Ageing populations and geographical health disparities in the UK

Betsy Goodfellow from Pharmafocus considers how the UK’s ageing population impacts general health trends, focusing on how a greater proportion of people’s lives are spent in ill health as more people are living much longer
In the UK, people are living significantly longer than in previous decades, leaving the country with an ageing population that has various impacts on healthcare. This also means that more people spend a greater proportion of their lives in poor health, which, combined with the migration of younger people to cities and the older population remaining in rural and coastal areas, leads to many older and elderly people living in areas with poorer healthcare services.1
The movement of young people to cities, and the older population’s tendency to remain in rural and coastal areas, has been referred to as an ‘elderly boom’ and tends to take place in areas such as Scarborough, North Norfolk and the south coast of England.1 Therefore, the populations in these areas are ageing more rapidly than elsewhere, which, coupled with the poorer provisions in these areas, can lead to the elderly spending more time with health concerns.1 As well as alienating elderly people from certain healthcare requirements, the relocation of younger people to cities suggests that there will be less people available in these more rural areas to take on healthcare roles and care for the elderly. This is likely to leave the healthcare system in these areas overstretched, leading to a lower standard of care for the older, more vulnerable patients.
Age UK reports that there are almost 11 million people over the age of 65 in the UK, with approximately 2.1 million pensioners living in poverty.2 With life expectancy increasing (currently at 82.9 years for women and 79 for men in the UK), and the number of years without disabling health conditions declining (now 60.9 years for women and 62.4 years for men), it is evident that the UK’s ageing population is becoming a problem in healthcare as the elderly spend a longer portion of their lives with various health issues leading to further strain on the healthcare system.2
Professor Dame Carol Black, from the Centre for Ageing Better, said: “We don't all have an equal opportunity to age well. Wealth, work, housing, discrimination; all play a significant role in the huge gap in healthy life expectancy between the richest and poorest areas of the country.”1 This highlights the vast geographical and age-related disparities in health within the UK.
As well as this elderly boom in more deprived areas, tech and digital literacy can also be linked to health disparities. Age UK also suggests that approximately 25% of people over the age of 65 do not use the internet, which can severely limit their access to various health resources in an increasingly digital world.3
The number of health services provided digitally or available online is also increasing, with 54% of people looking up health information online over a three-month period and 40,000,000 people visiting the NHS UK website each month.4 This emphasises the need for digital literacy to assist patients when accessing healthcare services and information, especially in a post-COVID-19 world where many healthcare appointments are carried out via phone or video.
According to an analysis of the English Longitudinal Survey of Ageing (ELSA), the level of digital use can be linked to financial status, showing that internet use among the over-50s is higher in wealthier areas, and that those living in more deprived areas are less likely to use the internet than those in wealthier areas.5
Similarly, a lack of mobility can also become a barrier to healthcare for older people, as those living in more rural areas may find travelling more difficult or may be forced to move to get access to better healthcare provisions. Various studies have shown that mobility is key in helping those over 60 to maintain their health and well-being, as well as their independence to access healthcare services.6 The link between mobility and ageing is well known, however its impact on health has become more evident following further research surrounding the ageing population.
It is, of course, positive that medicine and healthcare have progressed to the point that people are able to live longer than ever before, however this has already begun to put pressure on the NHS. To combat this, NHS England has been working with Age UK since 2015 to raise awareness of the healthcare needs for older people.7 NHS England is working with partners across health and social care to:
  • ‘Reframe frailty as a long-term condition to be prevented, identified and managed alongside other long-term conditions
  • Reduce the amount of time someone spends in long-term ill health in later life through early identification and offering support and self-management through, for example, healthy ageing and healthy caring guides
  • Support public services to work together to support people. This includes safety and wellness visits carried out by the fire and rescue service, who also work with people to identify common health and fire risks
  • Identify and support implementation of best practice interventions for key stages of frailty
  • Promote proactive frailty case finding (identifying people at risk of frailty) to target prevention strategies among those most at risk of ageing with multiple long-term conditions. For example, the Toolkit for General practice in supporting older people living with frailty offers a suite of tools to GPs and practice staff to support case finding, assessment and case management of older people living with frailty. This toolkit will assist GPs and practice staff in meeting the GP contract requirement to identify frailty in patients aged 65 and over
  • Promote tailored care and personalised care planning, which documents people’s preferences and supports choices about key aspects of care towards the end of life for people with advanced frailty.’ 8 Clearly, there is a strong link between the fact that many people are living longer than ever before, leading to an ageing population, and the health of the elderly, as well as a geographical disparity in healthcare. In addition, there is a considerable link with tech literacy and a decreased level of mobility with a lower standard of care for older people as the UK’s ageing population levels continue to increase.