Introduction

Health preservation strategies, to keep people well and independent for longer, are crucial to reduce the need for care and support. More people are surviving to their late 80s and beyond, but not surviving in good health. Around 27 per cent of those receiving social care across the life-span are over 85, and 11 per cent 75– 84. As mentioned in Chapter 3, the likely cost of health and care services is substantially affected by the age at which impairments of older age begin.

Fortunately the incidence of difficulties with activities of daily living (ADLs) among seniors has fallen between 2011 and 2021, from 31.3 per cent to 26 per cent. But this might not continue, since arthritis, diabetes and dementia5 are all rising rapidly. Healthy life expectancy at birth has been falling since 2006– 8, more for women than for men (Centre for Ageing Better, 2022). Those who were already 65 just before the COVID-19 pandemic could expect to live 9.8 to 9.9 more years disability-free, followed by 8.9 years with some disability. A key concern of public health services, in which the community can play an important role, is therefore extending healthy life expectancy and reducing prevalence of long-term conditions from middle age onwards.

People with early-stage or minor impairments could be helped a lot by preventive measures through the kind of support the community can give. If you have a painful arthritic knee, support with heavy shopping, or company for a gentle walk, may stop you getting worse. If you lack strength and energy for house jobs, help with fixing a loose handrail or tidying high cupboards may prevent a fall.