PROFILE FOR West Mid Beds 2014

Transcription

1 Older Adults LOCALITY PROFILE PROFILE FOR West Mid Beds 2014 Population Health & Public Health Intelligence Directorate of Public Health Locality Profile 2014

2 Foreword I am delighted to present the first Older People s Locality Profile. It has been designed to support both the locality GP commissioners to develop priorities and for Local Authorities commissioners to assess practice by practice variations, identify inequalities and compliment the JSNA. It brings together GP practice level information about the health needs of our population. The report has been compiled by the Core Public Health team at Bedford Borough and Central Bedfordshire Councils with support from our Local Authority colleagues. Over the past few years we have seen significant reforms to the health system following the enactment of the Health and Social Care Act Undertaking these reforms during a period of austerity has presented a particular challenge. However, it has provided an opportunity to take a life course approach to improve the health of our population and part of that involves getting services right for older people. More people are living longer, however, as people age they are progressively more likely to live with multiple illnesses, disability and frailty. It is important that we get services right for older people, in terms of prevention, early intervention, and better health outcomes. This will enable older people to stay healthy and independent in their own homes and will help to reduce their reliance on the health and social care services. One of the Director of Public Health s responsibilities is to reduce health inequalities by ensuring that disadvantaged groups receive the attention they need. Presenting information at GP practice level can unmask important variations in health needs and outcomes that can be addressed. It is our intention to refresh the Older People s Locality Profile on an annual basis. We welcome your feedback on what you find useful and what other information would help you to improve services and outcomes for your local population. Dr Sanhita Chakrabarti MRCOG FFPH Assistant Director of Public Health Core Public Health Team Bedford Borough and Central Bedfordshire Councils September 2014

3 1 Contents 1 Contents Introduction Demography Population of Older Adults Living alone and social isolation Index of Multiple Deprivation (IMD) and Income Deprivation Affecting Older People Index (IDAOPI) Health Ambulatory Care Sensitive conditions Hospital admissions: elective and emergency Dementia Falls and hip fractures Alcohol Smoking Winter Deaths Immunisation: influenza, pneumococcal pneumonia & shingles Older people registered blind or partially sighted in Central Bedfordshire Hearing Loss Learning disability Mortality Social Care Safeguarding Housing & households

4 6.1 Food banks Fuel poverty Assets Community Centres Village Care Faith groups Volunteering Libraries Third sector References

5 2 Introduction The first phase of the Locality Profiles was published in October 2013 provided GP practice level health and health care data to help the Clinical Commissioning Group localities to identify areas of variation and opportunities for improvement in primary care services. This Locality profile focuses on older people, bringing together information from both health and social care. It uses an asset-based approach which aims to look for the capacities or resources available to individuals and communities which could enable more control over their lives and support their wellbeing 1 2. Where ever possible 2013/14 data were used. Local figures are benchmarked against national figures and/or figures for Bedfordshire Clinical Commissioning Group overall. We hope that by sharing these profiles with colleagues in primary care, social care and the voluntary sector we will not only influence the services that are currently provided but also receive feedback from our multidisciplinary colleagues on what other information would be useful and what information they have to share. This feedback will shape the next edition. Please indicate any comments / improvements / additions on the comment form at the end of this document and return to us in the core public health team. An asset-based approach seeks positively to report on the assets, capacities or resources available to individuals and communities which could enable them to gain more control over their lives and circumstances - focusing on factors that support well-being rather than factors that cause disease. Assets include: Individual assets e.g. Resilience, commitment to learning, self-esteem Community assets e.g. Family and friendship networks, social capital, community cohesion, religious tolerance, intergenerational solidarity Organisational or institutional assets e.g. environmental resources for promoting physical health, employment security and opportunities for volunteering, safe housing, political democracy and participation. Asset mapping identifying and recording the strengths and contributions of the people and other resources available to a community is often the first step to enabling individuals and communities to recognise the resources available to them. 5

6 3 Demography 3.1 Population of Older Adults In quarter /14 the total population for those aged 75 and over is 4,520 of whom 1,212 were 85 and over (see Table 1).With the exception of Dr Glaze & Partners (9.3%), Houghton Close Surgery (8.6%) and Asplands Medical Centre (8.5%) who all have a higher proportion of 75+ practice population compared to the England average. Table 1: Total and older population, West Mid Beds, quarter /14 Total Population # % # % GP by Locality West Mid Beds Greensand Surgery (Ampthill) 6, % % West Mid Beds Dr Ling & Partners 16,334 1, % % West Mid Beds Dr Glaze & Partners 10,857 1, % % West Mid Beds Asplands Medical Centre 11, % % West Mid Beds Houghton Close Surgery 10, % % West Mid Beds Oliver Street Surgery 3, % % West Mid Beds 58,795 4, % 1, % BCCG 451,186 33, % 9, % England 53,493,700 4,212, % 1,220, % Source: Exeter Q2 Mid-2012 Population Estimates: England; estimated resident population by single year of age and sex (Produced by Public Health Intelligence Team, 2014) 6

