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Healthy active ageing & the role of community services Emer Ahern 26th March 2010

Healthy active ageing & the role of community services Emer Ahern 26th March 2010

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Healthy active ageing & the role of community services

Emer Ahern

26th March 2010

Healthy ageing

Introduction

We are seeing an enormous demographic shift in our society

2006 (11%)

2011 (15%)

2030 (19%)

These changes are a cause for great celebration…

but these changes also present us with a challenge…

how do we ensure that our longer lives are also happy, healthy and independent ones?

Kilkenny

Kilkenny

Total 65+ 9,992 (11%)

65-74 5,489 (6%)

75-84 3,418 (4%)

85+ 1085 (1%)

2011 ~ 13,625

2030 ~ 17,259

Being old in Ireland: a fit stateIMJ, 2009

Health status

Functional ability

Patterns of service use

n = 776 over 70

Mean age 78.69 years

(Range:70 - 99)

73% owned their own homes

39% lived alone

5% NH care

65% rated their health as good,very good or excellent

36% reported long-term illness

17% moderate or severe disability

Physical function declined

Levels of disability increased

“Where would you prefer to live?”

Being old in Ireland: a fit state

During most of the adult years people closely rate their general health to their physical function and this association breaks down markedly after the age of 70

Self-rated general health remains reasonably stable despite objective deterioration in physical function and an increase in disability

“Selective optimisation with compensation model”

Suggests that as life options are restricted individuals select from the options available, optimise their ability to engage in whatever behaviour they wish to pursue and compensate where capacities are reduced

This implies that, despite increased levels of disability, older people adapt to their circumstances as physical function declines

HeSSOP 2

80% rated their quality of life as good or very good

75% scored high on morale

75% reported being self-sufficient in their abilities to perform tasks of daily living

12% usually needed help with one or more tasks of daily living

60% reported no functional disability

2006 census, 30% indicated they had a disability

92% attended a GP in previous 12 months, SLAN 2008, DOHC

Being old in Kilkenny: a fit state???Most are living at home (~91%)141 St Luke’s GH (~3.5%)11 ED8 MAU

690 NH care (~5.5%)

5,250 falls1,050 ED attendances450 emergency admissions600 fractures

320 Stroke diseases/ yr200 Parkinson’s Disease1200 Dementia

What older people want…

Promotion of person-centred holistic-based wellness throughout the life-cycle

Develop health service options that allow integrated planning and funding and delivery of primary, secondary, nursing home care and community services

Age Action, Submission to the National Ageing Strategy

What older people want…

“Living life to the full until the very last day” “Living life as far as possible without restrictions”“Living life to our best ability with the aid of trained people”“A really good living with all possible help until we die” Age Action, Submission to the National Ageing Strategy

87% wanted to remain living in their own homes, HeSSOP 2000

We want…

Best outcomes

Quality

Safe

Organise around what we know people want and what we know works to give the best results

More efficient use of resources

Collaborative & integrated services not limited by cultural or traditional organisational boundaries

Targeted assessment and management programmes

Standardised care and pathways

PCT/ SLGH community clinic

Rehab Falls & fractures Stroke

n = 9,992•All patients identified by GP or PCT MDM

16, KK320/yr

FacilityDean St PCT St Columba’s, KK

SLGHPCTs

SLGHPCCCCaredocAmb

Current services CGA to all patients identified by GP or PCT MDM

•Stroke•Other neuro•Orthogeriatircs•General•Community

Falls clinic - MDMFalls classFracture liaison serviceOrthogeriatrics service

ASUThrombolysisCaredocAmb

Organisations SLGHPCTsPCCC

SLGHWRHPCTsPCCCOther

SLGHPCTsPCCCWRHSTGHWGH

SLGHPCCCCaredocAmb

Evidence base Y Y Y Y

National Strategy N N Y Y

We can do… Provide service county wide“At risk” register

? Re-designate public NH beds to deliver more rehab

Outcomes, performance and quality measurements

Transient stroke and f/u clinicDemetia clinicPD clinic