1. Rachel Winder, Research Fellow Epidemiology and Public Health University of Exeter Medical School

2. David Melzer, Behrooz Tavakoly, Rachel Winder, Suzanne Richards, Luke Mounce, Christian Gericke and Iain Lang University of Exeter Medical School

3. 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?

4.  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 1:Population, disease prevalence Section 2:Health risks Section 3:Quality of treatment for common conditions Section 4:Older people’s experiences

5. Source data: General Lifestyle Survey, ONS 2011 51 Smoking trends in men and women aged 50+ years, England, 1974 - 2009

6. Source: Scarborough et al, 2010 40 Age-specific death rates from coronary heart disease (CHD) in men aged 35+ years, UK, 1968 to 2008 Major reductions in coronary heart disease death rates Image from medicinenet.com

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

8. Source: Social Trends 40: 2010 edition, ONS Life expectancy at birth in men and women, UK, 1901 to 2021.

9. doing well, but could do better? 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 =HEALTH_STAT

10. Source data: Scarborough et al, 2010 (British Heart Foundation) Prevalence of obesity* in men and women age 55+ years, England, 1994-2008 (*Based on body mass index of >30kg/m 2 ) Image from The Guardian, Feb 2013

11. Diabetes – an epidemic unfolding Source data: HSE, 2009 58 Percentage of respondents with doctor diagnosed diabetes (all types) in men and women aged 55+ years, England, 1994-2009

12. Hazardous and harmful alcohol consumption Source data: Adult Psychiatric Morbidity in England, 2007 Results of a Household Survey Hazardous and harmful drinking in men and women in the past year aged 55+ years, England, 2007

13. Percentage of people aged 50+ years not living with a spouse/ partner who replied “Often”, as opposed to “Sometimes” or “Hardly ever”, when asked if they felt isolated or lonely. ELSA, 2010

14. Source data: Adult Psychiatric Morbidity in England, 2007: Results of a household survey 16. Copyright © 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved Prevalence of common mental health disorders in the past week in men and women aged 55 + years, England, 2007

15. Source data: ONS, 2011 Trends in excess winter deaths in 65+ age groups, England and Wales, 1991 to 2011 (EWM = winter deaths minus average non-winter deaths. EWM Index = (EWM / average non-winter deaths) x 100. Winter excess death

16. Burden of disease: 60+ years old – much is potentially avoidable Source data: World Health Organisation: http://whqlibdoc.who.int/hq/2012/WHO_DCO_WHD_2012.2_eng.pdf?ua=1http://whqlibdoc.who.int/hq/2012/WHO_DCO_WHD_2012.2_eng.pdf?ua=1 Proportion of ‘Disability Adjusted Life Years’ (DALYS) in High-income countries caused by specific risk factors in adults aged 60+ years

17. Social inequalities – shorter lives with more disability Source data: Health Statistics Quarterly 50, summer 2011, ONS 48 Life Expectancy with Disability and Disability Free Life Expectancy for men and women at age 65 years, by Index of Multiple Deprivation (IMD) 2007 quintile, England, 2006–08

18. Mobility, arthritis and pain Source data: HSE 2005. Copyright © 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved Prevalence of mobility problems in men and women aged 65 +years, England, 2005

19. Pain or discomfort Source data: HSE 2005, 2006 and 2008 data (aggregated 3 year’s data). ESDS,© Copyright 2003-2012 http://www.esds.ac.uk/findingData/hseTitles.asp Universities of Essex and Manchester. All rights reserved. http://www.esds.ac.uk/findingData/hseTitles.asp Self-reported prevalence of pain in men and women aged 50+ years, England, 2005, 2006 & 2008

20. Dementia - a major challenge Source data: Alzheimer’s Society 2007 Reproduced with permission from Alzheimer's Society. © Alzheimer's Society, 2007 The consensus estimates of the population prevalence of late onset dementia in men and women aged 65 +years, UK, 2007

21. Dementia – comparison (Prince et al 2013 The global prevalence of dementia: A systematic review and metaanalysis) 85-90yrs: Prince et al (Western Europe): 17.4%; our data: ~10% 90+ yrs: Prince et al (Western Europe): 33.4%; our data: ~14%

