Let’s talk about death and dying

Let's Talk about Death and Dying! cover

This blog post was contributed by Lesley Carter, Joint Head of Health Influencing at Age UK. 

“How people die remains in the memory of those who live on”, Cicely Saunders (1918-2005), founder of the modern hospice movement. 

Positive advances in health care and public health mean that most of us will die later in life. Hooray! Yet most of us have never had a conversation with someone we love about death and dying and actually most of us don’t really want to. I think it’s a generational thing. But this is not the best place to be – this approach will not help us cope with our own death, or that of a loved one, or to manage our own feelings during death and bereavement.

Continue reading “Let’s talk about death and dying”

Mental health services are failing older people

Age UK’s new report on the state of mental health care for older people in England, Hidden in plain sight: the unmet mental health needs of older peoplesheds new light on the current state of NHS mental health services for those in later life.

Incomplete care 

The scale of the problem surrounding old age mental health cannot be underestimated. An estimated 1 in 4 people over the age of 65 live with a common mental health condition such as depression or anxiety, rising to a staggering 40 per cent of people living in care homes. Yet the Royal College of Psychiatrists has estimated that nearly 85 per cent of older people do not receive any help. Continue reading “Mental health services are failing older people”

Tackling the future funding of social care

Age UK has responded to a Department of Health consultation on the future funding of social care. This marks the latest stage in the long march to reform how we pay for care. The ‘Dilnot’ Commission on long term care funding recommended a new system whereby the amount that individuals would be expected to pay towards their care needs would be capped. The government has announced that it will implement a modified version of these recommendations. However there are still many unanswered questions about the new system and concern about its complexity.

The proposals are based on a new national system of eligibility for local authority care. The only spending by an individual that will count towards the 440px_older_carers_handscap is that required to meet needs which fall within these criteria – currently set at ‘substantial’ . If the criteria are too restrictive people might have spent large amounts before their outlay even starts to count towards the cap. Age UK has therefore argued that eligibility for local authority care should include people with what would currently be defined as moderate needs. Continue reading “Tackling the future funding of social care”

Will there be Warm Homes, Healthy People this winter?

It’s the last day of August, and frankly I’m clinging to the hope that this pretty miserable summer will give us at least a few warm days this September before it’s done. So I really don’t want to be thinking about the cold dark days of winter which may be just a couple of months away.

But actually my working days at the moment are spent thinking about nothing else. For many older people, the onset of winter is not a good time, especially if your home is cold and poorly insulated or you cannot afford ever increasing fuel bills.

Over the last ten years, there have been around 26,700 additional deaths each winter, when compared to the other months of the year (ONS). The vast majority of these ‘excess winter deaths’ – more than ninety per cent – are among older people. There is also an associated increase in GP visits, hospital admissions and social care calls due to cold weather. This useful website gives a picture of the situation across England.

This ‘phenomenon’ (as the scientists call it – I prefer the term ‘disgrace’) has been well studied. We know, for example, that the primary risk factor is exposure to cold. And we know that 40 per cent of deaths are due to cardiovascular problems – heart attacks and strokes – and another 30 per cent to respiratory issues. Hypothermia is relatively rare, and influenza is generally only a significant factor when there is an epidemic. Continue reading “Will there be Warm Homes, Healthy People this winter?”

The Tip of the Iceberg

In 1841, Registrar General William Farr, a distinguished mathematician and physician who famously said to Florence Nightingale, ‘Statistics should be as dry as dust’ produced the first report which identified a seasonal excess of deaths in the British winter.  Some 170 years later, we are still recording a yearly excess of between 20 and 40,000 winter deaths.  And by far the greatest numbers of those dying in the winter are those over 65, for many of whom both physiology and social conditions create a special vulnerability.

It has taken generations of scientists to unravel the causes of winter mortality.  The evidence is now clear on cause – it is the cold that is the killer.  All other factors, except in conditions of epidemic influenza, pale into insignificance.  So precise is this relationship that it has been calculated at 8,027 extra deaths for every 1°C the winter is colder than the average.  Paradoxically, this algorhythm applies only to the United Kingdom.  The irony is that the colder countries of the world – such as the Nordic lands, Russia, Canada and so on – have much lower winter mortality than the ‘warm’ UK.  It is an amazing truth that Yakutsk, the coldest city on earth with average winter temperatures of – 30°C, has virtually no seasonal fluctuation in mortality.  How can this be?

