Scottish Government Equality Outcomes: Age Evidence Review

11 Health

11.1 This section summarises the findings of the 2012 Scottish Health Survey and the 2010 Patient Experience Survey in Scotland. It then explores evidence on self-reported health, emergency admissions to hospital, disease, suicide and accidental death across the UK, from a variety of sources.

Health outcomes

11.2 According to the Scottish Health Survey (2012)^[136], older groups were significantly less likely to report being in good or very good health than younger age groups. 89% of 16-24 year olds reported being in good or very good health and this fell consistently with increasing age to reach a level of 53% for those aged 75 and over.

11.3 There was a complex association between mental wellbeing and age. The WEMWBS scale measures positive mental wellbeing, with higher scores indicating greater wellbeing. People aged 16-24 (scoring 50.3 on WEMWBS) and 65-74 (51.1) had the highest levels of positive wellbeing, and those aged 45-54 (49.1) and 75 and over (49.0) had the lowest (see Figure 14). The relationship between GHQ12 (which indicates mental ill-health) and age showed an inverse pattern to that observed for WEMWBS. 45-54 year olds were most likely to have high GHQ12 scores (18%) whilst 65-74 year olds were least likely (10%). These patterns fit with the widely cited 'U-curve' in subjective wellbeing, where levels of self-reported subjective wellbeing dip during the middle years and among the oldest in society.

Figure 14: WEMWBS mean score, by age, 2008-2011 combined (Source: Scottish Health Survey, 2012)

11.4 Dental health has a strong, linear association with age. Almost all adults aged 16-24 (99%) had 20 natural teeth or more compared with one in five adults over 75 (19%). Prevalence of toothache in the previous month was inversely associated with age. Younger age groups were more likely to report having experienced toothache in the last month with 18% of 16-24 year olds reporting this compared to 7% of those aged 75 and over.

11.5 Prevalence of overweight and obesity increased with age, peaking at age 55-64, before falling slightly for older age groups. 16-24 year olds were least likely to be overweight (35%) or obese (13%) whilst 55 to 64 year olds were the most likely to be overweight (77%) or obese (36%). For children, younger children are consistently more likely to be in the healthy weight range than older children^[137].

11.6 There was a strong association between cardiovascular disease and age. The likelihood of having a cardiovascular condition increased steadily with age from 5% of 16- 24 year olds, to 41% of over 75 year olds. The prevalence of diabetes also increased with age: this was more pronounced between the ages of 45-54 and the 65-74 age group, where diabetes prevalence rose from 5% to 12%^[138].

Health Behaviours

11.7 Prevalence of hazardous or harmful drinking was greatest among 16-24 year olds (30%) and dropped to 23%-26% between the ages of 25-64 before falling to 18% for 65-74 year olds and 10% for those aged 75 and over. The proportion of 16-24 year olds drinking above daily recommended limits on their heaviest drinking day was not significantly different from other age groups under 55 (figures ranged from 45% to 47%). From the age of 55 onwards, the proportion of adults drinking over the daily limit decreased with increasing age, reducing to 9% for the 75 and over age group.

11.8 Age was significantly associated with smoking prevalence and the number of cigarettes smoked. Prevalence was highest in the 25-34 year old age group (31%) before falling gradually until the age of 55-64 and dropping more dramatically from the age of 65 onwards. The pattern was somewhat reversed when looking at the average number of cigarettes smoked. 16-24 year-old smokers smoked the least (10.3 cigarettes a day) and smokers between the ages of 45-54 smoked the most (16.9 per day). Levels dropped off among older groups to reach an average of 12.6 among those aged 75 and over. The average age at which people started smoking was 17.5 years.

11.9 Regarding the consumption of fruit and vegetables, consumption of 5-a-day was significantly associated with age. Adults aged 16-24 were least likely to eat 5 or more portions per day (16%) and ate the fewest portions per day (2.7). Consumption peaked at age 55-64 (when 25% ate 5 or more portions per day with an average of 3.5 portions) before decreasing to a level of 21%(and 3.3 portions) at age 75 and over.

11.10 In Scotland there were large increases for men taking recommended amounts of exercise among those aged 25-34 and 35-44, both of which saw rises of 10 percentage points of those meeting the recommendations. Exercise levels are lower in those over 65 years. This is likely to be largely accounted for by the increase in 'poor' health and life-limiting illnesses and the decrease in mobility that is associated with older age; however, social and environmental factors, including increasing personal security concerns may also contribute to this situation^[139]. Further detail is available from the Scotland Performs National Indicators^[140], which confirm that physical activity is highly associated with age, with activity declining as age increases. Around half of 16-44 year olds meet the recommendations. This compares to one in five 65-74 year olds and less than one in ten of those aged 75 or older.

