‘RE-IMAGINING AGEING INTO THE FUTURE’

Director of Public Health - Annual Report 2019 Foreword FOREWORD

Reflecting on this year’s report in the current Last year’s annual report of the Director of Public It is important that we frame our conversations Older people in situation where Covid-19 has affected so many, Health ‘Moving Forwards: Move More, More around ageing in a positive way. Sometimes Cardiff and the Vale of Glamorgan and changed the way that people are living and Often’ focused on how people can be active in people have negative attitudes and assumptions working, it is clear that we will all need to adapt their daily lives and addressed some of the barriers around older people, believing them to be a to a new environment for some time to come. to activity. We have made good progress but there burden on society, dependant or frail. We need Older people in particular have been affected is still more to do, and you can read a summary of to ensure these attitudes are not allowed to limit What is healthy by the ‘stay at home’ policies that have been the progress in the appendix. the capacity of older people to be a positive part ageing? necessary to protect them, and these policies may of our communities and provide the substantial have had an impact on their physical and mental My report for this year focuses upon three key contributions that they can make. wellbeing. We need to be aware of the effect of themes that we know also influence people’s these changes, and consider how we can best ability to experience healthy ageing and This report will highlight some personal stories of Purpose in life provide support for our community members as have a good quality of life: feeling a sense of older people in our local community who have they age. meaning and purpose in life; having good social spoken about their experiences around each of connections; and living in places that enable them the three themes. Their thoughts and views are Societies around the world are ageing faster to remain safe, active and independent. There is a underpinned by the latest evidence around each than ever before, and in Cardiff and the Vale great deal of evidence which tells us that if people theme: having purpose in life, social connections, Connections in life of Glamorgan this is reflected in our local experience these three things, they are more likely and healthy places to live. The online report population. In 20 years time we will have more to have happy, healthier lives into older age. is supported by a summary booklet with the people in our local community who are over key messages and a call to action. Importantly, the age of 65 than we have ever had. This is For many people, getting older is a very positive the call to action outlines what we can do as something to be celebrated and valued as older experience, and they have much to look forward individuals and as organisations which can Places for life people make such a strong contribution to to. Many people feel a sense of community, enjoy help the population of Cardiff and the Vale of society in so many ways, including the economy, where they live and have good connections to Glamorgan to experience healthy ageing into the volunteering and caring for others. We can family and friends. Despite the fact that many future. We want to ensure that we have enabled all play a part in creating positive and healthy older people in Cardiff and the Vale of Glamorgan people to have good health and wellbeing as futures, with and for the older members of our are in good health and are happy with their they approach older age so that they are able to Appendix community, and my aim with this year’s report is lives, there are some inequalities that need to be continue making valuable contributions to society. to draw attention to the ways in which we and addressed, as there are people who are not ageing society in general can re-imagine healthy older in good health, and are experiencing very different I hope you find the report useful to help shape age. levels of wealth, happiness and security in later life. your thinking over the next year and beyond. References

01 Director of Public Health - Annual Report 2019 Foreword FOREWORD

My thanks go to everyone who has contributed to this Older people in report, including: Cardiff and the Vale of Glamorgan Kate Roberts, Laura Wilson, Louise Yau, Carl Rogers, Brian Marsh, Megan Luker, and Shelagh Maher.

What is healthy Thanks to Cheryl Williams for bringing the report ageing? together and acting as chief editor. Fiona Kinghorn Executive Director I would like to extend my particular thanks to of Public Health the members of the local community and local Purpose in life organisations who gave up their time to take part in focus groups, interviews and films, including:

Marcia Greaves, Rita Greaves, Anthony Atkins, Ron Walton, Maggie Beecher, Jaswant Singh, Tony Connections in life Denning, Vanessa Mordin, Matt Hutcherson, Claire Gilhooly, Georgia Hurst, and Joanne King.

A final thank you to the learners from Cardiff and Vale College, Letitia Aherne and Lucy Thomas, for putting Places for life together two of the films used in this report with local community members.

Appendix

References

02 Director of Public Health - Annual Report 2019 Foreword TABLE OF CONTENTS

Older people in Cardiff and the Vale of Glamorgan

What is healthy 07 Older people in Cardiff and the Vale of Glamorgan ageing? 12 What is healthy ageing? 14 Purpose in life Purpose in life 23 Connections in life 36 Places for life

Connections in life 46 Appendix: Director of Public Health Annual Report 2018 progress summary 48 References

Places for life

Appendix

References

03 Director of Public Health - Annual Report 2019 Introduction Population projections Foreword whilst the number of people aged under This chapter provides some facts and key In Wales, as in the rest of the UK, over 65 years is growing at a slower rate. data figures about the people who live the last ten years the population aged in Cardiff and the Vale of Glamorgan. 65 and over has had the highest growth The charts below illustrate how this Older people in 2 It also outlines some key information of all broad age groups at a rate of trend is reflected in the Cardiff and Cardiff and the about the health and well-being of older 1.6% increase (England 1.7%, Scotland Vale of Glamorgan Vale of Glamorgan population. The people, and why it is so important to 1.8%, Northern Ireland 2.1%). This means 2019 population is compared to the make sure people can stay healthy as that in Wales, and in Cardiff and the predictions for 2039 according to three they age, and for as long as possible. Vale of Glamorgan, the age profile of age groups for Cardiff and the Vale of What is healthy the population has been changing. This Glamorgan separately, and for Cardiff ageing? Population estimates from the Office for trend is set to continue, with projections and the Vale of Glamorgan University National Statistics1 for mid-2019 indicate showing increases over the next 20 years, Health Board area as a whole. that in Wales, 21% of the population is aged 65 and over, higher than for the Purpose in life UK overall (18%). In Cardiff and the Vale of Glamorgan around 16% of the Figure 1: Cardiff population projections, all age groups, 2019 to 2039 population is aged 65 and over2. Projections indicate that in Cardiff, the 0-15 age group will increase slightly, the 16-64 age group decrease, whilst both the 65-84 and 85+ age groups increase. The population estimates indicate that Connections in life there are just over 500,000 people living 2 Projected population, percentage, all persons, Cardiff, 2019 and 2039 in Cardiff and the Vale of Glamorgan Produced by Public Health Wales Observatory, using 2014-based population projections (366,903 in Cardiff and 133,987 in the AND THE VALE OF GLAMORGAN AND THE VALE Vale of Glamorgan in 2019). There are 80,539 people aged 65 and over (52,192 2019 19.0 66.6 12.3 2.2 Places for life in Cardiff and 28,347 in the Vale of Glamorgan). Cardiff as a city is expected CHAPTER 1 OLDER PEOPLE IN CARDIFF 2039 19.2 63.1 14.2 3.5 to grow by just over 20% over the next 20 years, or an additional 70,000 people overall, meaning it is one of the fastest Age 0-15 Age 16-64 Age 65-84 Age 85+ Appendix:Appendix 2019 growing cities in the UK3.

References

04 Director of Public Health - Annual Report 2019 Figure 2: Vale of Glamorgan population projections, Figure 4: projected population increase for persons aged 65 to 84 in Foreword all age groups, 2019 to 2039 Cardiff and the Vale of Glamorgan, 2019 to 2039 In the Vale of Glamorgan, the changes in population age structure are The graph below depicts the actual numbers of people in the 65 to 84 age predicted to be even greater than in Cardiff, with decreases in the 0-15 and group which is predicted to increase from around 70,000 people in 2019 to 16-64 age groups, and large increases in the 65-84 and 85+ age groups. 93,000 people in 2039. Older people in Cardiff and the Projected population, percentage, all persons, Vale of Glamorgan 2019 and 2039 Projected population, counts, all persons, aged 65 to 84, Vale of Glamorgan Produced by Public Health Wales Observatory, using 2014-based population projections Cardiff & Vale UHB, 2019 and 2039 Produced by Public Health Wales Observatory, using 2014 population projections (WG)

2019 18.5 59.7 18.9 3.0 100,000

What is healthy 90,000 ageing? 80,000 2039 17.1 52.9 23.5 6.5 70,000

60,000

Age 0-15 Age 16-64 Age 65-84 Age 85+ 50,000 Purpose in life 40,000 30,000

20,000

Figure 3: Cardiff and the Vale of Glamorgan population projections, 10,000

all age groups, 2019 to 2039 0

Connections in life In Cardiff and the Vale of Glamorgan as a whole, the number of people 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 in the 65 to 84 age group and the 85+ age group are both predicted to increase, whilst other age groups decrease. Vale of Glamorgan Cardiff Cardiff & Vale UHB Projected population, percentage, all persons, Cardiff & Vale UHB, 2019 and 2039 Produced by Public Health Wales Observatory, using 2014-based population projections Places for life

2019 18.8 64.8 14.0 2.4

AppendixAppendix: 2019 2039 18.7 60.8 16.2 4.2

Age 0-15 Age 16-64 Age 65-84 Age 85+

References

05 Director of Public Health - Annual Report 2019 Figure 5: projected population increase for persons aged 85+ in Demographic differences across Cardiff and Foreword Cardiff and the Vale of Glamorgan, 2019 to 2039 the Vale of Glamorgan The number of people who are aged 85 and over is expected to rise even more noticeably, with numbers expected to double in the next 20 years. There are some differences across the Cardiff and the Vale This will mean a rise from approximately 12,000 people in 2019 to 24,000 of Glamorgan area in terms of where older people live, Older people in people in 2039. Cardiff and the which can impact upon the provision of services, and the Vale of Glamorgan Projected population, counts, all persons, aged 85+, location of appropriate and adequate housing options. There Cardiff & Vale UHB, 2019 and 2039 are also differences in the levels of disadvantage across the Produced by Public Health Wales Observatory, using 2014 population projections (WG) area, meaning that people are often dealing with health inequalities, and differences in their ability to access the What is healthy 30,000 services they may need. ageing?

25,000 Using the latest small area population estimates available for mid-2018, the map in figure 6 illustrates the proportion of

20,000 people in the 65-84 and 85+ age groups compared with the Purpose in life whole population, residing in each of the nine primary care 4 15,000 clusters . The cluster with the largest proportion of people in the 65-84 age group is Western Vale (23%) and the cluster

10,000 with the lowest proportion is Cardiff South East (5.5%). Eastern Vale has the largest proportion of people over 85 Connections in life 5,000 years (3.4% of the population), and Cardiff South East has the lowest (0.9%).

0

2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 Places for life Vale of Glamorgan Cardiff Cardiff & Vale UHB

AppendixAppendix: 2019

References

06 Director of Public Health - Annual Report 2019 Figure 6: Population breakdown for 65-84 and 85+ age groups by Foreword primary care cluster in Cardiff and the Vale of Glamorgan Cardiff North Cardiff West 17% Source: Office for National Statistics (25 October 2019 dataset). 17% 2.9% Census output area population estimates- Wales 2.9% Older people in Lisvane Cardiff and the Population % aged 65-84 years Western

Vale Pentyrch Pontprennau & Vale of Glamorgan Population % aged over 85 years Whitchurch & Old St Mellons Tongwynlais 23% Rhiwbina Llanishen Cardiff East

Pentwyn 3.1% Cyncoed 12.6% Morganstown Trowbridge Creigiau Llanrumney Whilst the percentage proportion Heath Radyr 2.2% What is healthy of people in each age group North Gabalfa Penylan in the clusters provides an St Fagans Rumney ageing? Fairwater Cathays Cardiff Plasnewydd Peterston-super-Ely Riverside illustration of the age structure Adamsdown South East Canton CC Ely of the population, the absolute Caerau Splott 5.5% Llandow numbers in the age groups are Cowbridge 0.9% St Bride’s Major Grangetown also important to note. The Butetown City & Purpose in life Cardiff South table in Figure 7 below provides Wenvoe 6.9% the population numbers and Dinas Powys 1.1% percentages in the 65-84 and 85+ Penarth age groups by cluster4. As noted Llantwit Major Rhoose above, it is predicted that these St Athan Barry Connections in life numbers will rise substantially over the next 20 years.

Cardiff Eastern Central Vale South West Vale 15.6% 20.4% Places for life Figure 7: Population of residents age 65-84 and 85+ in Cardiff and 15.6% 1.9% 3.4% Vale of Glamorgan estimates by primary care cluster, mid-2018 1.7%

AppendixAppendix: 2019 Cardiff North Cardiff West Cardiff South West City & Cardiff South Cardiff East Cardiff South East Western Vale Central Vale Eastern Vale No. of people age 65-84 16,003 10,620 6,312 2,475 4,728 4,150 5,773 10,792 7,702 % of total population 17% 17% 15.6 6.9% 12.6% 5.5% 23% 15.6% 20.4% No. of people age 85+ 2,859 1,632 945 399 817 648 788 1,340 1,296 References % of total population 2.9% 2.9% 1.7% 1.1% 2.2% 0.9% 3.1% 1.9% 3.4% Total population (all ages) 96,923 62,850 56,016 35,639 37,352 75,468 25,293 69,025 37,847

07 Director of Public Health - Annual Report 2019 Just over half (56.7%) of people aged 65 and over rate Figure 9: Life satisfaction among older people, 2017/18 – Foreword their health as good or very good in Cardiff and the Vale of 2018/19 Glamorgan. Figure 8 illustrates how this compares with other Health Boards in Wales5. Respondents who rate their satisfaction with their life as 7 out of 10 or higher, percentage, persons aged 65+, health boards 95% confidence interval Older people in Figure 8: Older people in good health, 2017/18 – 2018/19 Cardiff and the Area Percentage Vale of Glamorgan Percentage, persons aged 65+, health boards Powys THB 95% confidence interval Betsi Cadwaladr UHB Swansea Bay UHB Area Percentage Cardiff and Vale UHB What is healthy Powys THB Cwm Taf Morgannwg ageing? Betsi Cadwaladr UHB Hywel Dda UHB Cardiff and Vale UHB Aneurin Bevan UHB Wales Hywel Dda UHB 0 10 20 30 40 50 60 70 80 90 Swansea Bay UHB Aneurin Bevan UHB OF OLDER PEOPLE IN Cwm Taf Morgannwg Wales 95% Confidence Purpose in life Area Value Interval 0 10 20 30 40 50 60 Powys THB 87.8 (85.7 to 89.9) Betsi Cadwaladr UHB 86.8 (85.2 to 88.4) Swansea Bay UHB 85.3 (82.9 to 87.7) 95% Confidence Cardiff and Vale UHB 84.4 (81.9 to 87.0) Area Value Interval Count Cwm Taf Morgannwg 83.1 (80.5 to 85.7) Connections in life Powys THB 61.0 (57.8 to 64.1) N/A Hywel Dda UHB 83.1 (80.7 to 85.4) Betsi Cadwaladr UHB 60.3 (57.8 to 62.7) N/A Aneurin Bevan UHB 82.6 (80.6 to 84.6) Cardiff and Vale UHB 56.7 (53.2 to 60.3) N/A Hywel Dda UHB 55.1 (51.9 to 58.3) N/A Wales 84.7 (83.8 to 85.5) Swansea Bay UHB 55.0 (51.5 to 58.5) N/A Aneurin Bevan UHB 53.2 (50.5 to 55.9) N/A Places for life Cwm Taf Morgannwg 51.1 (47.6 to 54.7) N/A Produced by Public Health Wales Observatory, using NSW (WG)

Wales 56.1 (54.9 to 57.3) N/A This chapter has provided an illustration of the population of older people in Cardiff and the Vale of Glamorgan. There are

CARDIFF AND THE VALE OF GLAMORGAN CARDIFF AND THE VALE rising numbers within both the 65-84 and 85+ age groups and Produced by Public Health Wales Observatory, using NSW (WG) AppendixAppendix: 2019 differences across primary care clusters in where people in these age groups live. The data in this chapter provides the demographic Eighty four percent of people aged 65 and over rate their information for this report, and the following chapters will build HEALTH AND WELLBEING HEALTH satisfaction with life as 7 out of 10 or higher in Cardiff and the upon this, with a focus upon the issue of healthy ageing and Vale of Glamorgan. Figure 9 illustrates how this compares with what can be done to ensure that people in Cardiff and the Vale of References other Health Boards across Wales5. Glamorgan can age well into the future.

