3.10 This highlights the importance of how and where people live, their social networks and local community, working conditions and income and other factors that together interact to impact on how well people are, and feel and whether or not people feel generally satisfied with their lives. Understanding deprivation – the extent to which people in an area are likely to experience lower levels of income, employment, education and skills, health, access to housing and services; higher levels of crime and disability and a poorer living environment – is therefore important in understanding the likelihood that they will need assistance to maintain or improve their health and general wellbeing.
3.11 Nationally, 50% of all people who are on a low income are older people; this fact alone highlights the importance of understanding the circumstances of Durham’s older population and developing policies to support independence in a healthy and enabling environment.
Deprivation
3.12 The economic history of the County, particularly the mining industry connections, has left a legacy of small scattered towns and villages and some significant challenges, particularly in East Durham. Although there are huge economic variations across the area, it is ranked the 50th most deprived local authority area in England. Around a third of the population lives in areas determined as amongst the 20% most deprived in England and 44% of the super output areas in the county lie within the 25% most deprived in England. Within these communities, weekly wages and rates of car ownership are low; the health of the population is poor; life expectancy is below the average for the country and there are high levels of disability and long term illness.
3.13 Areas of high deprivation across all ages are found predominantly in East, North West Durham and the Bishop Auckland, Crook and Willington areas, withEasington having the highest levels of deprivation, where 41.4% of the population fall within the national top 10%. Of the 20 worst wards in England for health outcomes, ten are in East Durham.
3.14 However, for older people specifically, the most deprived areas are somewhat different, with the worst 10% of all lower super output areas across County Durham concentrated in:
Wear Valley (10 lower super output areas) Derwentside (6) Easington (1) Durham (2) Sedgefield (3) Chester-le-Street (2).
3.15 The map below shows the areas of higher deprivation of older people.
3.16 It is apparent from the reported demand for welfare benefits advice (provided by Age Concern Durham) that there is a significant need for assistance in maximising income amongst older people. Considering levels of pension credit claims, and adjusting for the estimate drawn from the study in Cambridgeshire that around 40% of people eligible do not claim pension credit generates an estimate that 45.5% of the older population are entitled to, if not claiming, pension credit. Older people themselves, and agencies working with older people, identify that the single most important issue in enabling people to have choice and control over their own lives is money: choices are effectively limited by low income and poverty. We know that owner occupiers in particular find it difficult to live on basic pension and still maintain their home.
Life expectancy
3.17 In Durham, life expectancy at birth is 76.5 years for men (England average 77.7 years) and 80.2 years for women (England average 81.8 years). According to ‘Better Health, Fairer Health’ (Public Health North East 2008), when looking at wards in County Durham with a population over 5,000, for males, the difference between the best and the worst wards is 12.2 years; for females it is 16.7 years.
Limiting long-term illness and ‘health not good’
3.18 Both ‘Limiting Long-term Illness’ and ‘Health Not Good’ are useful indicators of health status and are defined subjectively by each person completing a Census form. The 2001 Census reported that 24% of Durham’s population has a long-term limiting illness which limits daily activities or work. Unless there are significantrelativeimprovements in health, by 2030 we can anticipate that there will be a 54% increase in long-term limiting illness amongst all those over 65, and for 85+ year olds, an increase of 116%.
3.19 Our analysis of Census data highlights concentrations older people with limiting long-term illness in:
Seaham-Murton, especially among owner occupiers Easington-Peterlee
Ferryhill-Spennymoor, especially amongst social renters Shildon-Bishop Auckland.
3.20 And of older people who considered that their health was not good, in: Easington-Peterlee
Ferryhill-Spennymoor, especially amongst social renters Shildon-Bishop Auckland.
