Older People

The Somerset Intelligence website contains a wealth of information relating to older people in the county. Collectively, this forms a major element to the Somerset Joint Strategic Needs Assessment (JSNA), the evidence base for those involved in running or commissioning services for people in the county. In 2016/17, the JSNA will focus on Ageing Well. Consequently, this section will be developed further in the coming months.

Public Health England (PHE) have published Older Peoples Health and Wellbeing profiles for Somerset and other local authorities and CCGs. These incorporate a range of indicators relating to themes such as deaths, hospital stays, life expectancy, social care and sensory impairment.

Key Issues 

Ageing Population

• An estimated 125,000 people aged 65 or older live in Somerset (2014 Mid-Year Estimates).
• Between 1984 and 2014, the number of people aged 85 or older has increased by 170% to an estimated 18,100.
• The number of people aged 75 or more is projected to double in the next two decades.The fastest-growing group are men aged 80 or more.
• In parts of West Somerset and Burnham-on-Sea, more than half of the population is projected to be aged 65 or older by 2033
• Life expectancy is at an all-time high. Those aged 65+ can expect to live for another twenty years, but barely half of this will be disability-free.
• Many people post-retirement are often very active in their community and provide a valuable resource for action. However, we must acknowledge the challenges Somerset’s ageing population will present for health, social care and housing providers.
• For more information, see Population Estimates and projections.

Dementia

• An estimated 9,000 people in Somerset have dementia, and many more are carers for those with dementia.
• Healthier lifestyles can reduce the risk of developing dementia, particularly vascular dementia, which is linked to the circulatory system therefore also potentially reducing the risk of developing cardiovascular disease.
• For more information, see Dementia.

Falls

• Up to 50% of people aged 80 or older fall each year.
• In Somerset, there were 855 emergency hip fractures and an estimated 4191 people 65+ were admitted to hospital as a result of a fall in 2014/15. Of these, about a half were by people over the age of 85.
• As well as physical conditions, a fall can also lead to loss of confidence, greater social isolation, reduced physically activity and subsequent loss of independence.  
• Those with osteoporosis are more likely to experience fractures. The Somerset Bone Health Pathway focusses on awareness, prevention, risk identification and treatment 
• Falls awareness, risk assessment and prevention are addressed in Somerset through:- 
  • Somerset Falls Pathway
  • Groups such as the Somerset Active Living Network
  • Integrated Rehabilitation Service
  • Balance and Safety group courses
  • Identifying and remedying outdoor hazards such as uneven paving and slippery slopes
  • Improving design of housing for older people, including provision of handrails, etc
• For more information, see Accidents, Injuries and Falls

Housing

• Over one in four (almost 60,000) households in Somerset contain only residents aged 65 or older
• Half of the occupants of single-person households are aged 65 or more (41% in England and Wales).
• More than two-thirds of those aged 65 years and over own their own home outright, and one in six rent.
• Almost 4% of those aged 65 or older live in a communal establishment (mainly care homes), but amongst the population aged 85+ the proportion is 16%.
• Despite the number of over 85s living independently in Somerset, people often require increased levels of support to maintain this.  In the UK, it is estimated that around half the care home population moved there after hospitalisation because a return to home is simply not practical, and 15% are admitted because of housing problems linked to mobility issues, illness, frailty and inability to cope at home. Continued attention to design of housing, models of support and wider transport and local infrastructure are important in supporting the oldest cohort to remain independent.
• For more information, see Supported Housing and Housing Improvements.

Physical Activity

• Maintaining good physical fitness is an essential part of maintaining independence and wellbeing as we age.  Being overweight can compromise this and places people at an increased risk of vascular diseases such as coronary heart disease and stroke, as well as diabetes, breast and colon cancer, depression and falls.
• In Somerset, 1 in 8 people aged 65 or older undertake at least three sessions of activity a week, compared with around 1 in 4 of all adults (2013/14 Active People Survey). 
• There are many factors, physical and mental, which may lead to an older person having reduced physical fitness, including the effect of the ageing process itself on muscle mass and strength.
• Physical activity is considered very important in reducing the risk of an older person experiencing a fall. There is also evidence to show the risk of hip fracture is up to 40% lower in older people who are more active.
• Various physical activity opportunities tailored to meet the needs of the older population are commissioned across Somerset. Details are available through the Somerset Activity and Sports Partnership (SASP) visit www.sasp.co.uk.
• For more information, see Diet and Physical Activity.