7 Figure 1 shows Bedfordshire locality population changes for people 75 and over from with a projection to the year Over the period , it is predicted that West Mid Beds will gain around 440 people above the age of 75 years. Figure 1 Locality population growth projections from 2013 to 2017 for adults 75 years and over Source: National General Practice Profiles, Public Health England (Produced by Public Health Intelligence Team, 2014) 7

8 3.2 Living alone and social isolation Loneliness, social isolation and social exclusion all contribute to ill health and mortality in older people. 3 There is emerging evidence that they are linked to poor physical health and mental health including depression. 4 Conversely evidence shows that positive relationships with close family contribute to older people s wellbeing. However, those aged 75 and over are less likely to have these support networks. 5 The number of older people estimated to be living alone in Central Bedfordshire from, 2012 to 2020 is shown in Table 2. By year 2020 the number living alone is projected to be 11,850. An approximate estimate for West Mid Beds was 2,065 in 2012 rising to 2,665 in Table 2 Number of older people predicted to be living alone in Central Bedfordshire, People aged 75 and over predicted to live alone Males 2,720 2,958 3,128 3,332 3,672 Females 6,466 6,832 7,015 7,503 8,174 Total 9,186 9,790 10,143 10,835 11,846 Source: Projecting Older People Population Information, 2014 (POPPI) 8

9 3.3 Index of Multiple Deprivation (IMD) and Income Deprivation Affecting Older People Index (IDAOPI) The Index of Multiple Deprivation (IMD) is made up of seven domains (Crime, Health deprivation & disability, Employment, Education, Skills & training, Barriers to housing & services and Living environment). An area with a higher IMD score is more deprived. The Income Deprivation Affecting Older People Index (IDAOPI), however, is the proportion of those aged 60 years and over who are living on pension credit. In West Mid Beds all of the GP practices IMD and IDAOPI were lower than the BCCG averages (Figure 2). The results suggest that elderly poverty exists in pockets in West Mid Beds. Figure 2 Income Deprivation Affecting Older People and Index of Multiple Index Deprivation Score, West Mid Beds locality, Source: National General Practice Profiles, Public Health England (Produced by Public Health Intelligence Team, 2014) 9

10 4 Health There is evidence that people are living longer, however as people age they are progressively more likely to live with complex co-morbidities, disability and frailty. People over 65 accounts for 51% of gross national local authority spending on adult social care and two-thirds of the primary care prescribing budget, while 70% of health and social care spend is on people with long-term conditions. 4.1 Ambulatory Care Sensitive conditions Ambulatory care sensitive (ACS) conditions are chronic conditions for which it is possible to prevent acute exacerbations and reduce the need for hospital admission through active management, such as immunisation; better self-management; disease management or case management; or lifestyle interventions. Examples include congestive heart failure, diabetes, asthma, angina, epilepsy and hypertension. The ACS conditions that tend to affect older people are influenza, pneumonia, chronic obstructive pulmonary disease (COPD) and congestive heart failure. Table 3 to Table 5show number of hospital spells, rates of spell per 1,000 population and costs for these ACS conditions for GP practices in West Mid Beds. The numbers of Influenza and Pneumonia spells for patients in West Mid Beds appear to have increased between 2011/12 and 2013/14. 10

11 Table 3 ACS Conditions: Influenza and pneumonia hospital spells for adults aged 65 and over, 2011/ /14, by GP practice and locality ACS Influenza and Pneumonia 2011/ / /2014 No. of Total Cost No. of per 1000 Total Cost No. of per 1000 per 1000 Total Cost ASPLANDS MEDICAL CENTRE - E , , ,305 DR GLAZE & PARTNERS - E , , ,907 FLITWICK SURGERY - E , , ,992 GREENSAND SURGERY (AMPTHILL) - E , , ,376 HOUGHTON CLOSE SURGERY - E , , ,928 OLIVER STREET SURGERY - E , , ,370 Total: West Mid Beds , , ,878 ACS Influenza and Pneumonia 2011/ / /2014 No. of Total Cost No. of per Total Cost No. of Total Cost per per 1000 Total: Chiltern Vale , , ,917 Total: Ivel Valley , , ,026 Total: Bedford ,539, ,982, ,462,047 Total: Leighton Buzzard , , ,933 Total: West Mid Beds , , ,878 Total BCCG ,339,083 1, ,312,459 1, ,763,801 Source: MedeAnalytics (produced by Public Health Intelligence, Bedford Borough Council & Central Bedfordshire Council) 11

