Overview

How many people are aged over 75? Over 90?

How many older people are likely to have Dementia?

How many of these older people have a recorded diagnosis of Dementia?

How many people are living with frailty?

How many older people are living in care homes?

Using data from a number of different sources it is possible to answer these questions, or at least make informed estimates.

The main data sources are:

  • Population estimates from the Office for National Statistics;
  • Dementia prevalence estimates based on research published by the Alzheimer’s Society;
  • Dementia diagnoses from Health & Social Care Information Centre (HSCIC);
  • Frailty prevalence estimates from the development of an electronic Frailty Index.
  • Care Quality Commission (CQC) Care Directory

Click here to see local estimates or read below for more information on the data sources.

ONS Population estimates

The Office for National Statistics (ONS) publish mid-year population estimates every June for the previous year.  This provides an estimate of the population by local authority area by single year of age for both males and females.  The latest publication is for 2015 mid-year estimates published on 23 June 2016.

Nationally, 8% of the population in England are aged 75 and over, with around 1% aged 90 and over.

The Office for National Statistics also produce population projections.  The latest projections were published in October 2015 and were based on the 2014 mid-year estimates and assumptions for fertility, mortality and migration.

Across England the population is estimated to increase by 10% over the next 15 years.  However, the number of people aged 75 and over is projected to grow by 52% from 4.4m to 6.8m.  An increasing proportion of these people will be aged 85 and over (from 29% of those aged 75 and over to 32% by 2030) as the number of people aged 85 and over is projected to grow by 66% from 1.3m to 2.2m.

Population projection_Eng

Dementia UK prevalence estimates

Published in 2014, the Dementia UK report presents the findings of research commissioned
by Alzheimer’s Society to update the Dementia UK (2007) report. It provides a synthesis of best available evidence for the current cost and prevalence of dementia.  It provides a consensus estimate of Late Onset Dementia by 5-year age bands and gender for the population aged 60 and over.  This is shown in the chart below. It shows a steep rise in prevalence with age, particularly females aged 75 and over.  The overall age standardised prevalence is estimated to be around 7.1% of the population aged 65 and over, which is unchanged since 2007.

Late onset dementia

Recorded dementia diagnoses

HSCIC collect data on the number of patients in England with a diagnosis of dementia recorded on their clinical record.  This data is published monthly as part of the National Dementia Strategy and the Prime Minister’s Dementia Challenge, which aim to improve the national diagnosis rate of dementia.   Recorded diagnoses are reported at GP practice level allowing aggregation to Clinical Commissioning Groups or other groupings.

The diagnosis rate is defined as the number of patients with a recorded diagnosis divided by the expected number of patients with dementia based on prevalence estimates. The difference between estimated prevalence and recorded diagnoses is sometimes referred to as the diagnosis gap – the number or proportion of people that are estimated to have dementia but have not yet been diagnosed formally.

Nationally the number of people with a recorded diagnosis of dementia is around 4.3% of the population aged 65 and over (414,000 recorded diagnoses) as at March 2016.  This implies a diagnosis rate of around 61% across England.  However, research published in the Lancet in 2013 and subsequently used as part of a wider Western Europe Policy View published in the Lancet in August 2015 suggested a reduction in dementia prevalence over a 20-year time period.  Hence prevalence rates may be lower than those used in the Dementia UK estimates which would mean a higher diagnosis rate.  For further information, see “Matthews FE, Arthur A, Barnes LE, et al. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 2013; 382: 1405–12.”

Frailty Prevalence

There are a number of different sources that can be used to estimate the prevalence of frailty in the population.  Based on a systematic review of 21 cohort studies, (Collard et al. JAGS 2012: 60; 1487-92) the weighted average prevalence of frailty in community dwelling individuals aged 65 and over was 10.7% with the following breakdown by age band:

  • 65-69 = 4%
  • 70-74 = 7%
  • 75-79 = 9%
  • 80-84 = 16%
  • Over 85 = 26%

Recently published work on the Development and validation of an electronic frailty index using routine primary care electronic health record data defines the population 65 years and older as “Fit”, “Mild Frailty”, “Moderate Frailty”, or “Severe Frailty” based on the accumulated deficits recorded in primary care records.  This is summarized in the chart below:

This suggests that 15% of the population aged 65+ may be considered to have moderate (12%) or severe (3%) frailty.  The work has also shown a relationship between deprivation and eFI scores. The greater the level of deprivation, the higher the average eFI score.

Care Home Population

The Care Quality Commission (CQC) maintains a directory of all the places in England where care is regulated by CQC.  It includes every hospital, care home, GP, dentist and care home agency in England as well as other types of service like ambulances, prison care services and hospices.  For care homes, the number of beds at each location is also listed as well as the Regulated Activity (e.g., Accommodation), Service Type (e.g., with or without nursing care), and Service User band (e.g., older people).  From this it is possible to estimate the number of available beds in care homes within a local authority area, and the proportion that are for older people and whether nursing care is available.  Estimates for number of people living in care homes can then be made based on assumed levels of occupancy (how many beds are in use at any point in time).  Across England there are over 460,000 care home beds of which around 403,000 are for older people.  Just over half (53%) provide nursing care, with the remainder being “Residential care homes” without on site nursing support.

The older people beds are distributed across around 11,000 locations, of which around 70% have received a recent CQC rating (as at 1 June 2016).  Just 47 locations have been rated “Outstanding” (0.6% of those with a rating), whilst 286 (3.7%) have been rated “Inadequate” (lowest rating).  61% have been rated “Good” with the remaining 35% rated “Requires Improvement”.

Click here to see local estimates or see below for links to useful data sources.

 Useful links