The third major report by the Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin was published today. This report presents findings from Wave 3 of TILDA, which impact on the health and well-being of Ireland’s adult population aged 54 years and over and maps changes that have occurred since the first wave of TILDA data collection in 2010. The report is available at www.tilda.ie.
The findings demonstrate that the over 50s adult population continue to make substantial contributions to their families and the communities in which they live. However, many treatable conditions and serious health challenges such as high cholesterol and hypertension remain undiagnosed and untreated four years later. In addition to increased obesity rates and poor adherence to dietary guidelines in older adults, these undiagnosed and untreated conditions contribute to increased risk of cardiovascular disease and lower quality of life. While some screening programmes, such as those for cancer and influenza are working, the study authors believe that there are areas that require fresh policy drives.
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, generating insight and discovering solutions as Ireland and the world faces the challenge of an ageing population.
To continue this research over the next five years, TILDA was recently awarded continued funding with a grant of €10 million from the Department of Health and €5 million from the Atlantic Philanthropies with continued support from Irish Life. This new round of funding will enable TILDA to strengthen its national and international reputation as a highly valuable longitudinal study on ageing.
Professor Rose Anne Kenny, Principal Investigator of TILDA said: “The good news is that Irish adults over 54 years continue to make a tremendous contribution to our society. In this report, TILDA has further identified important risk factors which, if modified or treated can make a big difference to positive health and well-being.”
Minister of State for Health Promotion, Marcella Corcoran Kennedy said: ““Today’s report confirms that older people make an enormous contribution to Irish society. The health findings of Wave 3 show that we have a way to go in optimising the health and wellbeing of older people. My Department and the HSE will examine these findings with a view to identifying the responses we need to ensure the best outcomes for older people. As a longitudinal study with a health assessment, TILDA is a critical source of evidence to better understand ageing in Ireland over a sustained period of time and across a number of domains. I am very happy that the Department of Health has been able to provide €10 million over the next five years to support the continuation of TILDA. I look forward to working with TILDA to ensure that policy making is more and more based on good research and hard evidence.”
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.
Health care coverage and health insurance requires more flexibility for a competitive market
- VHI Healthcare remains the dominant provider of private health insurance policies for this age group with 59% having their policy with VHI.
Professor Rose Anne Kenny said “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.”
Professor Kenny continued: “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.”
Minister Corcoran Kennedy continued: “From my own point of view as Minister for Health and Wellbeing, the high rate of overweight and obesity among older adults continues to be a cause for concern, as is the lack of adherence to the food pyramid. My Department has recently published an obesity policy which includes a focus on older adults, and we have published a revised food pyramid for the entire population, with specific food portion guidelines for various age groups including older adults. We are also working on a nutrition policy which will include a focus on the over 50s.”
Dr Mairead O Driscoll, Interim Chief Executive at the Health Research Board said: “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. What we need to do is ensure this evidence informs policy and practice. As part of managing this renewed government investment of €10 million, the Health Research Board will actively work with TILDA and the Department of Health to set up a dedicated Knowledge Translation Group. 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.”
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.
- 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.
- 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.
Professor Kenny said: “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. 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. Consequently, limited resources can be distributed to secure maximum impact so that our later years can be independent, active and healthy.”
As a result of the funding support to TILDA over the past ten years:
- TILDA is engaged in more than 45 national research collaborations and more than 25 international collaborations.
- TILDA has reached over 10,000 social media learners through their free online course, Strategies for Successful Ageing, which will run again for Positive Ageing Week, this September 26th 2016.
- The TILDA study is harmonised to 13 other international longitudinal studies on ageing which allows cross country comparisons of key indicators of health, wealth and happiness.