12 Table 4 ACS Conditions: Congestive heart failure hospital spells for adults aged 65 and over, 2011/ /14, by GP practice and locality Congestive Cardiac failure 2011/ / /2014 No. of per 1000 ASPLANDS MEDICAL CENTRE - E , , ,056 DR GLAZE & PARTNERS - E , , ,074 FLITWICK SURGERY - E , , ,582 GREENSAND SURGERY (AMPTHILL) - E , , ,153 HOUGHTON CLOSE SURGERY - E , , ,576 OLIVER STREET SURGERY - E , , ,680 Total: West Mid Beds , , ,121 Total Cost No. of per 1000 Total Cost No. of per 1000 Total Cost Congestive Cardiac failure 2011/ / /2014 No. of Total Cost No. of Total Cost No. of Total Cost per 1000 per 1000 per 1000 Total BCCG ,458, ,523, ,339,448 Total: West Mid Beds , , ,121 Total: Leighton Buzzard , , ,853 Total: Ivel Valley , , ,348 Total: Bedford , , ,980 Total: Chiltern Vale , , ,146 Source: MedeAnalytics (produced by Public Health Intelligence, Bedford Borough Council & Central Bedfordshire Council) 12

13 Table 5 ACS Conditions: COPD hospital spells for adults aged 65 and over, 2011/ /14, by GP practice and locality COPD ACS admissions 2011/ / /2014 No. of per 1000 Total Cost No. of per 1000 Total Cost No. of per 1000 Total Cost ASPLANDS MEDICAL CENTRE - E , , ,544 DR GLAZE & PARTNERS - E , , ,038 FLITWICK SURGERY - E , , ,158 GREENSAND SURGERY (AMPTHILL) - E , , ,040 HOUGHTON CLOSE SURGERY - E , , ,417 OLIVER STREET SURGERY - E , ,669 Total: West Mid Beds , , ,866 COPD ACS admissions 2011/ / /2014 No. of Total Cost No. of Total Cost No. of Total Cost per 1000 per 1000 per 1000 Total: Leighton Buzzard , , ,553 Total: Ivel Valley , , ,400 Total: Bedford , , ,031 Total: Chiltern Vale , , ,774 Total: West Mid Beds , , ,866 Total BCCG ,323, ,475, ,615,624 Source: MedeAnalytics (produced by Public Health Intelligence, Bedford Borough Council & Central Bedfordshire Council) 13

14 Preventing unplanned admissions - some key points from the evidence This summary focuses on the evidence for reducing unplanned admissions. There may be independent positive impacts on quality and clinical outcomes. Summaries of key reports are included below with references in the Appendix. Interventions where there is evidence of effectiveness Self-management with education for COPD Rehabilitation for COPD Heart failure case management on discharge Early palliative care Coordination of End of Life care In primary care: continuity of care, ratio of patients to practitioners, training practice Early senior review in A&E Structured discharge from hospital Assertive case management in mental health Exercise based rehabilitation in cardiac care Early supportive discharge reduces length of hospital stay for stroke patients Interventions where the effectiveness is uncertain or insufficient Telemonitoring for heart failure, hypertension and in older people Influenza vaccination Fall prevention programmes Medication reviews in older people, heart failure or asthma Care pathways Specialist clinics positive for heart failure, uncertain for asthma or older people Case management overall no effect but positive for mental health and heart failure Integrated care (reduced outpatient and elective care activity but not admissions) Interventions where there is evidence of no or negative effectiveness Hospital at home 14

15 4.2 Hospital admissions: elective and emergency Table 6 shows the number of hospital admissions ( spells ) for cardiovascular disease among adults aged 75 and older, excluding strokes. In West Mid Beds in 2013/14 there were spells per 1,000 population at a cost of over 1M. Table 6 Cardiovascular disease hospital admissions for adults aged 75 and over, by locality, 2013/14 GP Practice (Derived) No. of per 1000 Total Cost Chiltern Vale ,366,502 Bedford ,196,065 Ivel Valley ,363,014 Leighton Buzzard ,337 West Mid Beds ,008,600 Total: NHS BEDFORDSHIRE CCG 2, ,524,518 Source: MedeAnalytics 2013/14 (produced by Public Health Intelligence, Bedford Borough Council & Central Bedfordshire Council) 15

