1. Joint Strategic Needs Assessment Older People in Birmingham – Key findings from the JSNA Iris Fermin, Head of Information and Intelligence Jim McManus, Joint Director of Public Health

2. www.bhwp.nhs.uk The JSNA for Older People The Joint Strategic Need Assessment (JSNA) for Older People is a compilation of work that has been executed aiming to highlight and understand the complexity of the needs and issues around health and social care of this age group. The objective of the JSNA is to enable Public Health and Commissioners to provide the best care through appropriate commissioning strategies, identifying groups that are more at risk, and changes in the population health patterns Figures in this presentation are taken from the JSNA report

3. www.bhwp.nhs.uk Birmingham’s Age Structure 2007

4. www.bhwp.nhs.uk Project Age Structure 2020

5. www.bhwp.nhs.uk Demographic Trends Rate of increase of 23% from 45+ to 50+ Rate of increase of 21% from 45+ to 50+

6. www.bhwp.nhs.uk Key Points The age structure of Birmingham is youthful, People are living longer despite our life expectancy being lower than England and the age group 45 and over makes up 33.7% of the population. Older people are a complex population segment that requires lots of services. –It is most characterised by long term conditions and the 75 and over age range is the critical group. Two of the most important issues in terms of health are physical mobility and mental health. Physical mobility for older people is put at risk due to falls. Falls have a social cost for the population and an economical cost for the authorities. In the last year there have been increases in falls and its resulting consequences in Birmingham.

7. www.bhwp.nhs.uk Key Points 2 Mental health admissions were 16,956 for 2007/08, with drugs related mental health disorder being the highest reason followed by dementia. –Females are most affected except, however, in drugs related mental disorders. –Longer life expectancy of the female population is a contributory factor for the high dementia prevalence. –Age-specific rates for mental health show that at 70 and over mental health problems are acute. There are several social determinants that have an impact on older people’s health and their experience in later life: transport, housing, participating in physical activity, eating patterns, alcohol and drugs; among others.

8. www.bhwp.nhs.uk Health determinants 45s Female Male Time 50s Male Female hypertension CHD COPD Cancer 85+

9. www.bhwp.nhs.uk Social determinants Drugs & Alcohol & Smoking Housing Transport & Isolation Healthy life expectancy Be active Nutrition

10. www.bhwp.nhs.uk Falls FindingsRecommendations Osteoporosis as secondary diagnosis Revision of the mechanism for detection Increase in arthritis and rheumatoid arthritis Study interventions for improvement risk factors management Increase in joint replacement Introduce mechanism to facilitate awareness about fall and its consequences 75+ most vulnerablePrediction modelling and more focus study Mortality and secondary cost More than age

11. www.bhwp.nhs.uk Mental Health FindingsRecommendations Increase in dementia, depression and stress Revision of the mechanism for early detection Drugs related mental health affect more male and dementia, depression affect more female Study interventions for improvement drug-mental health related illness More people living along is admitted due to mental health Investigate isolation issues: housing, transport, ill-health Accommodation is one of the most used resource Prediction modelling and more focus study

12. www.bhwp.nhs.uk Personalisation & Social Care FindingsRecommendation Improvement in delay of transfer is needed Study into causes and decompose of the data for better understanding and alignment of the strategy Close the gap between services and demand for End of life and palliative care Define an effective strategy to increase satisfaction and LTCs register Gap in services such as Transport, Housing and people awareness Promote living independently Mismatch of type of specialist housing provision Revision of demand and supply for housing

13. www.bhwp.nhs.uk Females/Males – where’s the gap? There is a common view that There is a gap between males and females on health – men are actually getting illnesses earlier –Drugs related mental health affects men more. –For those males with mental health problems, from the age of 45 and over there is unmet need and lack of provision. Males over 45 don’t seem to be going into services. LTCs more aggressive for male

14. www.bhwp.nhs.uk The Gap….

15. www.bhwp.nhs.uk Key Priorities for Commissioners Intervening from the age of 50 onwards as envisaged in Ageing with Opportunity to prevent and minimise decline in health Mental Health – Depression and dementia Falls – preventing and intervening earlier Personalisation – individual budgets, impact of isolation of independent living, holistic palliative care Early Intervention and prevention agendas to prevent worsening of situation and worsening of care need Housing and Transport Cancers and Long Term Conditions

16. www.bhwp.nhs.uk Information and Analysis The data need to reflect age-specific issues Social and health determinants data relation is needed Data from interventions and services should be made available Recording of low level spatial data is needed Sharing and availability of data should be encouraged