Elderly population

In 1994 in the United Kingdom 8000 people (7000 women and 1000 men) were aged 100 and over. In 2031 it is estimated that 28000 women and 6000 men will be in this age group. In 1994 a man of 60 could be expected to live for another 19.7 years and a woman of the same age for 23.6 years. It is estimated that people over 75 years of age will have doubled by t he middle of the next century whilst the oldest old, that is aged over 90 will have more than tripled (Age Concern 1997).

This group presents a challenge to the primary health care team with a variety of unique problems associated with the physiological changes of ageing, chronic illness and declining social support. Because of the wide variety of conditions and illnesses that they suffer, they are also likely to experience the adverse effects of multiple medications prescribed by health professionals. They are most susceptible to falls, incontinence and alteration of mental status and evaluation of their care must include their social, functional and medical status best carried out using a multi-disciplinary approach. (Roche R 1996).

Many elderly live alone and many experience hardships associated with reduced finances, lack of transport and lack of basic facilities such as washing machines and central heating. Hypothermia and associated winter deaths contributed to a 19% above average death rate betw een 1991 and 1995, compared with rates for Germany and Scandinavia which were 4% and 7% respectively above average (Age Concern 1997).

Carers take the burden of care from the State and in 1990 57% of carers had dependants (mostly female), over 75 years of age (Age Concern 1997). (See elsewhere for account of Carers in the Community).


Older People in the United Kingdom. Some basic facts. (September 1997).

Age Concern Roche, R (1996) in Medicine - a primary care approach. W B Saunders Company



population profile

Elderly population as a percentage of total population 17 - 22%

(national average 16%)

2 - 3000 Male

nearly 5000 Female


breakdown of population in ages

65 - 74 yrs = 6 - 9% in Haywards Heath area

National average 9%

75 - 84 yrs = 6 - 8% in Haywards Heath area

National average 5.6%

85 + 1.5 - 2.5% in Haywards Heath area

National average 1.5%


Population Profile for Mid Susex

Mid year projections for 2001

65 -74 yrs 2500 decrease

75 - 84 yrs 1400 increase

85+ yrs 1900 increase


Over 75 Health Checks


Commenced 1990 as contractual requirement for GPs in the Terms of Service (Dept of Health 1989):

1. All patients aged 75 and over offered annual health assessment in form of written invitation

2. Assessment carried out at Practice for mobile patients, at home for the housebound

3. Responsibility delegated to Practice Nurse with suitable training and/or experience

4. Assessment takes the form of physical, psychological, emotional and social assessment

5. Risk factors and needs identified and appropriate referrals made

6. Carers identified and needs assessed

Current Practice

8.6% of practice population over 75 (463 patients) compared with National Average of 5.6% and 6-8% in Haywards Heath area (West Sussex Reference Atlas 1994)

Annual Invitation sent at least 6 months late due to pressure of work

98% acceptance of invitation

Health assessment perceived as achieving little medical benefit but greater social and psychological benefit by professionals, but perceived as very beneficial by most patients (anecdotal evidence)

Very little published evidence to date of any actual benefits from annual screening of whole "over 75" population

Research has shown that Doctors see little merit in the assessment, nurses and patients see more benefit (Tremellen 1992)


Audit of Over 75 Health Checks to determine effectiveness, efficiency (financial), and acceptability

Review method to ensure resources targeted to those most in need

Write Practice Protocol to ensure all members of team have same aims and objectives

Revise assessment sheet


Department of Health (1989)

Terms of Service for Doctors in General Practice London: HMSO Tremellen, J (1992)

Assessment of patients aged over 75 in general practice British Medical Journal 305, pp 621-624 25

Cuckfield Medical Practice Carers Project


Started in 1997 following "Audit of Carers" initiative by MAAG.


1. Notices and leaflets in waiting room and at reception advertising need to identify carers and availability of practice information booklet

2. Carer questionnaire devised for completion by carers

3. Register of carers, and read code for ease of identification by practice staff

4. Carers Information Leaflet and booklet devised

Audit to date

15 carers identified

All received questionnaire and information leaflet

8 received Carers Booklet


Identify more carers through posters and leaflets in waiting room; opportunistic during consultations

100% identified carers will have received Information Booklet

100% identified carers will have been offered annual health check for screening and identification of unmet needs

Annual invitation letter currently being devised

Regular updating of Information Leaflet and Booklet

Date to be set for Audit of Project