3.21 Given these profiles, the increases in the numbers of older people with limiting long-term illnesses can be anticipated as follows:
People in County Durham aged 65 and over with a LLTI, by age group, projected to 2030
% change 2030 2025 2020 2015 2009 Condition +54% 77,794 70,753 64,360 58,764 50,643 Total population aged 65 and over with a limiting long-term illness +36% 35,070 32,188 32,188 30,480 25,889 People aged 65-74 with a limiting long-term illness +58% 29,549 27,695 23,429 21,018 18,669 People aged 75-84 with a limiting long-term illness +116% 13,174 10,870 8,743 7,266 6,085 People aged 85 and over with a limiting long-term illness
(Source: POPPI extracted from Table S016 Sex and Age by General Health and Limiting Long-term Illness. Numbers have been calculated by applying percentages of people with a limiting long-term illness in 2001 to projected population figures)
3.22 The 2009 Joint Strategic Needs Assessment (JSNA) for Durham reports that rates of coronary heart disease, heart failure, stroke and transient ischaemic attack, hypertension and chronic obstructive pulmonary disease are all above national rates. These conditions all increase in prevalence with age.
Mental health
3.23 Dementia has been described as ‘one of the most severe and devastating disorders we face’(16)and, like the rest of the country, Durham needs to plan for the needs of the increasing numbers of those with dementia; over the next 30 years, the numbers are anticipated to double nationwide. For Durham, in 2007, 5.3% of males and 8.2% of females over 65 years were identified as having some form of dementia and the numbers are proportionately much greater amongst the over-80’s, where it affects around 1 in 5 people.
Prevalence of dementia amongst people in County Durham, 2007
Female Male
Proportions
8.2% 5.3%
% of population over 65 with dementia
1.6% 0.8%
% of total population with dementia
(Source: Dementia UK, the Alzheimer’s Society 2007)
3.24 Depressive illnesses are also seriously debilitating; Durham GP records indicate levels of 11.7% all over-65s across the county, with relatively higher proportions in the Dales (15%) and Sedgefield (21%). Many factors influence depression, but environmental and living factors can play an important part. Older people spend between 70% and 90% of their time at home: isolation is recognised as a key issue in mental ill health.
3.25 The Older People with Mental Health Needs Joint Commissioning Strategy, 2009-13 provided the following current ‘crude estimates’ of the number of people over 65 who, by 2013, will have mental health problems assuming 5% of those over 65 and 20% of those over 80 will develop a dementia and between 12% and 15% of those over the age of 65 will have some form of depression):
24,506 will have a functional mental health problem of varying degrees as identified in prevalence rates in the original strategy
7,916 will have a dementia as identified in prevalence rates in the original strategy Making a total of 32,422 older people in County Durham with mental health problems of varying degrees.
3.26 Data from POPPI provided projections of the number of people aged 65+ with depression and dementia between 2010 and 2025 as follows.
Projections of mental ill health amongst older people in the County of Durham, 2010-2025
% change 2025 2020 2015 2010 Condition +36% 18,525 16,950 15,510 13,635 Depression +36% 6,175 5,650 5,170 4,545 Severe depression
+51% 9,113 7,810 6,785 6,048 Dementia (Source: POPPI)
Housing circumstances
3.27 There are over 230,000 homes in County Durham, of which 80% are privately owned (including private rented properties). 35 registered social providers own and manage around 48,000 social rented homes, with the ten largest providers managing 94% of homes. Housing associations own and manage about 60%, and 40% are owned and managed by the local authority.
3.28 Terraced housing, mostly pre-1919, predominates in the private sector and accounts for nearly half of the stock in Derwentside and Wear Valley, and is never less than a third of the stock in any of the districts, except Durham City. The 2006 English House Conditions Survey estimated that 35% of older people aged 60+ and of older vulnerable households lived in non-Decent Homes. The relationship between poor housing conditions and poor heath is well established and remains one of the principal means by which health improvement can be secured.
Tenure and its impact on living standards and choice
3.29 In 2001, 61.2% of people aged 65+ (who are now 74+ years old) owned their own homes. For people then aged 50 to 64 years, now all approaching or well into retirement, the proportion was 78.6%. In under a generation, owner occupation had leapt up by over 28%. This age range saw the greatest change in owner occupation but the trend will continue, at a far lesser pace, down the age groups.