08 Director of Public Health - Annual Report 2019 Before we start to outline each of the the Vale of Glamorgan say that they are activity (cycling, very frequent weekend Foreword themes in this report, it is important to in good health7. However, if people do recreational activity plus regular walking, understand what we mean by healthy develop health conditions as they age, or sporting activity once a week) can ageing, and why we should be focusing it can start to make daily activities more lower the health risks for individuals9. our attention on it. difficult, such as washing and dressing. If Three physical activity levels were Older people in people have a long term health condition studied: low/decreasing over time; light/ Cardiff and the We are referring to older people in such as arthritis, dementia or breathing stable and moderate/increasing over Vale of Glamorgan this report as those aged 65 and over, problems it can make daily life even more time. Compared with the low/decreasing although we acknowledge that people difficult. group, people who were in the light/ can be categorised as ‘older’ from the stable and moderate/increasing groups What is healthy age of 50. There is also a particular need Lifestyle plays a key role in how well we experienced lower risks of heart disease ageing? to focus on people aged 85 and over age. Doing exercise, whether we smoke and mortality. when considering the future needs of or drink alcohol, our weight and what

HEALTHY AGEING? HEALTHY the population as this group is rapidly we eat can all make a big difference to The Older People’s Commissioner for WHAT IS CHAPTER 2 WHAT growing and is most likely to require health in later life. Many older people are Wales10, in their strategy for making health and social care services, reflecting not active enough to benefit their health Wales the best place in the world to Purpose in life the higher needs than other age groups. and well-being, including reducing their grow older, states that ageing well – This growth will have a major impact on risk of falling which can have substantial ‘adding life to years, not just years to the amount of public spending required impacts both physically and mentally. In life’ – is important for each of us, and for health and social services and will Wales, 38% of people age 65 and over for our country as a whole. Whilst the Connections in life require consideration in planning of these are meeting the recommended levels of fact that people are living longer is services in years ahead6. physical activity (150 minutes every week); certainly a significant achievement, which and 47% say they were active for less enables older people to continue to make Healthy ageing is not just about the than 30 minutes in the previous week8. great contributions to society, there are absence of disease and ill health, it Fifty eight percent of people aged 65+ some significant inequalities which can Places for life is about being able to have positive, are overweight or obese, and 75% of be seen through increasing levels of independent lives and being able to do people eat less than the recommended poverty amongst older people and the the things we want to do for as long as number of fruit and vegetables every difference in life expectancy and healthy possible. day8. life expectancy (living without illness or disease) between the wealthiest and the Appendix We need to recognise that although it is There is a great deal of evidence about poorest areas. Public Health Wales data Healthy ageing common for people to start to develop how making positive lifestyle choices indicates that in 2017 there was a gap of is not just about conditions and illness in older age, can influence health and enhance 8.6 years of life expectancy at birth for the absence of many people age in good health. As the healthy ageing. A study with over males and 6.6 years for females between disease and ill previous chapter highlighted, 56.7% of 3,000 men over a 20 year period the most and least disadvantaged areas References health people aged 65 and over in Cardiff and found that moderate levels of physical in Cardiff and the Vale of Glamorgan11.

09 Director of Public Health - Annual Report 2019 Reducing inequalities needs action Foreword around resources and service provision, but also around a joined-up place based approach which recognises the wider determinants of health such as housing, Older people in employment and education12. People Cardiff and the need to be able to access services and Vale of Glamorgan activities that will enable them to live healthier lifestyles, and ensure they have the support to remain healthy, such as What is healthy being able to access immunisations and ageing? screening.

Giving recognition to the important role that lifestyles, screening and immunisations play in healthy ageing Purpose in life is key, but there are also wider areas that play a part in health and wellbeing into later life. This report focuses upon three of these key areas which we know Figure 10: Three This chapter has provided an overview Connections in life matter to older people and which can key areas for of what healthy ageing means and the support them to experience good health healthy ageing elements which contribute to individuals and wellbeing in later life: Purpose and in the future fulfilment in life being able to have good health and wellbeing. The following chapters will • having purpose describe in detail the three key areas, Places for life • having social connections Quality Places and employment & provide the evidence base for each, and homes for • having active and healthy places to A society volunteering life opportunities set out a call to action for organisations live. in which everyone enjoys and communities. later life with Figure 10 illustrates the three key areas good health and wellbeing This film shares the stories of some of Appendix and highlights the connections between Active Social the members of the local community and them all. The overarching outcome for and healthy connections organisations who work with them. the future that all three of these key places Inclusive in life planning and areas contribute towards is that we all design live in a society in which everyone enjoys References life with good health and wellbeing.

10 Director of Public Health - Annual Report 2019 Throughout our lives, having of older people live longer than those Working in later life 20 Foreword purpose and enjoyment in what previously . Adults in this generation have rich life experiences, having seen Employers value older employees as we do brings great benefits to changes throughout their lives including a great asset and many are able to

IN LIFE our well-being. enormous technological advances such accommodate a diverse workforce Older people in as the advent of mobile phones and the through their employment policies which Cardiff and the It drives us to achieve goals, giving us internet, and have much to offer and support people to work for longer if they Vale of Glamorgan 13 a sense of meaning and direction . It contribute. Staying in work, volunteering wish to22. is also known to contribute to good or joining a community group can make health as evidence has shown a strong sure people stay physically and mentally Characteristics and skills that employers What is healthy link between being purposeful and living active for longer21. value in older people include23,24 ageing? longer13. Having a purpose in life might help us to deal better with negative or • Loyalty, commitment and stressful times by helping us to learn conscientiousness

CHAPTER 3 PURPOSE from these experiences constructively and • Experience and knowledge to refocus on wider goals14,15. Purpose in • Good networks and relationships built Purpose in life life has also been linked to overall quality up of life16. • Better time management skills • Better people skills Purpose and meaning can be found in • Able to remain calm under pressure or Connections in life many aspects of our lives. For people of when faced with challenges a working age, our job is likely to be a • Mentoring and sharing of skills and major influence as we know that working knowledge within workforce is linked to our wider identity and social • Contribution to service improvement roles17 and is associated with better life as workforce reflects population of Places for life satisfaction18. For older people, work service users can also provide an opportunity to make social connections and boost self- Being in work is, in general, good for both esteem19. This chapter will explore what can help mental and physical health and wellbeing. people to maintain and enhance purpose Good quality work, which offers people a Appendix For many people, later life presents an into later life and will include a focus sense of control over how they work and For many people, opportunity to take on new challenges, on working and retirement. It will also good relationships with managers and later life presents learn new things, have new experiences consider how people can maintain their colleagues, helps give people a sense of an opportunity and be more active than ever before. It health and well-being in order to have the purpose. Working later in life also provides to take on new can be an opportunity to embrace having best opportunities to do things that will an opportunity to build up pensions and References challenges more time available. Current generations give them that purpose. have increased income once retired25.

11 Director of Public Health - Annual Report 2019 Policies around working later in life have Vale of Glamorgan are living on average Foreword changed over the last 15 years due to the 16.8 years and 21 years – or around a population living longer and the growth fifth of their life – in poor health29. in the number of years people spend in retirement. The age at which people Long-term health effects in older Older people in can access their state pension has risen populations from COVID-19 is an area Cardiff and the and will continue to rise26. There has also for consideration for the future. These Vale of Glamorgan been a recognition of age discrimination effects may prevent people from working in the law and since 2006, organisations later in life as planned or prevent a can no longer set a default retirement purposeful and enjoyable retirement. A What is healthy age and dismiss employees once they new study into these long-term effects, ageing? reach a set date. Many people will likely led by the National Institute for Health work into later life through choice, but Research, launched in July 2020 will others may need to work longer than track a cohort of around 10,000 of they would wish to in order to be able those infected for a year or longer to to have a comfortable retirement. It is gather more data on this30. Healthy Purpose in life estimated that 136,000 people aged life expectancy is lower for those from 60 and over (just over 16% of the older more disadvantaged areas leading to population) are currently employed in inequalities not only in health but also in Wales, making up around 10% of the access to employment and income. One Connections in life workforce and within five years, 1 in 3 in three people aged 60-74 in Wales have people of working age in Wales will be incomes of less than £200 a week, or over 50 years old27,28. £10,400 a year with more women than men experiencing poverty27. Working later in life will only be possible Places for life for many if their health is good enough. In November 2019 1,665 people aged In Cardiff and the Vale of Glamorgan, over 50 in Cardiff and 460 in the Vale of healthy life expectancy (how long people Glamorgan were claiming out of work can expect to live in good health) for benefits31. In the UK the proportion of men is 61.9 years (61.4 for Wales), while men leaving the labour market for health Appendix for females it is 62 years (62 for Wales) reasons was highest in construction and compared with 63.4 years for males and transportation and storage, both of which 61.9 years for females in England29. are physically demanding job areas32. Males and females in Cardiff and the

References

12 Director of Public Health - Annual Report 2019 Foreword WHAT CAN EMPLOYERS DO TO ENCOURAGE FUTURE RECRUITMENT AND RETENTION OF OLDER WORKERS?

Older people in Cardiff and the This section will outline ways in Employers have reported limited used to better support their employees. Vale of Glamorgan which employers could support experience in offering flexible working Examples of assistive technology include to older employees and it is less likely ergonomic chairs, lighter hand tools, people to continue to work to be available to those in lower paid lifting equipment and magnifying lenses What is healthy or take up new or alternative roles, particularly those that are physically for close up work, all of which take some ageing? employment opportunities in demanding24.The COVID-19 pandemic of the physical strain out of work33. later life. and subsequent ‘Stay at Home’ guidance led to many people spending an increased amount of time working from When discussing employer home. For some, benefits have included Purpose in life Flexible Working support for their workforce reduced commuting time, better work/ within the focus groups One way to support employees, which life balance and a less stressful work could be of particular value to older environment. However, a Health Impact conducted for this report, workers, is flexible working33. This includes Assessment for Wales also found that one group member Connections in life a range of elements such as a reduction there could be negative effects including: commented that his in hours, flexible start/finish times, job feelings of isolation; stress caused by employer had supported sharing, compressed hours (working full having to use new technologies to time hours over fewer days), and work carry out their work; the potential for him to work his role as a base. For example, working from home or people not to have a break from stressful job share in the last few Places for life a different location could allow employees situations at home; and for those who years before he retired. He to achieve a good work life balance. were lower paid, issues around increased One way fuel costs of working from home35. felt that this had greatly to support Employees who have been employed helped him to be prepared employees, which for 26 weeks or more have the right Due to the high levels of older people when he did then retire, as Appendix could be of to request flexible working34. Flexible leaving physically demanding work due he had ‘eased down’ into particular value to working policies could be used by to health reasons, organisations should older workers, is employers to help older employees find consider how flexible working or assistive retirement. flexible working33 ways to make work suit their needs better. technology where available could be References

13 Director of Public Health - Annual Report 2019 Employer support for health Training Foreword and wellbeing Department for Work and Pensions and Public Larger organisations are more likely to provide training opportunities than It is predicted that by 2030, 40% of Health Wales smaller or medium sized employers but the working age population in the UK Older people in older people are often employed in will have a long-term condition such Cardiff and the In 2018, individuals in Wales over the latter leading to less opportunities as coronary heart disease or diabetes. Vale of Glamorgan the age of 50 made more than overall25. Furthermore those in the With more people working into later 75,000 claims for Employment and lowest 3 occupational groups or working life, health will play an ever larger role Support Allowance: almost half within the public sector report less in determining their ability to stay in of all claims. Evidence suggests incidence of training in their role across What is healthy work32. Employers can help support that opportunities may currently all age groups36. There is therefore a ageing? their employees to adopt healthier be lost to support individuals to lack of equity across employment and lifestyles, which can help to prevent return to the workplace where demographic groups in accessing training many long-term health conditions. adjustments to their working which could lead to less enjoyment Schemes around active travel, healthy conditions would make this and engagement in the workplace and eating, help to stop smoking and Purpose in life possible. Public Health Wales, opportunities to progress or diversify. access to support for wellbeing can all working with the Department for Training can be provided in less formal help. For employers who want to take Work and Pensions, is carrying ways for example through mentoring or a more structured approach, Healthy out a project to engage with GPs, by taking on differing projects or roles Working Wales can provide expert employers and other stakeholders within an organisation. These could have Connections in life advice. to establish what obstacles the benefit of sharing knowledge across and opportunities exist to use age groups within a setting and better Employers can also support their the ‘fit notes’ issued to those overall knowledge of the organisation. workforce by making adjustments who are off work due to illness to working hours or conditions, or more effectively and so support Places for life supporting people to return to work healthier working lives across the after a period of ill health, such as the population. This work is due to be example below outlines. Fit notes, completed in 2020 and will report which inform employers of the tasks an in the first instance to the Effective individual is able to undertake, have the Appendix Employee Health Management potential to be used to much greater Partnership. effect to support employees to return to work successfully and stay in work.

References

14 Director of Public Health - Annual Report 2019 Employer support with if due to health reasons, experience a Summary 38 Foreword planning for the future lower sense of wellbeing . In short, helping people stay well into retirement This section has shown the importance can help keep them healthy and well in of employers and employees proactively “Retirement Many organisations do not have a process their communities for longer. discussing and planning for an older in place to discuss planning for future Older people in planning sessions workforce both through policy and work, health needs and retirement with Cardiff and the starting as early Cardiff and Vale University Health Board procedures but also in individual their employees, and some feel that such Vale of Glamorgan as the beginning employees who completed a survey circumstances. For employers looking for conversations could be insensitive or of service, during the preparation of this report guidance to make their workplaces more potentially discriminatory37. even if that is felt strongly that conversations around age friendly, Welsh Government has retirement should be happening much published a guide39 with links to useful What is healthy in someone’s Financial planning for future retirement sooner in their working life. resources. Key actions include: ageing? 20s, but is important, and one which employers having regular 1. Checking marketing and recruitment can help people to do. There are “Retirement planning sessions starting update sessions procedures are suitable for all clear inequalities in the experiences of as early as the beginning of service, even 2. Ensure skills development is for all throughout a employees depending on their socio- if that is in someone’s 20s, but having ages Purpose in life career, given that economic group. Older people with regular update sessions throughout a 3. Offer flexible working or circumstances can lower household incomes are less likely career, given that circumstances can opportunities to use skills within always change.” to have had engagement with financial always change.” planning for the future and have less other roles financial resources33. They are also more “Explain more clearly about the pension Connections in life likely to experience health problems and and what it will mean in future years to have a shorter healthy life expectancy but people in their 40s - to prepare ahead of have more caring responsibilities and less “Explain more time.” independence within their work roles. clearly about the Conversations could be part of regular Places for life pension and what People who have control over the timing supervision or yearly appraisals and have it will mean in of and can plan for their retirement, and standardised content for all age groups future years to voluntarily retire, have a higher sense of around training, development and work/ people in their well-being and get more pleasure from life balance, which would allow the 40s - to prepare free time in retirement. On the contrary, employee opportunities to raise issues as Appendix ahead of time.” people who involuntarily retire, especially they arise.