16 Table 7 shows the number of hospital admissions for stroke among adults aged 75 and over. In West Mid Beds in 2013/14 there were spells per 1,000 population at a cost of over Table 7 Stroke hospital admissions for adults aged 75 and over by locality, 2013/14 GP Practice (Derived) No. of per 1000 Total Cost Chiltern Vale ,024 Bedford ,061 Ivel Valley ,962 Leighton Buzzard ,095 West Mid Beds ,360 Total: NHS BEDFORDSHIRE CCG ,058,502 Source: MedeAnalytics 2013/14 (Produced by Public Health Intelligence Team, 2014) Table 8 shows the number of hospital admissions for respiratory disease among adults aged 75 and over. In West Mid Beds in 2013/14 there were spells per 1,000 population at a cost of over 750,000. Table 8 Respiratory disease hospital admissions for adults aged 75 and older, by locality, 2013/14 GP Practice (Derived) No. of per 1000 Total Cost Chiltern Vale ,137,369 Bedford ,315,592 Ivel Valley ,042 Leighton Buzzard ,717 West Mid Beds ,703 Total: NHS BEDFORDSHIRE CCG 1, ,710,423 Source: MedeAnalytics 2013/14 (Produced by Public Health Intelligence Team, 2014) 16

17 Table 9 shows the number of hospital admissions for cancer among adults aged 75 and over. In West Mid Beds in 2013/14 there were spells per 1,000 population at a cost of over 440,000. Table 9 Cancer hospital admissions for adults aged 75 and over, by locality 2013/14 GP Practice (Derived) No. of per 1000 Total Cost Chiltern Vale ,332 Bedford ,534,382 Ivel Valley ,325 Leighton Buzzard ,551 West Mid Beds ,400 Total: NHS BEDFORDSHIRE CCG 2, ,838,990 Source: MedeAnalytics 2013/14 (Produced by Public Health Intelligence Team, 2014) 17

18 4.3 Dementia Table 10 shows the estimated dementia prevalence for West mid Beds GP practices. The estimated number of people aged 65 or over with dementia in West mid Beds locality, adjusted for the number of care home places, is 602. Of these 110 are estimated to be living in care settings and 492 are estimated to be living in the community. Practices should consider how these estimates compare to their registered numbers of dementia patients. A gap between the expected number of cases and those registered with the practice could indicate unmet need in the community. Table 10 Estimate of patients in West Mid Beds diagnosed with Dementia for aged 65 or over, 2013/14 Quarter 2 Organisation Name Practice List Size National Dementia Prevalence (No.) Adjusted National Dementia Prevalence (No.)* Community National Dementia Prevalence (No.) Care National Dementia Prevalence (No.) Mild Dementia (No.) Moderate Dementia (No.) Severe Dementia (No.) ASPLANDS MEDICAL CENTRE DR GLAZE & PARTNERS FLITWICK SURGERY GREENSAND SURGERY (AMPTHILL) HOUGHTON CLOSE SURGERY OLIVER STREET SURGERY WMB locality 57, BCCG 443, ,816 3, *This has been adjusted by weighting by number of care home places Source: Public Health Intelligence Team- Dementia Prevalence Calculator 18

19 Memory Assessment Service The first of the four objectives of the National Dementia Strategy is to achieve "good-quality early diagnosis and intervention for all 6. To help achieve this, the National Audit Office has recommended that "Primary Care Trusts commission sufficient memory services, which are based on best practice and accredited by the Memory Services National Accreditation Programme. 7 Additionally, knowledge of the diagnosis can reduce the number and length of acute hospital admissions, delay the need for long-term residential care and allow families to plan future medical care and finances 8. Table 11 shows that a total of 562 referrals to the Memory Assessment Service (MAS) were made in 2013/14. From this 246 were diagnosed with dementia, 40 with mild cognitive impairment, 38 with another mental health diagnosis and 112 received no diagnosis. 126 were discharged to the prescription clinic. Prescription clinics relate to the number of patients who were prescribed dementia medication and attend follow up clinics to have their medication reviewed. Not all patients who receive a diagnosis of dementia receive dementia medication. Of the Central Bedfordshire Council s over 75 s population, about 23% live in West Mid Beds. If we assume an even distribution of dementia incidence, we would expect approximately 55 new cases per year among people of all ages in West Mid Beds. Table 11 Referrals from Central Bedfordshire to the Memory Assessment Clinics by age group, 2013/14 Age bands Under Over 85 Total Yearly total Source: Memory Assessment Clinics- South Essex Partnership Trust,

20 4.4 Falls and hip fractures National evidence shows that falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people over 65 and 50% of people over 80 falling at least once a year. The human cost of falls includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falls also affect the family members and carers of people who fall. Best practice guidance is provided by NICE. Figure 3 shows the rate of hip fractures and falls by GP practice. The rate of falls among patients in all Practices are significantly similar to the BCCG overall. Figure 3 The rate of hospital admissions for hip fractures and falls per 1,000 population for adults 65 years and older, West Mid Beds, 2012/13 Source: MedeAnalytics (Produced by Public Health Intelligence Team, 2014) 20

