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Suddenly everyone is in their late-sixties
...and there are signs that it's already causing problems
Sexual intercourse began in 1963. That’s what Philip Larkin told us in his poem Annus Mirabilis. But Larkin got the year wrong. Sexual intercourse actually began eighteen years earlier, in 1945. At least, that’s the year when there were more conceptions in the UK than there had been for many, many years.
All those extra conceptions in 1945 led to a lot of extra babies being born in 1946. And it didn't stop there, because it turned out that sexual intercourse stayed in fashion for the next four years. If we look at a graph that shows how many live births there were in the UK from 1921 to 2011, we can’t help but see a flurry of activity in the four years between 1946 and 1949. Just in case you find it difficult to notice this spike (which you won't), I’ve coloured it in red:
These people who started life in the four red columns, the people born between 1946 and 1949, are now either in—or just about to enter—their late-sixties. We are slap-bang in the middle of a massive expansion of the 65-69 age group. We talk a lot—often glibly—about the pressures on the NHS caused by an ageing population. But what we usually mean by that is the increase in the number of older people: people in their late-seventies, eighties and nineties. We have tended not to focus very much on people in their late-sixties.
But this group of people—the 65-69-year-olds—has just increased in size by 26% in the last five years. In England, for example, in 2008, there were less than 2.3m people in the 65-69 age-band. Now there are nearly 2.9m of them.
So: what's this got to do with anything?
Well, it might be relevant when we consider that in recent weeks we've been getting reports of increasing numbers of emergency hospital admissions. As a piece this week by Alastair McLellan (the editor of the Health Service Journal) put it, "England's hospitals are starting to run ferociously hot."
A couple of notable examples of this "ferocious hot-ness": East Kent Hospitals Trust declared a major incident earlier this month because of the unusually high demand for its emergency care. Norfolk and Norwich University Hospitals had to put up a tent outside its doors as it struggled to cope with the number of admissions. And everywhere in England performance against the four-hour target seems to be deteriorating.
How much of this extra demand for emergency care is coming from that rapidly-expanding cohort we've just identified: people in their late-sixties?
To try and answer that question, let’s take just one general hospital as an example, and let’s look at its emergency hospital admissions last year, broken down by the age of the patient at the time of their admission. In fact, I’ve restricted it to admissions of patients aged between 16 and 89, and I’ve shown not the absolute numbers of admissions by age, but—instead—the rates of admission per 1,000 population:
I've coloured in the people in the 65-69 age group.
I think this graph tells us five things.
The first thing it tells us is something we probably already know. The left-hand side of the graph tells us that the demand for emergency inpatient care by adults up to the age of about 50 is pretty constant. In other words, it doesn't seem to matter whether you're 19, 29, 39 or 49, the likelihood of you being admitted to hospital as an emergency is pretty much the same regardless of your age.
The second thing we also probably knew already. An age gradient begins at the age of 50. From then on, your chances of being admitted to hospital as an emergency increase as you get older.
The third thing is something we tend not to talk about too much: the age gradient is a gradient of two halves. It starts fairly slowly and then suddenly gets steeper. If you've ever ridden a bike up a long hill, you'll be familiar with that deeply unpleasant feeling you get when a gradual climb (that's already made you feel quite tired) suddenly turns into a very steep climb. That steep climb looks as if it begins for patients somewhere around their late-60s. If we round the numbers, it looks as if people aged 70 are admitted as emergencies at twice the rate of 60-year-olds.
The fourth thing is where we have to connect this graph with the earlier graph. This steep age gradient is being encountered—and about to be encountered—by a much, much bigger number of people than ever before. To repeat, there are now more than half a million more people in their late sixties in England than there were five years ago. These people are entering that phase of their lives when their likelihood of being admitted to hospital as an emergency rapidly increases.
Which leads us nicely on to the fifth thing this graph tells us: we ain't seen nothing yet.
[26 April 2013]
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