References

15 Director of Public Health - Annual Report 2019 A Healthy Retirement Foreword Retirement from working life marks a key transition for many Respondents to the Cardiff and Vale UHB staff survey also identified factors besides people and for most is a positive experience but, as with the loss of earnings which they think they could experience in retirement: employment, experiences vary greatly within different groups. Older people in Upon retirement, a drop in income may particularly affect those Cardiff and the from lower socio-economic backgrounds and ethnic minorities. Vale of Glamorgan “Miss my friends and work-day structure” People from a black and minority ethnic group are twice as likely to be poor in later life when compared to white people40. This is linked to experiences of inequality over time with increased “Loss of identity” What is healthy experiences of lower earnings, higher levels of self-employment ageing? and breaks in employment which impact on pension savings “Loss of status” in some groups41. Women are also more likely to experience a pension deficit caused by lower overall earnings combined with “Worried about spending too much time alone” caring responsibilities. Where these issues come together, for Purpose in life example the experience of being an older woman from black or minority ethnic background, these issues can be compounded. Figure 11: Retirement expectations A survey of Cardiff and Vale UHB staff found that 38% of respondents said that they were looking forward to a more Top five aspects of work people Top five aspects of work people Connections in life relaxing pace of life and time to enjoy more leisure activities. expect to miss when they retire actually miss once they retire However, the drop in income was of concern to many people. Fifty-one percent of respondents noted they would need to be The money 65% Friends and colleagues at work 67% mindful of their money and nearly 10% felt they would worry about the loss of earnings. Friends and colleagues at work Satisfaction/fulfilment from the Places for life 36% work itself 49% The importance of being both financially prepared and having a sense of control over our retirement has previously been Having a daily routine Having a sense of importance or noted, but the transition into retirement also impacts on social 33% role to play 45% connections and feelings of purpose. Sometimes what people Satisfaction/fulfilment from Appendix expect to miss on retirement can differ from what they actually The money the work itself 23% 43% miss, as shown in the results of a large study42 with over 6,000 adults in the UK in 2016 (figure 11 below). Many people reported Having a sense of importance Giving myself new challenges/ that they missed colleagues, and the satisfaction and sense of or role to play 21% experiences 21% purpose that work gave them more than they thought they References would. Source: Aviva. Voice of new retirement report. 2016

16 Director of Public Health - Annual Report 2019 When it comes to retirement many Research into the provision of the Health literacy is an important factor Foreword people do not have clear ideas of how retirement planning courses outlined in self-care and the management of they want to spend their time with in the section above, found that after health as it gives us the skills to find many just reporting goals around ‘living attendance, 90% of participants had information and make informed choices comfortably’41. This lack of expectations a conversation with their partner, about healthy lifestyle behaviours, and Older people in and planning is likely to lead to lower 40% started a new leisure activity and to be able to seek support and to care Cardiff and the levels of purpose on retirement. around two-thirds had started to do for others. Lower health literacy levels Vale of Glamorgan more physical activity43. Retirement are linked to an individual’s increased Participants from focus groups held for planning courses should include support likelihood to have a poorer diet, smoke this report said that they found purpose for people to consider what kinds of and take less physical exercise. Those What is healthy from many different areas in their life activities or volunteering opportunities with lower health literacy are also likely ageing? in their retirement including from their they could get involved with upon to struggle to access appropriate health faith, caring responsibilities, volunteering retirement. services and less likely to take part in and helping plan community events. screening and vaccination programmes46. They valued using their experience in life Keeping Healthy in Later Life to help others and defined purpose as The groups within the population most Purpose in life ‘something to get up for’ and ‘something People with higher levels of purpose are likely to have lower health literacy to use your brain for’. include47: ACTIVITY IN RETIREMENT more proactive in taking care of their health, they have better impulse control, 44 • older people PURPOSEFUL UNDERTAKING and engage in healthier activities . Connections in life Research on the transition into retirement • lower socioeconomic groups has found that those who had difficulties • ethnic minorities and migrants moving into retirement were more • disabled people likely to have poor lifestyle behaviours • people with a long term health and have a decline in both mental and condition Places for life physical health41. Whilst it can be difficult to spot if someone has lower health literacy, it can “I like to keep People could be helped to find Supporting Health Literacy be addressed in a few simple ways. NHS busy, I think that’s activities by organisations providing Scotland has recently produced guidance Health literacy is about people having Appendix my motivation. I retirement planning support with a for health professionals which includes: enough knowledge, understanding, like to be active holistic approach. Currently, much of using pictures and simple language skills and confidence to use health and busy, and I the information, advice and support avoiding jargon on written instructions, information, to be active partners in their like to get out and around retirement is aimed at financial breaking up information into manageable care, and to navigate health and social about and engage or practical matters and neglects the ‘chunks’, tailoring information to people’s care systems45. References with people” emotional and social impact41.

17 Director of Public Health - Annual Report 2019 needs, offering help with form filling and use of Summary Foreword ‘teach-back’ techniques. These involve asking a person to use their own words to explain back Purpose is an important driver of health and to the health professional information that they wellbeing which can be found in many aspects have been given, for example how to take their of our lives including work, volunteering (this will Older people in medication. This can then identify any gaps in be covered in the next chapter) and retirement Cardiff and the understanding45. activities. The picture of working and retirement Vale of Glamorgan is changing. Employers recognise the benefits Supporting Digital literacy of an age diverse work force but will need to engage further with the older age group to What is healthy A further layer to health literacy is the shift be able to retain and best use the skills and ageing? towards more information being available only on knowledge of these employees and provide a the internet with many paper-based sources of supportive and flexible environment.

information reduced due to cost and sustainability For those approaching retirement, it is clear that issues. This shift has been accelerated within there is great importance attached to having a healthcare recently due to the COVID-19 Purpose in life level of control over this process and to consider pandemic. Many services within Cardiff and finances, health and building activities into the Vale of Glamorgan are now offering online retirement. Early planning is key for the health consultations. In the Health Board these include and wellbeing of people planning retirement, and services such as rheumatology, podiatry, mental employers can offer many ways of helping people Connections in life health and physiotherapy. to move through these phases.

Digital literacy can be defined as those capabilities Looking after our health to support us working that fit someone for living, learning, working, longer and to enjoy a healthy retirement should participating and thriving in a digital society48. be supported both by our employer and through Places for life In Wales, in 2018-19, 49% of people aged 75 or self-care. Health and digital literacy are vital skills over were internet users, an increase from 22% to help people stay healthy and manage health in 2012-13. As tech-savvy population groups conditions and some groups in the population age, use of the internet and technology will also will need additional support to ensure their Appendix further increase. Chapter 4 will explore in more needs are met. People should be able to access detail how using technology can help people to information in a way that they can understand connect with others and the services and support and be able to learn skills around improving they may need. literacy.

References

18 Director of Public Health - Annual Report 2019 Foreword CALL TO ACTION

Older people in Cardiff and the Public Workplaces and employers holistic information on financial Vale of Glamorgan Plan early for retirement ensuring you Develop an age-friendly framework for planning, healthy lifestyles, volunteering consider existing or new activities that the organisation, which incorporates opportunities, learning opportunities and are purposeful and meaningful to you. the adoption of Ageing Better’s guide activities What is healthy Find out if your employer offers a to become an age-friendly employer, or ageing? retirement planning course and start uses the Welsh Government toolkit Offer retirement courses for employees planning, ensuring you understand your to be able to receive specialist advice and pension and have planned for your • Be flexible about flexible working information, at various stages in their financial needs for retiring • Hire age positively employment, not just when they are • Ensure everyone has the health close to retirement age Purpose in life Cardiff and Vale of Glamorgan support they need Public Services Boards • Encourage career development at all Seek support from Business Wales on Advocate for the development and ages training and skills development for your implementation of age-friendly policies • Create an age-positive culture workforce Connections in life across public services For employers of physically demanding Cardiff and Vale University job roles, consider how jobs can be adapted or assistive technology used Health Board to support people in their employment Improve support for health literacy and when needed Places for life consider accessibility of information when designing or providing services, providing Support employees to ensure transition information and advice, or when to retirement is well planned. Provide prescribing medication Appendix

References

19 Director of Public Health - Annual Report 2019 Previous chapters have focused on how This chapter will outline the importance has had an impact on people’s mental Foreword individuals are able to create and maintain of social connections and highlight the health and wellbeing. Social distancing purpose and meaning in later life; through issues of loneliness and social isolation and not having face to face contact have working, retirement, taking part in which can sometimes impact on older been found to have a significant negative activities and in keeping healthy. Being people in our communities. We will short term impact in relation to isolation, Older people in connected to others is also important in suggest ways in which individuals, loneliness and disconnection from social Cardiff and the being able to have a happy later life49. communities and organisations can support for older people53. Vale of Glamorgan CHAPTER 4 Positive social connections with family, enable people to stay connected, make friends, community and colleagues help new connections, reduce the risks of To overcome the impact of staying at us to feel that we belong, give purpose becoming lonely and enhance wellbeing. home many people may have adapted What is healthy to our lives and increase our sense of the way they connect with other people ageing? wellbeing. The Covid-19 pandemic has changed our using technology, social media and daily lives and routines. The measures meeting up virtually. Many organisations As well as providing a sense of belonging put in place to control the spread of the have also adapted the way that they and security there is growing evidence virus have prevented many people from communicate with people, using CONNECTIONS IN LIFE Purpose in life that positive social connections contribute seeing family, friends and members of telephone and online services. to good physical health. Participating in their community. Community groups, shared activities not only supports physical clubs and activities that supported health and a feeling of connection, it can social connections have been cancelled. also enhance brain health by helping to Spending more time at home has meant Connections in life maintain our ‘thinking skills’ as we age, that the usual way that people connect and slowing down cognitive decline50. face to face with others has not been Being socially active may also reduce the possible for several months. risk of developing dementia. Conversely, evidence highlights that loneliness and People over the age of 70 are more Places for life lacking social connections is as bad for likely to be hospitalised if they acquire health as smoking 15 cigarettes a day51. Covid-19 and therefore have been Loneliness and social isolation can have advised to stay at home as much as as negative an impact as chronic long possible. Although this guidance was term conditions such as diabetes and put in place to protect the health of Appendix hypertension52. older people it is likely that this period

References

20 Director of Public Health - Annual Report 2019 Social connections environment can enhance the ability of Foreword people to connect with others. People differ in the way that they seek Helping people to make and maintain out company of others, but humans have social connections can be complex. a fundamental need to interact with The Campaign to End Loneliness has Older people in others. People who have meaningful produced a Loneliness Framework (left), Cardiff and the relationships are happier, have fewer which sets out the range of interventions Vale of Glamorgan health problems, and live longer than that need to be in place to tackle the those who do not54. issue of loneliness and a lack of social connections. What is healthy In Cardiff and the Vale of Glamorgan ageing? many people have active social lives and Loneliness and social connections that they have developed isolation during a lifetime and will continue to feel happy and fulfilled into old age The terms loneliness and social isolation Purpose in life connecting with family, friends and the are often used interchangeably but they local community. Indeed, 65.5% of are not the same thing. People can be people aged 65 and over in Cardiff and isolated yet not feel lonely, and people the Vale of Glamorgan report that they can be surrounded by others but still feel 55 feel a sense of community . Only Powys lonely. In the newly published strategy to Connections in life Teaching Health Board area has a higher tackle these issues, Welsh Government percentage of people reporting feeling defines these terms56, where the first is this level of a sense of community. subjective and the second is objective. Social connections are enhanced by a Places for life wide range of community assets that Loneliness is a subjective, include good transport links, green spaces, leisure amenities, community unwelcome feeling of lack groups, clubs, libraries, community hubs, or loss of social relationships. learning and volunteering opportunities It happens when there is Appendix and more. Where people live, and a difference between the how they are able get around, plays an important role in how well they can make social relationships we have and keep social connections. Chapter 4 and those we want. Source: Campaign to End Loneliness on ‘place’ will explore how the physical References https://campaigntoendloneliness.org/guidance/

21 Director of Public Health - Annual Report 2019 as loneliness can also lead to social wealth and happiness and security in Foreword Social isolation is when an isolation. later life59. People living in the most disadvantaged areas experience greater individual has an objective As people move into later life there can levels of poverty, and the link between lack of social relationships be a number of triggers which could social isolation and poverty appears Older people in (in terms of quality and/ lead to loneliness and social isolation, to be stronger among older people Cardiff and the including bereavement, retirement, 60 or quantity) at individual, than working age adults . Poverty can Vale of Glamorgan giving up driving, taking on a caring role mean that some older people may be 56 group, community and or experiencing ill health . unable to afford the cost of transport to societal levels. visit friends or family or attend a social There are some recognised variables activity56,61. Older people need to be What is healthy which can be used to identify people supported to access activities in areas of ageing? who may be at risk of becoming lonely Loneliness is not an inevitable part of disadvantage, and to be able to access or isolated58: getting older: 88.5% of people aged advice in order to maximise their income. 65 and over in Cardiff and the Vale • Having a head of household over 65 of Glamorgan do not feel lonely55. Purpose in life years old However, for the 11.5% who do report • A household with one occupant feeling lonely, which is currently around • Not owning a car 7,800 people, this is an issue which can • Speaking to neighbours less than impact upon their wellbeing. Although once a month or never people can experience loneliness at any Connections in life • People saying they are not satisfied time during their life, older people are with their social life particularly vulnerable as their social • Having a low annual income connections change with age and circumstances such as retirement, caring Places for life responsibilities and bereavement57. Inequalities and social isolation Older people Social isolation is about the number of Most older people living in Cardiff and are particularly social contacts that people have, and not always about the quality of these the Vale of Glamorgan feel connected to vulnerable to Appendix contacts. People may choose to have their communities, families and friends. experiencing a small number of social contacts, However, there are often differences loneliness as their and often people are able to develop in experiences depending on where social connections more contacts should they wish to. people live, their financial circumstances and circumstances Isolation can lead to loneliness if people and ethnic backgrounds which can References change with age are unable to connect to others, just result in unequal levels of health,

