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Inequalities in mental health, cognitive impaitment and dementia among older people

The likelihood of having good physical and mental health in later life in England is not evenly distributed across the population and there is a social class gradient in life expectancy, and disability free life expectancy. This report focuses on inequalities in the experience and prevalence of poor mental health, cognitive impairment and dementia.

Sixty thousand people die each year from symptoms directly attributable to dementia, and 25% of older people are diagnosed with depression, rising to 40% in residential care homes. Lower socioeconomic groups have higher incidence of poor mental health and are more likely to have earlier onset of dementia than higher socioeconomic groups. The social determinants of these health outcomes are more likely to be experienced by people in lower socioeconomic groups, some BAME groups and for women.

The risks and likelihood of experiencing poor mental health, mild cognitive impairment and dementia are influenced by factors across the life course. In earlier life, poor educational attainment, unemployment, or poor quality employment, poor quality housing conditions and neighbourhood deprivation increase the risk of developing these health outcomes. Poor mental health, mild cognitive impairment and dementia are also profoundly influenced by experiences in later life. Significantly – and the focus of this report – social isolation, lack of mental stimulation and physical activity, before and after retirement, and in later old age, exacerbate risks of poor mental health, cognitive impairment and dementia.

Each year, 60,000 older people die from effects directly attributable to dementia. Postponing the onset of dementia by five years would decrease the number of deaths by half; 30,000 per year. The financial cost of caring for people with dementia is over £26 billion per year, including healthcare, social care and unpaid care from family members, more than the cost of cancer or heart disease. Therefore, delaying the onset of dementia would result in significant cost savings as well as considerable benefits to health and wellbeing.

Older people from lower socioeconomic backgrounds are also more likely to experience cognitive dysfunction at earlier stages of cognitive decline and cognitive impairment, and will have fewer resources to cope with the symptoms than their counterparts from higher socioeconomic groups.

This report examines the effect of social isolation, physical inactivity and a lack of mental stimulation in later life on inequalities in poor mental health, dementia and cognitive decline. People from lower socioeconomic groups are more likely to live, work and age in physical and economic environments that do not support social connectedness, physical activity or mental stimulation. The report provides clear evidence that this can increase the risk of poor mental health, cognitive impairment and dementia in later life.

This report will:

1. Provide an overview of inequalities in poor mental health, cognitive impairment and dementia, and their social determinants across the life course.
2. Describe how social isolation, loneliness and a lack of mental stimulation and physical exercise can impact on mental health, cognitive impairment and dementia.
3. Present evidence of the ameliorating effects of social connectedness, physical exercise and mental stimulation on poor mental health, cognitive impairment and dementia in older age.
4. Provide an overview of the effects of health and social care interventions on mental health, cognitive impairment and dementia.
5. Make proposals for policies at a national level and interventions at a local level to achieve better health and reduced health inequalities for older people.