Transcript Realising the potential of late life

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
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We live and age in unprecedented times
Dementia – the big challenge to
independence?
Depression – strong link with dependency
The well-being paradox – your money or
your health?
Ageing as growth and development?
Global Population Growth
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Two centuries of
sustained growth in
the percentage of
the population age
60 and older
Regional Growth
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The pace of
population ageing
for different regions
of the world
Wales – 1871
Wales - 1931
Wales - 1991
Wales - 2001
Wales - 2009
Wales - 2012
Wales – 2033?
An older population - UK
14
12
10
Millions
1985
1995
2005
2015
2025
8
6
4
2
0
65+
An older older population - UK
4
3.5
3
2.5
Millions 2
1.5
1
0.5
0
1985
1995
2005
2015
2025
80+
What do these changes mean?
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More people with physical health
difficulties
Physical health and older people
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Arthritis – 47% females; 32% males 65+
Cardiovascular disease – 31% females;
37% males
Hypertension – 64% females; 62% men
Limiting long-term illness
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40% aged 65-74
60% aged 75-84
Over half rate their health as good or fairly
good
Physical health and older people - 2
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Functional limitations in 3 or more areas
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Hearing impairment – 34% females, 48%
males 65+ (USA)
Falls in previous 12 months
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Aged 65-69, 2% females, 4% males
Aged 85+, 19% females, 17% males
23% females, 18% males 65-69
43% females, 43% males
Medication – more frequent use of
benzodiazepines
What do these changes mean?
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More people with physical health
difficulties
More people living with dementia
Prevalence of dementia in older people
(UK Dementia Report, 2007)
35
30
25
20
Prevalence of
dementia (%)
15
10
5
0
6569
7074
7579
8084
8589
90- 95+
94
How old are people with dementia?
(Prevalence figures for Gwynedd 2011 – UK
Dementia Report)
30-64
65-74
75-84
85+
Ageing population predicted to
increase number of people with agerelated conditions such as dementia
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37,000 people in Wales with dementia in
2007
50,000 people in Wales with dementia in
2021
Number of people with dementia predicted to
increase by 33% by the year 2021
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Gwynedd from 1,719 to 2325
Anglesey from 905 to 1,223
Conwy from 2,062 to 2,793
But some good news!
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(Lancet, July 2013)
UK estimate down
from 884,000 to
670,000 (2011)
Wales estimate
35,000 cf. 40,000
Figures from CFASWales (Anglesey,
Gwynedd, Neath, Port
Talbot) in 2014
Why are the dementias so
challenging?
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Fluctuation, variation and change
Different perspectives on need for care
Interaction with physical health conditions and
medication
Role of personality, biography and attempts to cope
and make sense of the condition
Relocations can be damaging
Major issue for general hospitals
Providing person-centred care – easy to say, difficult
to deliver
Availability of family care?
Care homes and dementia
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Estimates suggest that 37% of people
with dementia live in care homes
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27% of 65-74’s
61% of over 90s
As many as 75% of care home residents
have dementia (not reflected in proportion
of places registered for dementia care –
approximately one third)
What do these changes mean?
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More people with physical health
difficulties
More people living with dementia
More people at risk of depressed mood
Depression in later life
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Prevalence
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(Lindesay et al, 1989):
4.3% severe depression
13.5% mild/moderate depression
More common in older people? Not in
older people at home, but high rates in
care homes and in older people in
receipt of services and in people with
dementia
Risk factors for depression
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Representative sample of over 14,000
people aged 75 and over (Osborn et al.,
2003).
Risk factors:
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Life events
Two or more physical illnesses
Not having a confiding relationship
Depression in care homes
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High rates - 40% or more
Not simply a response to environment
(although it may not help)
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Lack of activity? Involvement in preferred
activities critical
Sense of control key factor? (But, control not
wanted by all)
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Mann et al (2000) - rates of depression
related to staff awareness of physical health
issues (e.g. sensory and mobility problems)
Despite it all:
the well-being paradox
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“in the face of age-related increases of
somatic and socio-economic risks, the
ageing self has reserve capacities that
prevent considerable changes in aging
satisfaction” Staudinger et al., 1995
Compensatory models of
adjustment
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Selective optimization with compensation (Baltes
& Baltes, 1990) e.g. musician, typists
Selection – reduce the range
Optimization – practice more
Compensation – find a different way
Encapsulation – Bingo! Areas important / special
to the person show growth and maintenance of
function
Self-resources
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Environmental mastery
Resilience (Windle et al., 2010)
Self-esteem
Self-efficacy
Locus of control
Hardiness
European Study of Ageing Well –
UK data
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1847 people aged 50-90 in England,
Wales & Scotland
Part of 6 nation European study, led from
UWB (Burholt, Wenger, Woods)
Analysis of effects of ‘resilience’
undertaken by Gill Windle
Does money bring happiness?
Age 50-59
Life satisfaction
25
20
15
High Resilience
Low Resilience
10
5
0
Low
High
Material resources
Moderating effects of resilience on
relationship of health and life
satisfaction (Windle et al., 2010)
N=1847
Windle, G., Woods, R. T., & Markland, D. A. (2010). Living with ill health in older age:
the role of a resilient personality. Journal of Happiness Studies, 11, 763-777.
European Study of Ageing Well –
UK data
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Resilience important factor in linking
good health, material resources, social
support, independent function, and
activity participation with life
satisfaction
For 80-90 age group, volunteering and
maintaining independent functioning
were most important sources of wellbeing
Ageing as growth &
development?
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You CAN teach old dogs new tricks!
Learning German - Naylor & Harwood,
(1975)
Open University students (Cohen, 1996)
Creativity - quality v. quantity
Swansong phenomenon
Examples of productivity in late life
Creativity in late life
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Michelangelo (14751564) worked on St
Peters in his 80’s, and
was working on this
emotionally intense
Rondanini Pieta a few
days before he died
at the age of 89
Creativity in later life
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Titian (1485-1576)
was painting up to his
death at the age of
91
Pieta (1573-1576) –
his final work – was
intended for his own
tomb
Increasing well-being in
dementia
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Quality of life not related to degree of
cognitive impairment in people with
dementia
Evidence that a number of therapeutic
programmes lead to increased well-being
in people with dementia
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Life story books
Creative arts
Cognitive stimulation
‘Exhibition of Engage Cymru
Project at Plas Maesincla’
“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/8
531176.stm
New project funded by AHRC
(Gill Windle, DSDC, Bangor U)
Conclusion
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Dementia and depression are the major
threats to independence
Resilience can moderate the effects of
poor health on well-being
Later life can continue to be a time of
growth and development, and a
contribution made
Thank you!