The prevalence of hearing loss, incontinence and treatable diseases in people aged over 54 is higher than expected a new study in Ireland has shown, with implications for the longer term health and care needs of the broader population.

The third major report by the Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin was published last week and looks at the impact on the health and well being of Ireland’s adult population aged 54 years and over.

Over the course of the study researchers have mapped changes that have occurred since the first wave of TILDA data collection in 2010, enabling government and stakeholders to better target information and services.

 

Established in 2006 for an initial 10-year period with funding of €29 million from the Department of Health, The Atlantic Philanthropies and Irish Life, TILDA at Trinity College Dublin has become the ageing ‘laboratory’ for generating and analysing data to impact policy and inform all the ageing research domains.

As a national longitudinal study of 8,504 people aged 50 and over in Ireland, it has laid the foundation for an enormous body of research in Trinity and other Irish institutions, as well as other countries with an ageing population.

Every four years a comprehensive health assessment is done with the majority of the people who are taking part in the study. Alongside this, every two years researchers undertake very detailed interviews with the participants in their homes.

Key findings from the latest report:

Treatable conditions that contribute to disability such as pain, urinary incontinence, hearing loss, depression are common and often untreated and/or under reported/diagnosed

  • 1 in 7 older adults in Ireland experience urinary incontinence; almost 1 in 5 in older age groups experience it; it is up to three times more common in women.
  • Despite the availability of treatments, a high burden of symptoms and significant impact on quality of life, mood and social participation, only 3 out of 5 report their symptoms to a doctor, nurse or other healthcare professional.
  • Half of adults aged 75 years and over experience some hearing loss. Older men in particular experience difficulty following a conversation with multiple people due to hearing loss, thus leading to lower social participation and quality of life, and more loneliness and depressive symptoms.
  • Despite the availability of financial support for hearing aids in Ireland, their use is low with only 21% who report fair or poor hearing, using hearing aids.
  • 1 in 20 older adults in Ireland experienced a major depressive episode in the last year.
  • Only 30% are prescribed appropriate medical therapy for depression.
  • Depression has a significant detrimental effect on the health and independence of older people in Ireland.
  • Pain is a common complaint affecting a third of adults in Ireland, with the majority reporting chronic back pain.

High obesity rates and poor adherence to dietary guidelines in older adults

  • The majority of older adults do not meet the 2012 Department of Health Food Pyramid recommendations.
  • 76% do not meet the daily recommendations for fruit and vegetable intake.

  • 68% over consume food and drinks high in fat, salt and sugar.
  • There has been an increase in central obesity (a substantially increased waist circumference), particularly in women aged 50-64 (57% at Wave 3 versus 49% at Wave 1) highlighting the growing problem of obesity.

Health service utilisation has increased for the over 80s

  • There has been significant increased ED attendance (from 16% to 25%) and hospital admission (16% to 26%) in the oldest old, i.e. those over 80 years, compared with 2010.
  • Length of stay in hospital is significantly longer in the oldest patients. These increases in ED attendance and hospital admissions will likely have knock on consequences for hospital and community services.

The prevalence of untreated ‘treatable’ conditions has not changed in 4 years and requires a fresh policy drive

  • TILDA conducts both objective and subjective assessments of health, whereby a discrepancy between diagnosed and undiagnosed disorders can be detected.
  • At Wave 1, TILDA reported significant discrepancies for hypertension, high cholesterol, osteoporosis, osteopenia and atrial fibrillation in the order of up to a 40% mismatch between TILDA’s objective identification of these conditions and a diagnosis by an individuals’ GP.
  • The prevalence of undiagnosed disorders was almost unchanged 4 years later, meaning that this mismatch persists and despite the evidence, there have not been increased diagnoses or management of these existing conditions

Falls are common and one in five necessitate hospital attendance

  • 37% of older adults experienced a fall between Wave 1 and Wave 3 (2010 and 2014), rising to 40% in men and 60% in women aged 75 years and over.
  • 18% sustained a fall causing injury and which required hospital attendance – this equates to 60,000 people per year in Ireland.