21 Falls prevention evidence Whilst the evidence for falls prevention initiatives impact on emergency admissions is uncertain there is evidence for the effectiveness of falls prevention on the rate of falling. These include: Routine identification of those at risk of falling and/or osteoporosis 9 Fracture liaison service 10 Prevention strength and balance programmes for those most at risk Urgent home care and falls response service: attends fallers in their own home following ambulance call (best practice) Advice and education sessions for fallers to reduce fear of falling 21

22 4.5 Alcohol Nationally, 90% of the adult population drink alcohol with over a quarter of the population estimated to be drinking at hazardous levels. There has been a marked increase in alcohol consumption by middle and older aged individuals, with approximately a third of older people developing alcohol problems for the first time late in life. Although the exact reasons for this are unclear, there are likely to be links to the ageing population and a greater number of people living alone with poor social support networks leading to loneliness. Other reasons include diminished mobility, multiple bereavements, chronic pain, poor physical health and poor economic and social support networks 11. Figure 4 shows the rate of hospital admissions for alcohol related conditions for adults aged 65 and over by GP practice. No practices were statistically different from BCCG overall. Figure 4 The rate of hospital admissions for alcohol related conditions per 1,000 adults over 65, West Mid Beds, 2012/13 Source: MedeAnalytics (Produced by Public Health Intelligence Team, 2014) 22

23 4.6 Smoking Smoking is a health risk throughout the whole of life and is significant risk factor for emergency admission with a dose response relationship for smoking with heavy smokers having higher risks than moderate smokers, light smokers or ex-smokers Winter Deaths The ONS method for calculating excess winter deaths defines the winter period as December to March, and compares the number of deaths that occurred in the winter period to the average number of deaths occurring in the preceding August to November and the following April to July. In England in 2012/13 there were 31,100 excess winter deaths, an increase of 29% on the previous winter (Figure 5). Most excess deaths occurred in people aged 75 and over. 13 Figure 5 The number of Excess Winter Deaths in England Source: Office for National Statistics 23

24 4.8 Immunisation: influenza, pneumococcal pneumonia & shingles Influenza occurs most often in winter and usually peaks between December and March in the northern hemisphere. The influenza virus is unstable and new strains and variants are constantly emerging, which is one of the reasons why the flu vaccine should be given each year. The most common complications of influenza are bronchitis, secondary bacterial pneumonia, meningitis, encephalitis and septicaemia. These illnesses may require treatment in hospital and can be life threatening, particularly for the elderly, asthmatics and those in poor health. Although the winter of 2012/13 was considered a quiet flu season for England, other countries in Europe experienced more severe flu serving as a reminder that the disease remains highly unpredictable. Flu vaccinations are currently offered free of charge to the following at-risk groups: People aged 65 years or over (including those who will be 65 years old by 31 March) People with a serious medical condition such as: chronic (long-term) respiratory disease, such as COPD or bronchitis; chronic heart disease, such as heart failure; chronic kidney disease at stage 3, 4 or 5; chronic liver disease; chronic neurological disease, such as Parkinson's disease or motor neurone disease; diabetes; A weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment). People living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality People who are in receipt of a carer s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill. The target for flu vaccinations is an uptake of 75% or over among those who are offered the vaccine. Pneumococcal polysaccharide vaccine (PPV) is offered to all adults 65 years and over and to children and adults in defined clinical risk groups to protect against infections caused by the bacteria Streptococcus pneumoniae. Pneumococcus is one of the most frequently reported causes of bacteraemia and meningitis and it is the commonest cause of community-acquired pneumonia. Only one dose is required. The target is that 100% of eligible patients should be invited for the vaccination. The shingles vaccine is offered to adults aged 70 years and a catch-up programme is being undertaken for adults aged 79 years. It aims to boost immunity to prevent the development of shingles in later years and reduce the incidence of post herpetic neuralgia. The target is that 100% of eligible patients should be invited for the vaccination. 24

25 Table 12 shows the uptake of the three immunisations among eligible adults 65 and over for West Mid Beds, 2013/14. Four of the practices achieved the 75% uptake target for the flu vaccine. There are appear to be small differences between GP registers for adults 65 and over eligible for flu and PPV vaccines, despite identical eligibility criteria. GP practices should ensure that 100% of eligible patients are offered both vaccines. Table 12 Influenza, pneumococcal and shingles vaccine uptake among eligible adults 65 and over for West Mid Beds, 2013/14 Flu Pneumococcal (PPV) Shingles, Routine Practice Patients registered 65 years and over 65 years and over 70 years only No. vaccinated % uptake Patients registered No. vaccinated % of patients Patients registered No. vaccinated % of patients Asplands Medical Centre 2,290 1, , Dr Glaze & Partners 2,410 1, , Dr SJ Morris & Partners 2,480 1, , Greensand Surgery (Ampthill) Houghton Close Surgery 2,067 1, NA Oliver Street Surgery Total 10,805 7, , Source: Immform (Produced by Public Health Intelligence Team, 2014) 25