Patient experience

11.11 Scotland's 2010 Inpatient Experience Survey^[141] reports that older patients were generally more positive than younger patients. In 50 of the survey questions, older patients were more likely to report a positive experience. There were four questions where older patients were less likely to report a positive experience. These were: danger signals to watch for when they got home, and questions related to medicines. Given that there is some anecdotal evidence of frail, elderly patients having worse experiences in hospital, the findings that older patients are generally more likely to report positive experiences may be surprising. However this is consistent with findings from other studies. Differences may be accounted for by lower expectations of quality of care among older people. However the differences may be accounted for by young people feeling that they are seen as not needing the same care and attention as older people; staff may perceive that younger patients may be more able to look after themselves. This seems to correspond with some of the findings from our initial analysis of the open text comments which respondents provided in the survey. The analysis revealed that some of young people felt distressed at being expected to 'just get on with it' and look after themselves.

11.12 There are several other factors to consider. The survey will not capture the experiences of very frail elderly patients sufficiently because although the survey achieved a good response rate among older patients, very frail patients who may have more limiting illnesses are probably less likely to respond than others.

Emergency admission

11.13 The older an adult the more likely they are to make an emergency admission to hospital^[142], with the sharpest increases seen for age bands above 65. For example, for every 100,000 people aged 65 to 69 in 2010/11, there were 14,196 emergency admissions. This compares to 25,557 for those aged 75 to 79 and 47,744 for those aged 85 or older. The National Indicator data from Scotland Performs^[143] focus on younger people: young adults (16-24 year olds) show the lowest rate of emergency admissions, and the rate of emergency admissions increases with age. Under 16s have a higher rate of emergency admissions than 16-44 year olds but a lower rate than those 45 and older.

Workforce

11.14 As at end December 2011, 13% of the NHS Scotland workforce (full-time equivalent) were aged under 30 years, whilst over half (54%) were aged between 30 and 49 years, and a further third (33%) were aged over 50 years^[144].

Mortality

11.15 For both men and women, advancing age increases the number of deaths from ischaemic heart disease and cerebrovascular disease (or stroke), which increase across England, Scotland and Wales after 65 years^[145].

11.16 The EHRC Triennial Review^[146] reports that men continue to experience more cancer-related deaths overall than women, although women have a higher rate in a number of age groups. In England and Wales in 2008, the overall cancer mortality rate for all ages was 206 per 100,000 for men and 150 per 100,000 for women. Overall cancer rates are far higher in Scotland for both men and women. In 2008, Scottish men had an overall cancer mortality rate of 309 per 100,000 and women had a slightly lower rate of 283 per 100,000. Although there is a higher number of cancer deaths in the over 65s, cancer causes a greater proportion of the deaths among younger people. Three-quarters of cancer deaths (76%) occur in people aged 65 years and over, but cancer caused more than a third (36%) of all deaths in the under 65s in the UK in 2008, compared with 25% of all deaths in the over 65s.

11.17 Although suicide has fallen for most groups in recent years, the EHRC Triennial Review reports that it remains a disturbing cause of early death, especially among younger adults whom it affects the most. Around three times as many men as women committed suicide in Britain in 2008. The suicide rate in Scotland is higher than that in England and Wales for both women and men in most age groups, and is particularly high in Scotland for men aged 25-34 and 35-44^[147].

11.18 Men have higher rates of accidental death than women in every age group except 85+^[148], and linked to this difference, almost all people killed at work are men: only four fatalities (out of 129) at work in 2008/09 were women. The risk of accidental death rises rapidly in very old age for both men and women. Because of women's greater life expectancy, a higher number of older women than older men die from accidents.

11.19 The EHRC Triennial Review reports that in the forthcoming Children's Measurement Framework, it is proposed that there is a specific indicator on the numbers of children in fatal traffic accidents. The number of children that have been killed or seriously injured in traffic accidents has been decreasing over time. The number of children killed or seriously injured in road or traffic accidents in 2009 was 2,671 (down 5% on 2008). Of those, 1,660 were pedestrians, 7% down on 2008. A study carried out in 2003 by the AA Foundation for Road Safety Research^[149] in Britain identified higher risks where there is an intersection between youth and ethnicity or hearing impairments. Scotland Performs National Indicator data^[150] show that fatality numbers are highest among young adults, with a quarter of fatalities on Scotland's roads in 2010 for those aged 16-24 although this group represents just over a tenth of the total population.