3.30 Owning a home should allow more choice, as equity locked into the value of the home can be used to move to a smaller, more conveniently designed home in a preferred area. It also has disadvantages, though, as older people are more likely to be equity rich, income poor, which makes repairs and improvements far less affordable. In the recent recession, owner occupation has locked more older people into an unsuitable home; stakeholders told us of older owner occupiers who were offered a rented home of their choice but who could not sell their home and so stayed in a property with which they were struggling.
3.31 For older social housing tenants there are advantages in that:
There is generally more opportunity to move (although not necessarily to a home that meets one’s aspirations)
Repairs and maintenance are paid for through the rent, so homes should be safe and well-maintained
All social housing must be brought up to the Decent Home standard – and Durham registered housing providers have either completed improvement programmes or these are being progressed
Decent Homes standards include insulation in lofts and, where the walls have cavities, cavity-wall insulation; double-glazed windows are being fitted throughout the social stock. Keeping properties warm is therefore easier and more affordable (though note that some social housing homes are not able to be brought up to this standard owing to their design).
3.32 Older people on limited incomes should therefore be better protected from acquiring or exacerbating ill health due to poor housing conditions.
3.33 Private tenants are the most likely to be adversely affected by poor property maintenance, since private landlords are not required to bring homes up to Decent Homes standard and private tenants often find it difficult to complain and challenge a landlord about their home conditions and repairs, for fear of being given notice to leave the tenancy. Private landlords are however required to have gas heating systems inspected annually whereas owner occupiers may skimp on this owing to costs. Older private tenants will, given the excess of retirement housing (identified in Annexe D), find it easier to access social rented housing but may not know about that choice, or may decide not to exercise it. This could be because social housing is in the wrong place or offers standards below those of the home currently occupied (especially space standards) or simply because the person is happy and settled where they are. We need to remember that not all privately rented property is either in poor condition or poorly managed.
3.34 We have looked at the type of tenure occupied, in 2001, by 65+ year olds (who are now 74 and over) most of who will not have moved home or changed tenure in the intervening nine years:
There is a low proportion of owner occupiers in Sedgefield and a high proportion in Teesdale A high proportion of social renters in Sedgefield and a low proportion in Teesdale
A very high proportion of private renters in Teesdale.
3.35 For those who were between 50-64 years old in 2001 (now approaching or actually retirement age), there was:
A high proportion of owner occupiers in Chester-le-Street
A high proportion of social renters in Easington and a low proportion in Teesdale
A low proportion of private renters in Chester-le-Street and a very high proportion in Teesdale.
3.36 Although more people move home in their 50’s and early 60’s than in later years, few change tenure so we can anticipate that this picture is fairly accurate for people who are between 59 and 74 years old now.
Housing quality
3.37 The private sector stock condition survey completed in 2008 identifies that 30% of all households living in private sector homes (owner occupied or privately rented) are ‘vulnerable’, ie, are on means-tested benefits. A significant proportion of these vulnerable households are older people. Across Durham, 18% of vulnerable people are living in homes that are ‘non-decent’ but this ranges from 13% to 27% across the area. Around 11% of all owner occupied homes are in serious disrepair, so we can expect that as a minimum (and probably significantly higher) 11% of older occupiers are living in homes that present a health risk.
3.38 Excess mortality in winter is strongly related to cold and damp living conditions and good insulation and effective heating systems can be very effective in reducing the number of people dying in winter months, largely because deterioration of an existing health condition, or adverse effects of virus-related ill health. Within County Durham in 2004/05, the Excess Winter Deaths Index was highest in Derwentside (25.6) and Durham (24.8), and lowest in Chester-le-Street (10.3).
3.39 A significant number of private sector homes fail to provide an affordably warm home and many of these are occupied by older households. Older people on limited incomes are thereby faced with the choice of high fuel bills, or being cold in their home, and as they spend so much more of their time at home, this also impacts on their physical and mental health. Excess winter deaths are frequently associated with cold homes, and older people are twice as likely to experience fuel poverty.