22 Director of Public Health - Annual Report 2019 Supporting older people to Foreword make connections

There are many approaches Older people in to supporting older people Cardiff and the Vale of Glamorgan to make and maintain social connections, and reduce the risk of loneliness and social What is healthy isolation. ageing? Recognise older people as assets

Purpose in life Assets are resources, skills, or knowledge which enhance the ability of individuals, families and communities to sustain their health and wellbeing62. Asset based approaches value, nurture Film by Lucy Thomas, Creative Media Level 3 student, Cardiff and Vale College Connections in life and use this potential to enhance local community connections, build resilience Social capital is defined as the functioning of to develop new social connections and build social and improve wellbeing at individual and social groups, a shared sense of identity in a capital following their retirement through taking community levels63. community, values and trust developed through part in a wide range of hobbies and activities such Places for life social relationships. Having strong social capital as volunteering, clubs and sport. They benefit Chapter 1 outlined the extent to which can support individuals’ resilience to and recovery individually from connecting with people, but they our older population will grow by 2039. from illness63, and the quality of longer term social are also important assets, supporting other people This increase in numbers brings a large relationships can protect health and wellbeing62. and their local community. In the film above, we number of community-based assets Older people can support the development of meet Maggie, who has set up exercise classes for Appendix we can draw on to improve health strong social capital through volunteering, caring, older people as what she describes as her ‘second and wellbeing. All age groups can education and employment. career’, enabling her to build social capital for benefit from the skills, experience and herself and for others in the community. People knowledge of older members of the Many of the people that we have spoken with in who come to her classes make new connections, as community. developing this report have had the opportunity well as benefit from the exercises. References

23 Director of Public Health - Annual Report 2019 Foreword Recognise the risks of loneliness and social isolation Older people in Cardiff and the Although loneliness is a Vale of Glamorgan subjective and personal experience, there are factors that can lead people to be Retirement - though Bereavement - the A lack of close family A lack of regular more likely to feel lonely. It many of us look forward loss of a partner, family connections - many contact with friends - to retiring from work members or friends is a people live far away from as we age our friendship What is healthy is important that we enable ageing? the reality can be very key trigger for loneliness loved ones. Modern circles will change. individuals, their families, friends different. People often often leaving people life sees more families Companions can move and the professionals that work miss the routine of going living alone. geographically scattered away and friends can with older people to recognise to work, social contact across the UK and even become limited by poor some of the triggers that with work colleagues overseas due to work or health making socialising Purpose in life can lead to changes in social and the sense of purpose family changes. more difficult. connections outlined earlier in that work can bring. this chapter. If people are more aware of the factors listed here it could help them to make Connections in life plans and engage with services that can support them as their circumstances change64.

Places for life Source: AgeUK, Evidence Review: Becoming a carer for Poor physical health Lack of transport - being able Financial difficulties - Loneliness in later life (2015) partners or family - as we age health to travel to social activities and can be stressful, and also members - caring for may deteriorate and meet with friends and family is limit how often people others is an important our mobility may be key to maintaining connections. can get out and socialise. Appendix part of life that can be affected. This can Losing the ability to drive can very rewarding but also limit how we socialise impact on independence and brings challenges. Being and make it difficult limit social lives. Access to a carer may mean that to maintain our regular public transport is key you don’t have the time connections. to enable older people to travel. or energy to see friends This can be problematic in rural References or family. areas where connections are less frequent.

24 Director of Public Health - Annual Report 2019 ‘Making Every Contact Count’ Identify areas where people Age UK recommend that health care Foreword (MECC) is an approach that may be lonely or isolated professionals can support initiatives to address loneliness including social encourages people to build prescribing67. Health professionals can In addition to taking a MECC approach play a key role in identifying people on their daily interactions with and having conversations with people to Older people in who may be lonely or isolated. It is people to improve their health identify triggers for loneliness or isolation, Cardiff and the estimated that three out of four General and identify issues which may some of the variables listed earlier can Vale of Glamorgan Practitioners (GPs) across the UK see be mapped for Cardiff and the Vale of be affecting their health and between one and five people every day Glamorgan. If the geographical areas EVERY MAKE EVERY who have come to them because they wellbeing. where people at greatest risk live are are lonely68. What is healthy identified, this would enable targeting Having short interactions provides an ageing? of interventions to improve social CONTACT COUNT CONTACT opportunity to ask individuals about The Royal College of GPs (RCGP) has connectedness. lifestyle topics such as physical activity launched a community action plan to or smoking, provide information and help GPs tackle loneliness. The plan signpost or refer to local services as Develop social prescribing includes providing training for health Purpose in life needed. approaches care professionals to help them identify patients at risk of becoming lonely and If individuals, professionals and Social prescribing, sometimes called building links with voluntary sector organisations are aware of the triggers community referral, links people to organisations that can help. The RCGP for loneliness they can make every Connections in life community services that can offer support would like to see a dedicated ‘social contact count, having conversations with emotionally, socially or practically. There prescriber’ in every GP surgery who can older people to identify triggers and are different models of social prescribing work with patients to match them with signpost to services that can help build most of which involve a ‘link worker’ or community activities that will help them social connections. ‘navigator’ who will help people to access to build social connections68. Places for life local sources of support or activities. These Welsh Government will be exploring local activities can include volunteering, Social prescribing is available at some the potential for a specific ‘Making befriending, gardening, creative activities GP practices in Cardiff and the Vale of Every Contact Count’ training module and walking groups and can provide Glamorgan delivered by the ‘Wellbeing on loneliness for public and third sector an opportunity for people to socialise 4U’ team. The team can offer one to Appendix organisations. This would enable staff and make new social connections65. The one support and signposting and often to develop their skills and consider approach has been recognised as having a work with patients who have been loneliness when promoting healthy number of positive outcomes that include referred because they are lonely would lifestyles and signpost people to services reducing isolation alongside improved self like to get involved with their community. that can support them56. esteem and resilience66. References

25 Director of Public Health - Annual Report 2019 Wellbeing4U Use technology to connect There are several ways in which Foreword offers GPs an organisations can support people who opportunity to Confidence in using, and having access want to access the internet. For example, support people to, digital technology has the following administrative staff in GP practices could with non- benefits69: be trained to support customers to Older people in register and manage their appointments medical needs, Cardiff and the • Improved self-care for minor ailments online71. Organisations can also sign up Vale of Glamorgan such as social • Reduced loneliness and isolation to a Digital Inclusion Charter from Welsh support • Improved self-management of long Government which outlines six principles term conditions to support their staff, volunteers and What is healthy • Improved take-up of digital health users. www.digitalcommunities.gov. It is not only GPs who can identify people ageing? tools and services wales/digital-inclusion-charter/ who are lonely. From hairdressers to • Time saved through accessing post office staff, and many staff in local services digitally Welsh Government is currently offering authorities and community organisations, • Cost saved through accessing services support to organisations through Digital many colleagues will come across older Communities Wales - Digital Confidence, Purpose in life digitally people who need support to build their Health and Well-being. The project aims social connections. Social prescribing, Despite the benefits, there are barriers to increase people’s confidence in using or community signposting, can be to using the internet for some older digital technology to help them improve undertaken by all of these people, as people. Security risks, lack of knowledge, their health and reduce loneliness well as volunteers and local community support and skills, access and disability and isolation. The project includes the Connections in life members and it can be done simply and have all been cited as reasons that older training of Digital Volunteers, who can easily. people may not use the internet70. Older link to organisations to provide support Welsh Government is committed to people we spoke to highlighted that people to learn and gain confidence in support the further development of social some people may see using technology using technology Places for life prescribing in Wales. The recent strategy such as the internet or social media as www.digitalcommunities.gov.wales/ for tackling loneliness has a number of detrimental to social connections. They actions around social prescribing that fear that as more people communicate The ‘Digital Companions’ project helps include: continuing to work in partnership online rather than face to face, they risk organisations working with older people to develop the evidence base for social becoming disconnected from people to identify and support someone in their Appendix prescribing; developing an outcomes and the real world around them. It is clients support network to become their framework for social prescribing and important to recognise the barriers companion and support them to get on launching an online resource portal to people face and support them to line. support social prescribing activities in become digitally included71. Wales. References

26 Director of Public Health - Annual Report 2019 ‘I enjoyed being In addition, the all-Wales ‘Digital Loneliness’ suggests that families, friends Foreword a ‘digital hero’ Heroes’ project brings together the and neighbours stay in touch by calling because it was older generation with children and each other regularly by phone, creating young people to share their digital WhatsApp groups and using Facebook really rewarding knowledge and skills. Children and and Twitter to stay connected74. Older people in to know that young people are trained to help others Cardiff and the we are changing use the internet safely. Pupils from Use community facilities Vale of Glamorgan someone’s life for St Mary’s Catholic Primary School in the better, not Cardiff have trained to become ‘Digital as assets to enhance social just by showing Heroes’ and have been supporting older connections What is healthy them how to be patients at St Davids Hospital to access ageing? online but also the internet when they are in hospital. “I think the more groups you Although technology can be a very just by chatting join, the better it is. I haven’t useful tool for connecting people, many of us enjoy the experience of meeting to them, visiting There are many local opportunities got enough time to join them face to face. During the current pandemic them and taking to help people get online including support at libraries and Council hubs all, that’s the trouble!” many face to face activities have been Purpose in life time to find out in Cardiff and the Vale of Glamorgan, paused, but some could potentially about their lives’ and on line support and resources During the Covid-19 pandemic many resume, in a physically distanced way as for those who want to increase their people have adapted the way they we move into the next phase of living Year 6 pupil, St confidence (www.dewis.wales). These connect with others and have used with Covid-19. Community groups, clubs Mary’s Catholic should be advertised and promoted technology and social media to and activities can support people to Connections in life Primary School to older people using appropriate communicate with and meet people reconnect, maintain existing relationships communication such as local virtually. This has helped to overcome newsletters, and providing information the impact of staying at home more at local activities such as lunch clubs and missing out on the usual ways of Places for life and exercise groups. connecting. For some older people, the range of digital connections has made Focus group participants spoken to in it easier to access information, but developing this report were keen to talk many others have needed to reply on about their use of the internet, social other people to provide them with the Appendix media, Skype and Facetime. These information73. enable them to stay in touch with family and friends who live far away, make Although technology cannot replace new friends by belonging to online meeting people face to face, it can groups and forums and finding out provide an opportunity to maintain social References about local activities. connections. ‘The Campaign to End

27 Director of Public Health - Annual Report 2019 and make new connections. A review Providing benches as resting points Foreword of loneliness initiatives has identified the is essential for enabling older people most effective loneliness interventions as to walk easily in their community. If being group based, targeted at specific benches are being provided as part of groups, focused on a shared interest a development or regeneration project, Older people in and set up to involve older people in the having some designated as ‘happy to Cardiff and the running of the group.75,76 chat’ benches could help to address Vale of Glamorgan isolation. A participant in one of the focus groups gave her thoughts about face to face At the other end of the spectrum there What is healthy connections: are activities that can help people to ageing? connect face to face and in groups It’s (social connections) like a ranging from coffee mornings, luncheon spectrum… at one end there is clubs, knit and natter groups to physical “I run my local community a ‘Hello’ and a smile and at the activity opportunities such as walking hall on a daily basis, I football. Purpose in life other end there are meaningful communicate with the various relationships. “I never get lonely, I’ve always groups who use it, helping Focus group participant (January 2020) been busy” with the bookings and if they’ve got any issues they These activities often take place in Connections in life In Cardiff and the Vale of Glamorgan contact me” there are a wide variety of services and community buildings such as village community activities at all levels on this halls that are a substantial asset to communities, allowing people to spectrum. At one end there are ‘happy to Several organisations working attend groups and activities in their chat’ benches in Cardiff and the Vale of to support older people across locality without having to travel far. Places for life Glamorgan to encourage people to talk Cardiff and the Vale of Glamorgan Places of worship also help to maintain to one another face to face. The idea provide support such as befriending connections and run social activities and came from the observations of a Cardiff schemes and community support groups. In Cardiff the Council run ‘Hubs’ woman who noticed an older gentleman to signpost people to appropriate bring together library services, council sitting alone in a park. Many people services. These projects aim to services and often community cafes Appendix passed him by but nobody said ‘Hello’ reduce loneliness and link people under one roof, and the Independent resulting in the idea of tying a sign to the with community activities as well as Living Service supports older people bench saying ‘Happy to chat bench. Sit provide practical support. here if you don’t mind someone stopping to access services and make new to say hello’. connections. References

28 Director of Public Health - Annual Report 2019 Some examples of community groups Provide information to older Provide volunteering Foreword and activities available in Cardiff and the people in an accessible way opportunities Vale of Glamorgan Although there are activities and services Volunteering can be a positive experience at any age and gives people Older people in • The ‘Men’s Sheds’ movement is for men who may available, many older people will not Cardiff and the have free time due to retirement, bereavement know they exist. It can be a challenge the opportunity to learn new skills, Vale of Glamorgan or because they are new to an area. They aim to to reach people who are isolated with contribute to their local community, gain benefit men’s health and wellbeing in an environment information about support services. confidence, have fun and meet new where they can pursue practical activities such as people. Older people have many skills woodworking, metalworking, repairing and restoring. The Dewis Cymru website and talents to share which can benefit What is healthy www.dewis.wales is an online directory fellow volunteers, organisations and ageing? where people can find information about communities. Volunteering in later life organisations and services that can help can increase the quantity and quality of support their health and wellbeing. It social connections, enhance a sense of enables the public and organisations purpose and self-esteem and improve life Purpose in life to search for community groups satisfaction, happiness and wellbeing77. and activities that will can help build community connections. The National Survey for Wales indicated that in Cardiff, 32% of adults aged Although directories and websites are between 65 and 74 years volunteer78. Connections in life important tools, speaking to older people However, there are barriers that prevent for this report highlighted the need people volunteering that include poor “Men’s Sheds is a community based to also use more traditional methods health, caring responsibilities, and project which keeps people socially active, of communication. People felt that financial challenges. People from black targeted delivery of flyers and leaflets and minority ethnic communities also Places for life mentally and physically active, doing can be effective as well as posters in face barriers to volunteering79. Older projects for their own community” shop windows, GP surgeries, community people living in rural areas may also have notice boards and adverts in local press. limited volunteering opportunities. For • ‘Goldies Cymru’ host singing and activity sessions for Word of mouth was also mentioned some people there also be emotional older people in community venues across the area as being an important way to promote barriers that stop them from volunteering Appendix encouraging people who are socially isolated to meet community groups and activities. such as a lack of confidence. others sharing ‘singing and smiles’. • There are many luncheon clubs running in community venues and churches where older people can meet References new people, build a social network and enjoy a meal for a small cost.

