News & Views

4th June 2014

Rise of the 100-year-old puts NHS under strain: Centenarian population expected to hit half a million in 30 years

  • Hospitals are put under pressure as more people live to 100, experts warn
  • 35,000 people have lived to see 100th birthday in England in past ten years
  • But number expected to reach half a million in Britain by 2066, says study
  • Many people who die at this age are frail and need tailored end-of-life care

Hospitals are being put under unprecedented pressure as record numbers of people live to 100 or more, experts warned last night.

Care homes and the NHS will struggle to cope as Britain’s centenarian population soars, with 35,000 people living to see their 100th birthday in England in the past ten years.

But the number is expected to reach half a million in Britain by 2066, according to a ten-year study at King’s College London.

Many who die at this age are frail, suffering from pneumonia and need tailored end-of-life care, it says.

Palliative care researchers are calling for more care home beds and better planning of health services so fewer very old people need to go into hospital in the last weeks of their life.

Admitting patients to hospital at this time also pushes up the cost to the NHS significantly.
Dr Catherine Evans, clinical lecturer in palliative care at the Cicely Saunders Institute, King’s College London, said: ‘Centenarians have outlived death from chronic illness, but they are a group living with increasing frailty and vulnerability to pneumonia.

 

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THE RISE OF THE CENTENARIAN

The number of centenarians has risen by 73 per cent in the last decade alone.

Just before the First World War, there were only 100 centenarians in the whole of Britain.

Reaching such a ripe age was rare enough for there to only be 24 recipients of the first congratulatory telegrams sent out by King George in 1917.

But now Buckingham Palace sends out around 10,000 hundredth birthday cards a year.

When the latest figures were collected in 2012, there were some 13,350 people over 100 in the UK, up from 7,740 in 2002.

And the trend for an ageing population is set to continue, with the number of people of retirement age expected to rise by more than a fifth in the next decade, according to the Office for National Statistics.

Even in London, which has the youngest demographic in England, 22 per cent of the population is predicted to be over the age of 65 by 2022.

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‘We need to plan for healthcare services that meet the hidden needs of this group, who may decline rapidly if they succumb to an infection or pneumonia.

‘We need to boost high quality care home capacity and responsive primary and community health services to enable people to remain in a comfortable, familiar environment in their last months of life.’

The King’s study, published in the journal PLOS Medicine, found that more centenarians die in NHS hospitals in England than in other European countries, which provide better care at home or in care homes.

The number of those aged more than 100 dying each year increased by 56 per cent in ten years, from 2,823 in 2001 to 4,393 in 2010.

There are already half a million people in Britain aged 90 or more, and life expectancy for the next generation is also rising, the Office for National Statistics says.

The latest study shows centenarians are more likely to die of pneumonia and frailty and less likely to succumb to the chronic conditions often associated with old age, such as cancer or heart disease, compared to those under 100.

Although 61 per cent die in a care home, a significant 27 per cent die in hospital. Only a tenth die in their own home and just 0.2 per cent die in hospice care.

The research included 35,867 people with an average age of 101 years at time of death, of whom 87 per cent were women.
Hospital admission in the last weeks of life pushes up healthcare costs disproportionately, said Dr Evans, but surveys show most older people would prefer to die at home or in their care home.

Older people are now the biggest users of NHS and social services.

The Department of Health estimates the cost of providing hospital and community health services for someone aged 85 or more is three times greater than for those aged 65 to 74.

The number of centenarians in the UK has doubled every ten years since 1956. The number worldwide is projected to hit 3,224,000 by 2050.

Dr Evans said: ‘Compared to other European countries, the proportion of people aged 90 years and over dying in hospital in England is high, and the number dying in care homes is low.


'Centenarians have outlived death from chronic illness, but they are a group living with increasing frailty and vulnerability to pneumonia'
Dr Catherine Evans


‘For example, in the Netherlands and Finland more than three-quarters of people aged over 90 die in long-term care such as a nursing home. Far fewer die in hospital.

‘Hospital admission in the last weeks of life accounts for a third of the total cost of end-of-life care per patient.

'Increasing the number of care home beds could reduce the reliance on hospital care, but we need to ensure high-calibre services are provided to enable people to remain in their usual residence at the end of life if they choose.’

 

 

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