Older People - An Introduction

Welcome to Older People section of Physiopedia

This section is being created as part of a project undertaken through AGILE (Chartered Society of Physiotherapy Clinical Interest Group of Physiotherapists working with Older People in the UK).  Please do not edit these pages until the project is complete, but feel free to contact the author with any comments. 

Original Editor - Bhanu Ramaswamy as part of the AGILE Project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Introduction

Ageing describes the process of growing old, with both complicated and simple explanations:

1……gradual biological impairment of normal function, probably as a result of changes made to cells (mitotic cells, such as fibroblasts and post-mitotic cells, such as neurons) and structural components (such as bone and muscle). These changes would consequently have a direct impact on the functional ability of organs (such as the heart, kidney and lungs), biological systems (such as the nervous, digestive and reproductive system) and ultimately the organism as a whole.

2. ……normal ageing is that which occurs without disease.

‘The Greying of the Nations is a common phrase that describes the process of a population explosion worldwide population increase, a large proportion of who are older adults. In recognition of this increase, 1999 was designated by the United Nations as The Year of the Older Person. In real terms, these expanding populations will impact on global resources and economies given the cohorts out of work (children or retired people) compared to those in work. Governments are supporting increasing amounts of research to investigate their older populations to use results to provide / estimate the resources required to sustain as healthy a population as possible.

There are recognised age differentials between mortality in the developed and the developing countries, however on average, the older adult group span a 20 - 30 year period. The need to survey populations for the national Census has led to an arbitrary division of this group into three ages of ‘old’:

1. Between 60 – 75 years = young old
2. Between 75 – 85 years = old
3. Those 85+ are considered the frail older population

As populations age, it will be of interest to see if these age bands alter.

 The divisions confirm older people to be a varied group requiring consideration according to their needs. The National Service Framework for Older People of 2001 categorised the three cohorts broadly as:

• Entering old age: People from 50 to the official retirement age who have completed their career. They are supposed active and independent and many remain so into late old age.
  Goals of health and social care policy: To promote and extend healthy active life, and compress morbidity (the period spent in frailty and dependency before death).
• Transitional phase: A group in transition between healthy, active life and frailty, often occurring in the seventh or eighth decades, but can occur at any stage.
  Goals of health and social care policy: To identify emerging problems pre-crisis, ensuring effective response that prevents crisis and reduces long-term dependency.
• Frail older people: A vulnerable group due to health problems e.g. stroke or dementia, social care needs or a combination of both. Frailty often experienced in late old age, so services people should be designed with their needs in mind.
  Goals of health and social care policy: To anticipate and respond to problems, recognising the complex interaction of physical, mental and social care factors which can compromise independence and quality of life.
  

Demographics (study of population size, density, distribution and statistics)

Human life expectancy has increased dramatically. The first documented case of a 100 year old was in 1800 compared to the 11,000 centenarians recorded in the 2001 UK Census - the fastest growing section of the UK population (Figure 1).

Figure 1: Fastest increase in the ‘oldest old’

File:Oldest old.jpg

Life expectancy

The average life expectancy in the UK for females is 83.7 years, and for males is 77.5 years (National statistics online figures for 2006 – 8) although wide variations exist in different parts of the UK. The worldwide range of life expectancy spans from 36 years (Afghanistan) to 76 years (Japan).

Improvements in extrinsic (environmental) factors over the last century have enhanced the health of the population. The fall in the death rates at older ages contribute the most to the increase in the number of older people with increasing average life expectancy mainly from:

• A reduction of child mortality
  
• Biomedical advances, e.g. discovery of antibiotics
  
• Improvement in sanitation and public health measures
  
• Change in life habits
  
• Improvement in socio-economic conditions.

In the UK, the number of people aged over 65 has doubled in the past 70 years, and those aged over 90 will double in the next 25 years. In 2002, there were 19.8 million people aged over 50 in the UK (Figure 2), of which over 11 million were over 60.

The trend of growth of older adults in developed countries is gradually slowing but continues in the developing countries. By the year 2030 most countries are expected to have similar age structures. The predicted social impact of the ageing population is that Western societies will develop a large group of affluent elderly voters with disposable income. This is notable during major elections in the West where political parties actively seek to discuss the needs of older citizens. Despite what has just been stated, there exists a contradictory expansion between the rich and poor in many countries, and between those in better and worse states of health. Overall the older population fall into the latter categories of these issues with a correlated impact on the health of the nation as conditions like heart disease, diabetes and obesity rise  .

Figure 2. UK Population: by gender and age, 2002, United Kingdom

File:UK population.jpg

Evidence from longitudinal studies demonstrates loss of independence from acquired disabilities with a gradual change toward sedentary lifestyles . This insufficient physical activity contributes to disability impacting on the use of social services and healthcare resources.

Remember though, for many people, their later years will be active and a time of good health, although for some people it is a period of loss of health, wealth and status due to retirement from work, or loss from bereavement.

Discussion Point

In developed countries, a decrease in population life expectancy is predicted. This is due to a combination of sedentary lifestyles and poor diet choice increasing the likelihood of high-risk diseases. These include heart disease and diabetes or stress related and mental health disorders. What is your experience or thoughts about this statement?

If you think the ageing population is only of concern to physiotherapists specialising in older people, think again! Table 1 records bi-yearly number of 60+ year olds admitted to a Sheffield Teaching Hospital (1999–2009) as a percentage of total admissions by speciality. Note the increasing trend of admissions of people over 60.

Table 1. Percentage of over 60’s admitted to Northern General Hospital (Figures reproduced with permission from the Northern General Hospital, Sheffield Teaching Hospitals Trust)

Speciality Description	1999 (%>60)	2001	2003	2005	2007	2009
Burns	17	13.3	15.1	12.9	22.4	18.6
Cardiology	57	59.0	60.8	60.4	61.9	62.1
Cardio-thoracic Sx	57	58.9	62.4	66.3	59.5	68.8
General / chest Medicine	60	64.5	65.2	75.4	67.7	56.2
General Surgery	44	40.0	40.5	39.4	40.1	39.0
Heart Transplant	27	28.0	35.4	55.8	53.3	100
Nephrology	42	43.3	50.1	56.5	59.8	63.8
Orthopaedics	40	41.4	44.5	45.2	45.6	45.9
Plastic Surgery	27	31.3	30.3	31.6	29.4	35.4
Rehabilitation	19	13.5	28.1	8.6	31.7	16.1
Spinal Disabilities	19	7.9	5.9	9.5	13.4	17.1
Spinal Injuries	18	21.9	23.8	21.3	22.1	26.0
Vascular Surgery	61	64.4	59.0	51.6	53.9	60.5
Average	37.54	37.49	40.1	41.11	43.12	46.88

These people should receive the same level of service and care as anyone else. For example, those with co-morbidity and disability associated with ageing will require effective rehabilitation compared with those who have a laceration only following a fall; their intervention will be minimal before discharge.

Discussion Point

Evidence (mainly literature about musculo-skeletal physiotherapy or from monitoring demographics of hospital readmissions) illustrates a correlation between poor outcome from intervention and people in the lower socio-economic sectors of society (includes the older population). In striving to provide evidence of efficacy, at what point should we consider whether our input to such groups of our population is ineffective? Think about these both in terms of value through satisfaction of the individual receiving therapy, as well as the cost, given our finite resources of numbers of therapists and budget?

References

Department of Health (2001). National Service Framework for Older People. London, HMSO