Health of Older People highlighted in new Ministry of Health report

Health of older people comes under the spotlight in a new Ministry of Health report released today.

The comprehensive report about older people's use of health and disability support services is aimed at helping health service planners and providers meet the demands of an ageing population.

Health of Older People in New Zealand: A Statistical Reference will help the country's 21 District Health Boards (DHBs) implement the Health of Older People Strategy: Health Sector Action to 2010 to Support Positive Ageing, which was launched in April this year.

Director-General of Health Dr Karen Poutasi said the statistical reference provided important information for DHBs, service providers and other interested groups about the health status of older New Zealanders, the services they use and how this may change in the future.

``New Zealand faces a dramatic demographic change in the next 50 years, with our population of people aged 65 years and over more than doubling from one person in 10 today, to one person in four by 2051,'' Dr Poutasi said.

``We are planning now to make sure we are ready for these changes, so we have the services in place to support older New Zealanders.''

Most people aged 65 or over are fit and healthy, but a minority are frail and vulnerable and require high levels of care and disability support. The extent of this support is detailed in the report.

One trend identified in the report is an increase in hospitalisations for conditions that could be treated at the primary health care level. The population-based approach of the Primary Health Care Strategy is designed, among other things to reverse this trend.

``This report is a significant step towards achieving our goal of developing integrated health and disability support services that are responsive to older people's varied and changing needs,'' Dr Poutasi said.

The next major step will be a workshop in Wellington on 3 December 2002. It will provide a platform for showcasing best practice and innovative models that support integrated services. It will also facilitate relationship building and information sharing among planners, funders and providers of health and disability support services for older people.

The information in the statistical report will be augmented by background statistics on the Ministry website. This information will gradually be expanded and updated as more data becomes available.

Key facts from the report

Life expectancy in New Zealand is increasing. Since 1986 it has been increasing more rapidly for men than for women, but women can still expect to outlive men. Currently life expectancy at birth is 80.4 years for women and 75.2 for men.

Once women reach the age of 65 they can expect to live, on average, another 19.5 years. This is 3.5 years longer than men of the same age.

Life expectancy for Mäori has been increasing more rapidly than for the total population, but is still lower. Life expectancy at birth is currently 72 years for Mäori women and 68 years for Mäori men. Shorter life expectancy for Mäori is reflected in fewer years free of disability requiring assistance

Life expectancy at birth for Pacific peoples is 76 years for Pacific women and 70 for Pacific men.

Mortality rates in older ages have been decreasing, with the biggest reduction being in the 65-74 age group. Between 1980 and 1998 mortality rates decreased by 37 percent for people aged 65-74 and by 35 percent for people aged 75 and over.

The biggest increase in the older population in the medium term will be among people aged 85 and over. This is partly due to the post World War II baby boom generation reaching this age group from about 2035.

The older population will become more diverse, with increasing proportions of Mäori, Pacific and Asian peoples reaching 65 and over, both as a result of increasing life expectancy and larger birth cohorts reaching older age.

The proportion of people aged 65 and over who are in paid employment or seeking work has increased over the last 10 years (currently 12 percent). Labour force participation rates for Mäori aged 65 and over are even higher (16 percent).

Older people contribute significant amounts of unpaid and voluntary work, such as caring for a child or someone who is ill or disabled, or voluntary work for an organisation, group or marae.

While older people have lower average incomes than the working population, many older people own their own home. Research on the living standards of older New Zealanders found that most older people were doing quite well and had relatively few material restrictions and difficulties.

Most older people live independently in their own home. The likelihood of needing help to remain at home does increase with age, with 57 percent of people aged 85 and over receiving assistance in their own home. However, even in the oldest age group 15 percent were living at home without assistance. The remaining 27 percent were in residential care.

The proportion of older people living alone has been increasing since the 1960s and is likely to continue to increase. Currently 43 percent of women and 20 percent of men aged 65 and over live alone.

As younger cohorts reach older age their changing marital status and living arrangements will affect the nature and type of support services that both families and government may need to provide.

Older people like the rest of the population are highly urbanised (69 percent at the 2001 Census lived in main urban centres), but older people also tend to concentrate in small urban areas (under 10,000 population) often following retirement.

Population ageing will affect DHBs differently, with some of the smaller boards already having up to 15 percent of their population aged 65 and over. DHBs in areas where there has been significant growth in retirement settlements are already experiencing higher demand for services.

Older people are significant users of both health and disability support services. Actual Vote Health expenditure for the financial year 2001/02 is currently estimated at $6,700 million (GST exclusive). Around 39 percent of that expenditure was for the 12 percent of the population aged 65 and over.

There is growing international evidence that acute health care costs do not rise so much with age as with proximity to death. A large part of observed health expenditure for older people may be explained by the 'high cost of dying' and the higher probability of people aged 75 and over being in the last year or two of their lives, in comparison with people in younger age groups.

Older people use hospital services, pharmaceuticals and laboratory tests more than people aged under 65. This is reflected in higher per capita public expenditure on these services for older people than for younger age groups. General practice services, however, are used predominantly by the very young and very old, but because of the higher government subsidy for children under six, public per capita expenditure is much higher for young children than for any other age group.

Over the last 10 years medical and surgical hospitalisation rates for older people have been increasing at a faster rate than for people aged under 65. The highest increase has been for people aged 85 and over.

Part of the increase in medical and surgical hospital admissions has been because increases in day treatments and reductions in length of stay in hospital have enabled more people to be treated. Conversely, since the early 1990s there has also been an increase in the complexity and cost of hospital treatment, with the introduction of more sophisticated surgical techniques and increases in both cardiac and orthopaedic surgery.

Older people are lower users of ACC funded services than younger adults. In 2000/01 ACC spent $1,110 million for the treatment, rehabilitation and support of people who had an accident. Only 3.9 percent of this was for people aged 65 and over.

International evidence points to improving health status and declining rates of disability, but, as the baby boom generation reaches older age, the rapid increase in the number of older people is expected to result in a dramatic increase in the number of older people with disabilities in the medium term. As a result demand for, and cost of, both health and disability support services is likely to continue to increase as the population ages.

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