26 4.9 Older people registered blind or partially sighted in Central Bedfordshire Sight loss is linked to age and it is estimated that 1 in 7 people over the age of 65 and 1 in 3 people over the age of 85 are living with sight loss, nationally. 14 Those with sight loss (complete or partial) and aged 75 or over are likely to already have up to three or more long term conditions (for example, dementia, stroke), thereby resulting into the challenge of maintaining independence, wellbeing and social networks. 15 Table 13 shows the estimate of registered blind or partially sighted people, with additional disabilities. Table 13: The estimated proportion of adults 65 and over registered blind or partially sighted, and an estimated proportion with additional disabilities, Central Bedfordshire, 2011 % of Blind % of Partially Registered people sighted people Registered blind partially sighted registered who registered who people with people with are aged 65 and are aged 65 and additional additional over over disabilities disabilities Central Bedfordshire 65.91% 72.22% 68.4% 61.9% England 73.30% 75.39% 73.2% 77.2% Source: The Health and Social Care Information Centre 2011 (Produced by Public Health Intelligence Team, 2014) 26

27 4.10 Hearing Loss People who do not have the right support to manage their hearing loss effectively can experience significant disability. It is thought that around 70% of people aged over 70 and more than 90% of people aged over 80 are living with hearing loss. Hearing loss tends to worsen with age. Older people with hearing and sight loss may become withdrawn and depressed. Their isolation may also have a negative effect on their relationships with family and friends. 16 Table 14 shows the estimated number of people registered as deaf or hard of hearing people in Central Bedfordshire in This equates to approximately 90 people in West Mid Beds. Table 14 The estimated number of people registered deaf or hard of hearing, Central Bedfordshire, 2010 People registered as deaf or hard of hearing Central Bedfordshire 400 England 212,900 Source: The Health and Social Care Information Centre 2010 (Produced by Public Health Intelligence Team, 2014) 27

28 4.11 Learning disability The prevalence of learning disabilities (LD) in the localities was estimated from the Projecting Older People Population Information System (POPPI) 17 Table 15 shows the estimated number of people 65 and over with a LD in each locality in 2013/14. People with moderate or severe LDs are more likely to be in receipt of services; in West Mid Beds there are an estimated 28 people in this category 65 years and over. These figures should be treated cautiously as local estimates were obtained by multiplying national prevalence estimates by local population sizes and assume an even distribution of people with LD throughout the population, which is unlikely to be the case. Table 15 Estimates for any learning disability and moderate/severe learning disability by locality and age, 2013/14 Locality Total Moderate/ severe Any LD Moderate/ severe Any LD Moderate/ severe Any LD Moderate/ severe Any LD Moderate/ severe Bedford Chiltern Vale Ivel Valley Leighton Buzzard West Mid Beds Source: Projecting Older People Population Information System, 2013/14 Any LD 28

29 4.12 Mortality Table 16 shows the number of deaths among adults aged 65 and over by locality in 2011/12. That year 2,811 Bedfordshire residents died of whom 312 were from West Mid Beds. Table 16 Number of deaths above the age of 65 years by Localities, 2011/12 Age Band Locality Grand Total Bedford Locality ,208 Chiltern Vale Ivel Valley Leighton Buzzard West Mid Beds Total ,268 2,811 Source: ONS Mortality Data (Produced by Public Health Intelligence Team, 2014) Death occurs in a wide variety of settings including hospitals, care homes, hospices and at home. The 2010 national PRISMA survey reported that most East of England residents would prefer to die at home or in a hospice (62% and 32% respectively). A local End of Life Care strategy has been developed by a multiagency group with the main aims of enabling patients to have a good death, for carers and families to feel comforted from their experiences and for people to die in their preferred place of death. Targets have been set to bring about improvements in end of life care. There is evidence to show that patients who receive palliative care have improved quality of life, better symptom control and have reduced costs from fewer hospital admissions, and that those that receive palliative care are more likely to die at home (or less likely to die in hospital). 29

30 Figure 6 shows place of death by GP practice in West mid Beds for 2011/12. Elsewhere relates mainly to deaths in hospices. There is some variation between GP practices in the place of death which may reflect the local availability of hospice and care home settings. The proportion of people dying at home has increased since 2011/12 but it was not possible to update the practice level data 18. Figure 6 Place of death by GP practice, West Mid Beds, 2011/12 Source: ONS Mortality file & Exeter 30

