Robert Butler Memorial Lecture and Debate on

Centenarians and Oldest Old

29 November 2011

This event is kindly supported by JRFThe ILC-UK work on “Centenarians and Oldest Old” is supported by Age UK

Centenarians and Oldest Old

David SinclairILC-UK

This event is kindly supported by JRFThe ILC-UK work on “Centenarians and Oldest Old” is supported by Age UK

Who wants to live forever. Centenarians and the oldest old

International Longevity Centre -UK

Centenarians and the oldest old• While advances have

been made in researching antecedent factors that predict living to 100, less attention has been paid to life as a centenarians

• The body of evidence on centenarians is far from consistent or extensive (hence looking at oldest old).

http://www.flickr.com/photos/pondspider/4170990903/sizes/m/in/photostream/

Limitations

• Panel surveys tend to have a very small sample of the oldest old (IFS, 2010, p 229).

• “Those who were very ill or frail had higher dropout rates, and people in worse health were less likely to be re-contactable”. Chatfield et al (2005)

• “a strong link between attrition and cognitive decline…cognitive decline may be underestimated by epidemiological studies as a result”

• Are the predictions right?

How many centenarians are there?• There are currently 11,800

people in the UK who are currently at least 100 (DWP)

• There are fewer than 100 people who are aged more than 110. (DWP)

• In 1911 there were just 100 Centenarians living in England & Wales

• Growth has been about 7% p/a

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Projected number of centenarians in the UK

How likely is it that we will reach 100?

The likelihood of living from birth to 100 might have increased from 1 in 20 million to 1 in 50 for females in low-mortality nations, such as Japan and Sweden. (Vaupel and Jeune, 1995) http://www.flickr.com/photos/iain_ritchie/2739823588/

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Number of people currently alive who can expect to see their 100th birthday, by age in 2010

Public policy seems oblivious to the growth

• Opportunity Age: did not mention centenarians (2005)

• Lifetime Homes, Lifetime Neigbourhoods: Mention of centenarians in passing.

• Don’t Stop Me Now, Audit Commission (2008). Mentioned that services for a 50 year old may be different to services for an 80 year old

• Building a Society for All Ages (2009) growth in the number of centenarians as a reason “why we need to go further”

But are the predictions right?In Population Trends, 1999, Thatcher projected a rise in the number of centenarians to 95,000 by 2066 (Thatcher, 1999).

By 2010 the DWP and ONS were projecting that there would be at least 507,000 people in the UK aged 100 or over in 2066.

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And are the numbers today right?

More than 230,000 Japanese centenarians missing

The majority of centenarians are female

In 2003, among the oldest old there were 257 women for every 100 men. (Tommassini 2005).Between 2001 and 2006, the number of men aged between 90 and 99 increased by 24 per cent whereas for women the increase was just over 8% (Dini and Goldring. 2008).

And they live in Southern England

In the UK, a higher concentration of the oldest old live in Southern England and a lower proportion in urban areas and Northern Ireland. (Tomassini C, 2005)

http://www.flickr.com/photos/lawrence_chernin/5716015430/sizes/z/in/photostream/

Life is not easy for the oldest old• Three quarters of the oldest

old suffer from limiting longstanding illnesses, and one out of three perceive themselves as being in poor health. (Tomassini C, 2005)

• “almost 50% of men and women aged 80-84 report severe limitations in activities” (IFS, 2010)

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And many find it difficult to do day to day tasks

Sixty per-cent of over 90s report difficulties shopping for groceries, almost a quarter report difficulties making telephone calls and 35% report difficulties managing money. (Sinclair, 2010/ELSA)

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But dependency is not inevitable

Dependency is not inevitable and a ”considerable proportion of the centenarians maintain a good level of auto sufficiency for the basic performance of the everyday life”. (Antonini et al, 2008)

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And some of the oldest old become more active

Many live independently

• Substantial numbers of centenarians and nonagenarians continue to live independently in the community, either alone or with family members.

• 8% of those aged 90 and over were living in privately rented accommodation and 30% in socially rented accommodation. 2009 Understanding Society

Proportion living in communal establishments

A relatively high proportion live alone

Of those living in private households, four in ten very old men and seven out of ten very old women live alone. One out of five very old people live in communal establishments. (Tomassini C, 2005).

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And the proportion living alone is growing.