29 Director of Public Health - Annual Report 2019 “When people Elaine, aged 78, volunteers for Age Organisations or groups who recruit sporting events that can benefit health Foreword finish work, I Connects as a ‘Befriender’. Before volunteers should have an age-friendly and wellbeing and be an opportunity think it’s filling she retired she was a social worker approach and allow people to be flexible for further social connection. that time, what for older people and had a lot of skills in the time they give, to feel supported, can I do? We all and experience to offer Age Connects socialise with other volunteers, feel Earning time credits through Older people in and the older people they support volunteering can be a great opportunity want to feel as valued and the work they do should have Cardiff and the in the community. Elaine describes meaning and purpose, making good use for people to build social connections if we’re still part Vale of Glamorgan volunteering as of their skills81. and meet people in their community, of a community and help to reduce loneliness. and that people “giving structure to your time. Opportunities to earn credits are care about us” What is healthy When you retire it is not always available across Cardiff and the Vale ageing? of Glamorgan and are open to all ages as pleasant as you imagined as (www.timecredits.com ). The Vale of you can feel a bit lost. When Glamorgan Council has established you first finish work you can a successful time credits scheme for housing tenants which is expanding to Purpose in life drift”. include non council tenants.

“… it’s a positive feeling when you see your client making Volunteering can also be a way to earn Connections in life ‘time credits’. The Time Credits scheme progress. They look forward to is run by ‘Tempo’ a charity that started in seeing you as they often don’t Wales and now operates across the UK. see anyone else during the Time credit schemes encourage people week. You feel that you have to volunteer in projects from community Places for life gardens to befriending schemes. By done something positive and are volunteering one hour of time people can giving something back. It helps earn one time credit. Time credits can be them to reconnect”. Elaine, Age ‘spent’ on activities and services such as cinema tickets, swimming or attending Appendix Connects volunteer.

References

30 Director of Public Health - Annual Report 2019 Develop intergenerational people in the community and build social physical health. In Cardiff and the Vale Foreword projects connections. of Glamorgan many of us have active social lives and connections and will Another example of an intergenerational continue to feel happy and fulfilled into Intergenerational projects bring older project taking place in a school setting old age. However, there are sometimes and younger people together. They Older people in is the Cardiff and Vale University triggers in life that can lead to changes in aim to build relationships, respect and Cardiff and the Health Board “Staying Steady Schools’ social connections and potentially lead to understanding between different age Vale of Glamorgan project”. The initiative brings together loneliness and isolation. Recognising and groups, challenge attitudes and can primary school children and older responding to these triggers is important involve sharing skills, memories and ideas adults along with university students, for both individuals and organisations between different generations81. to provide intergenerational learning who support older people. What is healthy The majority of intergenerational projects around falls awareness. The aim is to ageing? aim to support older people to improve increase knowledge about falls risks There is not a ‘one size fits all’ approach their health and wellbeing, reduce whilst creating an opportunity for social to supporting people to increase and loneliness and isolation, improve access interaction and learning83. enhance their social connections and to services and provide an opportunity to tackling loneliness is complex and a long engage in other activities82. Benefits also Purpose in life The Older People’s Commissioner for term challenge. However, there are a include an increased sense of community Wales wants to support communities wide range of approaches that can help, belonging and improved community to establish intergenerational groups and the increased use of technology due connections. that bring younger and older people to Covid-19 should be used, and continue together. In partnership with the to be used, as a key mechanism for Connections in life The ‘Time after Time’ project in Cardiff Children’s Commissioner for Wales, a engaging with older people in addition involved Goldies Cymru working in set of resources have been launched to the face to face activity. partnership with Thornhill Primary to help communities set up and run School to enjoy time together and sing intergenerational projects and enabling There are many opportunities for with the pupils. Following the success both the older and younger generations professionals, communities and Places for life of this project, Goldies have launched to benefit and build new community individuals to identify older people who a new intergenerational project called connections84. may be lonely and support them to ‘Back 2 School’ to encourage primary access one of the many services and schools to invite older people from their projects in Cardiff and Vale that can local community into a school setting to Summary enable connection with others, improve Appendix share memories of their school days and wellbeing and help them to enjoy and sing together. Schools can access a free Positive social connections give purpose celebrate later life. project pack and resources to set up a to our lives, increase our sense of project that can benefit pupils and older wellbeing and contribute to good References

31 Director of Public Health - Annual Report 2019 Foreword CALL TO ACTION

Older people in Cardiff and the Older People interventions across Cardiff and the Vale of Workplaces and employers Vale of Glamorgan If you find it difficult to use technology and Glamorgan Encourage all staff to ‘make every contact count’ access the internet, find out how you can get and ask older clients and service users if they support to get connected by visiting your local Cardiff and Vale of Glamorgan Public would like support to make social connections, What is healthy library or Council hub Services Boards and to be aware of triggers for loneliness ageing? Support those with low levels of digital Join a group, volunteer or try a new activity, as literacy through involvement with the Digital Raise awareness of the opportunities and these are great ways of meeting people and Communities project targeting those most in resources available in local communities to making social connections. Your local library or need of support tackle loneliness and isolation. Promote www. hub can help you find activities Dewis.wales using accessible and appropriate Purpose in life Sign the Digital Inclusion Charter and implement communication tools for older people Public its six principles Be aware of the potential triggers for loneliness. Support the provision of ‘Time Credits’ If you are in contact with older people, ‘make Implement the principles of ‘Age Friendly schemes to encourage older people to take up Connections in life every contact count’ and ask them if they would Communities’ volunteering opportunities like to know more about how to make social connections and help them to find out what is Cardiff and Vale University Health Board Use intergenerational activities to bring older available in their local community Promote the Royal College of General and younger people together to learn from one Practitioners ‘Tackling Loneliness. A community another, tackle loneliness and improve community Places for life Welsh Government action plan for Wales’ amongst primary care connections Develop a national campaign to raise awareness colleagues and partners to raise awareness of about loneliness to compliment ‘Connected loneliness and advise how lonely patients can be Promote volunteering opportunities for older Communities. A strategy for tackling loneliness identified and supported people in the local community using methods and social isolation and building stronger social such as fliers, posters and the local press Appendix connections.’ Ask patients about social connections during their alongside digital promotion appointments in primary or secondary care and Regional Partnership Board signpost them to social prescribers or community Map the risk factors for loneliness and isolation organisations when needed and identify geographical areas to target References

32 Director of Public Health - Annual Report 2019 The previous chapter focused on the Foreword importance of staying connected with others as we age. The physical environment and where we live plays an important part in how well we are able Older people in to do that, such as where local services Cardiff and the including GP surgeries, dentists and Vale of Glamorgan

CHAPTER 5 pharmacies are located, what amenities are in our local area such as parks and shops, and what public transport is What is healthy available to get to places. With the ageing? PLACES FOR LIFE recovery from Covid-19 being at the forefront of current attention, where we live is going to play an increasingly important role in helping us to live healthier lives. With restricted movement Purpose in life from our homes, our home and the local environment become even more important to our wellbeing. The physical Film by Letitia Aherne, Creative Media Level 3 student, Cardiff and Vale College environment is important in supporting people to have good physical and mental Connections in life wellbeing and deal with the impact of In later life we may start to face some Across Europe there is a growing social isolation. challenges in how we get around our movement to create more age-friendly local area, and mobility needs can environments88 and this chapter will Mobility, or our ability to get around, change. Flexible transport options are highlight some of the approaches that and transport are important in helping Places for life needed, such as public or community can support this movement and help people to remain healthy, active and transport, or being able to walk or people to experience good health and connected in later life. Being able to get cycle, but these can sometimes be well-being as they move into later life. to shops, services and see friends and limited. There are many factors which family enables us to have a good quality influence how easily people are able In the film above, we meet Ron, who of life in a practical sense, but it also Appendix to live independently within their talks about what he enjoys about living supports our emotional needs as we can community, and in particular for people his local area and how important the connect to others85. Mobility and having with reduced mobility. These factors can local facilities are to his wellbeing. social support are key to healthy ageing, include environmental obstacles such as and to improve these, there is a need poorly maintained pavements, a lack of References to consider how we can create age- pedestrian crossings, or poor signage87. supportive environments86.

33 Director of Public Health - Annual Report 2019 Age-friendly spaces: an Foreword international concept, locally applied

Older people in The World Health Organisation (WHO) Cardiff and the Global Network for Age-friendly Cities Vale of Glamorgan and Communities is about cities and communities worldwide who are striving to better meet the needs of their older residents89. Creating age What is healthy ageing? friendly environments requires action from across the spectrum of sectors, from local government to the third sector, and from housing to care providers. Cardiff Public Services Board Purpose in life has already committed to work towards gaining age-friendly status. It could The age-friendly outdoor spaces and buildings • Separate cycle paths for cyclists provide impetus and a mechanism checklist from the World Health Organisation • Street lighting for adding value to our urban and includes the following: • Services are close to where older people live rural environments, as accessible and • Clean spaces with enforcement around noise and easily accessed (on ground floor), clustered Connections in life supportive in order to meet older levels and odours together people’s needs now and in the future • Well maintained green spaces with adequate • Adequate public toilets that are clean, well so it would be useful to also explore this toilet facilities maintained and accessible, well signed and in opportunity in the Vale of Glamorgan. • Pedestrian friendly walkways in open spaces, convenient locations • Buildings are accessible and have the following Places for life free from obstructions with smooth surfaces When planning and designing outdoor • Outdoor seating available, particularly in parks, features: spaces and buildings, there are ways to transport stops, and public spaces. Spaced at o Lifts ensure that the environment is age- regular intervals, and safe to access o Ramps friendly and supportive for people as • Pavements are well maintained, smooth, level, non- o Adequate signage o Railings on stairs Appendix they move into later life. The WHO slip and wide enough to accommodate wheelchairs, toolkit for policy makers and planners with low curbs. Pedestrians have priority of use o Stairs that are not too high or steep provides guidance on developing, • Sufficient pedestrian crossings over roads which o Non-slip flooring implementing and evaluating age- allow enough time to cross where lights are o Rest areas with comfortable chairs friendly policies and interventions88. included o Sufficient numbers of public toilets References Source: World Health Organisation (2007) Global Age-friendly Cities: A Guide. https://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf

34 Director of Public Health - Annual Report 2019 Accessible transport Older people told us that transport was a big Foreword We spoke to a number of older concern. There was a feeling that public transport people in the preparation of this Many older people use public transport to get to needed to be improved, and provided adequately report, and they gave their views places, but equally many do not because of reasons in new developments, particularly in the rural parts on what they feel makes their such as it not being convenient, expensive, difficult of the Vale of Glamorgan to ensure that people are Older people in community a good place to live: to access, or because they are struggling with ill able to stay connected to others and to services and Cardiff and the health90. At the current time, many older people activities in the area. Vale of Glamorgan • Community meeting spaces are reluctant to use public transport due to concern where activities could be held over Covid-19, and have reduced use along with “As far as future developments are and people don’t have to travel many other people in the population91. Older people concerned, the Council must ensure What is healthy too far to see other people we spoke to talked about some difficulties with that they are adequately provided with ageing? • Gardens and communal green using public transport. spaces transport links (buses). Also community • Easy to walk to places “I am in my late 60s and dread the halls and space for shops. Need good • Reliable and accessible public thought of losing my partner as I don’t infrastructure to bring the community Purpose in life transport together” • Better pavements drive. In outlying areas buses stop after • More benches 5pm and you often don’t know when Focus group participant (January 2020) • Traffic calming to slow down public transport services are cancelled or traffic delayed” Pedestrian crossings Connections in life • More public toilets • New housing estates – need focus group participant (January 2020) There are guidelines used around the world for good transport links, maintained setting the speed at which people should be able community open spaces If people are to be able to remain connected to to safely use pedestrian crossings, which say that • More bins others, accessible transport links are vital, and people should be able to walk across at 1.2 metres Places for life • Restrict the number of cars at services and facilities need to be positioned as per second95. Local authorities use this guide to each property close to people’s homes as possible92. How we get reduce the risk of pedestrians being hit by cyclists or around also influences our health as we age, with motorists. However, studies in the UK have found an increasing body of evidence suggesting that that many older people cannot walk fast enough Appendix walking, cycling and the use of public transport all to use a pedestrian crossing because their walking contribute to better health outcomes. Many people speed is below 1.2 metres per second95,96. The still drive in older age and find this to be an essential studies recommend that a crossing speed of 0.8 means of maintaining social contact, particularly in metres per second should be the standard timing to rural areas85. allow for the slower walking speeds of older people. References

35 Director of Public Health - Annual Report 2019 Age-friendly environments When people feel safe in their Walkable neighbourhoods Foreword communities and find it easier to get A poorly designed environment and around, it encourages them to have a Being physically active is an important part of healthy unpredictable public transport services more active lifestyle97. Barriers that the ageing as it enables people to retain mobility and can can reduce older people’s ability and focus group highlighted included the postpone physical decline and lower the risk of ill health Older people in willingness to access activities and remain shared use of pavements and footpaths such as heart disease and also lower the risk of falls93. Cardiff and the independent87. Sometimes the design by pedestrians and cyclists. Some people Vale of Glamorgan of public spaces can impact on people’s said they were reluctant to use them as Having safe and pleasant local places to get to on foot, ability and desire to walk to places, cyclists often travel very fast along them along with recreational facilities, open spaces, shops such as a lack of amenities (benches and do not use a bell to warn people. and public transport leads to older people having higher levels of physical activity94. A ‘walkable neighbourhood’ What is healthy and public toilets), the condition of Pavements are also often used by cyclists ageing? pavements, and the design of pavements when they are not designated for cycling. means that people can travel on foot from their home to and footpaths, and a lack of appropriate the places that they want to go. As people age they may signage or maps85. If a new shared use route is being become less mobile and able to walk less distance but proposed, it is important to consider this change is not always well accommodated for by the 87 who may be using that route, and if this design of the environment . Purpose in life “As we age, we need to keep includes older people it may be necessary walking as much as possible and to make some modifications to meet their do more to stay healthy. Walking particular needs98. in my area (an urban area in Connections in life Cardiff) is more pleasant than it The availability of seating areas is seen by many older people, including those was due to the better air quality who took part in the focus groups, with some factories closed now, as an essential feature of an urban but there are barriers to walking environment. It can be difficult for some Places for life older people to walk around their local around such as the poor quality area without having somewhere to rest of pavements and the fact that along the way. people park on pavements, and 15 minute city bikes travel fast along them” Although there is a desire to reduce This concept is an urban planning strategy aimed to Appendix car use generally, when urban realm improve the quality of life for people living in a city improvements or pedestrian schemes are Focus group participant (January 2020) or a neighbourhood. It is about making services, being planned, it is important to consider amenities, green spaces and homes all within a 15 the need to provide disabled parking and minute walk of each other. www.youtube.com/ drop off spaces for those who need them. watch?v=McGyONofhi4&t=33s References

36 Director of Public Health - Annual Report 2019 Planning for people Foreword Creating an environment where people and ease of movement by walking are given priority will benefit the whole of society, but particularly older people for whom walking may be their chosen mode of getting around. We Older people in know that if there is less traffic on the streets, more people will interact, Cardiff and the move around in the environment, stop and talk to each other, and have Vale of Glamorgan much more community interaction, as well as experience lower levels of air pollution, all of which is beneficial for health and well-being99,100. Providing easy access to community growing spaces and allotments enables people to What is healthy benefit from growing their own food, physical activity and social interaction. ageing? Dementia Designing a dementia-friendly environment friendly environment There are approximately 5,000 people currently diagnosed with dementia Purpose in life living in Cardiff and the Vale of Glamorgan and a large number living without a formal diagnosis101. There are a number of initiatives which are underway that will ensure we have a future inclusive society for everyone, including those people living with dementia. One of these initiatives is the ‘Dementia Friendly Communities’ work which includes training people to Connections in life better understand dementia and how to support people. There are now over 25,000 ‘dementia friends’ in Cardiff and the Vale of Glamorgan who have undertaken this training. Urban design can be highly beneficial for people with dementia, as well as Places for life wider society, to ensure that the local environment is as easy to navigate as possible. Some specific elements of urban design recommended by the Royal Town Planning Institute for people with dementia are102: • Accessible environment – there should be facilities such as shops and services within a 5 to 10 minute walk of housing. Entrances should be • Familiar environment – making the function of a building or a space clear clear and obvious and conform to disability access regulations; and obvious, and any changes to this are small scale and incremental; Appendix • Comfortable environment – open spaces well defined with adequate • Legible environment – having a hierarchy of street types, which are seating, toilets, shelter and lighting. Minimise noise through planting and short and fairly narrow. Clear signage at decision points, for example at fencing. Minimise street clutter to keep pathways as clear as possible crossings or junctions; and to not distract attention; • Distinctive environment – using features in a variety of styles and • Safe environment – footpaths are wide, flat and non-slip, development is References materials to make them unique. Use a variety of practical features like oriented to avoid dark shadows or bright glare. trees and street furniture; Source: RTPI Practice Advice (Jan 2017) Dementia and Town Planning

37 Director of Public Health - Annual Report 2019 Housing get to see friends or family, or get to services, it can lead to loneliness and Foreword isolation. As outlined in chapter 4, loneliness can be detrimental to health The quality of housing is one of the key things that can impact our health and wellbeing. Ensuring that older people’s housing is within easy reach of and wellbeing103. The infographic below highlights some health and well- transport, services and amenities is very important to maintain good health being impacts of poor housing. and well-being104. Older people in Cardiff and the The vast majority of older people in Cardiff and the Vale of Glamorgan Vale of Glamorgan live in their own home, which reflects the UK position shown in figure 12 below. Most people who live in their own homes intend to stay there106.

