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Large increase in numbers of elderly needing 24-hour care predicted

Number of very elderly needing round-the-clock care set to double by 2035 in England

Ingrid Torjesen

Friday, 31 August 2018

The number of adults aged 85 years and older needing round-the-clock care will almost double to 446,000 in England over the next 20 years, whilst the overall numbers of over-65s requiring 24-hour care will rise by more than a third to over one million in 2035, according to a modelling study* published in The Lancet Public Health.

Estimates suggest that the number of people aged over 65 will increase by just under 50% from 9.7 million in 2015 to 14.5 million in 2035. The number of adults aged 65 years and older living independently (without care needs) is set to rise to 8.9 million by 2035 in England - an increase of over 60% from 5.5 million in 2015, with the increase in independence seen mainly in men.

However, little research has been done on how levels of dependency might change for different generations of older people, so researchers from Newcastle University and the London School of Economics and Political Science developed the Population Ageing and Care Simulation model that accounts for multiple risk factors for dependence and disability including a wide range of sociodemographic factors (e.g. level of education) and health behaviours (e.g. smoking status, physical activity), as well as 12 chronic diseases and geriatric conditions including coronary heart disease, stroke, hypertension, diabetes, arthritis, cancer, respiratory disease, and cognitive impairment, and depression. Using longitudinal data from three large nationally representative studies of adults (aged 35 and older), the study modelled future trends in social care needs for the population aged 65 years and older in England between 2015 and 2035, according to varying levels of dependency.

“Over the next 20 years, although young-old cohorts (aged 65-74) are more likely to enter old age independent, the proportion with multi-morbidities is projected to rise with each successive cohort, and this will result in a greater likelihood of higher dependency with further ageing”, explained Professor Carol Jagger from the Newcastle University Institute for Ageing, Newcastle, UK.

Between 2015 and 2035, life expectancy for men aged 65 is projected to rise by 3.5 years to 22.2 years, and the average number of years spent independent is expected to increase by 4.2 years (from 11.1 years to 15.2), whilst time spent living with substantial care needs is likely to decline.

In contrast, for women average life expectancy at 65 will increase by just three years (from 21.1 to 24.1). Over this time, the average number of years spent independent is expected to rise by less than a year (from 10.7 years to 11.6), and women will spend almost half of their remaining life with low dependency needs such as help with activities like washing and shopping, alongside a small increase in years requiring intensive 24-hour care (from two years in 2015 to 2.7 years in 2035).

The study highlights the importance of ensuring that health and social care services adapt to the unprecedented needs of an increasing older population with complex care needs. The authors warn that relying on the informal carers who provide around £57 billion worth of care in the UK is not a sustainable solution.

“The challenge is considerable”, says Professor Jagger.

“Our study suggests that older spouse carers are increasingly likely to be living with disabilities themselves, resulting in mutual care relationships, that are not yet well recognised by existing care policy and practices. On top of that, extending the retirement age of the UK population is likely to further reduce the informal and unpaid carer pool, who have traditionally provided for older family members. These constraints will exacerbate pressures on already stretched social care budgets.”

The researchers also analysed how the burden of dementia with and without other chronic diseases will change demands for social care over the next 20 years. It is predicted that the number of people living into old age with multiple long-term conditions will rise, with the majority (80%) of older adults with dementia and in need of substantial care in 2035 likely to have two or more other diseases.

*Kingston A, Comas-Herrera A, Jagger C for the MODEM project. Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study. The Lancet Public Health. Published: August 30, 2018, DOI: 10.1016/S2468-2667(18)30118-X

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