The State of Ageing 2023–24 report provides a contemporary overview of older people living in England, drawn from a range of sources, including ONS data from the Census 2021 (Centre for Ageing Better, 2023). The population of England and Wales is older than ever before. Almost 40% of people are over 50 years of age and the population of people aged 80 years and over is growing most rapidly. Older people are a diverse heterogeneous group and the report highlights marked variations in health status relating to ethnicity, wealth, geography and sexual orientation. It highlights how older people living in the most deprived geographical areas face a three-fold challenge: they are more likely to have a disability that limits their ability to carry out daily activities, most in need of help and are the least likely to receive the help needed.
Health inequalities have widened over the last decade. The proportion of older people living with self-reported poor health is increasing, along with huge inequalities in healthy and disability-free life expectancy between the least deprived and the most deprived (Iacobacci 2020). Added to this, austerity has taken a significant toll on equity and on the health of older people (Office of Health Improvement and Disparities, 2023).
It would appear that inequalities have a cumulative effect over time. As the older person ages, the effects of poverty, poor health, discrimination and marginalisation accrue, and the impact of these factors interact on each other and place the older person at even greater disadvantage (Jolly 2024).
As people grow older, they experience increasing difficulties with activities of daily living. Of people aged 85 years or more, 43.9% will have some level of need for care (Age UK, 2023). The projected increased population growth of this demographic will lead to a greater demand for health and care services. Identifying and supporting older people that need care, who suffer the effects of health inequalities, is particularly relevant to community nurses. There is evidence that targeted interventions aimed at promoting self-management, increasing health literacy and improving social capital by supporting individuals to make use of local community assets will improve health outcomes (Office for Health Improvement and Disparities, 2023). Delivering care at home is now viewed as a good alternative to hospital admission for many older people living with complex care needs (Sheppard, 2022) and community nursing teams are major providers of healthcare at home. Age UK has called for ‘home first’ being the foundation of health and social care for older people now and in the future. Community nursing teams are the vanguard of ‘home first’ and integrated primary care services. Care teams in community settings are required to flex and respond to the changing needs of older people and their unpaid carers, to optimise care and avert crises (Age UK, 2023). Community nurses routinely support older people with multimorbidities and complex needs, caring for individuals so that they remain well and at home. Community nurses can enhance care delivery using local public health information, local community profiling and by exploring local community assets across different sectors. In this way, community nursing teams can signpost older people to a wider range of local services, identify and highlight unmet needs, and recognise the impact and consequences of inequalities on their caseload, challenging inequities in health and care.