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Limiting long-term conditions and disability are generally more prevalent amongst the older age group, with 55% of the over 65 population in the three LA areas reporting having a long-term illness or disability (Hywel Dda University Health Board, 2016a). The number of people over 65 with limiting long term illness has been steadily increasing and predictions suggest that this will continue to varying degrees across all LA areas, with the highest increase predicted in Carmarthenshire.
Frailty is a complex concept as it not an illness but a distinctive state of health, related to the ageing process, in which multiple body systems gradually lose their in-built reserves. We have no specific data on the prevalence of frailty in the West Wales region but national research shows that around 10% of people aged over 65 years have frailty (Clegg, 2013). It is estimated that one in four people aged 85 and over is living with frailty. This typically means that a person is at a higher risk of a sudden deterioration in their physical and mental health, can be expected to have longer stays in hospital, experience increased rates of re-admission and is more likely to be discharged to residential care (British Geriatrics Society, 2014).
The risk of being admitted to hospital also increases with age; whilst 21% of the current West Wales population is over 65, 55% of all emergency admissions are of those who are over 65, with 78% of emergency admission beds taken up by people who are over 65, which equates to 57% of all bed days (Hywel Dda University Health Board, 2016a). There is an also a significantly increased likelihood of a person over 65 with a chronic condition receiving inpatient care.
As people age they are more likely to need help with self-care, domestic tasks and have reduced mobility. Evidence in the three LA areas supports this, with data trends predicting an increasing need to support older people with the activities of daily living.
The prevalence of dementia is also associated with aging and the condition is one of the major causes of disability in later life. Above the age of 65 the risk of developing dementia doubles roughly every 5 years, with estimates that dementia affects 1 in 14 people over 65 and 1 in 6 over 80. Recent projections show a rapid increase in dementia across all LA areas with some of the more rural areas, including North Carmarthenshire and Pembrokeshire, seeing the highest rises of up to 44% by 2035 (Roberts and Charlesworth, 2014; Public Health Wales Observatory, 2013). People with dementia stay far longer in hospital than other people who come in for the same procedure; at least 40–50% of bed days relating to emergency admission in West Wales will relate to people who have dementia as part of their multi-morbidity (Hywel Dda University Health Board, 2016). It has been estimated that Hywel Dda has the lowest rates of dementia diagnosis in Wales at 37.2% (Alzheimer’s Society, 2015).
West Wales Population Assessment March 2017 Older people