3.40 The following table is drawn from County Durham’s 2008 Private Sector Stock Condition survey and identifies in particular:
The low incidence of poor house conditions and vulnerable households in Chester-le-Street The high incidence of poor house conditions and vulnerable households in non-Decent homes in rural Teesdale.
3.41 Two specific and key indicators of relevance are:
Private sector vulnerable households in non-decent homes as a proportion of all private sector households in wards in Durham
Private sector properties failing Decent Homes standard due to inadequate thermal comfort in wards in Durham.
House condition and vulnerable households in County Durham and former districts: key statistics, 2008 Households Dwellings Former District Vulnerable in non-Decent Homes Vulnerable h/holds Fuel poverty Disrepair Inadequate thermal comfort Non-decent 8% 23% 15% 8% 13% 29% Chester-le-Street 12% 29% 19% 11% 15% 36% Derwentside 10% 25% 16% 10% 14% 32% Durham 14% 39% 19% 8% 13% 29% Easington 11% 31% 18% 10% 13% 30% Sedgefield 16% 27% 34% 21% 22% 57% Teesdale 14% 31% 21% 15% 17% 42% Wear Valley 12% 30% 19% 11% 14% 34% Total 8% 18% 12% 8% 17% 36% England
(Source: BRE Stock Modelling Service)
3.42 From national data, in the region of 35% of older people aged 60+ and the same proportion of older vulnerable households live in non-decent homes (EHCS, 2008), and it is assumed that similar patterns prevail for County Durham.
3.43 The following maps use 2001 data for Durham County to profile the incidence of private sector vulnerable households living in non-Decent Homes as a proportion of all private sector households and of the proportion of properties failing the Decent Homes standard due to inadequate thermal comfort. The colour keys are not available, but pink/orange/beige are the higher and green the lower incidence rates.
3.44 The maps identify in particular the concentration of poor housing conditions in the rural west of the County.
Private Sector Vulnerable Household in Non-Decent Homes as a Proportion of all Private Sector Households in Durham
Private sector properties failing Decent Homes standard due to inadequate thermal comfort in Durham
3.45 Teesdale and Wear Valley have the highest rates of inadequate thermal comfort at 26% and 22% respectively. Derwentside and Sedgefield return rates equal to the average for the sub region at 17%, while Chester-le-Street, Durham and Easington all return rates of 14%.
Living alone
3.46 The majority of household growth in the period to 2021 is expected to be of single person households and 83% of these will be households of pensionable age. Overall, there are expected to be 27,500 more single person households of pensionable age in 2021 than in 2006. This has great significance when considering housing needs, particularly for design and location of new homes. It also emphasises the need to support older people to decrease isolation and have an active social life.
Under-occupation of homes
3.47 Under-occupation is where a household has two or more rooms more than their household size would indicate is required. Rates of under occupation are high amongst older people; 83% of people over 65 years in County Durham under occupy their housing, which is consistent with national trends.
3.48 The 2001 Census data shows that for those who were 65 or over in 2001 (now 74 or over), there were higher levels of under-occupation in Wear Valley and lower levels in Chester-le-Street. For those who were 50 to 64 years old in 2001 (now 59 to 73 years old) the highest rates were in Teesdale and lowest rates in Easington.
3.49 Under-occupation may not present a problem to older people who are reasonably fit and well, enjoy having, and may use the additional space (eg, for visitors and/or hobbies) and who can manage to maintain and care for a larger home. However, many are unable to deal with larger homes and find the cleaning and maintenance a burden. These are often the homes in which they brought up their families, and there is a strong sentimental attachment. Family homes often have larger gardens and a common finding from consultation with older people is that their garden is problematic to look after. Older people who are unable to manage to keep their homes and gardens in good order also identify that this increases their isolation, as they feel unable to invite people into their home.
3.50 The wider population in housing need across Durham will also benefit if older people are made a housing offer that they find attractive; larger family homes are in high demand and over-crowding is an issue for growing families and particularly those who have insufficient relative