22. Prevalence of number of chronic diseases (of 18) by age group, from 2003/4 to 2011/12 Work supported by Age UK

23. Work supported by Age UK

24. Elderly patients squeezed into window bays on hospital wards Elderly patients are being kept in cramped window bays on hospital wards that have no alarm bells, proper curtains or lights, according to the latest in a series of inspection reports. The Telegraph 14 Jul 2011 Martin BeckfordMartin Beckford, Health Correspondent, Organise urgent care better, NHS told By Nick Triggle Health correspondent, BBC News The King's Fund review focussed on how to reduce admissions and lengths of stay among patients needing urgent care 9 August 2012 Elderly people would need to spend less time in hospital if care in England were better organised, experts say. A review by the King's Fund found there was scope to reduce the number of overnight stays by 2.3 million. That would free up 7,000 beds - 6% of the total - saving the NHS nearly £500m a year, according to the think-tank. Elderly NHS patients' harrowing plight is revealed in report Some elderly patients were given no help to eat or left in urine-soaked clothes, according to the health service ombudsman Denis CampbellDenis Campbell, health correspondent The GuardianThe Guardian, Tuesday 15 February 2011 Thousands of patients leave hospital malnourished Almost 200,000 NHS patients left hospital malnourished last year, it has emerged, raising questions about food standards on wards. Rebecca SmithRebecca Smith, Medical Editor 22 Jan 2010

25. Diabetes mellitus All diabetic persons aged 50 or older should have an annual examination of his/her feet Urinary incontinence If a person aged 50 or older has new urinary incontinence that persists for over 1 month or urinary incontinence at the time of a new evaluation, then a dipstick urinalysis and/or mid-stream urine sample should be obtained Osteoarthritis If oral pharmacological therapy is initiated to treat osteoarthritis among people aged 50 or older, then paracetamol should be the first drug used, unless there is a contraindication to use BMJ, 2008

26. Image from http://www.cedars-sinai.eduhttp://www.cedars-sinai.edu Source data: ELSA 2010 – graph updated 2013 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

27. Image from BBC News Source data: ELSA 2009 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

28. Condition No of quality indicators % Quality indicators achieved (95% CI) Ischaemic heart disease 583 (79.7 to 86.4) Hearing problems279 (76.7 to 81.1) Diabetes574 (72.2 to 76.0) Depression364 (57.3 to 69.8) Osteoporosis253 (49.3 to 57.2) Urinary incontinence 451 (47.2 to 54.2) Falls244 (36.5 to 50.6) Osteoarthritis429 (26.0 to 31.9) Assessing the Care of Vulnerable Elders Based on ELSA respondents - 2004/5 Conditions with 2+ indicators, From Steel et al, BMJ 2008 Steel et al, BMJ 2008

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

30. Cancer survival – international comparison Source data: Table 14, Web appendix, Coleman et.al. 2010 134 Age-specific relative survival estimates (%) at five years for colorectal cancer for ages 55-99, international comparisons, 2005–2007

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

32. Sicker people’s experiences of medical errors – international comparison Source: Commonwealth Fund International Health Policy Survey, 2011 http://www.commonwealthfund.org/Surveys/2011/Nov/2011-International-Survey.aspx Percentage of patients self-reporting medical, medication or laboratory test errors, all adults, international comparison, 2011 Image from the Louvre / http://dbdouble.blogspot.co.uk/http://dbdouble.blogspot.co.uk/

33. Population Ageing in the United Kingdom, its Constituent Countries and the European Union March 2012 2010 2035 Source: Office for National Statistics, Eurostat

34. Including:  Continuing challenges of dementia, mobility problems, falls, winter excess deaths  Evolving challenges: ◦ Obesity (physical inactivity) /diabetes prevention ◦ Social isolation, loneliness, mental health  We could do better on quality of treatment ◦ Especially for the disabling syndromes of older people ◦ Cancer in later life (awareness, early diagnosis, treatment as chosen)

35. Source data: Cooper et al (2010) Level of happiness reported by age group, England, 2007 Happiness in later life - age makes little difference

36. 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:Associate Specialist, Psychiatry of Old Age Dr Richard Byng: General Practitioner and Senior Clinical Lecturer, PCMD & PenCLAHRC Prof John Campbell: General Practitioner and Professor of Primary Care, PCMD Dr Phil Evans: General Practitioner and Senior Clinical Research Fellow, PCMD Dr Slav Pajovic: General Practitioner Dr Jonathan Powell: Honorary Senior Research Fellow, PCMD and former Co-director of the Ageing Research Programme, Unilever PLC Dr David Strain: Senior Lecturer in Geriatrics, PCMD Dr Nicholas Steel: Clinical Senior Lecturer in Primary Care and Honorary Consultant in Public Health, University of East Anglia Age UK Advisory Group Members: Prof David Oliver: National Clinical Director for Older People, Department of Health Mr David Buck: Senior Fellow, Public Health and Health Inequalities, The King’s Fund Prof Peter Crome: Professor of Geriatric Medicine, Department of Primary Care and Population Health, University College London Ms Helen Bradburn: Director of Public Affairs Communications, The Health Foundation Mrs Sue Howell-Richardson: Research, Development and Quality Manager, Age UK Devon Prof James Goodwin: Head of Research, Age UK Dr Matthew Norton: Social Research Manager, Age UK Ms Ruthe Isden: 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