Well-being, Independence and the future: Healthy ageing in Wales

Well-being, Independence Well-being, Independence and the future:and the future:

Healthy ageing in WalesHealthy ageing in Wales

Bob WoodsBob WoodsProfessor of Clinical Psychology of Older Professor of Clinical Psychology of Older

PeoplePeopleDementia Services Development CentreDementia Services Development Centre

Bangor UniversityBangor University

OverviewOverview

We live and age in unprecedented timesWe live and age in unprecedented times Dementia – the big challenge to Dementia – the big challenge to

independence?independence? Depression – strong link with Depression – strong link with

dependencydependency The well-being paradox – your money or The well-being paradox – your money or

your health?your health? Ageing as growth and development?Ageing as growth and development?

Global Population Global Population GrowthGrowth

Two centuries of Two centuries of sustained growth sustained growth in the percentage in the percentage of the population of the population age 60 and olderage 60 and older

Regional GrowthRegional Growth

The pace of The pace of population ageing population ageing for different for different regions of the regions of the worldworld

Wales – 1871Wales – 1871

Wales - 1931Wales - 1931





Wales – 2033?Wales – 2033?

An older population - UKAn older population - UK

0

2

4

6

8

10

12

14

Millions

65+

19851995200520152025

An older older population - UKAn older older population - UK

00.5

11.5

22.5

33.5

4

Millions

80+

19851995200520152025

What do these changes mean?What do these changes mean?

More people with physical health More people with physical health difficultiesdifficulties

Physical health and older Physical health and older peoplepeople

Arthritis – 47% females; 32% males 65+Arthritis – 47% females; 32% males 65+ Cardiovascular disease – 31% females; Cardiovascular disease – 31% females;

37% males37% males Hypertension – 64% females; 62% menHypertension – 64% females; 62% men Limiting long-term illnessLimiting long-term illness

40% aged 65-7440% aged 65-74 60% aged 75-8460% aged 75-84 Over half rate their health as good or fairly Over half rate their health as good or fairly

goodgood

Physical health and older Physical health and older people - 2people - 2

Functional limitations in 3 or more Functional limitations in 3 or more areasareas Aged 65-69, 2% females, 4% malesAged 65-69, 2% females, 4% males Aged 85+, 19% females, 17% malesAged 85+, 19% females, 17% males

Hearing impairment – 34% females, Hearing impairment – 34% females, 48% males 65+ (USA)48% males 65+ (USA)

Falls in previous 12 monthsFalls in previous 12 months 23% females, 18% males 65-6923% females, 18% males 65-69 43% females, 43% males 43% females, 43% males

Medication – more frequent use of Medication – more frequent use of benzodiazepinesbenzodiazepines



More people living with dementiaMore people living with dementia

Prevalence of dementia in older Prevalence of dementia in older people people (UK Dementia Report, 2007)(UK Dementia Report, 2007)

0

5

10

15

20

25

30

35

65-69

70-74

75-79

80-84

85-89

90-94

95+

Prevalence ofdementia (% )

How old are people with How old are people with dementia?dementia?

(Prevalence figures for Gwynedd 2011 – UK (Prevalence figures for Gwynedd 2011 – UK Dementia Report)Dementia Report)

30-6465-7475-8485+

Ageing population predicted to Ageing population predicted to increase number of people with age-increase number of people with age-related conditions such as dementia related conditions such as dementia

37,000 people in Wales with dementia in 37,000 people in Wales with dementia in 20072007

50,000 people in Wales with dementia in 50,000 people in Wales with dementia in 20212021

Number of people with dementia predicted to Number of people with dementia predicted to increase by 33% by the year 2021increase by 33% by the year 2021 Gwynedd from 1,719 to 2325Gwynedd from 1,719 to 2325 Anglesey from 905 to 1,223Anglesey from 905 to 1,223 Conwy from 2,062 to 2,793Conwy from 2,062 to 2,793

But some good news! But some good news! (Lancet, July (Lancet, July

2013)2013)

UK estimate down UK estimate down from 884,000 to from 884,000 to 670,000 (2011)670,000 (2011)

Wales estimate Wales estimate 35,000 cf. 40,00035,000 cf. 40,000

Figures from CFAS-Figures from CFAS-Wales (Anglesey, Wales (Anglesey, Gwynedd, Neath, Gwynedd, Neath, Port Talbot) in 2014Port Talbot) in 2014

Why are the dementias so Why are the dementias so challenging?challenging?

