In England, there are currently 11 million people aged over 65, with the number expected to rise by 32% (3.5 million) by 2043. The number of people over 85 is also predicted to double in the next 25 years, from 1.3 million to 2.6 million. Approximately 69% of people over 85 live with multiple conditions, and 35% of all older people (aged 65 and above) live with some form of frailty. Age related illness such as dementia are also predicted to rise in prevalence. This means that a very large proportion of older people require some form of health and care support to live well, particularly in the last years and months of their life.
Evidence suggests that approximately 47% of hospital inpatients aged over 65 are affected by frailty, costing the UK healthcare system around £5.8bn a year. And almost half of all people arriving in A&E by ambulance in 2021/22 were over 65, with a third over 75. This is particularly concerning as recent data shows that many older people who are ready to be discharged from hospital face significant delays, with research suggesting that over a fifth are waiting for short term rehabilitation in the community. In a significant number of local authority areas, over 65s make up a third or more of the population.
The increasing numbers of people with frailty will have a significant impact on health and care provision. The health and care system must therefore think differently about the way it supports this significant cohort of people, and their informal carers and families, to ensure they stay well for as long as possible at, or close to, home. Supporting people with frailty at home is often beneficial for the individual, who is able to stay well and independent in familiar surroundings for longer, as well as their family and friends who support them. It can also reduce pressure on the wider health and care system and support patient flow.
Recognising this, the past few years have seen a significant shift in national policy towards supporting people with frailty to live well at or closer to their home through community led initiatives. In December 2023 NHS England published the proactive care framework which supports a more 'consistent approach to proactive care across the country for people living at home with moderate or severe frailty'. The guidance provides some examples of best practice as well as five core components of the proactive care approach including: case identification, holistic assessment, personalised care and support planning, coordinated and multi-disciplinary working and continuity of care.
Community and primary care providers working together will be central to achieving national ambitions to support more people with frailty to live well at or closer to home. The sector plays a key role at every stage of the frailty care pathway: in prevention, crisis response and intermediate care.
