View
33
Download
0
Category
Tags:
Preview:
DESCRIPTION
Well-being, Independence and the future: Healthy ageing in Wales. Bob Woods Professor of Clinical Psychology of Older People Dementia Services Development Centre Bangor University. Overview. We live and age in unprecedented times Dementia – the big challenge to independence? - PowerPoint PPT Presentation
Citation preview
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 - 1991Wales - 1991
Wales - 2001Wales - 2001
Wales - 2009Wales - 2009
Wales - 2012Wales - 2012
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
What do these changes mean?What do these changes mean?
More people with physical health More people with physical health difficultiesdifficulties
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)
What do these changes mean?What do these changes mean?
More people with physical health More people with physical health difficultiesdifficulties
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!
Recommended