Fluctuation, variation and changeFluctuation, variation and change Different perspectives on need for careDifferent perspectives on need for care Interaction with physical health conditions and Interaction with physical health conditions and

medicationmedication Role of personality, biography and attempts to Role of personality, biography and attempts to

cope and make sense of the conditioncope and make sense of the condition Relocations can be damagingRelocations can be damaging Major issue for general hospitalsMajor issue for general hospitals Providing person-centred care – easy to say, Providing person-centred care – easy to say,

difficult to deliverdifficult to deliver Availability of family care?Availability of family care?

Care homes and dementiaCare homes and dementia Estimates suggest that 37% of people Estimates suggest that 37% of people

with dementia live in care homeswith dementia live in care homes 27% of 65-74’s27% of 65-74’s 61% of over 90s61% of over 90s

As many as 75% of care home As many as 75% of care home residents have dementia (not residents have dementia (not reflected in proportion of places reflected in proportion of places registered for dementia care – registered for dementia care – approximately one third)approximately one third)



More people living with dementiaMore people living with dementia More people at risk of depressed More people at risk of depressed

mood mood

Depression in later lifeDepression in later life Prevalence Prevalence (Lindesay et al, 1989)(Lindesay et al, 1989): :

4.3% severe depression4.3% severe depression 13.5% mild/moderate depression13.5% mild/moderate depression

More common in older people? Not More common in older people? Not in older people at home, but high in older people at home, but high rates in care homes and in older rates in care homes and in older people in receipt of services and in people in receipt of services and in people with dementiapeople with dementia

Risk factors for depressionRisk factors for depression

Representative sample of over Representative sample of over 14,000 people aged 75 and over 14,000 people aged 75 and over (Osborn et al., 2003). (Osborn et al., 2003).

Risk factors:Risk factors: Life eventsLife events Two or more physical illnessesTwo or more physical illnesses Not having a confiding relationshipNot having a confiding relationship

Depression in care homesDepression in care homes High rates - 40% or moreHigh rates - 40% or more Not simply a response to environment Not simply a response to environment

(although it may not help)(although it may not help)

Lack of activity? Involvement in preferred Lack of activity? Involvement in preferred activities criticalactivities critical

Sense of control key factor? Sense of control key factor? (But, control not (But, control not wanted by all)wanted by all)

Mann et al (2000) - rates of depression Mann et al (2000) - rates of depression related to staff awareness of physical health related to staff awareness of physical health issues issues (e.g. sensory and mobility problems)(e.g. sensory and mobility problems)

Despite it all:Despite it all:the well-being paradoxthe well-being paradox

““in the face of age-related increases in the face of age-related increases of somatic and socio-economic risks, of somatic and socio-economic risks, the ageing self has reserve the ageing self has reserve capacities that prevent considerable capacities that prevent considerable changes in aging satisfaction” changes in aging satisfaction” Staudinger Staudinger et al., 1995et al., 1995

Compensatory models of Compensatory models of adjustmentadjustment

Selective optimization with compensation Selective optimization with compensation (Baltes & Baltes, 1990) e.g. musician, (Baltes & Baltes, 1990) e.g. musician, typiststypists

Selection – reduce the rangeSelection – reduce the range Optimization – practice moreOptimization – practice more Compensation – find a different wayCompensation – find a different way Encapsulation – Bingo! Areas important / Encapsulation – Bingo! Areas important /

special to the person show growth and special to the person show growth and maintenance of functionmaintenance of function

Self-resourcesSelf-resources

Environmental masteryEnvironmental mastery Resilience Resilience (Windle et al., 2010)(Windle et al., 2010)

Self-esteemSelf-esteem Self-efficacySelf-efficacy Locus of controlLocus of control HardinessHardiness

