Examples of How the Trust Meets the Needs of Older People

Evidence for Equality Delivery System

Name of organisation:
The Newcastle upon Tyne Hospitals NHS Foundation Trust
Protected Characteristic
Age – Older People
Date: May 2015
General Points:
Useful links to Newcastle information
http://www.wellbeingforlife.org.uk/know-your-city
www.healthprofiles.info
Older people’s public health issues:
(‘Ageing the Silver Lining’ Local Government Association, June 2015)
·  Physical activity: The Department of Health recommends that those aged 65 or over should complete 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise per week.
·  Nutrition: One million people aged over 65 in the United Kingdom are malnourished and 93 percent of them live in the community
·  Falls: Falls and fractures in people aged 65 and over account for 4 million hospital bed days each year in England, cost the NHS around three quarter of a billion pounds,
·  Immunisation: Vaccination has been hugely successful in reducing the likelihood of early mortality, however around 600 people still die each year in the UK from a complication of seasonal flu.
·  Dementia: there is growing evidence indicating that certain medical conditions, such as high blood pressure, diabetes and obesity, can increase the risk of dementia.
·  Loneliness: Loneliness is associated with poor mental, physical and emotional health, including increased rates of cardiovascular disease, hypertension, cognitive decline and dementia.
·  Sexual relationships: These can provide a range of benefits for people regardless of their age, in terms of physical, mental and emotional health, and the achievement of sexual wellbeing can play an important part in older people’s relationships.
·  Fire prevention: Although not commonly thought of as a ‘public health’ issue, the prevention of fires is an important part of any comprehensive strategy to promote health and wellbeing in older people.
·  63% of all grandparents with a grandchild under 16 look after their grandchildren with an estimated value of £37.3 billion childcare provided by Grandparents.
·  Overall, age-related discrimination and stereotypes are firmly embedded in British society and their scope is wide ranging. Those over 70 have lowest status rating. People regard the status of different age groups in society differently; most notably, one-fifth of respondents rated people over 70 as having lower status. (Attitudes to age in Britain 2010/11 DH)
·  Evidence suggests that health professionals are less willing to treat older people living with frailty because they do not think they will recover or tolerate the side effects. Services must approach risk management with older people living with frailty in true partnership with them and their careers and with proper regard to wellbeing, quality of life and a true picture of their needs (understanding the lives of older people; IPSOS Mori for Age UK 2014)
·  There are several barriers to older service users identifying and planning for need and to prevent loneliness. One is lack of awareness of services. (Evidence Review: Loneliness in Later Life; Age UK 2014 Attitudes of older people)
·  In clinical terms, it is a person’s biological rather than chronological age that matters. Instinctively, most surgeons would support this approach. Yet delivering it can be challenging. With the ban on age discrimination now in effect in the NHS, there is a legal as well as a moral and professional imperative to ensure that older patients receive the most appropriate treatment for their individual needs. (Access all ages: Assessing the impact of age on access to surgical treatment (2012)(PDF, 1MB) Age Concern/Royal Colledge of Surgeons)
·  Over the past decade, rates of emergency hospital readmission have risen; the increase has been particularly steep for those over the age of 75 (the readmission rate for this age group is now about 50% higher than for 18 – 64 year olds). In a majority of cases, readmission had a negative impact. This contributes to feelings of depression and frustration. (Older people’s experience of emergency hospital readmission; Age UK 2012
·  Causes of death are available at
http://www.wellbeingforlife.org.uk/sites/www.wellbeingforlife.org.uk/files/4.3%20What%20people%20are%20dying%20from.pdf
The Strategy for Older People and an Aging Population in Newcastle has five overarching aims:
1. Making a positive contribution (active citizens)
2. Accessing information, advice and advocacy
3. Physical, mental and emotional health and well-being
4. Enjoying older person friendly environments
5. Financially and materially secure
·  As we see changes in our population with older people living longer, it is important that we continue to work for improvements which will make it easier for older people to live independently and to enjoy a good quality of life. ()
·  Social isolation is becoming an increasing problem in modern life particularly for older people (Audit Commission, 2008)
There is :
·  Lack of awareness of services. Older people, carers and frontline staff experience difficulties in finding out about services.
·  Insufficient time and attention is given to ensuring that people plan ahead. This leads to an increase in high level services being offered at crisis point, rather than lower level services earlier to prevent crisis.
·  Ineffective or non-referral between services and particularly between different sectors. (Joining the Dots 2010 Sandra Hillyard)
Partnerships for Older People Projects were funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and preventing or delaying their need for higher intensity or institutional care. The national evaluation (2010) of the projects demonstrated amongst other gains:
·  The reduction in hospital emergency bed days resulted in considerable savings, to the extent that for every extra £1 spent on the POPP services, there has been approximately a £1.20 additional benefit in savings on emergency bed days.
·  Overnight hospital stays were reduced by 47% and use of Accident & Emergency departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and clinic or outpatient appointments with a total cost reduction of £2,166 per person
Points related to Age
·  Approximately five million people over 50 take part in voluntary work.
(Older People Fact File NHS NE 2009)
·  Only 15% of people over 65 receive social care
·  Only 3% of people over 65, 18% of people over 80 and 28% of people over 90 live in residential care.
·  20% of people over 80 suffer from dementia
(Don’t stop me now Audit Commission 2008)
·  73% of older people in Great Britain agree that age discrimination exists in the daily lives of older people
·  68% of adults agree that once you reach very old age, people tend to treat you as a child
·  62% of over-fifties feel that they are turned down for a job because they are
