Older people

West Wales has a higher proportion of older people than average across Wales, with inward migration a major accelerating factor for the growth of the older population. Pembrokeshire has an older population than Carmarthenshire and Ceredigion. The projected increase in those 85 and over is 28% by 2030, with local increase variation projected as follows: Carmarthenshire=25%; Ceredigion=26% and Pembrokeshire=33%.

People are living longer with increasingly complex issues, whilst wanting to remain in their own homes and live as independently as possible for as long as possible. COVID-19 has had a significant impact on the physical and mental wellbeing of older people, due to long periods of social isolation, lack of access to health and care services as well as the direct impact of contracting COVID-19.

Care and support arrangements should be designed with older people; should be flexible and include a range of community, digital and technology-based solutions.

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.

The 2017 report emphasised the need for a holistic approach to care and support, able to respond to wide and varied levels of need and support the development of resilience and independence.

All partners in the region have continued to move towards a consistent model of care for older people based on the principles of wellbeing and prevention, encapsulated in the Social Services and Wellbeing (Wales) Act 2014 and informed locally by a range of plans and strategies, including Ageing Well plans, the Health Board’s Integrated Medium Terms 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) [17].

All partners in the region have continued to move towards a consistent model of care for older people based on the principles of wellbeing 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 is based around the three levels of service, which includes three ‘offers’ to individuals depending on their needs:

Offer 1: Help to Help Yourself

Provision of services to build resilience and independence of older individuals, helping people to help themselves and prevent the need for ongoing care.

Offer 2: Help When You Need It

Provide care and support to people so they can regain their previous level of independence after an illness or injury. Includes reablement and rehabilitation at home.

Offer 3: Ongoing Support

Includes services for people who require longer term care or support. Usually delivered through integrated assessment, providing multi-disciplinary professional support. Care support plans are based on the question ‘What matters to you?’ with outcome plans delivered accordingly.

Technology Enabled Care

Currently various technology enabled care programmes are being utilised across West Wales. These vary from using telehealth to monitor and support people with chronic conditions such as COPD and heart failure, to using telecare to monitor and prevent falls. Various technology enabled care programmes can help people to manage their conditions, increase confidence, and help people to live independently in their own homes for longer.

Information, Advice and Assistance

A wide range of information and advice is available, to help people to achieve their outcomes by directing them to support available in the community.

Third Sector

There is a wide range of third sector services available, which promote independence, social engagement and inclusion.

Domiciliary Care and Support

There is rapid access to domiciliary care to provide care and support when it is needed, or on a longer-term basis.

Residential and Nursing Care

There are several residential and nursing care options available across the region, from extra care to EMI nursing. A significant proportion of older people living in the residential care setting in West Wales currently fund their own placement but may need financial support at a later date.

Fewer people are choosing long-term residential care, creating a greater demand for community-based care and an increased need to develop alternative accommodation

Whilst recognising that technology does not provide solutions for everyone, the evaluation, standardisation and development of services such as telehealth and telecare across the region could mitigate increasing demand for care and support where appropriate

If current trends continue, 160,000 more people in England and Wales will need palliative care by 2040 [17]. In addition to improving palliative and end of life provision, increasing implementation of advance care planning would allow people to make informed choices before reaching crisis point and inform future development of services.

COVID has had a significant effect on quality of life for older people. A UK wide survey conducted in April/May 2020 showed that being unable to access social support services due to COVID contributed to worse quality of life and increased anxiety in older adults and those with dementia [11]. Social support services need to continue to adapt to provide support services to those potentially affected by COVID in the future

COVID has been responsible for the deaths of thousands of older people in Wales. During the first wave of COVID, there were an estimated 47,243 excess deaths in England and Wales, of which 41,608 were aged over 65. This includes an estimated 1,757 excess deaths in Wales [12]. In March and April of 2020 alone, there were an estimated 20,000 more deaths in the care sector of England and Wales than would normally be expected [13]. Additional exacerbating factors of the pandemic on the older population include the negative effect on mental health that come with the social isolation caused by lockdown, and possibly increased care needs due to the longer-term impact on health to survivors of COVID.

References:

1. [11] Giebel C, Lord K, Cooper C, Shenton J, Cannon J, Pulford D, Shaw L, Gaughan A, Tetlow H, Butchard S, Limbert S, Callaghan S, Whittington R, Rogers C, Komuravelli A, Rajagopal M, Eley R, Watkins C, Downs M, Reilly S, Ward K, Corcoran R, Bennett K, Gabbay M. A UK survey of COVID-19 related social support closures and their effects on older people, people with dementia, and carers. Int J Geriatr Psychiatry, 2021 Mar;36(3):393-402. doi: 10.1002/gps.5434. Epub 2020 Sep 25. PMID: 32946619; PMCID: PMC7536967
2. [12] Kontopantelis E, Mamas MA, Deanfield J, Asaria M, Doran T. Excess mortality in England and Wales during the first wave of the COVID-19 pandemic. J Epidemiol Community Health, 2021 Mar;75(3):213-223. doi: 10.1136/jech-2020-214764. Epub 2020 Oct 15. PMID: 33060194; PMCID: PMC7892396. 48
3. [13] Burki T. England and Wales see 20,000 excess deaths in care homes. Lancet, 2020 May 23;395(10237):1602. doi: 10.1016/S0140-6736(20)31199-5. PMID: 32446403; PMCID: PMC7241982
4. [16] Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ, Murtagh FEM. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med. 2017 May 18;15(1):102. doi: 10.1186/s12916-017-0860-2. PMID: 28514961; PMCID: PMC5436458
5. [17] https://www.carmarthenshire.gov.wales/media/3345/older-people-vision.pdf