LOCAL-POPULATION DIFFERENCES AND THE NEEDS OF PEOPLE WITH COGNITIVE IMPAIRMENT

Introduction. Variations in local population age structure have attrac ted less attention than national population ageing. As moderate and se vere cognitive impairment is a major cause of need for long-term care, population-based estimates of the numbers and characteristics of this group were calculated, to explore the effects of local differences. M ethod. The UK Office of Population Census and Surveys (OPCS) study of disability in adults (N > 14 000) was reanalysed. A group with moderat e or severe cognitive impairments was identified and age-specific esti mators of sociodemographic characteristics, household types, disabilit ies and service use were combined with population estimates for distri ct health authorities in England and Wales. Results, The proportion of the 65 plus population who are 85 plus varies from 8% to 15% across d istricts, equivalent to national population projections for 1986 and 2 031 respectively. The estimated prevalence of the study group varies f rom 53 to 70 per 1000 population aged 65 plus, with 34-48% of cases ag ed 85 plus. Curiously, the proportion with severe disabilities varies little across districts. If national norms applied, local rates of ins titutionalization would vary from 18 to 27 per 1000 aged 65 plus. Conc lusion. Local differences in population age structure are large compar ed to national changes over decades. Local differences have substantia l effects on overall prevalence and on the proportion of the cognitive ly impaired who would be institutionalized if national patterns applie d. Service design should be influenced by these complex variations, wi th estimates modified by local surveys. (C) 1997 John Wiley & Sons, Lt d.