Stats

Question 1

Population Demographics

Answer 1

16% of UK population >65yo
65% of IP >65yo
LE: M 81.8y, F84.6y
LE increasing 2y/decade

Question 2

proportion of population active and sedentary

Answer 2

29%M, 21% F active 55-74y
41%/32% gen pop
9/4% >75y

33/38% sedentary 55-74y
23%/24% gen pop
40%/65% >80y

Question 3

Physical ability stats: walk/stairs/stand/outside

Answer 3

50% can't walk 3mph
12% >65y can't walk independently
9% can't use stairs
30%M 50% F 65-74y can't stand from low chair
50% RH residents don't go outside

Question 4

Inactivity burden stats

Answer 4

17% inactive (RH/NH higher)
2x smoking or HTN
3% of disease burdern, 1.9 m deaths (35,000 UK)
£8.2m/year cost

Question 5

Loss of physical ability

Answer 5

muscles strength (max effort): 1% from 50, 3% 70y
muscle power: quick force (efficiency): lost 3-4% per year
activity: 10% per decade
bone density: 1% M, 2-3 F lost

Question 6

Ageing stats

Answer 6

11.3m pension (65M 60F)
368,150 >90y, 26% M

96% own homes; 20% LT care homes
4000 >90yo give >50h care

increasing proportion (UK fertility rate 1.84 - below replacement)

Question 7

Terminal Care stats (death location)

Answer 7

500,000 deaths per year
54% of complaints

approx 55% prefer home, approx 20% actually die at home (25% cancer pt)

approx 25% prefer hospice, 5% actual (20% cancer)

approx 10% hospital, actual 60% (45% cancer)

approx 5% nursing home, actual 15% (10% cancer)

Question 8

Long term care stats (location and cost)

Answer 8

living alone: ^#population, ^institutionalisation risk

60yo: 20%M 45% F
80yo: 35%M 65% F

spending:
EU15: 7.6% health, 9.1% pensions; mostly instiutions
England LTC: 50:50 formal:institutions; 1.2% GDP
private england: 0.5% GDP, 85% institutional

Question 9

Long term care - comorbidity prevalence

Answer 9

cognitive impairment: 50-75%
urinary incontinence: 50-75%
mobility issues (chair/bed bound): 25-50%
multiple diagnoses and medications: average 6.2 Dx, median 8 meds
behavioural Sx: 67%
malnutrition: 30% malnourished, 56% at risk
life expectancy: 1y in NH, 2y in RH

Question 10

Carers - prevalence, incidence, time

Answer 10

1in8 people; 6.5 million, 9 million by 2037
6,000 new per day, 2m/y
58% F; peak 50-59y (20%)
3million working age, 1in5 give up work
13m >50h/week

Question 11

Carer - demographics

Answer 11

58% F, 20% 50-59yo
parents/in-laws 40%
partner 26%
friend/neighbour 9%
grandparents 4%
other relatives 7%

Question 12

Carers - health impact

Answer 12

2x risk of permanent illness/disability
625000 direct physical/mental issues
83% neg physical, 87% neg mental
40% delay own treatments
longer care duration increases risk

Question 13

Carers - social impact

Answer 13

isolation, relationships, asking for help
37% no support
29% family but no SS support
40% no break in 18 months, no holiday in 5 years

reduced/stopped work - £30,000 lost
struggling to pay: 74% bills, 78% home repairs, 52% reducing food, 32% rent/mortgage issues

Question 14

Elder abuse - prevalence/perpetrator

Answer 14

4% prevalence (342000 per year)
2.1% of men, 5.4% of women in past year

35% partner, 33% family, 9% home help, 3% friend, 33% neighbours
can be institutions

Question 15

Elder abuse - types

Answer 15

5% verbal abuse
2% physical abuse
2% financial abuse

Proportions:
34% psychological, 20% financial, 19% physical, 12% neglect, 3% sexual, rest = other

Question 16

Delirium - types

Answer 16

hypo 40%
hyper 25%
mixed 35%

Question 17

Delirium - IP prevalence

Answer 17

20% IP prevalence

AMU 10%, post-op 15%, stroke 25%, HCOP 30%, post-op hip 50%, ITU 60%, palliative 80%

Question 18

Delirium - GP and Dementia

Answer 18

1-2% GP;

50% have dementia (5-10x risk);
affects 67% of dementia IP
delirium = 3x future dementia risk

Question 19

Depression - prevalence (OPD/IPD)

Answer 19

commonest mental disorder in elderly

affects 30% community, 15-20% clinically depressed
1 in 5 GP attendees have psychological symptoms
1 in 6 don’t discuss Sx with GP