What is healthy Figure 12: Percentage of older people living in mainstream housing ageing? in the UK

Purpose in life Source: Public Health Wales, BRE Trust and Welsh Government, 2020

Three key factors in homes have the highest health-related impact for older people according to a House of Commons report: if a home poses a Connections in life risk of falls due to trip and slip hazards; if a home is cold; and the location of the home as it can lead to isolation if people are far away from social contacts104.

A third of people over 65 and half of those over 85 fall each year105. Around Places for life half of all of the attendances at the emergency unit in UHW for people aged 65 and over who have fallen are those people who have had a fall in their own home. This is often due to steps or stairs, slipping on the floor or in the bath, or trip hazards like rugs or trailing wires. Falls can have major Wales has the oldest housing stock in the UK, and the highest treatment impacts on the health and wellbeing of older people, both physically and costs in relation to poor housing103. It is very important that investment is Appendix mentally as it can affect confidence when people are worried about going made in existing housing stock, as there are significant health benefits that out as they feel they may fall105. can be achieved, and also significant cost savings. For example, in a study by Care and Repair Cymru, home adaptations generated £7.50 of health and The impact of living in a cold home can be serious, with links to chronic social care savings for every £1 spent103. This was through enabling quicker diseases such as lung conditions and heart disease. The location of the hospital discharge, prevention of accidents in the home and preventing References home is important, as if people are isolated where they live and cannot people going into hospital.

38 Director of Public Health - Annual Report 2019 Access to information on the challenges this will bring in terms of Vale of Glamorgan the local authorities Foreword housing housing. Cardiff Council has published in partnership with RSLs, are making its Older Persons Housing Strategy provision for building new homes to 2019-2023107 and the Vale of Glamorgan accommodate future needs, with a One of the key issues identified in the Council will shortly be publishing its range of housing types and tenures. House of Commons Committee review Older people in strategy too. These strategies have been There is also a need to work with the into housing for older people104 was Cardiff and the developed following a comprehensive private house developers in order to build that there is a need for more advice and Vale of Glamorgan assessment of older people’s housing homes where people can remain living guidance for older people to help them and accommodation needs for the throughout their lives. make the right decisions about how and future which was undertaken in 2018 where they live in later life. Whether for Cardiff and Vale Regional Partnership New homes should meet basic design What is healthy people wish to make improvements to Board (RPB)108. Due to the predicted standards so that people with mobility ageing? their own home or move to a new home, significant growth in numbers of older issues can access them and move there can be a lack of appropriate and people the assessment concluded that around easily90. The housing needs accessible information available106. the need for housing of various types assessment for Cardiff and the Vale of would significantly increase by 2035, and Glamorgan recommended that new People often need specialist advice Purpose in life action was needed to address this. The housing developments should include about housing finance due to having RPB has developed an action plan based well designed homes which will appeal to consider things like pensions and on the assessment. specifically to older people who do paying for care at the same time. There not wish to move to housing which is is information available to try and The assessment undertaken for the RPB designed solely for older people108. This Connections in life understand all of this, but lots of it is included focus groups with older people could include being part of an inter- online, and although this will suit many to hear their thoughts about housing generational housing scheme and have older people, there are others who do need. One of the key messages from features of a ‘care ready’ home (being use the internet or would prefer a face the focus groups was that older people able to be adapted to needs). to face conversation106. This is also a wanted ‘lifetime homes’ to be a priority, Places for life problem for people who may not be able so that people didn’t feel they needed to read as well, or those who do not Design of homes and spaces to move, and that services could be speak English as their first language. accessed easily. Creating intergenerational spaces can support people to be able to remain Appendix Housing stock Planning Policy Wales 10 guidance living in their communities and help requires authorities to set specific targets create social connections87. There are Cardiff and Vale of Glamorgan local for older persons’ housing and to work also ways of designing homes that authorities, and registered social with developers to achieve this109, and can help achieve intergenerational landlords (RSLs), all recognise the issue plan for a mix of market and affordable spaces and homes that suit different References of having an ageing population and housing types. Across Cardiff and the needs throughout a lifetime including:

39 Director of Public Health - Annual Report 2019 “Don’t just look diverse spaces for playing, cooking Engaging older people about Foreword at a house as a and socialising; wider doorways to The HAPPI (Housing our design and developments building, think provide greater accessibility for example Ageing Population Panel about the people for wheelchairs, mobility scooters or for Innovation) principles Welsh Government technical advice inside” Focus pushchairs; use of appropriate sound notes provide detailed planning advice, Older people in are based on good design insulation; and stair designs that could and local authorities need to take them Cardiff and the group participant 110 accommodate a stair-lift . There was a principles but have particular into account when they are preparing Vale of Glamorgan feeling by some focus group participants (January 2020) relevance to older people’s development plans. Note 12: Design112, we spoke to in developing this report states that “in every area of development that newly built housing developments needs. The 10 HAPPI design criteria108 are: earlier and greater attention should What is healthy might be designed to meet the needs of be given to the needs of all sectors of ageing? younger generations, but they should be society, including older people”. The • Space and flexibility built thinking about who might live there principle of giving attention to all sectors • Daylight in the home and in in the years ahead. of society is to apply to the design of shared spaces public spaces, transport and the location, • Balconies and outdoor space All new homes have to conform to design and layout of public facilities Purpose in life • Adaptability and ‘care ready’ certain design standards. A future as well as the design of buildings. The design proofing approach could include needs of older people should be given • Positive use of circulation space planning policies requiring house builders particular attention and they should be • Shared facilities and ‘hubs’ to have a percentage of new homes included in designing new developments. • Plants, trees, and the natural Connections in life built using design principles which environment will particularly support older people’s Engagement of older people in designing • Energy efficiency and sustainable requirements, enabling them to remain new developments or services can design living in their homes for longer. Our provide many benefits to individuals, • Storage for belongings and two local authorities and social housing groups and organisations. This includes bicycles Places for life providers are already building homes to learning that can ensure developments • External shared surfaces and certain standards, using design criteria and services are fit for purpose; improved 111 ‘home zones’ such as the Lifetime Homes or HAPPI relationships in the community; and older (Housing our Ageing Population Panel for people learning new skills, increasing Innovation) standards. confidence and improving their health Appendix and well-being. Many older people want to have a say in the things that affect them113.

References

40 Director of Public Health - Annual Report 2019 Over the next 20 years, Cardiff and the As Cardiff and the Vale of Glamorgan Foreword Manchester has been recognised Vale of Glamorgan will experience a are in a period of substantial growth, it as a leading age-friendly authority, period of significant growth. The Local is an opportunity to involve older people having been a member of the Development Plans which were adopted in the design and development of new WHO Age-friendly Communities in 2016 in Cardiff and 2017 in the Vale homes, infrastructure and communities Older people in since 2010. Being ‘age-friendly’ in of Glamorgan include the provision of that will ensure their needs are being Cardiff and the Manchester means that older people around 50,000 new houses across the met. It is also important that we also Vale of Glamorgan have the right to influence decisions region, as well as infrastructure such as consider the needs of those people in that affect their lives, and to be able roads and rail routes, and community existing homes where improvements and to contribute to their neighbourhood facilities. This level of development investments are needed to achieve health 114 What is healthy and their city . People are very creates strong opportunities to design improvements. ageing? much part of decision making in the healthy ageing into the plans, to create city and have the opportunity to be places that support people to be able to In designing homes for the future, we involved in a wide range of activities have a healthy older age. Older people are not only planning for older people’s including:- should be engaged in the development needs, but for future generations, as of local development plans, and the homes can be adaptable. Good design Purpose in life • Being Age-Friendly Champions, plans should incorporate age-friendly principles can ensure that the health advocating for improvements and homes for life approaches. At a local and wellbeing needs of older people is a for older people, for example level, older people should be consulted key consideration when development is getting bus shelters put up around plans for new developments. undertaken. at bus stops in one area of Connections in life Manchester Summary • Holding coffee mornings to discuss plans for how homes In the chapter we have outlined the and neighbourhoods can be importance of ‘place’ in healthy ageing, Places for life designed to be age-friendly and how where we live impacts upon • Being part of the Age-Friendly our health and wellbeing. Having a Manchester Older People’s warm, safe home that is located in an Board, which influences the age-friendly environment and close planning and development of to services, can support older people Appendix services to remain connected to others, access • Taking part in consultation support when they need it, and retain activities around plans for new their mobility. developments

References

41 Director of Public Health - Annual Report 2019 Foreword CALL TO ACTION

Older people in Cardiff and the Public advice and help to declutter and pack up Create partnership opportunities to Vale of Glamorgan Take part in community consultation their homes, and also get advice about further advance planning and design processes when new development is maintaining their homes if they are not opportunities for older people through planned for your local area and the Local moving progressing a World Health Organisation What is healthy Development Plans are being drafted Age Friendly approach in both Cardiff ageing? Cardiff and Vale of Glamorgan local and the Vale of Glamorgan Welsh Government authorities Develop more detailed guidance around Undertake community engagement Cardiff and Vale University the design of age-friendly spaces and with older people as part of the local Health Board development plan review process and Purpose in life communities addressing the needs of Incorporate urban design principles older people in urban planning and local developments for older people when designing new design buildings or redeveloping existing Include specific policy in local buildings, both in community and acute Develop stronger and clearer planning development plans to address the needs sites Connections in life policies and guidance which will facilitate of older people, to include urban design the provision of a wider range of homes standards such as the Age-friendly for older people, and promote the use of World Health Organisation checklist and quality design standards such as Lifetime housing requirements for older people Homes or HAPPI (Housing our Ageing including intergenerational developments Places for life Population Panel for Innovation) to ensure housing for life is available across Apply urban design standards and tenures accessibility criteria when redesigning existing infrastructure, for example Enable older people to able to access increasing timing on light controlled Appendix advice and information to guide them pedestrian crossings to 0.8m/sec to make in moving home, whether purchasing or it safer to cross at slower speed renting, including specialised financial

References

42 Director of Public Health - Annual Report 2019 Foreword APPENDIX: PROGRESS REPORT: DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT 2018

Older people in Cardiff and the The 2018 Director of Public Health report ‘Moving Forwards: Move More, Cardiff and Vale • Support Clinical Boards to Vale of Glamorgan More Often’ made a number of recommendations for the public and key University Health o promote walking and cycling as prevention and treatment options for a Board number of chronic conditions partner organisations. o promote group opportunities for being active to reduce social isolation • Ensure the design of healthcare buildings prioritise physical activity and infrastructure is in place to support active travel What is healthy • Implement the commitments agreed within the Staff Healthy Travel Charter ageing? Who Key Messages • Use green spaces effectively • Connect health board facilities and services across Cardiff and Vale to Public • Sit less, move more and more often active travel routes • Build brisk walking and/or cycling into daily journeys • Invest in stairwells to ensure they are attractive environments • Be active with others. For example, group exercise classes at gyms or • Participate in and support annual campaigns such as walking month (May) leisure centres, sports teams, running groups, walks or bike rides with or bike to work day (15th August) Purpose in life friends and family • Visit and make use of the green and blue spaces for being active and for Cardiff and Vale • Prioritise physical activity within the public health work plan and within active play Public Health relevant action plans • Encourage children to limit screen time in favour of outdoor active play Team • Work with partners to develop, implement and monitor actions that increase inclusive physical activity and active travel opportunities Welsh • Develop and implement cross department and sector strategies and • Further consolidate and strengthen links with health board and local Government policies that prioritise walking, cycling and play, promotes being active and authority planning and transport departments to influence plans and designs infrastructure that supports the population to be more active Connections in life policies to support physical activity and active travel • Promote and support partners to engage in annual campaigns such as Cardiff and • Take action to make walking and cycling accessible to all walking month (May) or bike to work day (15th August) the Vale of • Implement and monitor the commitments agreed within the Staff Healthy Glamorgan Public Travel Charter Schools • Influence and support the active travel behaviour of pupils and staff Services Boards • Advocate for the protection and maintenance of green and blue spaces • Protect time for children and young people to be active throughout the and for infrastructure that supports the population to be active Places for life school day Cardiff and Vale • Design inclusive activity-friendly neighbourhoods that prioritises walking Workplaces and • Implement the commitments agreed within the Staff Healthy Travel Charter of Glamorgan and cycling and meets children’s needs for play Employers • Influence the design of healthcare buildings to ensure physical activity is Councils • Embed supportive infrastructure that increases physical activity prioritised and ensure the infrastructure is in place to support active travel opportunities, across land use and transport policies and plans • Invest in stairwells to ensure they are attractive environments • Protect and promote green spaces which connect communities and • Participate in and support annual campaigns such as walking month (May) provide outdoor spaces for people to be active Appendix or bike to work day (15th August) • Implement the commitments agreed within the Staff Healthy Travel Charter • Provide community wide and one to one physical activity interventions These actions focussed on addressing some of the barriers people of all ages across organisations and within local communities can face to becoming more active and recommended ways that can help us • Participate in and support annual campaigns such as walking month (May) or bike to work day (15th August weave being active into our day-to-day lives. We have made some excellent References progress against the recommendations but still have a lot more to do.

