Our Changing Population

The population of the Western Isles is changing. Over the next 15 years, the Western Isles population is predicted to decrease in size while the proportion of older people and the number of those with complex long-term conditions is expected to increase. This puts an obligation on us to redesign services to meet the changing needs of our communities.

The older adult proportion of the population is projected to increase for all of Scotland’s health board areas but is greatest in the Western Isles, with 37.1% of the population predicted to be 65 years of age or older by 2037.

Chart showing NHS Board projected population structures by percentage aged 65+

The impact of depopulation and an ageing society is that there will potentially be a smaller available workforce for health and social services, and fewer unpaid family carers. This presents a challenging circumstance and opportunities to support our citizens into the future.

The latest census estimates suggest that the Western Isles already has the greatest proportion of lone pensioner households in Scotland – and this is likely to increase into the future. Living alone has strong associations with social isolation and loneliness, which both increase risks to health. Indeed, evidence is now emerging that the health impact of loneliness on mortality is equivalent to that of smoking and greater than that of obesity. Western Isles tends to have high levels of such conditions relative to the rest of Scotland, which in part reflects the older population profile. Over the next 20 years, it is projected that there will also be a 73% increase in people with dementia.

The Western Isles has a high level of dementia prevalence and diagnosis rates, as indicated by the GP held dementia registers.

Chart showing Patients on QOF Dementia register 2014/15

Number diagnosed with dementia, NHS Western Isles, 2009/10-2015/16

2009/10 2010/11 20011/12 20012/13 2013/14 2014/15 2015/16
233 262 274 267 313 322 316

 

In the Western Isles, most people are diagnosed in later stage dementia with around only 11% in early stages in 2013/15. As with any disease, timely diagnosis gives the benefit of access to information, advice, interventions and support.

Despite this good performance we are only achieving 60% of the Scottish Government target for diagnosing people with dementia. 

Using age related risk factors, Alzheimer Scotland predicts local numbers to be almost double those we currently have diagnosed.

People with learning disabilities are known to have a higher rate of dementia, occurring at an earlier age.  Our current learning disabilities register indicates that there are 170 people who may be at such risk.

Area

Males

Females

Total

SCOTLAND

31,282

59,402

90,684

Western Isles

208

422

630

 

The International Picture

  • Dementia is one of the major causes of disability accounting for 11.9% of years lived with a disability due to a non communicable disease and it is the leading cause of dependency among older people.
  • WHO estimates 15% of people over the age of 60 in Scotland have a dependency.
  • In high-income countries, informal care (45%) and formal social care (40%) account for the majority of costs, while the proportionate contribution of direct medical costs (15%) is much lower.
  • Evidence from lower to middle income countries suggests that home-based support for caregivers of persons with dementia, emphasizing the use of locally-available low-cost human resources, is feasible, acceptable and leads to significant improvements in caregiver mental health and in the burden of caring
  • An average five year delay in the age of onset would tend to reduce population prevalence by 50%, hence greatly reducing its impact in the general population.
  • 7 modifiable factors identified for risk reduction are diabetes, midlife hypertension, obesity, depression, physical inactivity, smoking and low education.

DEMENTIA: A Public Health Priority. World Health Organisation & Alzheimer Disease International, 2012

Western Isles Picture

  • 70% of the residents in long term care facilities have a formal or informal diagnosis of dementia.
  • 1 in 5 people with dementia, who are admitted to hospital, do not return home and are discharged into a long term residential unit.
  • The average length of stay in hospital for a person with dementia is 29 days in comparison to 18 days for those who do not have dementia - this is the longest length of stay in Scotland and carries the often under-estimated risk of hospital acquired infections.
  • The length of stay in Western Isles  old age psychiatric ward (1809 days) is 6 times the average length of stay in Scotland
  • Despite the  considerable evidence that the use of antipsychotic drugs is associated with significant harm in older people with dementia, local prescribing of these drugs continues to be higher than the Scottish average.

Source: Western Isles Dementia Benchmarking Toolkit, 2016

So What Does the Data Tell us?

  1. We will need to respond to a growth in the long-term conditions associated with older age – and dementia in particular
  2. We will need to take account of the falling numbers of adults who will be able to provide paid and unpaid care
  3. We need to improve timely diagnosis, which will allow for more effective personal planning and service provision
  4. Integrated health and social care teams will be critical in delivering anticipatory care and self-management approaches
  5. When admitted to hospital, we need to focus on reducing length of stay and discharge processes.