Increased uptake in national screening programmes for cancer and influenza

  • Between 2012 and 2014, the uptake of national screening programmes in those who had not previously used the service has increased by 10%.
    • by 9% for influenza to 48% overall
    • by 6% for breast mammograms to 55% overall
    • by 12% for breast lump checks to 65% overall
    • by 10% to 82% for cholesterol testing overall
    • by 11% to 71% for prostate cancer screening (PSA and digital examination) overall

Older Irish adults, far from being reliant on social supports, are the net contributors to their extended family and the communities in which they live

  • Adults aged 54 years and over who have children are more likely to provide financial assistance to their children (48%) than receive financial help from them (3%).
  • Half of adults aged 54 to 74 years provide regular childcare for their grandchildren for an average of 36 hours per month. This facilitates labour market participation of parents and flexibility of schedules for unanticipated events.
  • More than half volunteered during the previous year and 17% do so at least once per week.
  • Volunteering, regular social participation, minding grandchildren and supporting children is significantly associated with better mood and quality of life.
  • 18% sustained a fall causing injury and which required hospital attendance – this equates to 60,000 people per year in Ireland.

Professor Rose Anne Kenny, Principal Investigator of TILDA, said the latest study shows the invaluable contribution that people continue make to society in their later years, but attitudes towards health need to change.

“This pervasive attitude in society and healthcare that health decline, chronic conditions, and falls are just a part of ageing and therefore are not being sufficiently diagnosed or treated must be changed as it is simply not true. It can have a major impact on people’s quality of life as they age, as well as impacting unnecessarily on the health system.”

“What these latest results from TILDA have shown is that far from later years being a time characterised by decline and increased dependency, older adults continue to make valuable contributions to society, with many characterised by active citizenship and participation in the lives of their families and their communities.”

As part of a new grant to keep the project running for another five years, the Health Research Board will set up a dedicated Knowledge Translation Group that links TILDA and the Department of Health, to ensure the evidence informs policy and practice.

“If our future health services are going to meet the needs of an ageing population, we need a picture of what it will look like. TILDA has made great advances in recent years to help understand the health, social and economic aspects of ageing,” Dr Mairead O Driscoll, Interim Chief Executive at the Health Research Board said.

“What we need to do is ensure this evidence informs policy and practice. The aim will be to ensure that we ask the right questions to inform future health needs and that the data gathered reaches the right people to underpin changes in policy and practice.”

Key recommendations: Treatable conditions that contribute to disability

  • There is a need to challenge the notion that urinary incontinence is an inevitable part of ageing, and efforts should also focus on modifying risk factors for urinary incontinence such as smoking and obesity.
  • Screening for hearing loss at an earlier stage, and promotion of uptake of hearing aids, has the potential to improve the ageing experience for many.
  • The prevalence of depression and of treated depression has not changed over the past four years emphasizing the necessity for new approaches to raise awareness among older people as well as their families and healthcare professionals. Efforts to reduce the stigma around mental health in later life and to encourage older people to seek help from a healthcare professional when they are experiencing symptoms of depression are now imperative.
  • There is a need to increase awareness about pain and adequate pain management.

Health service utilisation for the over 80s

  • The increase in ED attendance and hospital admissions for the over 80s has significant policy implications for implementation of admission avoidance services and for dedicated tailored care of the oldest old in emergency settings.
  • Innovations in early detection of risk factors and earlier interventions to avoid admission should be an important policy focus.

Prevalence of untreated ‘treatable’ conditions

  • Hypertension, high cholesterol, osteoporosis, osteopenia and atrial fibrillation are the key risk factors for stroke, heart failure, kidney failure and injurious falls. Innovative policy interventions to raise awareness of these common and treatable disorders is critical.

Falls

  • National falls and syncope prevention services should be introduced. These are poorly served at present in Ireland, however there is strong evidence for benefit in falls and fracture prevention, coupled with significant reductions in healthcare costs and in particular in hospital costs.

Health insurance

  • Given that flexibility to switch insurer is key to a competitive market, the high market share of one health insurer merits a full examination and possibly changed policy considerations.

“This third series of findings from TILDA shows that there are opportunities to target policy initiatives towards common disabling conditions in adults as they age,” Professor Kenny said.

“Our findings emphasise that there are still a significant proportion of Irish adults who remain undiagnosed and untreated, and many of these conditions put people at risk of falls and cardiovascular disease.”

“TILDA provides a valuable source of research on the current and future trends of an ageing population and will greatly assist clinicians and policy makers by identifying groups most at risk.”

The full report is available here.