The demographic transition in all advanced economies, including the UK, has been recognised for some time and has been accompanied by concerns about the potential demand for health and social care (Raymond et al, 2021). It is estimated that in the next 25 years, there will be 2.6 million people in England over the age of 85 years (Raymond et al, 2021), which is dwarfed by the global numbers of those expected to live beyond their 60th birthday. Globally, it is predicted that by 2050 there will be 2.1 billion people aged 60 years or over, with those aged 80 years or older reaching 426 million by 2050 (World Health Organization (WHO), 2021).
These data should be a cause for celebration as they indicate the success of medical advances and improved living standards upon population health, enabling many people to remain healthy and to live independently later in life. Older people also contribute to societies and economies through continued employment, informal caring of grandchildren and other relatives, and voluntary work. Raymond et al (2021) explored the relationship between age, and health and social care needs to reveal that the relationship between age and needs in England have changed over time. While health and care needs increase with age, many people with long term conditions live independently in the community without experiencing activities of daily life (ADL) limitations well into their 80s. Although Raymond et al (2021) found that a third of those with no ADL limitations had two or more long term conditions, all those with ADL limitations invariably had at least one long term condition and those with neurological conditions (multiple sclerosis, motor neuron disease, Parkinson's disease, stroke, dementia) had greater ADL limitations with increasingly complex social care needs.
The WHO (2015) has advocated healthy ageing, which comprises more than extra years lived, and includes the maintenance of functional abilities to enhance quality of life as people grow older. Sixsmith et al's (2014) report of how very old people (n=190; n=40 UK) across five European countries perceived healthy ageing revealed the importance of the home. The older people gave accounts of keeping active or busy and making contributions to society, together with deriving enjoyment as well as pride in managing ‘the self’ at home. Engaging in activities both inside and outside the home were not just about staying mentally active; it also gave meaning to their lives and offset boredom. The home was an important resource and was implicated in a sense of control over life and lifestyle, with the involvement of others, including domiciliary care due to ADL limitations, challenging notions of privacy and self-determination. Thus, the home was a meaningful space within which healthy ageing was negotiated despite changes in health status.
‘Community nurses should encourage older people to access healthcare when needed and support the re-establishment of normal behaviours to mitigate the risks of social isolation and loneliness so that older people have a high quality of life.’
However, Sixsmith et al's (2014) qualitative study was pre-pandemic and the impact of enforced isolation upon older people has yet to be revealed. The recent qualitative study by Brooke et al (2021) explored the experience of older people (n=15; aged 70-89 years) with household isolation and social distancing during the UK pandemic restrictions. They found that their sample tried to follow all the Government guidance, although changes in the guidance relaxing restrictions often caused confusion. Most of the sample was familiar with at least one online platform, and with time, the sample began to use various methods to keep in contact with friends and family, with some virtual socialising becoming the norm. Once permitted, some participants actively sought opportunistic physical social contact. Access to healthcare was a concern to all the sample and acute healthcare facilities were actively avoided due to the potential contact with the SARS-Cov-2 virus. However, during healthcare contacts their concerns were mainly allayed, although they described their visits as ‘unnerving’ due to waiting in a car prior to entering empty facilities. Despite these concerns and the greater use of online platforms for socialising (Brooke et al, 2021), those aged 75 years and over were up to 10 times less likely to contact their general practices online rather than by telephone or in person compared with all other age groups; this is according to the analysis of 7 558 820 patient-initiated requests for primary care between 1 March 2019 and 30 September 2021 in the 146 general practices using the askmyGP online consultation system (Clark et al, 2022). This report also noted increases in the proportion of requests from non-frequent attenders and from those asking about new medical problems during 2021, suggesting a post-pandemic catchup. But little is known about the impact of multimodal care delivery relating to socioeconomic and health inequalities.
Community nurses should encourage older people to access healthcare when needed and support the re-establishment of normal behaviours to mitigate the risks of social isolation and loneliness so that older people have a high quality of life.