 2013


7.2.4 Cancer incidence and mortality

The incidence of cancer is more common in deprived areas than in less

deprived areas in Scotland. People aged 45 to 74 years living in the

most deprived areas are more than twice as likely to die of cancer than

those in the least deprived areas 58 .

7.2.5 First hospital admission for alcohol and alcohol mortality

The rate of first ever admission to hospital for alcohol for people aged

45 to 74 years is significantly higher in the most deprived areas

compared to the least deprived areas: 464 per 100,000 population

compared to 96 per 100,000 population in areas of low deprivation.

The overall mortality rate in this age group in the most deprived areas

is ten times higher than in areas of low deprivation 58 .

7.2.6 Mental wellbeing

The mean WEMWEBS score for those in the most deprived decile was

3.8 points lower than the least deprived decile in 2009 (Scotland). The

absolute inequality has increased with the mean score in 2011 for the

most deprived decile at 5.0 points 58 .

7.2.7 Incidence and mortality of falls amongst older people

A large research study conducted to quantify the incidence and

mortality of falls in primary care in the UK found that these are

associated with relative deprivation and increased mortality. Women in

the older age groups and from the least advantaged social groups had a

higher incidence of falls and recurrent falls 59 . This type of information

should inform targeting of interventions locally.

7.3 Ethnic background and equality

People from minority ethnic groups experience specific difficulties in

accessing services in general with language as a barrier, stigma, lack of

confidence in one’s rights, low expectations of services and lack of

appropriate service provision. This is particularly difficult for those with

high support needs - for example, having dementia when English is not

a first language 57 .

Specific services for older people from ethnic minorities can be

welcomed. There was high satisfaction with exercise classes for falls

prevention by many ethnic minority groups because it involved social

contact. Classes run in ethnic minority languages demonstrated

inclusion of the whole community. It was noted that respect for

cultural and religious beliefs were important to older adults from

ethnic minority groups who may prefer gender segregated classes 52 .

Older people from minority ethnic communities have often had breaks

in their work histories usually due to the immigration process and this

means that their pension may be at a reduced level. This group are also

disproportionately over-represented in more deprived communities

have relatively poorer health and more long term conditions. Figure

112 shows that percentage of each ethnic group in relative poverty is

higher than the percentage of white – British in relative poverty.

Research has shown that around 30 to 40 percent of older people from

minority ethnic groups entitled to Pension Credits do not claim them

and that a high number do not claim pensions and other benefits. A

range of issues have been identified as barriers to claiming benefits and

pension such as language and lack of culturally specific services

together with educational, attitudinal and cultural issues 60 .

Complete draft OPNA Page 123 of 131 20 February 2013


Percentage

Percentage

Figure 112: Percentage of people in relative poverty (before housing

costs) by ethnic group: Scotland 2007/08 to 2010/11

40

35

30

25

20

15

10

5

0

16 17

White - British White - Other

37

Asian / Asian

British

29

32

Mixed, Black / Total Minority

Black Ethnic

British, Chinese

& Other

women than men being poorer in old age 61 . More women than men

live into old age and are more likely to be affected by poverty and

social isolation 54 . Figure 111 shows the inequality between male and

female single pensioners without children with a higher percentage of

women in relative poverty. However this could change with future

cohorts of older people as the recent recessions have adversely

affected male employment compared to female employment and it is

likely to impact men’s pensions 62 .

Figure 111: Percentage of adults in relative poverty (before housing

costs) by gender and by single-adult household composition, Scotland

2010/11

25

20

15

Adult Males

Adult Females

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Social-

Welfare/IncomePoverty

There is currently a lack of data about the number of older people from

minority ethnic groups within Ayrshire and Arran. The 2010 Census

should provide improvements to information in this area.

7.4 Gender inequality

Until recently, male employment rates have been higher than female

employment rates. Many women have experienced breaks in their

working lives to have children and many have had part-time and/or low

paid work with reduced pensions. This results in a higher proportion of

10

5

0

15

15

All adults

Source: www.scotland.gov.uk/Topics/Statistics/Browse/Social-

Welfare/IncomePoverty

17

Single pensioners

without children

19 20 19

Single working age

adults without children

Complete draft OPNA Page 124 of 131 20 February 2013


Access to services also demonstrates gender differences with more

women than men accepting and using befriending services and

handyman services, particularly older women living on their own.

Women are higher users of day care services and one explanation is

that they live longer and have a higher prevalence of long term

conditions. Men do not necessarily want to socialise with other men as

it was found that they often prefer the company of women 52 .

