1. Healthy active ageing & the role of community services Emer Ahern 26th March 2010

2. Healthy ageing

3. Introduction We are seeing an enormous demographic shift in our society 2006 (11%) 2011 (15%) 2030 (19%) These changes are a cause for great celebration… but these changes also present us with a challenge… how do we ensure that our longer lives are also happy, healthy and independent ones?

4. Kilkenny Total 65+9,992 (11%) 65-745,489 (6%) 75-843,418 (4%) 85+1085 (1%) 2011 ~ 13,625 2030 ~ 17,259

5. Being old in Ireland: a fit state IMJ, 2009 Health status Functional ability Patterns of service use n = 776 over 70 Mean age 78.69 years (Range:70 - 99) 73% owned their own homes 39% lived alone 5% NH care 65% rated their health as good,very good or excellent 36% reported long-term illness 17% moderate or severe disability Physical function declined Levels of disability increased “Where would you prefer to live?”

6. Being old in Ireland: a fit state During most of the adult years people closely rate their general health to their physical function and this association breaks down markedly after the age of 70 Self-rated general health remains reasonably stable despite objective deterioration in physical function and an increase in disability

7. “Selective optimisation with compensation model” Suggests that as life options are restricted individuals select from the options available, optimise their ability to engage in whatever behaviour they wish to pursue and compensate where capacities are reduced This implies that, despite increased levels of disability, older people adapt to their circumstances as physical function declines

8. HeSSOP 2 80% rated their quality of life as good or very good 75% scored high on morale 75% reported being self-sufficient in their abilities to perform tasks of daily living 12% usually needed help with one or more tasks of daily living 60% reported no functional disability 2006 census, 30% indicated they had a disability 92% attended a GP in previous 12 months, SLAN 2008, DOHC

9. Being old in Kilkenny: a fit state??? Most are living at home (~91%) 141 St Luke’s GH (~3.5%) 11 ED 8 MAU 690 NH care (~5.5%) 5,250 falls 1,050 ED attendances 450 emergency admissions 600 fractures 320 Stroke diseases/ yr 200 Parkinson’s Disease 1200 Dementia

10. What older people want… Promotion of person-centred holistic-based wellness throughout the life-cycle Develop health service options that allow integrated planning and funding and delivery of primary, secondary, nursing home care and community services Age Action, Submission to the National Ageing Strategy

11. What older people want… “Living life to the full until the very last day” “Living life as far as possible without restrictions” “Living life to our best ability with the aid of trained people” “A really good living with all possible help until we die” Age Action, Submission to the National Ageing Strategy 87% wanted to remain living in their own homes, HeSSOP 2000

12. We want… Best outcomes Quality Safe Organise around what we know people want and what we know works to give the best results More efficient use of resources Collaborative & integrated services not limited by cultural or traditional organisational boundaries Targeted assessment and management programmes Standardised care and pathways

13. PCT/ SLGH community clinic RehabFalls & fracturesStroke n =9,992 All patients identified by GP or PCT MDM 16, KK 320/yr Facility Dean St PCTSt Columba’s, KK SLGH PCTs SLGH PCCC Caredoc Amb Current servicesCGA to all patients identified by GP or PCT MDM Stroke Other neuro Orthogeriatircs General Community Falls clinic - MDM Falls class Fracture liaison service Orthogeriatrics service ASU Thrombolysis Caredoc Amb OrganisationsSLGH PCTs PCCC SLGH WRH PCTs PCCC Other SLGH PCTs PCCC WRH STGH WGH SLGH PCCC Caredoc Amb Evidence baseYYYY National StrategyNNYY We can do…Provide service county wide “At risk” register ? Re-designate public NH beds to deliver more rehab Outcomes, performance and quality measurements Transient stroke and f/u clinic Demetia clinic PD clinic