European Study of Ageing Well European Study of Ageing Well – UK data– UK data

1847 people aged 50-90 in England, 1847 people aged 50-90 in England, Wales & ScotlandWales & Scotland

Part of 6 nation European study, led Part of 6 nation European study, led from UWB (Burholt, Wenger, Woods)from UWB (Burholt, Wenger, Woods)

Analysis of effects of ‘resilience’ Analysis of effects of ‘resilience’ undertaken by Gill Windleundertaken by Gill Windle

Does money bring happiness?Does money bring happiness?Age 50-59Age 50-59

0

5

10

15

20

25

Low High

Material resources

Lif

e sa

tisf

action

High ResilienceLow Resilience

Moderating effects of resilience Moderating effects of resilience on relationship of health and on relationship of health and life satisfaction life satisfaction (Windle et al., 2010) (Windle et al., 2010)

N=1847N=1847Windle, G., Woods, R. T., & Markland, D. A. (2010). Living with ill health in Windle, G., Woods, R. T., & Markland, D. A. (2010). Living with ill health in

older age: the role of a resilient personality. older age: the role of a resilient personality. Journal of Happiness Studies, 11, Journal of Happiness Studies, 11, 763-777.763-777.

European Study of Ageing Well European Study of Ageing Well – UK data– UK data

Resilience important factor in Resilience important factor in linking good health, material linking good health, material resources, social support, resources, social support, independent function, and activity independent function, and activity participation with life satisfactionparticipation with life satisfaction

For 80-90 age group, volunteering For 80-90 age group, volunteering and maintaining independent and maintaining independent functioning were most important functioning were most important sources of well-beingsources of well-being

Ageing as growth & Ageing as growth & development?development?

You CAN teach old dogs new tricks!You CAN teach old dogs new tricks! Learning German - Naylor & Harwood, Learning German - Naylor & Harwood,

(1975)(1975) Open University students (Cohen, Open University students (Cohen,

1996)1996) Creativity - quality v. quantityCreativity - quality v. quantity Swansong phenomenonSwansong phenomenon Examples of productivity in late lifeExamples of productivity in late life

Creativity in late lifeCreativity in late life

Michelangelo (1475-Michelangelo (1475-1564) worked on St 1564) worked on St Peters in his 80’s, Peters in his 80’s, and was working on and was working on this emotionally this emotionally intense Rondanini intense Rondanini Pieta a few days Pieta a few days before he died at before he died at the age of 89the age of 89

Creativity in later lifeCreativity in later life

Titian (1485-1576) Titian (1485-1576) was painting up to was painting up to his death at the his death at the age of 91age of 91

Pieta (1573-1576) – Pieta (1573-1576) – his final work – was his final work – was intended for his intended for his own tombown tomb

Increasing well-being in Increasing well-being in dementiadementia

Quality of life not related to degree of Quality of life not related to degree of cognitive impairment in people with cognitive impairment in people with dementiadementia

Evidence that a number of therapeutic Evidence that a number of therapeutic programmes lead to increased well-being programmes lead to increased well-being in people with dementiain people with dementia Life story booksLife story books Creative artsCreative arts Cognitive stimulationCognitive stimulation

“Plas Maesincla residents in Caernarfon visited an exhibition before creating their own artwork ranging from paintings to pottery. The artwork is seen as a way to develop an interest and improve quality of life. Work created by the residents will be on show at the Gwynedd Museum and Art Gallery in Bangor later in the year. “

http://news.bbc.co.uk/1/hi/wales/north_west/8531176.stm

‘Exhibition of Engage Cymru Project at Plas Maesincla’

New project funded by New project funded by AHRCAHRC

(Gill Windle, DSDC, Bangor U)(Gill Windle, DSDC, Bangor U)

ConclusionConclusion

Dementia and depression are the Dementia and depression are the major threats to independencemajor threats to independence

Resilience can moderate the effects of Resilience can moderate the effects of poor health on well-beingpoor health on well-being

Later life can continue to be a time of Later life can continue to be a time of growth and development, and a growth and development, and a contribution madecontribution made

Thank you!Thank you!

Documents

Well-being, Independence and the future: Healthy ageing in Wales