considered too old, compared with 5% of people in their thirties (Older People Fact File NHS NE 2009)
Elder Abuse:
• Every hour, over 50 older people are neglected or abused in their own homes by family members(Older People Fact File NHS NE 2009)
Points related to Disability
See disability profile
·  Just over 25% of 50-64 year olds reported a long term illness or disability (Don’t stop me now Audit Commission 2008)
Mental health:
• Nearly 700,000 people were estimated to be suffering from dementia in the UK in 2007 and, by 2025, the number is expected to rise to 1m
• Depression affects about 1 person in 8 over 65
Points related to Race
·  There is an increasing diversity of our population, and increasing age of that population. Ethnic minority groups are generally young populations with less than one fifth aged 50 and over and fewer than one in ten aged 65 and over. However by 2051, in England and Wales, there will be 3.8 million Black and minority ethnic older people aged 65 and over and 2.8 million aged 70 and over. (Older BME people and financial inclusion report, Runnymede and the Centre for Policy on Ageing in July 2010)
·  In the short and medium term, life expectancies are different, in the longer term, the health and mortality patterns of ethnic minority groups might be expected to converge with those of the majority population. (Older BME people and financial inclusion report, Runnymede and the Centre for Policy on Ageing in July 2010)
·  ‘The ethnic balance is changing. Previously, we didn’t know the prevalence of dementia in the over 80s and the impact of this in BME groups. For example, people who have been fluent in English can lose their second language and revert to speaking their first language as dementia develops. Also, as trauma happens people can again revert to their first language. This has an impact on how we deliver services.’ (Don’t stop me now Audit Commission 2008)
·  All BME groups experience higher rates of pensioner poverty than the rest of the population. For instance nearly 1 in 2 Bangladeshi and Pakistani pensioners live in poverty compared to 1 in 6 white pensioners. ONS 2011
Points related to Religion and Belief
·  Each of us has our own unique identity, made up from complex sources, in which ethnicity, culture, gender, sexual orientation, religion and belief can all play a part.’ Dept. Communities and Local Government (2008)
·  Research suggests that attention to the religious needs of patients can contribute to their well-being. Religious beliefs can also impact on the types of treatment and drugs given to patients as well as on the amount of time patients spend in a hospital. Religious beliefs are therefore important considerations for patients and staff during service delivery.(Embracing Diversity in Mental Health Care 2010)
·  It is important to consider the spiritual, religious or faith needs of those using, and delivering healthcare services. Faith may be an important part of a person’s life. (Religion and Belief Fact File NE R&B Staff Network)
Points related to Marriage and Civil Partnership
·  A study investigating the relationship between health and marital status, focusing particularly on older persons, found that until about age 70, long-term illness rates are generally lowest for those in first marriage, followed by the remarried, with intermediate values for the widowed and divorced, and highest for the single. Beyond age 75 for both sexes, single people in the private household population report the lowest illness rates, but when the institutionalized population is included, single people at older ages no longer appear to be the healthiest group. (Glasser,K. Grundy, E.Journal of Marriage and Family Vol. 59, No. 1, Feb., 1997 )
·  People in Civil Partnerships have the right to joint treatment for income-related benefits, joint state pension benefits, right to register the death of a partner, right to claim a survivor pension, eligibility for bereavement benefits, recognition under inheritance and intestacy rules and tenancy succession rights (stonewall.org.uk )
Points related to Pregnancy and Maternity
·  60% of child care provision is provided by grandparents, saving the economy £4 billion per year (Grandparents Association)
Points related to Sex (Male/Female)
·  Life expectancy is 11.9 years lower for men and 9.1 years lower for women in the most deprived areas of Newcastle upon Tyne than in the least deprived areas. (Newcastle Health Profile Public Health England 2014)
Points related to Sexual Orientation
·  Older LGB people may have a greater need for health and social care services because, compared with their heterosexual contemporaries, they are:
two-and-a-half times as likely to live alone;
twice as likely to be single;
Four-and-a-half times as likely to have no children to call upon in times of need.
(Knocker, S (2006) The Whole of Me: Meeting the needs of older lesbians, gay men and bisexuals living in care homes and extra care housing, Age Concern, London. www.ageconcern.org.uk/openingdoors)
·  One of the biggest concerns for all older people is the possibility of needing residential care.
·  Older LGB people may feel particularly vulnerable about being open about their sexual orientation.(Older LGB People DH 2007)
Points related to Transgender
·  There is now a cohort of ‘first generation’ Trans people in the UK who transitioned to their acquired gender in the 1960s and 70s who are getting older.
·  We know that most Trans people will experience prejudice and discrimination from some individuals and institutions.
·  Transgender people may have been estranged from their family; it may be very difficult to have contact with them – particularly if they do not accept the acquired gender of the person. This may mean that Transgender people have less family support in their old age.
(Bereavement: A guide for Transsexual, Transgender people and their loved ones. DH 2007)
Key Messages from Older People
·  Develop clearer definition of pathways between services including referral pathways used by front line staff , in particular GPs and Intermediate Care and Community Nursing staff. This should include referral to a wider range of social activities through the voluntary and community sector (Joining the Dots 2010 Sandra Hillyard)
·  Make sure that staff are aware of the needs of older people with protected characteristics
·  Make sure that staff not specifically working with older people are aware of the value and needs of older people
·  Treat older people with respect & dignity; all older people have a life time of experience and many are extremely astute.
·  Do not assume that people you don’t know will appreciate being called ‘darling’ or ‘pet’
·  Speak clearly, but don’t patronise by speaking slowly or shouting
·  If you are providing written information, ask the person what format they would like the information in.