31 5 Social Care Extra Care Apartments (units) are privately owned and are designed for people who are aged over 75 years to encourage independent living with access to 24 hour on-site healthcare. Figure 7 shows the number of care homes in West Mid Beds and a breakdown of the number of people receiving social care support aged 65 and over is given in Table 17. In West Mid Beds there are 3 residential/nursing care homes accommodating 37 people. The increase in people above the age of 75 from 2013 to 2017 is likely to be about 440 (see Section 3.1) so it is likely that more Extra Care Apartments will be needed to accommodate the increasing elderly population. Figure 7 Care homes and nearby GP Practices in the West Mid Beds Locality Table 17 Number of adults aged 65 and over receiving social care in West Mid Beds, 2014 As at 1st April Receiving Community Services 294 In residential care 24 In nursing care 13 In receipt of Home Care 200 In receipt of a Direct Payment (including Carers) 100 Reablement Services 34 Source: Central Bedfordshire Council, social care, 2014 Source: Public Health Intelligence Team,

32 5.1 Safeguarding It is everybody s responsibility to report abuse wherever it is seen or suspected. Safeguarding is essential to ensure the safety, independence and wellbeing of people at risk. Central Bedfordshire Council received 821 alerts for adults 65 and over in 2012/13 and 298 alerts (36%) progressed to investigation. The number of alerts and investigations were similar to 2011/12 but markedly higher than 2010/11, when there were 526 alerts and 154 investigations. Figure 8 shows the source of referral of safeguarding alerts for people aged 65 and over in Central Bedfordshire, 2012/13. The largest sources of referrals were residential and nursing homes (20%) and health services (17%). The proportion of referrals from adult social care (15%) was markedly higher than the previous year (4%). Figure 8 Source of referral for safeguarding cases relating to adults 65 and over, Central Bedfordshire Council, 2012/13 Source: Safeguarding Adults Annual Report, Central Bedfordshire Council, 2012/13 32

33 6 Housing & households 6.1 Food banks Every day people in the UK go hungry for reasons ranging from redundancy to receiving an unexpected bill on a low income. Care professionals such as doctors, health visitors, social workers, Citizens Advice Bureau and police identify people in crisis and issue them with a food bank voucher that can be redeemed for three days emergency food. Last year food banks in the UK fed over 128,000 people experiencing food poverty. In Central Bedfordshire there are a number of food banks that are supported by the local authority. They include the Dunstable Foodbank, Leighton Linslade Homelessness Service and The Need Project. The food banks operate slightly differently with the Dunstable Foodbank using a voucher system issued by professionals to individuals who present at central points to claim food parcels. The other food banks operate a referral by phone system with food parcels both collected from central points and delivered directly to peoples doors. 6.2 Fuel poverty The Low Income High Costs (LIHC) indicator is now used to assess fuel poverty. The 2012 Hills Review 19 recognised that fuel poverty was a distinct issue, but found that there were some fundamental flaws with the existing indicator. Fuel poverty was formerly defined as households that spend more than 10% of their income to maintain an adequate standard of warmth. Hills proposed the LIHC indicator which defines a household to be fuel poor when: They have required fuel costs that are above average (the national median level) and Were they to spend that amount, they would be left with a residual income below the official poverty line In West Mid Beds the LSOA a (2010) range with fuel poverty is 4.5% to 25.2%; the latter is covered by Asplands Medical Centre s practice. 7 Assets For many people, the causes of ill-health are strongly influenced by the adverse social, economic or environmental circumstances in which they live. Unless these underlying determinants of health can be addressed it may be difficult or impossible to tackle the direct causes This section highlights some of the assets that can help community resilience: building social support, social networks and social capital within and between communities, especially in terms of wellbeing and mental health. a Lower Super Output Area: an area which has a population of 1,000-3,000 33

34 Due to the complex factors involved in isolation and loneliness, there is limited evidence on the effectiveness of interventions, although group activities have been shown to be more effective than one-to-one interventions. Volunteering and greater involvement with families and communities may tackle social isolation and exclusion and it has been suggested that participation in voluntary work improves wellbeing and quality of life for older people Community Centres Community centres provide a meeting place and base for activities for local people. Often at the heart of local areas, community centres provide a place to meet, hold social, cultural and educational activities for all ages and a place for people to get involved in the community s life. The aim is to improve people s quality of life by contributing to the social, physical, economic, educational and environmental wellbeing of the community. 7.2 Village Care Village Care schemes are groups set up and run by local residents to provide a structured "good neighbour" service to any fellow residents without close family or friends living nearby. All volunteers are insured and CRB checked. Each group has a phone number which is publicised around their locality and anyone in genuine need of occasional help is welcome to call. For further information please visit: Faith groups Central Bedfordshire has diverse population of different faiths and beliefs. Faith communities and religious venues can offer further network and support for older people. 7.4 Volunteering Voluntary and Community Action, South Bedfordshire, are committed to strengthening the effectiveness of the voluntary and community sector in Bedfordshire by developing, enabling, promoting and supporting local voluntary and community action. Community & Voluntary Service, Mid Bedfordshire, is an umbrella organisation that supports and represents the interests of voluntary organisations, community groups and charities in Bedford Borough (North Bedfordshire) and North Central Bedfordshire (formerly known as Mid Bedfordshire). 34

