The focus of prevention in older age groups is around healthy active ageing and supporting independence so older people area able to enjoy long and healthy lives, feeling safe at home and connected to their community.
Healthy ageing is associated with being physically active, not smoking, eating healthily, maintaining a healthy weight and drinking alcohol sensibly. Therefore, changing these common behavioural risk factors during adult life, not only reduces the risk of non-communicable disease (such as heart disease or stroke), but also helps prevent dementia, disability and frailty.
In January 2014, NHS England published Safe, compassionate care for frail older people using an integrated care pathway: http://www.england.nhs.uk/wp-content/uploads/2014/02/safe-comp-care.pdf.
Their pathway contains nine stages, each containing evidence-based examples taken from the Silver Book: http://www.bgs.org.uk/campaigns/silverb/silver_book_complete.pdf, and the King’s Fund’s Making our health and care systems fit for an ageing population http://www.kingsfund.org.uk/publications/making-our-health-and-care-systems-fit-ageing-population. The nine stages are:
- Healthy active ageing and supporting independence
- Living well with simple or stable long-term conditions
- Living well with complex comorbidities, dementia and frailty
- Rapid support close to home in a crisis
- Good acute hospital care when (and only when) needed
- Good discharge planning and post-discharge support
- Good rehabilitation and re-ablement after acute illness or injury
- High quality nursing and residential care for those who truly need it
- Choice, control and support towards the end-of-life
Further to this, the National Institute for Clinical Excellence (NICE) have recently published draft guidance on mid-life approaches to the prevention of dementia, disability and frailty entitled ‘Disability, dementia and frailty in later life – mid-life approaches to prevention’: https://www.nice.org.uk/guidance/indevelopment/GID-PHG64/consultation
This guidance emphasises changes to these behavioural risk factors during adult life will reduce the risk of dementia, disability and frailty in later life. The NHS Health Check programme provides one mechanism to do this. Individual behaviour change approaches such as this are likely to be more cost effective and less likely to widen health inequalities when combined with population-based approaches.
|Box 5, Non-Urgent Care, Perceptions and ExperiencesIn 2014 Healthwatch Devon ran a survey on non-urgent care which received over 500 responses. The survey was focused on access to primary care services, in response to national findings from Healthwatch England highlighting that some people were resorting to using urgent care services, such as accident and emergency departments due to difficulties in accessing primary care.
The majority of respondents found it easy to make an appointment with their GP.
“I feel my GP surgery is very good. I am always able to get an appointment if I need one, on the same day. The staff are friendly and helpful and the surgery is located in the same building as a pharmacy, which is very useful”
Around a quarter had some difficulty.
“Trying to get an appointment to see someone is like getting blood from a stone…when you ring at 8.30am everyone else is ringing at the same time”
Concerns and issues highlighted included:
Healthwatch Devon, ‘Speaking out on non-urgent care’ Report, August 2014 http://www.healthwatchdevon.co.uk/non-urgent-care