7.5 Rural inequality

Scottish projections show that there will be a higher percentage (21%)

of people aged over 60 living in rural areas compared to the

percentage (17%) living in urban areas 1 . Rural populations are ageing

and rural local authorities in Scotland tend to see in-migration of older

people and out-migration of younger people 63 . This has implications for

the dependency ratio and reduces the potential of informal family care.

Rural living therefore adds complexity and involves higher costs to

meet health and social care demand of older adults.

For older adults living in rural areas, that have experienced a reduction

in local post offices and shops as well as public transport, it can be

difficult to keep engaged with the community and social isolation can

affect independence and quality of life. The risk of social isolation on

mortality has been compared to risk factors such as smoking. It has also

been stated that it can increase the risk of falls and other injuries 64 .

7.6 Expenditure poor older adults

Research by the DWP has found that older pensioners spend a much

smaller proportion of their income than younger pensioners and the

general population. As well as spending less in general they were

spending lower absolute amounts on consumables including food.

Explanations given for these findings include that they were trying to

build up savings, a lack of mobility and exclusion from social relations.

Common factors identified in the research of low expenditure

households were that they were less likely to be headed by a woman,

less ikely to be a couple, more likely to own their home outright and

less likely to have built up savings before retirement. Those in receipt

of Disability Living Allowance and Attendance Allowance were more

likely to be low spenders than those not in receipt of these benefits 65 .

This has implications for older people both in terms of managing

budgets and in terms of ensuring adequate heating and nutrition to

maintain good health, independence and ability to stay in their own

home.

7.7 Sensory impairment and older adults

It is estimated that one in seven people in Scotland are affected by

hearing loss, that 4.3 percent of the population are partially sighted

and four people in every 10,000 are deafblind. The incidence of hearing

and sight loss increases with age. Of those registered as visually or

hearing impaired, 76% are aged over 65 years and and 65% are aged

over 75 years old. With the ageing population, it is estimated that the

incidence of sensory impairment will increase by 15 percent over the

next decade. Sensory impairment, particularly dual sensory impairment

(combined hearing and sight impairment), presents problems for the

individual as well as service providers. With older adults, it can result in

reduced mobility, social withdrawal, isolation, mental health problems,

increased falls, sleep disturbance with potential for confusion and

disorientation 66 . These factors will affect the older person’s

independence and ability to remain in their own home.

Complete draft OPNA Page 125 of 131 20 February 2013


It is reported that older people who are disabled, in ill health and/or

housebound, have a hearing and/or sight impairment feel less

connected to information networks that assist with access to services

than older people who are not. A proactive approach by services to

include these older people is recommended 67 .

7.8 Early intervention and prevention

Prevention resources are a key driver within older people’s policy

development and are needed in order to reduce demand and relieve

future pressures. Public health interventions earlier in life will go

towards mitigating the future pressures on the health and social care

system. Keeping people well across the life course will be imperative

and interventions appropriate to the older population need to be

researched and developed to ensure this is achieved to a greater rather

than a lesser degree.

Many of the lifestyle issues affecting older people have the same social

gradient as in all other age bands. Inequalities affect individuals across

their lives and policies need to tackle inequalities through targeting

those with most needs.

Increasing the number of people with better lifestyles is crucial for the

longer-term health of older people; evidence shows that lifestyle

behaviour change at any life stage and age can be of benefit to health

status. However, it is the risk-taking behaviours, such as smoking and

alcohol misuse in young and middle adulthood that have a negative

effect in later life. Public health interventions, such as smoking

cessation and alcohol brief interventions early in life, combined with

appropriate interventions in later life will increase the chances of a

longer, healthier and more independent old age. Active ageing is about

encouraging healthy ageing, social inclusion and independent living 68 .

If inequalities accumulate over the life course and into old age then

policies across all areas, such as education, employment and health are

required to address them. Life expectancy is increasing each year, but

policies to increase healthy life expectancy for children, adults and

older people need to be in place to allow older people to live well, have

an improved quality of life and be valued by society.

It is argued that the combined impact of the Welfare Reform Bill and

tightening of public sector expenditure will have a disproportionately

negative effect on older people and in particular older women many of

whom already live in poverty. The Welfare Reform Bill involves a new

assessment processes for disability related benefits, reductions in

monetary levels awarded may lead to an increase in poverty and this

will impact on health.

Cuts to public services, health, social care, transport, rights and advice

services will have a significant impact on poorer older women. It is

reported nationally that the poorest older women are finding it difficult

to meet the cost of food and fuel that have risen more quickly than

inflation 69 .

Complete draft OPNA Page 126 of 131 20 February 2013


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