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Older people let down by crisis in NHS and social care, says Age UK

The crisis in the NHS is largely a crisis in older people’s preventive care, says a new report.

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The crisis in the NHS is largely a crisis in older people’s preventive care, and we need to act now to fix it, says a new report from the charity Age UK.

A new in-depth report from the Charity Age UK, ‘Fixing the Foundations’, reveals how the NHS and social care system is struggling and sometimes failing to cope with the needs of older people. 

Longstanding problems, predating the pandemic but exacerbated by it too, are piling pressure on families and carers and leaving the NHS in constant crisis mode, the report says. This is contributing to ambulances being stacked up outside hospital emergency departments at the moment, and long waits for people of all ages to access urgent care.

NHS figures show half (49 per cent) of all people arriving in A&E by ambulance are over 65 and a third (35 per cent) over 75. The proportion of older people feeling supported to manage their health condition has fallen by almost 20 per cent since 2016/17, while one in five over 80s have some unmet need for social care, according to Age UK.

‘Fixing the Foundations’ provides a first-hand account of older people’s difficulties in getting the good, joined up health and social care they need to manage at home, leaving them at risk of crisis which often results in being admitted to hospital. 

It also shows how living with multiple long term health conditions, as a significant proportion of older people do, including more than two thirds of those aged over 85, makes it especially hard to navigate health services which are still usually organised around individual illnesses and diseases. Meanwhile social care was often inadequate or absent in these older people’s lives, according to the report. 

Age UK estimates that over 1.6 million older people have some level of fundamental care and support needs, such as help to get dressed, washed or getting out of bed, that is not being fully addressed. For those older people who do receive care and support it is often coming from unpaid family carers, who provide a far greater volume of care in our country than formal services. 

However, figures from 2019 estimate that 3.3 million older people now live alone and 1.5 million older people are ageing without children in our society and their numbers are expected to rise significantly in the coming years as our population ages. There are now 2.6 million people over 50 who have unmet social care needs, increasing to 15 per cent of people in their 70s and 21 per cent of people in their 80s. 

Between 2016/17 and 2021/22 the proportion of older people receiving long term support from their local authority went down by 13.5 per cent. In 2022, there were 165,000 vacant posts in social care- an increase of 50% and the highest rate on record. 

A call for change

On the back of the report the charity is calling for a number of changes in the health and social care system, including widespread social care reform, multidisciplinary working and the introduction of Integrated Care Systems (ICS) to develop comprehensive strategies for meeting the health and social care needs of older people at home, and in care homes, living in their areas. 

Alongside a better-paid health and social workforce, the charity also wants to see a step change in the recognition of and financial and practical support on offer to unpaid carers.

Caroline Abrahams, Age UK Charity Director, said: “As our new report shows, we need to turbocharge our efforts to recruit, retain and support all the brilliant professionals that older people depend on to help them stay well at home, especially if they are struggling to manage several serious health conditions, like heart disease and diabetes, as many are. We need lots more social care staff, and hugely important community health professionals like District Nurses and Occupational Therapists, as well as GPs. Then we need to get them working effectively together – not only at the point when an older person is at immediate risk of needing a hospital bed, as with urgent response teams and virtual wards, but well before they reach that point too.

“Although this winter is not yet over it won’t be long before next winter is upon us, and it’s imperative we start work now to make sure it’s a much better one for the NHS and social care, and for older people too. At Age UK we are committed to doing everything we can to support a major national effort to this end – the voluntary sector, including our wonderful local Age UK [branches], has a big potential role to play. As we have learned this year, and as our new report shows, if we can get it right for older people in the NHS and social care then we’ll go a long way towards making the whole health and care system work more smoothly for people of all ages.

Five years ago Age UK published a report called The Failing Safety Net, which looked at many of the same issues covered in this new report and made many similar recommendations.

Ms Abrahams added: “It would be terrible if Age UK had to publish another report in five years’ time that once again found these same problems were still to be addressed. The fact is we know what has to happen to unblock our jammed-up hospitals and give older people the dignified health and social care support they need and deserve, and it’s down to the Government above all, to provide the leadership and resources to make it happen.”

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Air pollution linked to increased hospital admission for heart and lung diseases

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Exposure to fine particulate matter (PM2.5) air pollution is linked to an increased risk of hospital admission for major heart and lung diseases, find two large US studies, published by The BMJ.

Together, the results suggest that no safe threshold exists for heart and lung health.

According to the Global Burden of Disease study, exposure to PM2.5 accounts for an estimated 7.6% of total global mortality and 4.2% of global disability adjusted life years (a measure of years lived in good health).

In light of this extensive evidence, the World Health Organization (WHO) updated the air quality guidelines in 2021, recommending that an annual average PM2.5 levels should not exceed 5 μg/m3 and 24 hour average PM2.5 levels should not exceed 15 μg/m3 on more than 3-4 days each year.

In the first study, researchers linked average daily PM2.5 levels to residential zip codes for nearly 60 million US adults (84 per cent white, 55 per cent women) aged 65 and over from 2000 to 2016. They then used Medicare insurance data to track hospital admissions over an average of eight years.

After accounting for a range of economic, health and social factors, average PM2.5 exposure over three years was associated with increased risks of first hospital admissions for seven major types of cardiovascular disease – ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, valvular heart disease, and thoracic and abdominal aortic aneurysms.

Compared with exposures of 5 μg/m3 or less (the WHO air quality guideline for annual PM2.5), exposures between 9 and 10 μg/m3, which encompassed the US national average of 9.7 μg/m3 during the study period, were associated with a 29% increased risk of hospital admission for cardiovascular disease.

