Our Changing Population

The population of the Western Isles is changing. Over the next 15 years, the size of our population will decrease and yet we can expect the number of older people to increase, as well as the number of people with complex long-term conditions. This puts an obligation on us to redesign our services to meet the changing needs of our communities.

The older adult proportion of the population is projected to increase for all partnership areas but is greatest in the Western Isles, with 37.1% of the population predicted to be aged 65+ by 2037.

Chart showing NHS Board area population structures ranked by % Aged 65+, 2037

The impact of depopulation and an ageing society is that we will have a smaller workforce to support our health and social services, and a smaller number of unpaid family carers. This presents a very challenging circumstance to support our older citizens into the future.

We will also see a rise in numbers of people living alone.The latest census estimates suggest that the Western Isles already has the greatest proportion in lone pensioner households in Scotland – and this is likely to increase into the future. This is particularly significant as living alone has strong associations with social isolation and loneliness, which increase risks to health for people with dementia and depression. 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.

A warm, well maintained home is the core requirement for the successful delivery of community care services. We therefore need to be aware of the high levels of fuel poverty experienced throughout the Western Isles. Fuel Poverty exists where a household has to spend more than 10% of its income on heating costs to keep the property at an acceptable level of warmth.The most recent figures show that a total 62% of our households, including 75% of pensioner households, are in Fuel Poverty, the second highest figure in Scotland. Contributory factors are high domestic fuel costs, generally low household incomes, older hard to heat properties and damp and wet maritime weather conditions.We also have to recognise the challenge of private sector homes potentially falling into states of relative disrepair over time, due to the unavailability of house improvement and repair grants as a result of legislative change. Unless properties are structurally sound, adaptations may not be feasible or cost effective, and the optimum benefit will not be realised from either their provision or the delivery of other health and social care services to the occupants.

Chart showing rate of alcohol related hospital stays

We also know that we have a significant challenge with alcohol misuse, which can increase injuries, mental health issues, violence, social disorder, family stress, and employment difficulties and is a contributory factor in a range of other diseases including cancer, stroke and heart disease.

Although above the national average, the latest figures demonstrate a substantial improvement, with the rate of alcohol related hospitalisations in Scotland decreasing markedly over the last decade.

By contrast, the proportion of our adult population who are overweight (72%) or obese (33.5%) in the Western Isles, is increasing and is among the highest in Scotland. The Western Isles is an outlier in terms of adults meeting recommended regular physical activity levels. This may be a contributory factor in higher-than-average Coronary Heart Disease (CHD), and stroke prevalence in the Western Isles.

As we survive longer and medicine improves, we can see a corresponding increase in the number of people living with a range of long term conditions.These range from the most common conditions like CHD, stroke and cancer, to a variety of other chronic physical or mental health conditions including diabetes, dementia, asthma and depression.Results from the annual Scottish Health Surveys in the Western Isles over period 2008-11 found that around 4 in 10 adults had a long-term condition or disability, with the majority describing these as limiting their quality of life.Most Long-term conditions have a strong association with age and as result there is a significant projected increase in prevalence over the next fifteen years.

Figure 3: Chart of Long-term Conditions prevalence projections, 2008/2031

Many long term conditions are mental health related, including depression, dementia and other mental health conditions. The Western Isles tends to have high levels of such conditions relative to the rest of Scotland, which in part reflects the older population profile Overall projections are for a 73% increase in dementia cases over the next 20 years.

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 unpaid care for family members
  3. We need to address the growing number of people living alone and who might experience social isolation
  4. High levels of obesity and physical inactivity are increasing the overall burden of illness and disease
  5. Integrated health and social care teams will be critical in delivering anticipatory care and self-management approaches
  6. Our record in keeping people out of hospital is reasonable but we are not good at supporting discharge
  7. Addressing health inequalities within Western Isles communities will be a key challenge for services
  8. Alcohol misuse continues to have an impact on the physical and mental health of our population
  9. Tackling fuel poverty and poor housing will be important to keep people healthy at home
  10. Mental health and well-being will be an increasingly important service aim