Dr David Melzer, Professor of Epidemiology and Public Health at the University of Exeter Medical School, spoke at our conference, Making health and care services fit for an ageing population. David analysed the UK's performance in preventing later life disease and disability and considered how well we are delivering treatment for the common disabling diseases of later life.

1. Professor David Melzer
University of Exeter Medical School

2. Quantitative evidence (~previous 5 years):


As a country, how successful have we been in preventing later
life disease and disability?
How well are we delivering high quality medical treatments
for the common disabling diseases of later life?

3. 






prevention or treatment of common conditions
Having a clear connection to the well-being of older people
Based on substantial research
Representative of large segments of the ageing population
Based on reliable, preferably nationwide data
Easy to understand by a wide range of audiences
Balanced, so that no single area dominates the report
Section
Section
Section
Section
1:
2:
3:
4:
Population, disease prevalence
Health risks
Quality of treatment for common conditions
Older people’s experiences

4. Source data: General Lifestyle Survey, ONS 201151
Figure 20: Smoking trends in men and women aged 50+ years, England, 1974 - 2009

5. Image from medicinenet.com
Chart 15: Major reductions in coronary heart disease death rates
Source: Scarborough et al, 201040
Figure 15: Age-specific death rates from coronary heart disease (CHD) in men aged 35+ years, UK,
1968 to 2008.

6. Source: ONS, 2011
Figure 14: Mortality by major cause, in men and women (all ages), England and Wales, 1911-2010

7. doing well,
but could do better?
Figure 3: International changes in
life expectancy in men and
women at age 65, 1980-2007
Source data: OECD Health Data 2011 - Frequently
Requested Data, Update - November 2011
http://stats.oecd.org/Index.aspx?DataSetCode=HEA
LTH_STAT

8. Image from The Guardian, Feb 2013
Source data: Scarborough et al, 201040
Figure 21:Prevalence of obesity in men and women age 55+ years, England, 1994-2008

9. Chart 31: Diabetes – an epidemic unfolding
Source data: HSE, 200958
Figure 31: Percentage of respondents with doctor diagnosed diabetes (all types) in men and women aged 55+
years, England, 1994-2009

10. Chart 27: Burden of disease: 60+ years old
– much is potentially avoidable
Source data: World Health Organisation: http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html
Last visited 30/04/2012
Figure 27: Proportion of ‘Disability Adjusted Life Years’ (DALYS) in high-income countries of the European region caused by
specific risk factors in people aged 60+

11. Chart 18: Social inequalities – shorter lives with more
disability
Source data: Health Statistics Quarterly 50, summer 2011, ONS48
Figure 18: Life Expectancy with Disability (LEWD) and Disability Free Life Expectancy (DFLE) for men and women at age 65 years, by
Index of Multiple Deprivation (IMD) 2007 quintile, England, 2006–08

12. Chart 41: Common mental health problems – accessing treatments
Source data: Cooper et al120 2010
Figure 41: Adjusted odd ratios for those accessing mental health treatments: Comparison of older age groups with the 16-34 age
group, England, 2007
Note: Significant trend with age, but wide CIs for individual age-groups

13. Assessing the Care of Vulnerable Elders
Steel et al, BMJ 2008
Based on ELSA respondents - 2004/5
Condition
No of quality
indicators
% Quality indicators achieved
(95% CI)
Ischaemic heart
disease
5
83
(79.7 to 86.4)
Hearing problems
2
79
(76.7 to 81.1)
Diabetes
5
74
(72.2 to 76.0)
Depression
3
64
(57.3 to 69.8)
Osteoporosis
2
53
(49.3 to 57.2)
Urinary incontinence
4
51
(47.2 to 54.2)
Falls
2
44
(36.5 to 50.6)
Osteoarthritis
4
29
(26.0 to 31.9)
Conditions with 2+ indicators,
From Steel et al, BMJ 2008

14. Image from Merck Manual
30
Percentage
25
20
15
10
17.1%
16.0%
50-64
65-74
Age bands
19.8%
5
0
75+
Source data: ELSA 2010
Figure 34: Percentage of people aged 50+ years with diabetes who reported not receiving their annual foot check.
ELSA, 2010

15. Image from BBC News
Source data: ELSA 2009
– graph updated 2013
Figure 39: Percentage of people aged 65+ years who reported falling and who answered “no” when
asked if a doctor or nurse had tested balance or strength or watched the respondent walk

