Abstract
SummaryBackgroundLittle is known about how the proportions of dependency states have changed between generational cohorts of older people. We aimed to estimate years lived in different dependency states at age 65 years in 1991 and 2011, and new projections of future demand for care.MethodsIn this population-based study, we compared two Cognitive Function and Ageing Studies (CFAS I and CFAS II) of older people (aged ≥65 years) who were permanently registered with a general practice in three defined geographical areas (Cambridgeshire, Newcastle, and Nottingham; UK). These studies were done two decades apart (1991 and 2011). General practices provided lists of individuals to be contacted and were asked to exclude those who had died or might die over the next month. Baseline interviews were done in the community and care homes. Participants were stratified by age, and interviews occurred only after written informed consent was obtained. Information collected included basic sociodemographics, cognitive status, urinary incontinence, and self-reported ability to do activities of daily living. CFAS I was assigned as the 1991 cohort and CFAS II as the 2011 cohort, and both studies provided prevalence estimates of dependency in four states: high dependency (24-h care), medium dependency (daily care), low dependency (less than daily), and independent. Years in each dependency state were calculated by Sullivan's method. To project future demands for social care, the proportions in each dependency state (by age group and sex) were applied to the 2014 England population projections.FindingsBetween 1991 and 2011, there were significant increases in years lived from age 65 years with low dependency (1·7 years [95% CI 1·0–2·4] for men and 2·4 years [1·8–3·1] for women) and increases with high dependency (0·9 years [0·2–1·7] for men and 1·3 years [0·5–2·1] for women). The majority of men's extra years of life were spent independent (36·3%) or with low dependency (36·3%) whereas for women the majority were spent with low dependency (58·0%), and only 4·8% were independent. There were substantial reductions in the proportions with medium and high dependency who lived in care homes, although, if these dependency and care home proportions remain constant in the future, further population ageing will require an extra 71 215 care home places by 2025.InterpretationOn average older men now spend 2·4 years and women 3·0 years with substantial care needs, and most will live in the community. These findings have considerable implications for families of older people who provide the majority of unpaid care, but the findings also provide valuable new information for governments and care providers planning the resources and funding required for the care of their future ageing populations.FundingMedical Research Council (G9901400) and (G06010220), with support from the National Institute for Health Research Comprehensive Local research networks in West Anglia and Trent, UK, and Neurodegenerative Disease Research Network in Newcastle, UK.
Highlights
A common concern with increasing lifespan is that higher levels of disease will translate into a decline in capability and independence, with increased demands for health and social care services.[1,2] Increased survival to very old ages does not always result in more disability and dependency at a population level because of selective mortality of the most dependent;[3] whether this observation will continue with further advances in medical technology remains unknown
Implications of all the available evidence Our research suggests that the current social care crisis is due to the increasing numbers of the very old, with their higher morbidity and greater health and social care use, but that current older people are spending more of their remaining life with low and high care needs
The past 20 years have seen continued gains in life expectancy at older ages, but not all have been healthy years, with about 2 years more spent with low dependency, but, more importantly, about 1 year more with high dependency (24-h care)
Summary
A common concern with increasing lifespan is that higher levels of disease will translate into a decline in capability and independence, with increased demands for health and social care services.[1,2] Increased survival to very old ages does not always result in more disability and dependency at a population level because of selective mortality of the most dependent;[3] whether this observation will continue with further advances in medical technology remains unknown. A key challenge for ageing societies worldwide will be the projected decline in traditional sources of formal and unpaid care from families to support people living at home and in long-term residential care,[4] and cuts to social care budgets that influence hospital discharge.[5]. We aimed to estimate years lived in different dependency states at age 65 years in 1991 and 2011, and new projections of future demand for care
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