The population of England and Wales is ageing, with the number of people aged 65–79 years predicted to increase by nearly a third to over 10 million in the next 40 years. Furthermore, those aged 80 years and over—the fastest growing section of the population—are set to double to more than 6 million (Centre for Better Ageing, 2023). We also know that life expectancy is slowly but steadily increasing. In 2020, the life expectancy in the UK was 87.3 years for males and 90.2 years for females (The Health Foundation, 2024). Age, as we know, is the strongest risk factor for developing dementia in later life; in England and Wales, the number of people living with dementia has been predicted to increase by 57% from 0.77 million in 2016 to 1.2 million in 2040 (Chen et al, 2023). Similarly, age also increases a person's risk of living with multiple long-term conditions. Multiple long-term conditions are linked to poor health outcomes and economic burdens for both individuals and health and social care services (National Institute for Health and Care Research (NIHR) Evidence, 2023) and over the next 20 years, it is predicted that England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity (Kingston et al, 2018).
Health and care professionals are faced with an ever-increasing number of research reports that describe a burgeoning range of statistics, proposing increasing numbers and percentages of older people, all with the implication that it will place stress and burden on health and care systems. For some of us, it is difficult to conceptualise what this might mean as we go about our day-to-day lives, or for the health and care services in which we work, when presented with such data. It may feel that such data seems a little abstract and less than tangible when our working week is spent in a local community service or within an acute hospital in one town or city. When working in a hospital setting we know that admission, length of stay, further complications, and readmission are common in the presence of dementia and multi-morbidity (NIHR Evidence, 2023).
I have worked in dementia care for over 40 years but have become increasingly cognisant of the impact dementia has on the wider family, friends and supporters of a person, and the relational care families often need. When we consider the person with the diagnosis of late-onset dementia, they can often experience various challenges in their ability to self-manage other long-term conditions and so, may come to rely on those around them. For many this will be their spouse. In a large UK cohort study, it was found that the majority (81%) of carers were the spouse or partner of the person with dementia (Victor et al, 2021). They will likely be of a similar age to the person with dementia and also experience their own health problems, long-term conditions and comorbidities, all of which will impact on their ability to care for the person with dementia. The needs of spousal carers of a person with dementia have been the focus of researchers for many decades, though these have largely focused on the psychological impacts of their caring role. More recently, we have seen an interest in their physical health conditions and how this makes the care of the dyad (person with dementia and their spousal carer) in enabling a relational approach to their care, rather than focusing on each in isolation. Sabatini et al (2024) explored data from a longitudinal study of carers of a person with dementia, including their number of comorbid conditions and if, over time, these impacted on their caring role over a 2-year period. At baseline the average number of co-morbid conditions was 1.5, which rose to 2.1 in the 2-year period of the study. In dementia care we often consider the needs of various stakeholders and partners in care and may even use guidance such as The Senses Framework (Nolan et al, 2006); however, the focus has largely been on the psychosocial elements of relational care, or education of carers and paid carers. What relational care meant to me, when I was a practicing Admiral Nurse, was also to embrace the physical health needs of the spousal carer, because without supporting them in their own physical health needs was to place the wellbeing of the dyad in danger. Therefore, when nurses think of the contribution they make to dementia care, it is not just about the needs of the person with the diagnosis and maintaining their wellbeing. Families affected by dementia come with their own experiences and care needs, but when the carer is a spouse who is also old, their own co-morbid conditions need to be considered by nurses when creating care plans.