Independence in older age

Traditionally older people have been defined as those of retirement age. However, in view of changing work patterns and the benefits of undertaking healthy activities in older age, the term increasingly relates to anyone over the age of 50 years.

The foundation for good health and independence in later life is laid during childhood and adolescence, however even at the oldest ages individual choices about a healthy lifestyle can strongly influence good outcomes. Therefore, creating opportunities which promote physical and mental activity is crucial to better ageing.

What do we know?

Older people report that they want to remain independent and make their own choices. Loss of independence and the need to rely on others for daily activities is a fear for many older adults. Important factors associated with maintaining independence in older age include having adequate financial resources, an active mind, good relationships with family and friends, fitness and health, and good self-esteem.

(Source: Dwyer and Gray Maintaining Independence in Old Age)

Though relatively small, the population of older people in Slough is growing and, due to an increasing prevalence of chronic diseases including dementia, the needs of older adults are increasing too. It is estimated that 68% of males and 82% of females aged over 85 are unable to manage on their own in at least one domestic task.

Age UK state that social isolation affects approximately one million older people nationally and has a severe impact on quality of life in older age. A considerable number of people already live alone and, according to Age UK estimates, the number of people aged 75 and over living alone will increase by over 40% over the next 20 years.

Reablement services involve short term and intensive support from physiotherapists, occupational therapists and reablement assistants provided to older people following a period of illness or injury when confidence may be lost. The purpose of Reablement is to enable people to maintain their independence and to remain in their own homes. It is a short term service that encourages people to work towards their own goals, e.g. regaining skills in personal care or domestic tasks.

Facts, Figures, Trends

Around 5,700 people aged 65 and over living in Slough were estimated to be unable to manage at least one domestic task (including shopping, housework etc) on their own in 2015. This figure is estimated to increase to over 6,300 by 2020.

Similarly, around 4,600 people aged 65 and over living in Slough were estimated to be unable to manage at least one self-care activity (including bathing, dressing, feeding) in 2015. This figure is expected to rise to 5,200 by 2020.

Around 3,200 people over the age of 65 were predicted to be living alone in Slough in 2015, with around 330 living in a care home (residential or nursing).

(Source: Projecting Older People Population Information).

In the last 12 months 1,085 people over the age of 65 were assessed by the Reablement Team in Slough Borough Council’s Adult Social Care Services. This is a small increase from the previous year. Of these, 853 (or 79%) were over the age of 75. The majority (82%) of the older people seen by the Reablement team had no ongoing needs at the end of the intervention.

(Source: Slough Borough Council)

As illustrated in figure 1, Slough performs well in terms of people not needing to be re-admitted to hospital soon after discharge. This reflects well on the support provided by reablement services.

Figure 1. Proportion of those aged over 65 still at home 91 days after discharge from hospital

Figure 1

National & Local Strategies (Current best practices)

The national institute for health and care excellence (NICE) guidelines NG32 “Older people: independence and mental wellbeing” provides guidance for best practice in terms of activities to improve independence in older people, following the principles:

  • to support a range of different activities
  • to involve older people in the design and delivery of activities.

A number of national policies which impact on older people, their families and carers have been produced. These documents have provided a framework for the development of Slough’s local strategy (Slough Commissioning Strategy for Older People) and helped underpin the planning of future services for older people in the Borough. The key priorities of this strategy include:

  • providing better information and advice to plan ahead to prevent care needs and ensuring people are better connected to those around them
  • more support within communities, better housing options and improved support for carers to help people maintain their independence and avoid crisis
  • reablement services and crisis response to help people regain their independence at home after a crisis.

In response to increasing demand on services, changes to legislation, and funding of services the provision of adult social care services in Slough has been reviewed and a programme of reform design. The Slough Adult Social Care Reform Programme is centred around use of asset-based conversations, community hubs and use of local links.

This programme hopes to move Slough towards a model that focuses on neighbourhood based support and care, maximising all the resources, assets and skills available to people and families where they live.

What is this telling us?

Retaining independence is not only vital for ensuring quality of life for our older population, but also for ensuring that acute healthcare services are used in the most cost-effective and appropriate ways.

While Slough’s reablement team are succeeding in helping those who have experienced illness or injury to regain their lost confidence and independence, there needs to be a greater drive towards primary prevention.

What are the key inequalities?

As described above, lack of financial resources are often a key factor in loss of independence for older people. Socioeconomic inequalities are therefore important to consider in this group of vulnerable older adults.

What are the unmet needs/ service gaps?

There is a gap in reaching those at risk of losing independence for primary prevention, before the injury or illness occurs.

Recommendations for consideration by other key organisations

  • To continue working towards integration of health and social care.
  • To continue to explore joint health and social care personal budgets.
  • To continue to develop models to enable people to take more responsibility for their own care and support with the assistance of council, voluntary sector and NHS partners.
  • To make more effective use of local assets and to develop community resilience.
  • To support people through the pathway by providing clear and concise information and advice in a seamless manner.

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