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Number of elderly needing round-the-clock care to double by 2035

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The number of adults aged 85 years and older needing round-the-clock care will almost double to 446,000 in England over the next 20 years, according to predictions.

In addition, the overall numbers of over-65s requiring 24-hour care will rise by more than third to over one million in 2035, according a new study published in the journal The Lancet Public Health.

“These constraints will exacerbate pressures on already stretched social care budgets”

Carol Jagger

It predicts an increase in the number of people living into old age with multiple long-term conditions, with 80% of older adults with dementia and in need of substantial care in 2035 likely to have two or more other diseases.

The study highlights the importance of ensuring that health and social care services adapt to the unprecedented needs of an increasing older population with complex care needs.

Its authors warn that relying on the informal carers who provide around £57bn worth of care in the UK is not a sustainable solution.

They said little research had previously been done on how levels of dependency might change for different generations of older people, and forecasts of future care needs remained poorly defined.

To improve the precision of care need forecasts, researchers from Newcastle University and the London School of Economics developed the Population Ageing and Care Simulation (PACSim) model.

It accounted for risk factors for dependence and disability including a wide range of sociodemographic factors and health behaviours, as well as 12 chronic diseases and geriatric conditions.

“Care provision at this intense level will require careful thought and planning at both local and national level”

Eric Brunner and Sara Ahmadi-Abhari

Using data from three large studies, the researchers then modelled trends in social care needs for the population aged 65 years and older in England between 2015 and 2035.

Adults were categorised as either high dependency if they required 24-hour care, medium dependency if they needed help at regular times daily, low dependency if they required care less than daily and were generally looked after in the community, or as independent.

The researchers estimated the number of people aged over 65 will increase by just under 50% from 9.7 million in 2015 to 14.5 million in 2035, with very differing future care needs for men and women.

Between 2015 and 2035, life expectancy for men aged 65 is projected to rise by 3.5 years to 22.2 years, and the average number of years spent independent by 4.2 years, from 11.1 years to 15.2.

“We hear of people with dementia being forced to choose between a wash or a hot meal due to the limited time of a homecare visit”

Jeremy Hughes

Meanwhile, time spent living with substantial care needs – medium or high dependency – was likely to decline for men.

In contrast, for women, average life expectancy at 65 will increase by just three years, from 21.1 to 24.1. Over this time, the average number of years spent independent is expected to rise by less than a year, from 10.7 years to 11.6.

Women will also spend almost half of their remaining life with low dependency needs such as help with activities like washing and shopping, alongside a small increase in years requiring intensive 24-hour care, from two years in 2015 to 2.7 years in 2035.

“The challenge is considerable”, said study author Professor Carol Jagger, from the Newcastle University Institute for Ageing.

“Over the next 20 years, although young-old cohorts (aged 65-74) are more likely to enter old age independent, the proportion with multi-morbidities is projected to rise with each successive cohort, and this will result in a greater likelihood of higher dependency,” she said.

Newcastle University

Extra 71,000 care home places needed in England by 2025

Carol Jagger

“However, trends for men and women are likely to be very different, with women experiencing more low level dependency than men, highlighting the importance of focusing on disabling long-term conditions such as arthritis that are more common in women than men,” noted Professor Jagger.

She added: “Our study suggests that older spouse carers are increasingly likely to be living with disabilities themselves, resulting in mutual care relationships, that are not yet well recognised by existing care policy and practices.

“On top of that, extending the retirement age of the UK population is likely to further reduce the informal and unpaid carer pool, who have traditionally provided for older family members,” she said. “These constraints will exacerbate pressures on already stretched social care budgets.”

The researchers also analysed how the burden of dementia with and without other chronic diseases will change demands for social care over the next 20 years.

They found that older people with substantial care needs were likely to change markedly. For instance, whilst numbers of over 65s with dementia will fall by around a third by 2035, those with dementia and two or more conditions will more than double.

Professor Jagger said: “This expanding group will have more complex care needs that are unlikely to be met adequately without improved co-ordination between different specialties and better understanding of the way in which dementia affects the management of other conditions.”

Writing in a linked Comment, Professor Eric Brunner and Sara Ahmadi-Abhari from University College Medical School, London, said: “Care provision at this intense level for more than one million people in 2035 will require careful thought and planning at both local and national level.”

“This report is a further warning of the crisis in adult social care and the urgent need to plug the immediate funding gap”

Nick Forbes

The study was funded by the Economic Research Council and the National Institute for Health Research.

Nick Forbes, senior vice chair of the Local Government Association, said: “This report is a further warning of the crisis in adult social care and the urgent need to plug the immediate funding gap and find a long-term solution on how we pay for it and improve people’s independence and wellbeing.

“Adult social care services face a £3.5bn funding gap by 2025, just to maintain existing standards of care,” he said. “The likely consequences of this are more and more people being unable to get quality and reliable care and support, which enables them to live more fulfilling lives.”

Jeremy Hughes, chief executive of the Alzheimer’s Society, said: “These new estimates paint a challenging future, with the number of people needing constant care – the majority of whom will be living with dementia – starkly increasing in the next twenty years.

“This study serves as a wake-up call of what’s to come,” he said. “We hear of people with dementia being forced to choose between a wash or a hot meal due to the limited time of a homecare visit, and ending up in hospital with an infection because they didn’t have the support to shower each day.”

Rachel Thompson, Admiral nurse professional and practice development lead at Dementia UK, said: “This report reflects the growing number of families in distress who contact our Admiral Nurse Dementia Helpline. People simply don’t know who to turn to for help when faced with intense caring responsibilities.

”It’s high time that we bridge the gap between health and social care,” she said. “Only by doing this can we truly recognise the complex needs of a population living with multiple health conditions, increased levels of frailty and yet more stress at the lack of care and support they are receiving.

”As specialist dementia nurses who provide vital support for families and help coordinate care across health and social care, Admiral nurses are playing an important role in this solution but more needs to be done,” she added.

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