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Health and housing what can the NHS do?

Health and housing what can the NHS do?

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Health and housing what can the NHS do?

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  1. Health and housingwhat can the NHS do? Dr Ian P Donald Consultant in Old Age medicine Gloucestershire Hospitals NHSFT

  2. Getting your GP to visit? • Most consultants do not do domiciliary visits • OT’s do carry out assessment visits, but very time-consuming, so fewer • Home Improvement Agency often unknown • Where to refer for impartial advice? The housing dimensionhas become opaque

  3. Housing in Comprehensive Assessment • Impact on disability • Impact on quality of life and mental health • Whether discharge home is possible Geriatricians have generally failed to make the connection between health, social care and housing disrepair

  4. Average length of stay around 7 days for over 80’s in DGH • Around 15 days for Community Hospitals, but often far away from their home • Hospital staff rely on community staff to pick up the issues eg fallers Time pressure

  5. Is self-evident (shown again in recent Gloucester survey), yet strong confounders: • Smoking • Education • Diet and obesity • Wealth • Employment • Mental health Absence of randomised controlled trials Only 2% of Gloucester residents thought their housing had adverse effect on their health The link between health and housing

  6. Those over 85 spend 90% of their lives indoors • LTC’s increase vulnerability to damp and cold • Loneliness and social isolation Impact greatest for older people

  7. Where older people live

  8. 52% = 3,300 households

  9. Home status vs age

  10. 37% live in non-decent homes • ¾ of these are in private housing • 14% are in homes in serious disrepair • ½ of all homes in serious disrepair are inhabited by old people Vulnerable Householders >75

  11. 80 years lady, lives alone • Early Alzheimer’s disease • Lives in this townhouse for 40 years • No savings, and cautious with money • recurrent chest infections (no admissions) • All windows and doors rotting • Uses storage heaters • No family Case example

  12. Home environment assessment by trained therapist observing the patient reduces falls frequency by 40% • Untrained assessment more equivocal benefit (eg home safety checks) • No evidence for reduced fractures • Most benefit for high risk fallers eg frequent fallers, poor vision etc Falls and environmental hazards

  13. Probably the most consistent impact and benefit from housing improvements • Improved quality of life for all in receipt? Falls and mental health

  14. How to measure things that have not happened • Multiple competing factors in frail older people • You may “prevent” the fractured hip, but a stroke occurs • Hospital admissions already very brief, so savings mainly in social care Prevention and avoided cost

  15. Investment in improved housing conditions can be cost-effective • Savings are clearer in younger disabled • Majority of older people awaiting an adaptation are not in receipt of homecare • For some, the adaptation may not be the critical determinant of staying at home • Best value where homecare no longer required • Health is less stable – so further deterioration may soon occur • Can save health expenditure in the future Evidence re health impact

  16. 40,000 more deaths in UK during winter • UK does not have hard winters • Much larger variation than in Scandinavia • UK homes have poor thermal efficiency • Those over 85 spend 90% of their time at home Seasonal fluctuation

  17. Mortality vs outside temperature

  18. Colder homes higher winter deaths

  19. One turned heating off • Another wandered outside at night and fell Hypothermia cases

  20. Health inequality is increasing

  21. Life expectancy at 65 and Deprivation

  22. Years difference Growing inequality in DFLE

  23. Usually reach the easiest to reach • Can result in increasing inequality • Exercise promotion • Healthy eating • Health checks • Breast feeding • Should we target better? • Can we find all the high risk households? Health promotion campaigns

  24. Case example – how to manipulate the system? Moving house

  25. I’ll have to have my back to the wall, kicking and screaming before I go • Major change in health • Dementia • NOT change in social support • NOT housing conditions • 70% couldn’t imagine anything that make them move • 10% only if there was a major catastrophe I have many friends, and can’t imagine them all going What triggers a move? Even if it falls on top of me, I’m not leaving. It would need to be a bloody big earthquake!

  26. Only 6% living in non-decent homes are dis-satisfied with home • Only 12% would consider interest-free loan Home-owners attitude

  27. Falls and fracture prevention through participation in exercise and balance classes, combined with trained home assessments for hazards • Targeted “Warm and Well” at >75’s • OT’s on rotation hospital to community, and Community Nurses, being regularly informed and updated My Top Tips