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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