43 Director of Public Health - Annual Report 2019 Foreword WHAT WE DID / OUTCOMES

Older people in Messages to the public including more bikes, a planned introduction of e-bikes, and expansion of the Cardiff and the • Making Every Contact Count training has been delivered to health care scheme into the Vale of Glamorgan. Working closely with health colleagues, Vale of Glamorgan professionals and staff from a wide range of organisations. The training equips Cardiff Council also supported and enabled Wales’ first GP referral scheme to attendees with information about the benefits of physical activity, the guidelines, Parkrun to be set up in Trelai Park. and physical activity opportunities available in the community. The participants are trained to be able to have behaviour change conversations with their patients/ Cardiff and Vale University Health Board (UHB) What is healthy clients, passing on key messages. • The UHB developed a Cardiff and Vale Physical Activity Health Pathway to ageing? • Throughout the Covid-19 pandemic, Cardiff and Vale Public Health Team have provide clinicians (usually general practice teams, but available to other specialists developed and shared specific social media messaging about the importance and health professionals). The Pathway provides accurate and local information of being active for health and wellbeing and building resilience. We have also for the clinician to discuss the benefits and local opportunities for physical signposted people to the many online opportunities available. A website has been activity with patients. They can then offer the patient a Cardiff or Vale Physical launched by Cardiff and Vale UHB to support those impacted by Covid-19, and Activity Prescription with the details for the local activities which they have Purpose in life promote the importance of being active to aid recovery. discussed. • Some of the activities on the Physical Activity Prescription scheme have been Cardiff and the Vale of Glamorgan Public Services Boards (PSBs) developed during the last year, with the opportunity for some GPs to prescribe • The PSBs and the Regional Partnership Board have together created a Move a free Nextbike membership to their patients. The development of the Trelai More Eat Well plan, and have pledged to deliver actions that will help to create Parkrun has encouraged nine GP practices in the Cardiff West cluster to sign up as ‘Parkrun practices’, and refer patients to the local Parkrun. Connections in life an environment which makes moving more and eating well the easy choice. There are many elements of the plan which will create change and help increase • The UHB has also provided the opportunity for NHS staff in Cardiff and the Vale walking and cycling across Cardiff and the Vale, including: of Glamorgan to access free vouchers for using Nextbikes for commuting during o Develop and implement Healthy Travel Charters across public, private and the Covid-19 pandemic. third sectors • The University Hospital of Wales’ B Block stairwells have been transformed, with o Implement and expand public cycle hire schemes, including electric bikes healthy living messages appearing throughout. It has made the stairwell more Places for life o Further develop and maintain cycling and walking infrastructure and cycling attractive and appealing, and resulted in an increased number of people using parking the stairs. o Develop an integrated public transport system • The UHB have developed a Covid-19 rehabilitation model for patients. The model o Current and future developments design in accessible blue and starts while patients are in hospital, and continues once they are home, with green space and formal places for outdoor play and recreation the aim of enabling people to live independently and continue their recovery. Appendix • Many of the PSB partners have signed the Public Sector Healthy Travel Charter, The model covers a broad range of rehabilitation and is focused around an and implemented many of the commitments within it. individual’s needs, but physical activity is a key part of the rehabilitation process. • The Clinical Diagnostics and Therapeutics Clinical Board worked with the Public Cardiff and Vale of Glamorgan Councils-led work Health Team to develop a workplace initiative called ‘Work Health, My Health’ to • Improvements have been made to the infrastructure for walking and cycling, illustrate to staff the small steps they can take to make a big difference to their and this has facilitated physical activity. Improvements include: new cycleways in health. In collaboration with staff, many resources have been developed, shared References Cardiff; active travel routes in the Vale of Glamorgan; development and expansion and used by staff, including ‘Moves of the week’, walking month trackers, and of street play schemes; and enhancement of the Nextbikes cycle hire scheme walking routes.

44 Director of Public Health - Annual Report 2019 Chapter 1 Foreword 1. StatsWales (2020) National level population estimates by year, age and UK country [Online] [accessed 21 July 2020]. Available at: https:// statswales.gov.wales/Catalogue/Population-and-Migration/Population/Estimates/nationallevelpopulationestimates-by-year-age-ukcountry 2. Office for National Statistics. (2020) Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2019. [online] [Accessed 21 July 2020] https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/ Older people in populationestimatesforukenglandandwalesscotlandandnorthernireland Cardiff and the 3. Cardiff Council. Delivering Capital Ambition, Cardiff’s Corporate Plan 2018-2021 [online] [Accessed 11 February 2020] Available at: Vale of Glamorgan https://www.cardiff.gov.uk/ENG/Your-Council/Strategies-plans-and-policies/Corporate-Plan/Pages/Corporate-Plan.aspx 4. Office for National Statistics (25 October 2019 dataset). Ward level population estimates. [online] [Accessed on 21 March 2020] REFERENCES Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/ wardlevelmidyearpopulationestimatesexperimental What is healthy 5. Public Health Wales Observatory (2019) Public Health Outcomes Framework. [online] [Accessed 21 March 2020] Available at: ageing? http://www.publichealthwalesobservatory.wales.nhs.uk/phof

Chapter 2 6. Government Office for Science (2016) Future of an Ageing Population [online] [Accessed 21 July 2020] Available at: Purpose in life https://www.gov.uk/government/publications/future-of-an-ageing-population 7. Public Health Wales Observatory 2019, Public Health Outcomes Framework [online] [Accessed 12 February 2020] Available at: http://www.publichealthwalesobservatory.wales.nhs.uk/phof 8. Stats Wales, National Survey for Wales 2018-19 [online] [Accessed 12 February 2020] Available at: https://statswales.gov.wales/Catalogue/National-Survey-for-Wales/Population-Health/Adult-Lifestyles/adultlifestyles-by-age-gender 9. Aggio D, Papachristou E, Papacosta O, et al. Trajectories of physical activity from midlife to old age and associations with subsequent Connections in life cardiovascular disease and all-cause mortality. J Epidemiol Community Health 2020;74:130-136. [online] [Accessed 12 February 2020] https://jech.bmj.com/content/74/2/130 10. Older People’s Commissioner for Wales Strategy 2019-22 ‘Making Wales the best place in the world to grow older’ [online] [Accessed 14 February 2020] Available at: https://www.olderpeoplewales.com/en/publications/strategy.aspx 11. Public Health Wales Observatory, Public Health outcomes framework reporting tool 2017 [online] [Accessed 14 February 2020] Available at: Places for life http://www.publichealthwalesobservatory.wales.nhs.uk/phof 12. Public Health England (2019) Place-based approaches for reducing health inequalities [online] [Accessed 14 February 2020] Available at: https://www.gov.uk/government/publications/health-inequalities-place-based-approaches-to-reduce-inequalities

Chapter 3 Appendix 13. Ryff (1995) The Structure of Psychological Wellbeing Revisited. Journal of Personality and Social Psychology 1995, Vol. 69, No. 4,719-727 14. Alimujiang et al (2019) Association Between Life Purpose and Mortality Among US Adults Older Than 50 YearsJAMA Network Open. 2(5):e194270. doi:10.1001/jamanetworkopen.2019.4270 15. Schaefer et al (2013) Purpose in life predicts better emotional recovery from negative stimuli. [online] [Accessed 10 January 2020] Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080329. References

45 Director of Public Health - Annual Report 2019 16. Gonzalez-Celis et al (2016) Purpose in Life and Personal Growth: Predictors of Quality in Life in Mexican Elders. Pyschology, 7, 714-720. Foreword [online] [Accessed 10 January 2020] Available at: https://pdfs.semanticscholar.org/f699/96d46d31abe373f4edba88a4bfe88fc000ac.pdf 17. Waddell, G and Burton, A.K. (2006) Is Work Good For Your Health and Well-being? London: The Stationary Office 18. BITC (2014) The Missing Million: Illuminating the employment challenges of the over 50s. [online] [Accessed 10 January 2020] Available at: file:///C:/Users/ka132476/Downloads/Missing-million-illuminating-the-employment-challenges-of-the-over-50s%20(1).pdf 19. Black,C. (2008) Working for a healthier tomorrow: Dame Carol Black’s Review of the health of Britain’s working age population. London. Older people in The Stationary Office. Cardiff and the 20. ONS (2019) Health state life expectancies, UK: 2016 to 2018. [Online] [Accessed 10 January 2020] Available at: https://www.ons.gov.uk/ Vale of Glamorgan peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2016to2018#healt hy-and-disability-free-life-expectancy-in-the-uk 21. Annual Report of the Chief Medical Officer 2015, On the State of the Public’s Health, Baby Boomers: Fit for the Future. [online] [Accessed on What is healthy 13 January 2020] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/654806/ ageing? CMO_baby_boomers_annual_report_2015.pdf 22. CIPD (2015) Research Report February 2015, Managing an age-diverse workforce: what employers need to know. [online] [Accessed on 13 January 2020] Available at: https://www.cipd.co.uk/Images/managing-an-age-diverse-workforce_2015-what-employers-need-to-know_tcm18-10832.pdf 23. Centre for Ageing Better (2018) Becoming an Age Friendly Employer. [online] [Accessed 24 February 2020] Available at: Purpose in life https://www.ageing-better.org.uk/our-work/age-friendly-employers 24. Department of Work and Pensions (2017) Employer Experiences of Recruiting, Retaining and Retraining Older Workers. [online] [Accessed 21 January 2020] Available at: https://www.gov.uk/government/publications/employer-experiences-of-recruiting-retaining-and-retraining-older- workers-qualitative-research 25. Department of Work and Pensions (2017) Fuller Working Lives: A Partnership Approach [online] [Accessed 24 February 2020] Available from: https://www.gov.uk/government/publications/employer-experiences-of-recruiting-retaining-and-retraining-older-workers-qualitative-research Connections in life 26. The Prince’s Initiative for Mature Enterprise (2014) The Missing Million. Illuminating the employment challenges of the over 50’s. [online] [accessed 13 January 2020] Available at: https://www.gov.uk/government/publications/fuller-working-lives-a-partnership-approach 27. Older People’s Commissioner for Wales (2019) State of the Nation: An overview of growing older in Wales. [online] [Accessed on 25 February 2020] Available at: https://www.olderpeoplewales.com/en/Reviews/SOTN.aspx Places for life 28. Business Wales (2019) People don’t have a best before date. [online] [Accessed 14 January 2020] Available at: https://businesswales.gov.wales/skillsgateway/skills-development/people-dont-have-best-date 29. Public Health Wales Observatory, Public Health outcomes framework reporting tool 2017 [online] [Accessed 14 February 2020] Available at: http://www.publichealthwalesobservatory.wales.nhs.uk/phof 30. NIHR (2020) Major study into long-term health effects of COVID-19 launched in the UK. [online] [Accessed 14 February 2020] Available at: Appendix https://www.nihr.ac.uk/news 31. NOMIS (2019) Labour Market Profiles. [online] [Accessed on 13 March 2020] Available at: https://www.nomisweb.co.uk/reports/lmp/la/contents.aspx 32. Department of Work and Pensions (2017) Fuller Working Lives: Evidence Base.[online] [Accessed 13 March 2020] Available at: https://www.gov.uk/government/publications/fuller-working-lives-evidence-base-2017 References 33. The Centre for Social Justice (2019) Ageing Confidently: Supporting an ageing workforce. [online] [Accessed 2 February 2020] Available at: https://www.gov.uk/government/publications/fuller-working-lives-evidence-base-2017

46 Director of Public Health - Annual Report 2019 34. UK Government website [online] [Accessed 3 February 2020] Available at: https://www.gov.uk/flexible-working Foreword 35. Public Health Wales (2020) ‘Staying at Home and Social Distancing Policy’ in Wales in response to the COVID-19 pandemic. Main Report. Cardiff, Public Health Wales NHS Trust. [online] [Accessed 15 July 2020] Available at: https://phw.nhs.wales 36. Welsh Government (2019) Work in Wales, 2006-2017: Evidence from the Skills and Employment Survey [online] [Accessed 17 January 2020] Available at: https://gov.wales/skills-and-employment-survey-work-wales-2006-2017 37. Centre for Ageing Better (2018) A silver lining for the UK economy: The intergenerational case for supporting longer working lives [online] Older people in [Accessed 11 January 2020] Available at: https://www.ageing-better.org.uk/publications/silver-lining-uk-economy Cardiff and the 38. What Works Wellbeing (2017) Retirement and Wellbeing Briefing [online] [Accessed 13 January 2020] Available at: Vale of Glamorgan https://whatworkswellbeing.org/ 39. Welsh Government (2020) People don’t have a best before date [online] [Accessed 12 February 2020] Available at: https://businesswales.gov.wales/skillsgateway/skills-development/people-dont-have-best-date What is healthy 40. Centre for Ageing Better (2019) The State of Ageing in 2019 [online] [Accessed 24 January 2020] Available at: ageing? https://www.ageing-better.org.uk/sites 41. Centre for Ageing Better (2018) The experience of the transition to retirement: Rapid evidence review [online] [Accessed 21 February 2020] Available at: https://www.ageing-better.org.uk 42. Aviva (2016) Voice of New Retirement Report [online] [Accessed 22 February 2020] Available at: https://www.aviva.com/newsroom/news-releases/2016 Purpose in life 43. Accessed 21 February 2020] Available at: https://www.ageing-better.org.uk 44. Kim et al (2017) JAMA Psychiatry. 2017;74(10):1039-1046. doi:10.1001/jamapsychiatry.2017.2145 45. NHS Scotland (2014) Making it Easy: A health literacy action plan for Scotland [online] [Accessed 10 December 2020] Available at: https://www.gov.scot/publications/making-easy/ 46. Public Health England (2015) Improving health literacy to reduce health inequalities [online] [Accessed 10 December 2020] Available at: www.gov.uk Connections in life 47. ONS (2019) Internet users, UK: 2019 [online] [Accessed 15 January 2020] Available at: https://www.ons.gov.uk/businessindustryandtrade/itandinternetindustry/bulletins/internetusers/2019 48. NHS (2018) A Health and Care Digital Capabilities Framework [online] [Accessed 21 January 2020] Available at: https://www.hee.nhs.uk/sites/default/files/documents/Digital%20Literacy%20Capability%20Framework%202018.pdf

Places for life Chapter 4 49. Centre for Ageing Better (2019) The State of Ageing in 2019, adding life to our years [online] [Accessed on 1 February 2020] Available at: https://www.ageing-better.org.uk/sites/default/files/2019-11/The-State-of-Ageing-2019-Adding-life-to-our-years.pdf 50. The Lancet (2017) Dementia prevention, intervention, and care. [online] [Accessed 5 February 2020] Available at: https://www.thelancet.com/commissions/dementia2020 Appendix 51. Holt-Lunstad J, TB, Layton JB. (2010) Social relationships and mortality risk: a meta-analytic review. PLoS Medicine 7 [online] [Accessed 5 May 2020] Available at: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316