Diet and Nutrition

• More than three million people in the UK are either malnourished or at risk of malnutrition.
• An estimated 1 in 10 people over 65 are malnourished or at risk of being so. 
• Malnourished individuals will experience increased ill-health, hospital admissions, risk of infection and risk of mortality
• Compared with well-nourished people, malnourished individuals in the community saw their GP twice as often, had three times the number of hospital admissions and stayed in hospital more than three days longer.
• Malnutrition leads to increased use of health and care services, with an estimated cost of  billions of pounds
• Severely malnourished patients identified by GPs incur additional health care costs of £1,449 per patient in the year following diagnosis
• There is a clear opportunity to identify those at risk, and improve access to food by a joined up approach from a variety of stakeholders. For more information on best practice and implementation guidelines, please read the Malnutrition Task Force document Malnutrition in Later Life
• For more information, see Diet and Physical Activity.

Road Safety

• Nationally, road casualties have been falling steadily in recent years but in 2014, there was a notable rise in casualties amongst people aged 60 or older.
• In Somerset, the number of fatal or serious casualties amongst the 60+ age group fell from 71 to 41 between 2009 and 2013. 
• However, the number of 'slight' casualties increased from 217 to 261.
• 2 in 3 road casualties amongst those aged 60 or older are car users, but the main increase in this age group has been amongst pedestrians.
• Poor road safety not only impacts on the levels of physical exercise people undertake, it can also lead to less social contact.
• This in turn can have serious effects on physical and mental health; people who have no social contact are between two and four times more likely to die prematurely than those who have the most social contact.
• Once again it is vital that the Local Authority develops an integrated working approach between health, social care and transport services and relevant stakeholders.
• For more information, see Road Safety.

Social Isolation and Loneliness

• Social isolation and loneliness are key factors contributing to the health and wellbeing of older people in particular.  
• Around 1 in 10 people aged 65 or older are thought to experience chronic loneliness at any given time.
• With an ageing population, numbers affected are rising to an estimated 12,000 in Somerset
• 1 in 7 Somerset households contain someone aged 65 or older living alone
• Thousands of older people rely on public transport to get out and about, which can be problematic in rural areas
• About 1 in 6 social care users aged 75 or older in Somerset said they had insufficient social contact and/or felt socially isolated.
• Loneliness can affect both mental and physical health and wellbeing and increases the risk of disability, cognitive decline and the onset of dementia
• Nationally, those aged 65-79 have the highest levels of life satisfaction, happiness and sense that what one does in life is worthwhile. However, people aged 85 and over have the lowest sense of any age group that what one does in life is worthwhile (see Subjective Wellbeing)
• There are a range of opportunities in Somerset for older people who are most at risk, such as Somerset Active Living groups, various social and activity groups and volunteering services.
• The South West has the highest rate of formal volunteering of any region in England. Many of these volunteers will be over retirement age and contribute substantially to communities and individual’s wellbeing and we need to promote and nourish this.

  A recent publication from the Campaign to End Loneliness and Age UK, ‘Promising Approaches’, is very helpful as a guide to solutions to reduce loneliness and social isolation.

• For more information, see Social Isolation and Loneliness

 Transport and Access to Services

• In 2013/14, 122,000 age-related concessionary bus tickets were issued in Somerset (Somerset County Council)
• In the same year, over 4 million bus passenger journeys were undertaken by concessionary ticket-holders in Somerset, the bulk of which are older people
• 1 in 5 Somerset residents aged 65 or more have no access to car or van. The proportion is even higher in some rural towns and villages and amongst women (2011 Census)
• Older people need to be supported in driving safely for longer, with viable alternative transport options available for those who are unable to drive.
• An estimated 50,000 people aged 85 or older have walking difficulkties and are restricted to public transport, yet 80% of them don't use it (English Longitudinal Study of Ageing 2012/13)
• Fewer than half of people over 80 find it easy to travel to a hospital. It's not just a matter of age; those with the worst health and the lowest incomes struggle the most to travel to health services (English Longitudinal Study of Ageing 2012/13)
• Age-friendly infrastructure is fundamental to developing innovative transport solutions. For example, planning and design of road networks, cycle lanes, safe crossings, level pavements, and the location of amenities and services
• For more facts, figures and discussion of ways to improve transport options for older people, please read The Future of Transport in an Ageing Society (Age UK and ILCUK, 2015) 
• For more information, see Transport and Older people.