The report looks not only at the health and well-being of those aged 65 and over, but also at the way in which housing conditions affect the lives of the elderly, and at how well our health and social services care for the vulnerable.
The dramatic rise in the number and proportion of older people in the South East sets the context for the report: by 2028, 23% of the population will be aged 65 or over (compared with 17% currently), and the total number of older people will have grown by a remarkable 55% to nearly 2.1 million persons.
The health and well-being of older people
The increase in the number of those aged 65 and over poses an important question: will these older people be living longer, active, independent lives, or will their final years be spent living in poor health and reliant on others?
Generally speaking, older people in the South East have good health. Limiting long-term illness rates and deaths from circulatory disease and cancer are all lower than in other regions.
But there are areas for concern. Almost four out of every five older people are overweight or obese. And there are marked inequalities in health which are strongly linked with deprivation: older people in the most deprived parts of the South East have the poorest health. Indeed, those living in the most affluent areas tend not only to live longer, but also to spend more of their lives in good health than those in less prosperous parts of the region.
Tackling these inequalities is a priority, but longer term, the growth in the number of older people means that the questions regarding who provides and pays for the care of the elderly are becoming increasingly urgent issues to resolve.
Older people, housing and fuel poverty
Housing quality is a major determinant of health. Homes which are cold or damp are associated with increased prevalence of cardiovascular disease and chronic chest disease.
An important indicator of poor housing quality relevant to older people is a lack of central heating. According to the 2001 Census, there are 91,400 older people (7% of those aged 65 plus) living in homes with no central heating across the South East. While the figure for the region as a whole is better than that the national average, there are exceptions: 24% of older people in Portsmouth live in accommodation with no central heating, the third highest figure in England.
A lack of central heating is one of several factors contributing to the problem of excess winter deaths. Those most susceptible to higher death rates in winter are the elderly: there are 28% more deaths among those aged 85 and over in the South East during December to March than would have occurred if the rates were the same as for the rest of the year. On average over the period 1999 to 2003, there have been 2,360 excess winter deaths each year among this group in the region.
There are likely to be three main reasons for why these excess winter deaths happen. The first is behavioural. Older people are more vulnerable to the effects of cold, and though they do tend to wear more, this is still not sufficient to prevent their blood becoming more ‘sticky’ which increases the risk of heart attack. Secondly, they are prone to infection in cold weather. This is why flu immunisation is particularly important. Thirdly, there are many older people who live in homes which are relatively expensive to heat. These tend to be older properties and the more expensive your home is to heat, irrespective of your income, the cooler it will be. Some people who live in such homes will be ‘fuel poor’ (in other words, spend 10% or more of their disposable income on heating) They are eligible for a range of grants for insulation work and central heating installation under the Warm Front scheme.
But it is also vital that older people appreciate the serious risks of cold weather and modify their behaviour accordingly. This includes wearing more, moving about when outside, and paying attention to bedroom temperature at night as well as sitting room temperature in the day.
The health and social care of older people
It is important to recognise that older people are not just consumers of health and social services, but also major providers of care. Across the South East, 12% of those aged 65 and over (or 145,500 persons) provide unpaid care to others, with a substantial minority providing 50 or more hours care. Many of these older people are themselves in poor health and will be among those most in need of help from health and social services.
The distribution of those aged 75 and over living in long-term care establishments in the South East is primarily a reflection of where those homes are located. But it is still important to note that 8% of those aged 75 and over (or 53,700 older people) are living in care establishments in the region. In some areas such as Hastings, the figure rises to more than 15%. These figures are not insignificant, and there remains a set of unresolved policy issues about payment giving rise to huge inequalities in the cost and use of care.
Moreover, the system is – as recently noted by the Joseph Rowntree Foundation – unnecessarily complex from the perspective of users and their families, and unacceptably variable in terms of quality. There needs to be a renewed debate, both nationally and regionally, about how best to provide and fund long-term care for the elderly.