35 7.5 Libraries The Library Service plays a significant role in helping older people improve their wellbeing and the quality of their lives. Access to services is provided through the different groups and schemes, offering older people an opportunity to engage with local community groups. Figure 9 shows local libraries in West Mid Bedfordshire: Figure 9 Leisure facilities and local libraries in West Mid Beds Locality Source: Public Health Intelligence Team (2014) 35

36 8 Third sector Third sector and voluntary organisations offer additional support and some organisations offer programmes and services that are aimed at older people, for example Age UK and the Alzheimer s Society. One of the projects that Age UK is currently promoting is the Fit as a fiddle campaign. This supports healthy, active ageing by promoting physical activity, mental wellbeing and healthy eating, reflecting the ideas and needs of older people. It is delivered in partnership with regional and national organisations and encompasses a diverse range of initiatives for instance, participation in activities, telephone peer support, chairbased exercise programmes and social networks for older men experiencing social isolation. The campaign s activities appear to have had a positive impact on wellbeing, levels of happiness, physical activity and social engagement. An independent evaluation of the programme is now under way

37 Feedback and comments on locality profile: Please suggest improvements and additions for subsequent versions. Where possible indicate the source of any additional information and contact details as appropriate. Please return to: with Locality Profile: Older Adults in the subject line Many thanks for your interest and contribution 37

38 9 References 1 Morgan A, Davies M, Ziglio E. Health assets in a global context: theory, Methods, Action: Investing in assets of individuals, communities and organizations. London: Springer; Foot J, Hopkins T. A glass half-full: how an asset approach can improve community health and well-being. London: Improvement and Development Agency; [accessed 12/11/13] 3 Steptoe A, Shankar A, Demakakos P, Wardle J (2012). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America, vol 110, no 15, pp Available at: (accessed on 16th June 2014). 4 WRVS Positive about age, practical about life. (2012) Loneliness amongst older people and the impact of family connections. [Online] the-impact-of-family-connections.pdf 5 Hoban M, James V, Beresford P, Fleming J (2013). Involving older age: the route to twenty-first century well-being. Shaping our age. Cardiff: Royal Voluntary Service. Available at: (accessed on 16th June 2014). 6 Age Concern (2007). Improving services and support for older people with mental health problems: The second report from the UK Inquiry into Mental Health and Well-being in Later Life. 7 Audit Commission (2002). Forget me not 2002: Developing mental health services for older people in England. 8 Audit Commission (2000). Forget me not: Mental health services for older people. 9 NICE guidance CG161 Falls: assessment and prevention of falls in older people [accessed 23/07/2014] 10 Department of Health (2009) Fracture Prevention Services: an economic evaluation. [accessed 23/07/2014] 11 Bedford Borough Alcohol Strategy, Hippisley-Cox J, Coupland C. Predicting risk of emergency admission to hospital using primary care data: derivation and validation of QAdmissions score. BMJ Open 2013;3:e Office for National Statistics: Excess Winter Mortality in England and Wales, 2012/13 (Provisional) and 2011/12 (Final) [Online] (accessed 24th April 2014) 38

39 14 Access Econmics, Future sight loss UK 1: The economic impact of partial sight and blindness in the UK adult population. RNIB [Online] Accessed on 24th April RNIB (2014) Evidence based review Older People. [Online] Accessed on 23rd June 2014) 16 Action on Hearing Loss, Caring for older people with hearing loss [accessed 30/07/2014] 17 Projecting Older People Population Information System (POPPI), [accessed 28/07/2014] 18 Bedford Borough JSNA, Getting the measure of fuel poverty Final Report of the Fuel Poverty Review: John Hills (2012) Morgan A, Davies M, Ziglio E. Health assets in a global context: theory, Methods, Action: Investing in assets of individuals, communities and organizations. London: Springer; Foot J, Hopkins T. A glass half-full: how an asset approach can improve community health and well-being. London: Improvement and Development Agency; [accessed 12/11/13] 22 Scottish Collaboration for Public Health Research and Policy (2010). Promoting health and wellbeing in later life: interventions in primary care and community settings. Edinburgh: Scottish Collaboration for Public Health Research and Policy. Available at: (accessed on 16 June 2014). 23 Age UK (2014) Fit as a Fiddle Available at: (Accessed on 17th June 2014) 39