Over the last 20 years there has been a significant increase in the proportion of the oldest old living alone. The likelihood of the oldest old men living alone has grown by one-third for men and one quarter for women. (Tomassini C, 2006). http://www.flickr.com/photos/driever/

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Many, but not all, have adapted their homes

Research finds that the oldest old are much more likely than other ages to have had made adaptations to their homes. For example. 40% of over 90s have had hand rails installed (compared to 16% of all over 50s), 41% had bathroom modifications (compared to 15% of all over 50s), and 24% are likely to have an alerting device (compared to 6% of the over 50s). (Atkinson and Hayes (2010).

Centenarian as a model for healthy ageing

A substantial number of centenarians remain physically healthy and cognitively intact into the last years of their lives.

Health and functional status of centenarians shows they are healthy and independent for most of their lives and experience a relatively rapid terminal decline”. (Hitt et al, 1999).

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Self reported health is pretty good?

(Just?) One in of three of the oldest old perceive themselves as being in poor health. (Tommassini C, 2005).

“despite substantial levels of disease and impairment”. Collerton, Davies and Jagger (2010)

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Most centenarians consult their GP

98% of centenarians and near centenarians consulted a GP and received prescription medicine during follow up. (Roughead, Kalisch et al, 2010)

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Centenarians do use drugs heavily

A study of 602 centenarians in Italy found that a very high proportion of this age group were users of drugs. They identified just 5% of this group who did not take any drugs. 13% of participants took one drug a day, 16% took 2 drugs per day, 65% took three drugs a day, and 5.5% took more than 3 drugs a day.

Some evidence of longer hospital stays

26 centenarians who had suffered from a hip fracture between 2000 and 2007 and compared them to a randomly selected control group of 50 hip fracture patients aged between 75 and 85. “the mean stay in acute orthopaedic wards for centenarians was 20.7 days and for the control group was 14.9 days”. They suggested that the longer acute hospital stay in our centenarian cohort would amount to a mean extra cost of £ 2511 per patient. (Verma et al)

Dementia among centenarians

The prevalence of dementia-free survival past 100 years of age varied between 0 and 50 percent.”

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Depression• “23% of those aged 85 and

over had levels of depressive symptoms indicative of clinical relevance”

• “Almost 13% of men and women aged 80 and over had high levels of depressive symptoms in 2008-09 but not in 2002-03” (IFS, 2010) ELSA

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Falls

• 60% of interviewees aged over 90 had had a fall and that of these, 4 in five were unable to get up after at least one fall and almost a third had lain on the ground for an hour or more.

• Call alarms were widely available but not used.

(Fleming and Brayne, 2008; Cambridge City over 75-Cohor. BMJ)

OAP recovering after getting trapped in bath for 5 days

Poverty is a very real challenge• There is evidence that the oldest old (aged

85 and over) are, as a group, at greater risk of poverty than younger older people (aged 65-85) (National Equality Panel, 2010).

• Up to 10% of the oldest old have total net wealth of £3,000 or less (Banks and Tetlow, 2009).

• Yet, over 61% of over 90s report that they never have too little money to spend on their needs. (Sinclair, 2010)

Their family carers are likely to be older

The advanced age of centenarians means that family caregivers are also likely to be relatively old. Younger cohorts of retired people (50-74 years) often provide care for their very old relatives and, even if untrained and unmonitored, have a significant role as caregivers (Richmond, 2008).

Quality of Life falls with age

Quality of life for oldest old – getting worse?

“longitudinal analyses comparing 2002-03 and 2008-09 show that most of the oldest old experienced a substantial decrease in quality of life over the period. Just over 10% experienced a substantial improvement of 5 or more points” (IFS, 2010)

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Recommendations• Energy companies to ensure that their oldest

customers access the best deals• Employers to ensure that they find ways to provide

flexible working to ensure that caring responsibilities do not pull people out of the workforce early.

• The Government should introduce a care voucher scheme for adults, similar to childcare vouchers, which would allow people of all ages to buy care vouchers to support the needs of older adults. This may help older carers of centenarians stay in the workplace longer.

Recommendations

• Significant development of the evidence base about centenarians in order to inform current and future ageing strategies.

• Policy-makers to take a more holistic approach to designing interventions that integrate health, care and housing solutions.

• Developers to plan for growing numbers of centenarians through ensuring that housing and neighbourhoods are better designed and/or adequately adapted to meet the needs of a growing centenarian population

David SinclairInternational Longevity Centre UKdavidsinclair@ilcuk.org.uk@sinclairda@ilcuk