There is interest in both society and Parliament regarding the future of adult social care, with a focus on the ageing population. There is extensive information available on this topic, looking at the reasons why people require care and ways in which this care is provided.
Current estimates show that 18.0% of people in England are aged 65 years and over and this is expected to rise to 26.1% in 50 years’ time according to the 2016-based national population projections. These estimates have led to a growing interest in the need for adult social care and the provisions in place to meet this need.
Adult social care includes support for adults with a physical disability, learning disability, or physical or mental illness, as well as support for their carers. This article looks at the demand for adult social care across the whole adult population, rather than focusing solely on older people. It aims to capture the need for care services throughout adulthood, as well as recognising that an ageing population is likely to impact on the demand for these services. This report presents a brief selection of indicators that are available at county and unitary authority level, along with links to further sources of data.Back to table of contents
2. Countryside and rural areas have the highest proportions of State Pension age people
One indicator of the demand for adult social care is the old age dependency ratio (OADR), a measure of the number of people of State Pension age (SPA) per 1,000 people of working age. If the OADR increases this means there are more people of pensionable age likely to be dependent on those of working age.
Although access to adult social care is not defined by age, it is recognised that as people age they are more likely to have multiple health conditions and therefore more likely to require assistance with day-to-day tasks. The number of people requiring help with at least one activity of daily living (ADL) increases for those aged 65 years and over. In 2016, at ages 65 to 69 years, 19% of people needed help, whereas at ages 80 years and over 43% of people needed help (XLS, 119KB). In the same year the OADR in England was 302.8 per 1,000 working age people and this figure is projected to rise to 348.7 by 2046.
In 2016, there was generally a greater old age dependency ratio within the English Countryside and Remoter Coastal Living areas, than all other area classifications (Figure 1). In contrast, there was a lower dependency in the London Cosmopolitan and Ethnically Diverse Metropolitan Living area classifications. In line with this, the Department for Environment, Food and Rural Affairs identified that between 2001 to 2015, there was a 37% increase in the number of people aged 65 years and over living in predominantly rural areas, compared with a 17% increase in predominantly urban areas.
Figure 1: Old age dependency ratio by counties and unitary authorities in England, 2016
3. Women are expected to live longer with a disability than men
The estimated number of years spent with a disability is a measure that indicates the number of years a person could expect to live with a long-lasting physical or mental health condition, that limits daily activities. This is calculated as the difference between life expectancy and disability-free life expectancy (DFLE).
Data on how long people are expected to live with a disability can indicate how long adult social care services may be required by people aged 65 years and over. By looking at where these people live, we can begin to understand the demand for services geographically. The maps in Figure 2 show the number of years males and females can expect to live with a disability at age 65 years, based on 2015 to 2017 data. Figures for other age groups are available in the Health state life expectancies bulletin.
In 2015 to 2017 across England, at aged 65 years, females were expected to live longer with a disability than males. The overall England figure for years spent with a disability was 8.9 for males and 11.3 for females. This is partly explained by the fact that females are expected to live longer than males (life expectancy is 18.8 and 21.1 years for males and females respectively at age 65 years). However, the gap between male and female life expectancy has been reducing over recent years.
It is useful to look at the number of years spent with a disability because a high proportion of people aged over State Pension age in an area does not necessarily show a greater need for care. Requiring help with daily tasks is one way of measuring care need and the proportion of older people requiring help varies across England. The 2016 Health Survey for England found that in the least deprived areas, 22% of people aged over 65 years needed help with Activities of Daily Living. But in the most deprived areas, 43% of people did.
Figure 2: Number of years spent with disability, at age 65 years by sex across counties and unitary authorities in England, 2015 to 2017
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