23% of RH, 30-35% of NH,
29% acute med IP, 40-45% post-stroke

Question 20

Depression - effects

Answer 20

1 in 20 are likely to respond to ADD
85% also have anxiety
25% of suicides are elderly
10-20% have delirium

Question 21

Depression - suicide

Answer 21

25% of suicides are elderly
1 in 4 success rate (others = 1 in 15-20)
less expressed

Question 22

Dementia - prevalence

Answer 22

prevalence: 17-25m worldwide; 
850,000 UK (>1m by 2025; 40% increase in next 15y)
33% >95yo; 20% >80yo; 
15,000 are younger (~1in20)
F>M (2x)
64% of care home residents
10-15% had MCI

Question 23

Dementia - M/M

Answer 23

60,000 deaths per year;
comorbidity: 70% have CMs; 61% anx/depp, 41% lonely, 52% lacking support, 24% feel isolated, 28% lacking capacity/decisions, 90% house-bound
10% delirium

Question 24

Dementia - cost/burden

Answer 24

cost: £26b to NHS yearly; family carers save NHS £6b; more than stroke + cancer + CHD; >1% GDP

£11.6b unpaid care, 4.3 health care, 4.5 state social care, 5.8 private social care; other = 0.1b

Question 25

Dementia - types

Answer 25

AD 62% (500,000); 7y LE, 3% make 14y;
Vasc 17%
Mixed (A/V) 10%
LBD 4%, 25,000 (

Question 26

Falls - prevalence

Answer 26

50% >80yo fall at least 1/y; 33% of >65yo
50% fall again within 1y
>75y = F>M, F (2x)
50% mobility issues

Question 27

Falls - M/M

Answer 27

fractures in 20%, injury in 75%
after #hip, 33% fully dependent, 50% partial
1% of falls » hip fracture
#NOF 1y mortality is 20-35%
10% mortality within 12/12 after a fall

Question 28

Pressure sores, incontinence, and falls cost

Answer 28

PS: 1.4-2 billion
incontinence £354 million
Falls: 1.8 billion (1%)

Question 29

Incontinence - prevalence

Answer 29

200m worldwide (~1 in 30); F >M
40% of women >60y; overall 25-45%
men 5-39%

increases with age: YA 20-30%, middle-age 30-40%, elderly 30-50%

Question 30

Incontinence - urinary/faecal/catheter stats

Answer 30

urinary +/- double: 30% acute, 57% HCE, 29% RH, 63% NH
faecal 4/3/3/4%;
catheter 17/17/4/13%

Question 31

Stroke - M/M

Answer 31

3rd leading M&M:
130,000 affected each year (1 every 5 minutes);
incidence 174-216 per 100,000/y

dysphagia 30-50%

Question 32

Stroke - TIA stats

Answer 32

TIA: 35 per 100,000; 1/3 stroke later;

5%

Question 33

Stroke - prognosis

Answer 33

TACS at 1 year: 60% dead, 35% dependent, 5% independent, 5% recurrence

PACS: 15% dead, 30% dependent, 55% independent, 20% recurrence

LACS (best): 10% dead, 30% dependent, 60% independent, 10% recurrence

POCS: 20% dead, 30% dependent, 50% independent, 20% recurrence

Question 34

Stroke - cost

Answer 34

cost: £7b per year (£2.8b NHS, £2.4b informal care, £1.8 lost productivity)

Question 35

Stroke - RF (odds/risk ratio)

Answer 35

HTN (3-4x), DM (2-4x), AF, IHD (2-4x), CCF (2-4x), IE

smoking (1.5-3x), alcohol (4x) cholesterol, pro-thrombo, IVDU

age, male, PMH, FHx
age risk doubles every decade >55y

Question 36

Stroke - thrombolysis effects

Answer 36

risks: 5% ICH, 1% fatal ICH; 3-5% get worse, 1% shortened life
benefits: 20-33% improve, 10% independent

Question 37

Polypharmacy - stats

Answer 37

90% of older people have prescriptions
>50% of 65-74yo take 3+ (>70% >75y);
12.6% of interactions involve polypharma

Question 38

ADR risk factors

Answer 38

cognition (12x), 
4+ comorbidities (8x)
dependent (4x), non-adherence (2x)
impaired renal function (2.5x)
polypharma (2.7x)

NSAIDs involved in 29%

Question 39

ADR - stats

Answer 39

30% of ADRs occur in elderly;
6-17% of elderly IP have ADR
10-12% of acute Ax due to prescriptions;
1in4 older adults over 5y;
6.5% of all Ax are ADRs; 30-55% avoidable