Spending constraints associated with a higher than expected number of deaths

Study published in the British Medical Journal suggests cuts to public funding of health and social care since 2010 could be linked to almost 120,000 excess deaths in England | BMJ | OnMedica

The study reports that between 2010 and 2014, the NHS in England had a real-term annual increase in funding of 1.3%, despite rising patient demand and healthcare costs. Real-term spend on social care has fallen by 1.19% every year during the same period.

Researchers compared actual death rates for 2011 to 2014 with those that would be expected, based on trends before spending cuts came into play, and taking account of national and economic factors, such as unemployment rates and pensions.

The researchers’ analysis of the data showed that between 2001 and 2010, deaths in England fell by an average of 0.77% every year, but rose by an average of 0.87% every year between 2011 and 2014.

The spending restraints were associated with 45,368 higher than expected numbers of deaths between 2010 and 2014 compared with equivalent trends before 2010.

Full reference: Watkins J. et al. |  Effects of health and social care spending constraints on mortality in England: a time trend analysis | BMJ Open 2017

Related: Excess deaths could be linked to health spending cuts

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The Impact Of Homelessness On Health

New report warns that that the rising number of older homeless will create significant extra pressures for councils | Local Government Association

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The Local Government Association (LGA) says that older homelessness is a growing hidden phenomenon that needs greater understanding.  Latest figures show that between April and June this year, councils accepted 620 people aged over 60 as homeless – at a rate of nearly 10 a day. This is up from the 270 accepted between October and December 2009, which was the lowest number since records began in 2005.

The LGA, which represents more than 370 councils in England and Wales, is warning that based on existing trends, this is set to double by 2025.

The LGA is calling for government to address the undersupply in specialist housing for older people, and an adaption to the implementation of welfare reforms to reduce the risk of homelessness. It says councils need to be able to borrow to invest in new council housing to increase supply, boost home ownership and reduce homelessness.

Full report: The Impact of Homelessness on Health: A guide for Local Authorities

 

Change in loneliness after intervention with cochlear implants or hearing aids

The aim of the study was to investigate the impact of hearing aid (HA) and cochlear implant (CI) use on loneliness in adults| The Laryngoscope

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Image source: Joonas Tikkanen – Flickr // CC BY-ND 2.0

One hundred and thirteen adults, aged ≥ 50 years, with postlingual hearing loss and receiving routine clinical care at a tertiary academic medical center, were evaluated with the University of California at Los Angeles Loneliness Scale before and 6 and 12 months after intervention with HAs or CIs. Change in score was assessed using linear mixed effect models adjusted for age; gender; education; and history of hypertension, diabetes, and smoking.

Treatment of hearing loss with CIs results in a significant reduction in loneliness symptoms. This improvement was not observed with HAs. We observed differential effects of treatment depending on the baseline loneliness score, with the greatest improvements observed in individuals with the most loneliness symptoms at baseline.

Full reference: Contrera, K.J. et al. (2017) Change in loneliness after intervention with cochlear implants or hearing aids. The Laryngoscope. Vol. 127 (Issue 8) pp. 1885–1889

Physical inactivity levels in adults aged 40 to 60 in England

Public Health England has released data on brisk walking levels and physical inactivity in people aged between 40 and 60 in England from 2015 to 2016.

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Data released by Public Health England (PHE) has shown that the amount of activity people do starts to tail off from the age of 40. PHE estimates 40% of 40- to 60-year-olds take a brisk 10-minute walk less frequently than once a month.

The analyses were carried out by PHE using data from Sport England’s Active Lives Survey, which is designed to measure participation in sport and physical activity in England.

PHE  say just 10 minutes a day could have a major impact, reducing the risk of early death by 15%. To help, the government agency is promoting a free app – Active 10 – which can monitor the amount of brisk walking an individual does and provide tips on how to incorporate more into the daily routine.

In addition, the PHE framework ‘Everybody active, every day’ has been updated. This framework aims to make active lifestyles a reality for all, with 4 areas for action which will:

  • change the social ‘norm’ to make physical activity the expectation
  • develop expertise and leadership within professionals and volunteers
  • create environments to support active lives
  • identify and up-scale successful programmes nationwide

Full document:
Everybody active, every day: an evidence-based approach to physical activity

Related: BBC News: Middle-aged told to walk faster

The Guardian: 6 million middle-aged people take no exercise

Substance misuse in older people

Action is needed to deal with growing levels of substance misuse in people aged over 50, claims BMJ editorial 

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Researchers in the UK and Australia said the number of people aged over 50 who were experiencing problems from substance misuse was growing rapidly and the numbers receiving treatment were expected to treble in the US and double in Europe by 2020.

In both the UK and Australia, dangerous levels of drinking are declining, except among people aged 50 years and older, they said. One of the authors warns that the issue goes beyond drinking, citing illicit drugs such as cannabis, and commonly prescribed medications such as opioid painkillers as also being an issue.

Full  editorial:  Rao, R. & Roche, A.  Substance misuse in older people: Baby boomers are the population at highest risk  BMJ 2017;358:j3885

Related : Baby boomers’ drink and drug misuse needs urgent action, warn experts | The Guardian

Impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures

Inadequate health literacy (HL) is associated with impaired healthcare choices leading to poor quality-of-care | Geriatric Nursing

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Our primary purpose was to estimate the prevalence of inadequate HL among two populations of AARP®Medicare Supplement insureds: sicker and healthier populations; to identify characteristics of inadequate HL; and to describe the impact on patient satisfaction, preventive services, healthcare utilization, and expenditures. Surveys were mailed to insureds in 10 states. Multivariate regression models were used to identify characteristics and adjust outcomes. Among respondents (N = 7334), 23% and 16% of sicker and healthier insureds, respectively, indicated inadequate HL. Characteristics of inadequate HL included male gender, older age, more comorbidities, and lower education. Inadequate HL was associated with lower patient satisfaction, lower preventive service compliance, higher healthcare utilization and expenditures. Inadequate HL is more common among older adults in poorer health, further compromising their health outcomes; thus they may benefit from expanded educational or additional care coordination interventions.

Full reference: MacLeod, S. et al. (2017) The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatric Nursing. Volume 38 (Issue 4) pp. 334–341

Unmet needs in social care among older people

Ipsos MORI and partners including AgeUK, NatCen Social Research and Independent Age has published Unmet Need For Care.

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Image source: http://www.ipsos.com

This report highlights the experiences of unmet need for care among older people living in their own homes.  The research for this report used secondary analysis of survey data from the English Longitudinal Study of Ageing (ELSA) and Health Survey for England (HSE) using data from 2011 – 13.

The report is set against a background of an increasingly ageing population and cuts to budgets placing pressure on services. At the same time, the Care Act 2014 has introduced a national eligibility framework and an emphasis on prevention and on well-being