The answers are peculiarly British. Our heritage of an old and poorly insulated housing stock has meant that for years many have been consigned to winters spent in indoor cold, unable to afford their heating bills.  Add to that the exceptionally cold winters of recent years, rising energy prices and declining winter fuel benefits, we have a lethal cocktail of risk.  Fuel poverty is a real and vital issue for increasing numbers of older people.

But the evidence shows that indoor cold is only half of the story.  Deaths in the winter are largely due to respiratory illness and disease caused by blood clotting, the so-called ‘thrombotic illnesses’ of heart attack and stroke. Over the last few decades we have seen a reduction in deaths from respiratory illness in the winter, brought about it is thought by improving indoor warmth.  What has not declined is the mortality through heart attack and stroke.  These conditions are more dependent on going out into the cold, insufficiently protected by our winter clothes.  If you doubt this, look at the typical British wardrobe: how many of us have a separate winter edition? And how many of us frequently take trips outside without hat, scarf, gloves and coat? And so we are ambushed by winter cold.

Even a conservative estimate shows that the British winter, since Farr’s first report, will have been responsible for over 3 million deaths, deaths which we now know are entirely avoidable.  No wonder research tells us that older people in Britain fear the winter more than any of their European neighbours.  The question is, then, how may these deaths be avoided? Physiologists will tell you that ‘man is a tropical animal’: we must stay warm in order to stay well.  That is why Age UK, working with the Met Office, has taken the best scientific advice to launch its campaign ‘Spread the Warmth’. On the basis of new and compelling evidence, we are advising older people of the risks of both indoor and outdoor cold in an effort to stem the ‘British disease’.   And with DH, we are joining the Met Office as it seeks to alert the public of impending severe cold.  

Some estimates have said that 2,700 people every winter die because of fuel poverty. This is only the tip of a huge iceberg of winter deaths brought about by cold.  By translating the best research evidence into practice and by working with others, we are attempting win the war against the British winter.

Find out more about the Spread the Warmth campaign

Read Met Office guest blog

 

Met Office Guest Blog – Cold Weather Alert Service

This year, our Spread the Warmth campaign is working with the Met Office and Department of Work and Pensions as part of the national Cold Weather Plan to provide targeted information to the older people who are most at risk, when a cold snap is imminent. The guest blog  below from the Met office sets out how the Cold Weather Plan will work:

There is a strong link between the weather and health, especially during cold weather in winter, with the elderly being especially vulnerable. As a result, this winter the Met Office has teamed-up with the Department of Health and the Health Protection Agency to provide a Cold Weather Alert Service.

We have developed a range of alerts with the Department of Health and the Health Protection Agency to pinpoint when winter weather will impact on people’s health. These alerts will be issued if mean temperatures are below 2 °C for 48 hours or longer, if there is heavy snow or widespread ice.

The alerts will be produced by the Met Office and will operate inEnglandfrom 1 November to 31 March. They will be sent to NHS Trusts inEngland, as well as being made available on our website and in other media.

We will also be working with AgeUK to provide their centres inEngland with the Cold Weather Alerts helping to keep the most vulnerable people well this winter.

The alerts are split into four different categories:

Level 1 – indicates winter preparedness and long-term planning and will be in place from the start of the monitoring period. This is the minimum state of vigilance during the winter. During this time social and healthcare services will ensure that there is ongoing awareness and preparedness

Level 2 – this will be triggered as soon as the risk is 60% or above for any of the three thresholds to be breached. This is an important stage for social and healthcare services who will be working to ensure readiness and swift action to reduce harm from a potential period of cold weather.

Level 3 — this will be reached when we are experiencing weather which breaches any of the three thresholds. This stage requires social and healthcare services to target specific actions at high-risk groups.

Level 4 – this will only be triggered when a period of cold weather is so severe or prolonged that its effects extend outside the health and social care system. A Red level warning would be issued on advice from, or in collaboration with our Government partners. At this level, health effectsmay occur among the fit and healthy, and not just in high-risk groups.

With up to 27,000 extra deaths each year as a result of cold weather, it is vital that we increase the awareness of the effects of cold weather on health. Our warning is designed to help people prepare for prolonged spells of cold weather and aims to reduce the number of extra deaths each year.

Last year was the coldest December in 100 years with many areas experiencing significant snowfall, widespread ice and low temperatures. Some areas saw temperatures fall as low as -20 °C overnight.

Statistics produced by the Department of Health show that for every 1°C decrease in average winter temperature inEnglandthere are approximately 8,000 extra deaths. This is why it is vital to stay one step ahead of the weather and make sure people ‘Keep Warm and Keep Well’ this winter.     

Find out more about the Spread the Warmth campaign

Find out more about the Cold Weather Alert Service