On an absolute scale, the risk of hospital admission for cardiovascular disease increased from 2.59% with exposures of 5 μg/m3 or less to 3.35% at exposures between 9 and 10 μg/m3.

“This means that if we were able to manage to reduce annual PM2.5 below 5 µg/m3, we could avoid 23% in hospital admissions for cardiovascular disease,” say the researchers.*

These cardiovascular effects persisted for at least three years after exposure to PM2.5, and susceptibility varied by age, education, access to healthcare services, and area deprivation level.

The researchers say their findings suggest that no safe threshold exists for the chronic effect of PM2.5 on overall cardiovascular health, and that substantial benefits could be attained through adherence to the WHO air quality guideline.

“On February 7, 2024, the US Environmental Protection Agency (EPA) updated the national air quality standard for annual PM2.5 level, setting a stricter limit at no more than 9 µg/m3. This is the first update since 2012. However, it is still considerably higher than the 5 µg/m3 set by WHO. Obviously, the newly published national standard was not sufficient for the protection of public health,” they add.*

In the second study, researchers used county-level daily PM2.5 concentrations and medical claims data to track hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease for 50 million US adults aged 18 and over from 2010 to 2016.

During the study period, more than 10 million hospital admissions and 24 million emergency department visits were recorded.

They found that short term exposure to PM2.5, even at concentrations below the new WHO air quality guideline limit, was statistically significantly associated with higher rates of hospital admissions for natural causes, cardiovascular disease and respiratory disease, as well as emergency department visits for respiratory disease.

For example, on days when daily PM2.5 levels were below the new WHO air quality guideline limit of 15 μg/m3, an increase of 10 μg/m3 in PM2.5 was associated with 1.87 extra hospital admissions per million adults aged 18 and over per day.

The researchers say their findings constitute an important contribution to the debate about the revision of air quality limits, guidelines, and standards.

Both research teams acknowledge several limitations such as possible misclassification of exposure and point out that other unmeasured factors may have affected their results. What’s more, the findings may not apply to individuals without medical insurance, children and adolescents, and those living outside the US.

However, taken together, these new results provide valuable reference for future national air pollution standards.

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Home health care linked to increased hospice use at end-of-life – study

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Patients who had previously received home health care had a higher likelihood of accessing hospice care at the end of their life, according to a new study.

Researchers, whose findings are published in the Journal of Palliative Medicine, examined the home health care and hospice care experiences of more than two million people.

Using Medicare data, researchers found when individuals received home health care before the last year of their life, they had higher odds of using hospice care than those who had never received home health care.

Researchers said this association underscores the potential benefits of receiving end-of-life care in the comfort of one’s home.

As the aged population increases, the findings also show the need for more resources in the health care sector and staff training in end-of-life care.

Home health care services including skilled nursing, therapy, social work and aide services are used to maintain functioning or slow decline in health. Hospice care provides similar services but is intended for those with life expectancies of six months or less and is focused on pain relief, minimising hospital visits and providing comfort and support. Both services provide patients the opportunity to receive more personalised care in their home.

Researchers say home-based care also encourages greater involvement of family caregivers in the caregiving process.

Olga Jarrín, senior author of the study, the Hunterdon Professor of Nursing Research at the Rutgers School of Nursing and director of the Community Health and Aging Outcomes Laboratory within the Rutgers Institute for Health, Health Care Policy and Aging Research, commented: “In addition to benefits for the patient, hospice care also provides resources and support to help family caregivers cope with the physical, emotional and practical challenges of caring for a loved one at the end of life.”

Hyosin (Dawn) Kim, research assistant professor at Oregon State University and first author of the study, added: “By providing personalised care, reducing hospitalisations, fostering family involvement and support, and improving symptom management, home-based care can enhance the quality of end-of-life experiences for patients with terminal illnesses and their families.”

 

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Sleep programme shows promise in those with memory problems – study

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A new study has shown promising results in improving sleep and quality of life in individuals living with memory problems.

A group of researchers from Penn Nursing, Penn Medicine, Rutgers School of Nursing, and Drexel University’s College of Nursing and Health Professions, have delved into the efficacy of a non-pharmacological approach in a trial known as the Healthy Patterns Sleep Program.

The study involved 209 pairings of community-residing individuals with memory problems and their care partners. Participants were assigned to either the Healthy Patterns Sleep Program, which consisted of one-hour home activity sessions administered over four weeks, or a control group that received sleep hygiene training, plus education on home safety and health promotion.

The Healthy Patterns Sleep Program trained care partners in timed daily activities such as reminiscence in the morning, exercise in the afternoon and sensory activities in the evening that can decrease daytime sleepiness and improve nighttime sleep quality.

Nancy Hodgson, PhD, RN, FAAN, the Claire M. Fagin Leadership Professor in Nursing and Chair of Department of Biobehavioral Health Sciences, who led the study, said: “The results from this study provide fundamental new knowledge regarding the effects of timing activity participation and can lead to structured, replicable treatment protocols to address sleep disturbances. Overall, the Healthy Patterns program resulted in improved QOL compared to an attention-control group.”

The findings also indicate that, compared to a control group, the four-week Healthy Patterns program improved sleep quality among persons living with memory issues who had depressive symptoms or poor sleep quality.  The study indicates the Healthy Patterns Intervention might need a longer dose to induce improvements in other sleep-wake activity metrics.

The study’s significance lies in its confirmation of the effectiveness of behavioural interventions in not only improving quality of life and addressing sleep quality issues in this population, but also potentially reducing care partner burden and overall care costs for persons living at home with memory problems.

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