Please note: The data in “demographics and trends” has been recently updated in preparation for the population assessment update taking place over the next year. The remainder of this page will be updated when the population assessment is published on 1 April 2022.

As a result of the increasing focus on supporting people living with dementia across the West Wales region, a dedicated section for dementia is under development and will be available shortly.

Overview and key messages

The population of West Wales has a higher proportion of older people than the Welsh average, and that already high proportion is predicted to increase significantly in the coming years, as average life expectancy in the region follows the national upwards trend (Office for National Statistics, 2011).

The change in the profile of the population will undoubtedly have an impact on health, as older people are statistically more likely to have a life limiting health condition (Office for National Statistics, 2011) These changes will significantly impact on the health and social care services provided, as demand for hospital and community services by those aged 75 and over is in general more than three times that from those aged between 30 and 40 (Parliamentary Select Committee on Public Service and Demographic Change, 2013).

A number of ‘accelerating factors’ add to the challenge of providing effective services to older people in West Wales, from pockets of significant deprivation to large areas of rurality and high levels of migration of older people to certain areas (Henry, 2012).

In 2013-14 an estimated £91 million was spent in West Wales on services specifically for older people including Tier 1 – Community, Universal and Prevention Services, Tier 2 - Early Intervention and Reablement and Tier 3 - Specialist and Long Term Services. Across the UK public expenditure related to older people is expected to rise from 20.1% of GDP in 2007-08 to 26.7% in 2057 (Mid and West Wales Health and Social Care Collaborative, 2015).


“public finances are likely to come under pressure, primarily as a result of an ageing population”

The Office for Budget Responsibility (2011)

Demographics and trends

There are increasing numbers of older people across Carmarthenshire, Ceredigion and Pembrokeshire.

The current population estimates for 2021 suggest that people aged over 65 living in the West Wales region make up approximately 24.1% of the population in Carmarthenshire, 26.2% in Ceredigion and 26.7% in Pembrokeshire. It is expected that the percentage of the population that is aged 65 and over will rise to 29.53% in Carmarthenshire, 32.54% in Ceredigion and 33.4% in Pembrokeshire, by 2043.

With large parts of Carmarthenshire, Ceredigion and Pembrokeshire being both rural and coastal, the region attracts high levels of inward migration of people over 65. People from elsewhere in the UK already account for almost 22% of the population of Wales, with the vast majority of the new arrivals retiring from England (Bingham, 2014). The highest levels are found in Pembrokeshire with a 31% migration rate with 87% of these being over 65. Ceredigion has the largest percentage of residents with a second home in the whole of the UK. Whilst this may be explained in part by the large student population, census data shows that 325 people over 65 in Ceredigion have second addresses outside the county. Of equal importance; data indicates that 1,182 pensioners have second homes in Ceredigion; these individuals have not moved permanently into the area but still spend a significant amount of time there, during which periods they might access health and social care services.

The latest data shows that 7,409 people migrated to Carmarthenshire between June 2018 and June 2019, with the majority in the 25-44 age bracket. 5,318 have migrated to Ceredigion, with the majority in the 16-24 age bracket. 4,779 migrated to Pembrokeshire, the majority being in the 25-44 age bracket, although this is closely followed by the 45-64 age band.

Dementia in people aged less than 65 is described as early onset dementia, young onset dementia or working age dementia. It is estimated that 1 in 1,000 people in Wales have early onset dementia. This figure is slightly higher in Carmarthenshire and Pembrokeshire, and higher still in Ceredigion.

The symptoms of dementia may be similar regardless of a person's age, but younger people often have different needs, and therefore often require different support. There is a wide range of diseases that cause early onset dementia and a younger person is much more likely to have a rarer form of dementia than an older person. However, people under 65 do not generally have the co-existing long-term medical conditions of older people. For example, diseases of the heart and circulation. Younger people are usually physically fitter and dementia may be the only serious condition they are living with (Alzheimer’s Society, 2015). The following chart shows the numbers of people with early onset dementia in Pembrokeshire, Ceredigion, Carmarthenshire and Wales.

Older adults in the West Wales region have increasingly complex needs. There are an estimated 6,884 people over the age of 65 with dementia in West Wales, 1,322 in Ceredigion, 2,358 in Pembrokeshire, and 3,204 in Carmarthenshire. Projections show that there will be 10,897 people over the age of 65 with dementia in West Wales by 2035, 1,993 in Ceredigion, 3,831 in Pembrokeshire, and 5,073 in Carmarthenshire.

There is evidence to suggest around 7% of dementia cases in Wales are early-onset dementia, backed up with other estimates of 5%-9% of early onset dementia diagnoses in the UK.

Current and future care and support needs

All partners in the region are moving towards a consistent model of care for older people based on the principles of well-being and prevention encapsulated in the SSWB Act and informed locally by a range of plans and strategies including Ageing Well plans, the Health Board’s Integrated Medium Term Plan, Carmarthenshire County Council’s ‘Vision for Sustainable Social Services for Older People 2015-25 and the regional Statement of Intent for the Integration of Services for Older People with Complex Needs in West Wales (2014).

Delivery across the region varies in detail but in each county area it is based around three levels of service described as ‘offers’ to individuals according to their need and circumstance and are as follows:

  • Offer 1: Help to help yourself
  • Offer 2: Help when you need it
  • Offer 3: Ongoing support

Gaps and areas for improvement

A number of areas need further development if the requirements of the Act, including well-being outcomes for older people and the aspirations of existing strategies are to be fully addressed:
  • Developing appropriate access to a range of information, advice and assistance including Dewis and advocacy services relevant to health and social care needs at relevant stages for health and social care
  • Improving anticipatory care across the health, social care and other sectors to avoid escalation of need
  • Reducing the reliance on residential and nursing care in favour of lower level, preventative and well-being services
  • Developing community-based, user-led, co-produced services that prevent isolation; promote community connectivity, well-being and resilience and support people to remain independent for longer in their own communities
  • Enhancing assessment and care planning processes to ensure older people and their carers are involved in decisions about them, including discharge planning
  • Ensuring that older people and their families are able to access services through their language of choice and that the offer through the medium of Welsh is available
  • Achieving a consistent, integrated approach to frailty across the region that aligns with regional frailty and dementia strategies and pathway
  • Developing consistent, integrated commissioning and procurement processes based on co-production principles, which involve older people, user-led community-based groups and fora in the design and delivery of services, to achieve market sustainability
  • Improving and standardising levels of telehealth and telecare across the region
  • Addressing the lack of transport links within very rural regions, which add to the difficulty of accessible service delivery and recruitment challenges
  • Growing an integrated approach to quality assurance and contract monitoring of care homes to identify and address emerging concerns and prevent placement breakdown