References

47 Director of Public Health - Annual Report 2019 52. Royal College of General Practitioners (2018) Tackling Loneliness: A Community Action Plan, Wales. [online] [Accessed 20 January 2020] Foreword Available at: https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2018/RCGP-loneliness-manifesto-wales-2018.ashx?la=en 53. Public Health Wales (2020) A Health Impact Assessment of the ‘Staying at home and social distancing policy’ in Wales. Main report. [online] [Accessed 13 July 2020] Available at: https://whiasu.publichealthnetwork.cymru/en/hia-reports/ 54. Age UK (2019) Social connections and the brain [online] [Accessed 18 February 2020] Available at: https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/mental-wellbeing/ Older people in 55. Public Health Wales Observatory (2019), Public Health Outcomes Framework [online] [Accessed 18 February 2020] Available at: Cardiff and the http://www.publichealthwalesobservatory.wales.nhs.uk/phof Vale of Glamorgan 56. NHS (2018) Loneliness in older people [online] [Accessed 18 February 2020] Available at: https://www.nhs.uk/conditions/stress-anxiety-depression/loneliness-in-older-people/ 57. Welsh Government (2020) Connected Communities. A strategy for tackling loneliness and social isolation and building stronger social What is healthy connections. [online] [Accessed 17 February 2020]. Available at: https://gov.wales/loneliness-and-social-isolation-connected-communities ageing? 58. Campaign to end loneliness (2013) Hidden Citizens: how can we identify the most lonely adults? [online] [Accessed 18 February 2020] Available at: https://www.campaigntoendloneliness.org/wp-content/uploads/CEL-Hidden-People-report-final-1.pdf 59. Centre for Ageing Better (2019) The State of Ageing in 2019, adding life to our years [online] [Accessed 1 February 2020] Available at: https://www.ageing-better.org.uk/publications 60. Joseph Rowntree Foundation (2020) Impact of poverty on relationships. [online] [Accessed 20 February 2020] Available at: Purpose in life https://www.jrf.org.uk/data/impact-poverty-relationships 61. Age UK (2019) Poverty in later life briefing. [online] [Accessed 20 February 2020] Available at: https://www.ageuk.org.uk 62. Foot J. (2012) What Makes us Healthy? The asset approach in practice: evidence, action, evaluation [online] [Accessed 20 February 2020] Available at: dec13.pdfhttp://www.assetbasedconsulting.co.uk/uploads/publications/WMUH.pdf 63. The Kings Fund (2013) Improving the public’s health: a resource for local authorities [online] [Accessed 20 February 2020] Available at https://www.kingsfund.org.uk Connections in life 64. Campaign to end loneliness. How do you identify or recognise the most lonely? [online] [Accessed 18 February 2020] Available at: https://www.campaigntoendloneliness.org/frequently-asked-questions/identify-most-isolated/ 65. Public Health Wales (2018) Primary Care Hub, Social Prescribing in Wales. [online] [Accessed 25 February 2020] Available at http://www.primarycareone.wales.nhs.uk/social-prescribing/ 66. University of Westminster (2017) Making sense of social prescribing [online] [Accessed 15 February 2020]. Available at: Places for life https://www.westminster.ac.uk/research/groups-and-centres/westminster-international-centre-for-social-prescribing 67. Age UK (2016) No one should have no one: working to tackle loneliness amongst older people. [online] [Accessed 13 February 2020]. Available at: https://www.ageuk.org.uk/Documents/EN-GB/No-one_Should_Have_No-one_Working_to_end_loneliness.pdf?dtrk=true 68. Royal College of General Practitioners (2018) Tackling Loneliness: A Community Action Plan, Wales. [online] [Accessed 20 February 2020] Available at: https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2018/RCGP-loneliness-manifesto-wales-2018.ashx?la=en Appendix 69. Welsh Government (2019) Digital Inclusion Guide for Health and Care in Wales [online] [Accessed 21 January] Available at: https://nwis.nhs.wales/files/publications/digital-inc-guide-0619-english-pdf/

References

48 Director of Public Health - Annual Report 2019 70. Age UK (2015) Later Life in a Digital World [online] [Accessed 18 January 2020] Available at: https://www.ageuk.org.uk Foreword 71. Welsh Government (2018) Improving people’s lives through digital technologies: Digital Inclusion Progress Report and Forward Look 2018 [online] [Accessed 21 January 2020] Available at: https://gov.wales/digital-inclusion-framework-report-and-forward-look 72. Welsh Government (2016) Delivering Digital Inclusion: a Strategic Framework for Wales. [online] [Accessed 18 February 2020] Available at: https://gov.wales/sites/default/files/publications/2019-05/digital-inclusion-framework_0.pdf Older people in 73. British Society of Gerontology (2020) COVID-19 vs Social Isolation: the Impact Technology can have on Communities, Social Connections Cardiff and the and Citizens [Online] [Accessed 21 July 2020]. Available at: https://ageingissues.wordpress.com/2020/03/18/covid-19-vs-social-isolation-the- Vale of Glamorgan impact-technology-can-have-on-communities-social-connections-and-citizens/ 74. Campaign to end Loneliness (2020) Coronavirus and social isolation. [online] [Accessed 20 July 2020] Available at: https://www.campaigntoendloneliness.org/blog/coronavirus-and-social-isolation/ What is healthy 75. Campaign to End Loneliness (2015) Age UK, Promising approaches to reducing loneliness and isolation in later life. [online] [Accessed 23 ageing? February 2020] Available at https://www.campaigntoendloneliness.org/wp-content/uploads/Promising-approaches-to-reducing-loneliness- and-isolation-in-later-life.pdf 76. World Health Organisation: Age Friendly Cities Framework (2014) [online] [Accessed 20 March 2020] Available at: https://extranet.who.int/agefriendlyworld/age-friendly-cities-framework/ 77. Centre for Ageing Better (2016) The benefits of making a contribution to your community in later life [online] [Accessed 18 February 2020] Purpose in life Available at: https://www.ageing-better.org.uk/sites/default/files/2018-06/Evidence-Review-Community-Contributions.pdf 78. Welsh Government (2020) National Survey for Wales, wellbeing and finances, percentage of people who volunteer by age [online] [Accessed 20 February 2020] Available at: https://statswales.gov.wales/Catalogue/National-Survey-for-Wales/Well-being-and-Finances/ percentageofpeoplewhovolunteer-by-age 79. Centre for Ageing Better (2019) Breaking down emotional barriers is key to making volunteering accessible to all. [online] [Accessed 18 February 2020] Available at: https://www.ageing-better.org.uk/news/ Connections in life 80. Centre for Ageing Better (2018) Age-Friendly and inclusive volunteering: Review of community contributions in later life. [online] [Accessed 18 February 2020] Available at: https://www.ageing-better.org.uk/ 81. Beth Johnson Foundation (2011) A guide to intergenerational Practice [Online] [Accessed 2 February 2020]. Available at: https://www.ageingwellinwales.com/en/resource-hub/afc-resources Places for life 82. Welsh Government (2019) Review of key mechanisms in intergenerational practices, and their effectiveness at reducing loneliness/social isolation. Executive Summary. [online] [Accessed 10 February 2020] Available at: https://gov.wales/key-mechanisms-intergenerational-practices-effectiveness-reducing-loneliness-social-isolation 83. Cardiff and Vale UHB (2018) Staying Steady Schools Report [Online] [Accessed 25 February 2020]. Available at: https://cavuhb.nhs.wales/patient-advice/keeping-people-well/public-health-help-and-advice/falls-prevention/ Appendix 84. Older People’s Commissioner for Wales (2019) Generations Together [Online] [Accessed 25 February 2020] Available at: http://www.olderpeoplewales.com/en/intergenerational/resources.aspx

References

49 Director of Public Health - Annual Report 2019 Chapter 5 Foreword 85. Centre for Ageing Better (2019) Ageing and Mobility: A grand challenge. Centre for Ageing Better [online] [Accessed 31 January 2020] Available at: https://www.ageing-better.org.uk 86. Levasseur M et al. (2015) Importance of proximity to resources, social support, transportation, and neighbourhood security for mobility and social participation in older adults: results from a scoping study BMC Public Health. 2015; 15: 503. Published online 2015 May 23. [online] Older people in [Accessed 31 January 2020] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460861/ Cardiff and the 87. Arup (2019) Cities Alive: Designing for Ageing Communities. Arup [online] [Accessed 12 January 2020] Vale of Glamorgan https://foresight.arup.com/publications/ageing-communities/ 88. World Health Organisation. (2016) Creating Age Friendly Environments in Europe: a guide for policy makers and planners. [online] [Accessed 31 January 2020] Available at: http://www.euro.who.int/__data/assets/pdf_file/0018/333702/AFEE-tool.pdf?ua=1 89. World Health Organisation website: Global Network for Age-friendly Cities and Communities [online] [Accessed 31 January 2020] What is healthy https://www.who.int/ageing/projects/age_friendly_cities_network/en/ ageing? 90. Centre for Ageing Better (2019) The State of Ageing in 2019: Adding life to our years. Centre for Ageing Better [online] [cited 31 January 2020] https://www.ageing-better.org.uk/sites/default/files/2019-11/The-State-of-Ageing-2019-Adding-life-to-our-years.pdf 91. Public Health Wales (2020) A Health Impact Assessment of the ‘Staying at home and social distancing policy’ in Wales [online] [Accessed 13 July 2020]. Available at: https://whiasu.publichealthnetwork.cymru/en/hia-reports/ 92. Public Health England (2019) A consensus on healthy ageing. Public Health England. [online] [Accessed 21 January 2020] Available at: Purpose in life https://www.gov.uk/government/publications/healthy-ageing-consensus-statement 93. NHS England (2018) [online] [Accessed 31 January 2020] Available at: https://www.nhs.uk/live-well/exercise/exercise-as-you-get-older/ 94. Barnett, D.W., Barnett, A., Nathan, A. et al. (2017) Built environmental correlates of older adults’ total physical activity and walking: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 14, 103 doi:10.1186/s12966-017-0558-z [online] [Accessed 31 January 2020] Available at: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0558-z#citeas Connections in life 95. Webb E et al (2017) Crossing the road in time: inequalities in older people’s walking speeds. Journal of transport and health 5. 77-83. [online] [Accessed 31 January 2020] Available at: http://dx.doi.org/10.1016/j.jth.2017.02.009 96. Asher L et al. (2012) Most older pedestrians are unable to cross the road in time: A cross sectional study. Age and Ageing 2012; 41: 690– 694 doi: 10.1093/ageing/afs076 [online] [Accessed 31 January 2020] Available at: https://www.researchgate.net/publication/225307198_ Most_older_pedestrians_are_unable_to_cross_the_road_in_time_A_cross-sectional_study Places for life 97. Ageing Well in Wales and COPA, Making Wales a nation of age-friendly communities [online] [Accessed 31 January 2020] Available at: http://www.ageingwellinwales.com/Libraries/Documents/AFC-guide-eng.pdf 98. Department for Transport (2012) Local Transport Note 1/12, Shared Use Routes for Pedestrians and Cyclists. September 2012. [online] [Accessed 31 January 2020] Available at: https://www.winacc.org.uk/wp-content/uploads/2012/11/shared-use-routes-for-pedestrians-and-cyclists.pdf 99. Living Streets (2016) Walkable Neighbourhoods. [online] [Accessed 31 January 2020] Available at: Appendix https://www.livingstreets.org.uk/policy-and-resources/our-policy/walkable-neighbourhoods 100. Living Streets. Low Traffic Neighbourhoods, an introduction for policy makers. [online] [Accessed 31 January 2020] Available at: https://www.livingstreets.org.uk

References

50 Director of Public Health - Annual Report 2019 101. Cardiff and Vale Integrated Health and Social Care Partnership (2018) Cardiff and Vale of Glamorgan Dementia Strategy 2018-2028. Foreword [online] [Accessed 4 February 2020] Available at: http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/1143/Dementia%20 Strategy%20C%20and%20V%202018-2028%20FINAL%20%28003%29.pdf 102. RTPI Practice Advice (2017) Dementia and Town Planning. [online] [Accessed 4 February 2020] Available at: https://www.rtpi.org.uk/media/2213533/dementia_and_town_planning_final.compressed.pdf 103. Public Health Wales, BRE Trust, Welsh Government (2019) Making a Difference Housing and Health: A case for investment [online] Older people in [Accessed 4 February 2020] Available at: https://phw.nhs.wales/files/housing-and-health-reports/a-case-for-investment-report/ Cardiff and the 104. House of Commons, Communities and Local Government Committee. Housing for Older People, second report of session 2017-2019. Vale of Glamorgan [online] [Accessed 30 January 2020] Available at: https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/370/370.pdf 105. Public Health England (2020) Falls: Applying all our Health [online] [Accessed 30 January 2020] Available at: https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health What is healthy 106. Centre for Ageing Better (2019) Home truths, Housing options and advice for people in later life: Learning from communities in Leeds. ageing? [online] [Accessed 4 February 2020] Available at: https://www.ageing-better.org.uk/sites/default/files/2019-07/Home-truths-report.pdf 107. Cardiff Council, Cardiff Older Persons Housing Strategy 2019-2023 [online] [Accessed 4 February 2020] Available at: https://www.cardiff.gov.uk/ENG/Your-Council/Strategies-plans-and-policies/Social-care-and-Housing/Older-Persons-Housing-Strategy/ Documents/Older%20People%27s%20Housing%20Strategy%202019.pdf 108. Housing LIN 2018 Assessment of Older Person’s Housing and Accommodation including with Care and Care Ready. [online] [Accessed Purpose in life 4 February 2020] Available at: https://www.valeofglamorgan.gov.uk/en/our_council/Council-Structure/minutes,_agendas_and_reports/ reports/Scrutiny-HSC/2018/18-09-12/Older-Persons-Housing-and-Accommodation.aspx 109. Welsh Government (2018) Planning Policy Wales – edition 10, December 2018. [online] [Accessed 5 February 2020] Available at: https://gov.wales/sites/default/files/publications/2018-12/planning-policy-wales-edition-10.pdf 110. NHS England (2019) Putting Health into Place: Principles 4-8, Design, Deliver and Manage [online] [Accessed 5 February 2020] Available at: https://www.england.nhs.uk/wp-content/uploads/2019/09/phip-2-design-deliver-manage.pdf Connections in life 111. Lifetime Homes (2010) The Lifetime Homes Standard [online] [Accessed 5 February 2020] Available at: http://www.lifetimehomes.org.uk/pages/revised-design-criteria.html 112. Welsh Government (2016) Technical Advice Note 12: Design. March 2016. [online] [Accessed 5 February 2020] Available at: https://gov.wales/sites/default/files/publications/2018-09/tan12-design.pdf 113. Age UK (2012) Engaging with Older People evidence review [online] [Accessed 5 February 2020] Available at: https://www.ageuk.org.uk/ Places for life Documents/EN-GB/For-professionals/Research/Evidence_Review_Engagement_with_Older_People.pdf?dtrk=true 114. Manchester City Council (2016) Living in Manchester, our age-friendly city. [online] [Accessed 5 February 2020] Available at: https://secure.manchester.gov.uk/downloads/download/6534/living_in_manchester_our_age-friendly_city

Appendix

References

51 Director of Public Health - Annual Report 2019