Examples of how the Trust meets the needs of Older People:

•  ‘Hearing Well’ Audit and action plan
•  Feeling Well and Overcoming Loneliness working group
•  Partnership work with Deaflink and PALS to raise awareness of ‘Hearing Well’ in Deaf Awareness week and at the Nursing and Midwifery Conference.
•  Maintained a falls rate below the National Acute Trust average of 6.8 falls/1000 bed days.
•  In relation to Safety Thermometer the Trust consistently reports a low rate of harm from falls
•  Joint working with North East Ambulance Service, continue to receive direct electronic referrals for falls assessment from North East Ambulance Service
•  Staying Steady Exercise Programme; collaborative working with 3rd Sector Organisation, HealthWorks Newcastle
•  Dementia friendly changes to the environment and signage; use of pictorial menus and crockery that distinguishes plate and cutlery; Dementia Memory Clinic

•  CQUIN target for ‘frail’ elderly people

•  ‘No falls on my patch’ Initiative

•  Partnership work with Nursing Care Homes to prevent unnecessary admissions

•  Partnership work to understand the needs of older gay people in Newcastle

•  CQC evidence in relation to quality services for all

•  Equality Objectives and Action Plan

•  Induction Training for staff further developed

•  EDHR training developed within Preceptorship, Mentoring and Nurses in Specialist Roles

•  Further development of Equality Analysis and the evidence to support staff to carry out effective analysis

•  Partnership with the Institute for Ageing

•  Partnership work with Health Works on Falls Prevention

•  Single Point of Entry Service for Rehabilitation and Ongoing Care