16. Image from http://www.cedars-sinai.edu
80
70
Percentage
60
50
40
30
20
55.8%
62.8%
43.6%
10
0
50-64
65-74
75+
Age bands
Source data: ELSA 2010 – graph updated 2013
Figure 37: Weighted percentage of people aged 50+ years with painful osteoarthritis who answered “no” when asked if
a doctor had ever recommended physiotherapy or an exercise programme. ELSA, 2010
Chart revised by Luke Mounce 2013, using Wave 5 ELSA data

17. Conditions
Difference:
Achievement %
(CI)
(%, p-value)
75.2
80.1
4.9
(73.0 to 77.4)
(78.6 to 81.7)
p=0.023
40.7
37.7
-3
(37.9 to 43.6)
Geriatric
2008-9
or 10-11
Achievement %
(CI)
General
Medical
2004-5
(36.1 to 39.3)
P=0.25
Table: Achievement rates aggregated by condition category, adjusted for weighted data, for
subset of indicators from 2004-5 that were repeated in 2008-9 or 2010-11
(data from ELSA study)

18. Chart 42: Cancer – a disease of ageing
Source data: Cancer Research UK http://info.cancerresearchuk.org/cancerstats/incidence/age. Date accessed: 21st March 2012
Figure 42: Average number of all cancers (excluding non-melanoma skin cancer) per year by age group, UK, 2006-8

19. Chart 45: Cancer survival – international
comparison
Source data: Table 14, Web appendix, Coleman et.al. 2010134
Figure 45: Age-specific relative survival estimates (%) at five years for colorectal cancer
for ages 55-99, international comparisons, 2005–2007

20. Image from healthcare informatics.com
Chart 48: Sicker people’s experiences of poor care coordination –
international comparison
Similar pattern for
medical errors
Source: Commonwealth Fund International Health Policy Survey, 2011
http://www.commonwealthfund.org/Surveys/2011/Nov/2011International-Survey.aspx
Figure 48: Percentage of patients self-reporting gaps in coordination of services in the past two years, all adults,
international comparisons, 2011

21. Including:

Obesity (physical inactivity) /diabetes
prevention
◦ a major threat to health in later life


Percentage of population
aged 65 and over EU-27
2035
help for 20% of 65-74 yr olds still smoking
Improving quality of treatment
especially for:
◦ the ‘geriatric’ and disabling syndromes

E.g. Incontinence, falls, bone health, mental
health
◦ Cancer in later life
as chosen)

(awareness, early diagnosis, treatment
But - lots of data poor areas
◦ severity & functional impact, use of ‘geriatric
assessment’ approaches in primary care,
oldest old etc
Source: Office for National Statistics, Eurostat
Population Ageing in the United Kingdom,
its Constituent Countries and the European Union
Date: 02 March 2012

22. Nick Steel et al, UEA (Acove)
Exeter Ageing Research Group Members:
Prof Paul Dieppe:
Professor of Medical Education and Consultant Rheumatologist, PCMD
Prof William Henley:
Professor of Medical Statistics, PCMD & PenCLAHRC
Colleague advisors:
Dr Susan Bedford:
Dr Richard Byng:
Prof John Campbell:
Dr Phil Evans:
Dr Slav Pajovic:
Dr Jonathan Powell:
Public
Dr David Strain:
Dr Nicholas Steel:
Age UK Advisory Group Members:
Prof David Oliver:
Mr David Buck:
Prof Peter Crome:
Ms Helen Bradburn:
Mrs Sue Howell-Richardson:
Prof James Goodwin:
Dr Matthew Norton:
Ms Ruthe Isden:
Associate Specialist, Psychiatry of Old Age
General Practitioner and Senior Clinical Lecturer, PCMD & PenCLAHRC
General Practitioner and Professor of Primary Care, PCMD
General Practitioner and Senior Clinical Research Fellow, PCMD
General Practitioner
Honorary Senior Research Fellow, PCMD and former Co-director of the
Ageing Research Programme, Unilever PLC
Senior Lecturer in Geriatrics, PCMD
Clinical Senior Lecturer in Primary Care and Honorary Consultant in
Health, University of East Anglia
National Clinical Director for Older People, Department of Health
Senior Fellow, Public Health and Health Inequalities, The King’s Fund
Professor of Geriatric Medicine, Department of Primary Care and
Population Health, University College London
Director of Public Affairs Communications, The Health Foundation
Research, Development and Quality Manager, Age UK Devon
Head of Research, Age UK
Social Research Manager, Age UK
Programme Manager, Public services, Age UK
NIHR PenCLAHRC Patient and Public Involvement Team Members:
Dr Andy Gibson:
Research Fellow, Patient and Public Involvement, PCMD & PenCLAHRC
Ms Lynn Tatnell:
Service user
Mr Jim Harris:
Service user
Ms Kath Maguire:
Service user