Getting to know Storage Media 1.Stores information 2.Retrieve information for later use.
Getting On: Wellbeing in Later Life
Transcript of Getting On: Wellbeing in Later Life
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GettingOn:Well-beinginlaterlife
JamesMcCormickwithJonathanClifton,AliceSachrajda,MyriamChertiandEleanorMcDowell
December2009
ippr2009
InstituteforPublicPolicyResearchChallengingideas Changingpolicy
WWW.IPPR.ORG
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Aboutippr ............................................................................................................................. 3
Aboutthecontributors.......................................................................................................... 3
Acknowledgements ............................................................................................................... 3
1.Introduction...................................................................................................................... 4
2.Understandingattitudestolaterlife.............................................................................. 11
3.Policiesforpeaceofmind?............................................................................................ 17
4.Lessonsfromabroad:ageingandwellbeinginaninternationalcontext ...................... 27
5.Creatingaresponsiveandsupportivecommunityforolderpeople:qualitativeanalysis
ofwellbeinginolderage.................................................................................................... 39
6.Wellbeinginlaterlife:summingupthethemes ............................................................ 51
7.Recommendations.......................................................................................................... 59
Contents
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TheInstituteforPublicPolicyResearch(ippr)istheUKsleadingprogressivethinktank,producingcutting-edgeresearchandinnovativepolicyideasforajust,democraticand
sustainableworld.Since1988,wehavebeenattheforefrontofprogressivedebateandpolicymakingintheUK.Throughourindependentresearchandanalysiswedefinenewagendasforchangeandprovidepracticalsolutionstochallengesacrossthefullrangeofpublicpolicyissues.
WithofficesinbothLondonandNewcastle,weensureouroutlookisasbroad-basedaspossible,whileourGlobalChangeprogrammeextendsourpartnershipsandinfluencebeyondtheUK,givingusatrulyworld-classreputationforhighqualityresearch.
ippr,30-32SouthamptonStreet,LondonWC2E7RA.Tel:+44(0)2074706100E:[email protected]
www.ippr.org.RegisteredCharityNo.800065
ThispaperwasfirstpublishedinDecember2009.ippr2009
Aboutippr
ipprwouldliketoacknowledgethegeneroussupportoffundingpartnersinthePoliticsofAgeingproject:CalousteGulbenkianFoundation,IntelHealthandtheNorthernRockFoundation.
TheauthorswouldliketothankallwhoparticipatedinthePoliticsofAgeing seminarseriesandinthefocusgroupdiscussionsinBerwick-Upon-Tweed,LondonandNewcastle.WewouldliketoexpressourthankstothetheYearsAheadForumspeerresearcherswhocommentedonadraftversionofChapter5,aswellasothercolleagueswhocontributedtoourwork:AndrewHarris,GeorginaKyriacou,CareyOppenheim,RuthSheldonandKateStanley.
Acknowledgements
MyriamChertiisaSeniorResearchFellowatipprwhereshespecialisesinqualititativeresearchmethods.MyriamholdsanMScinSocialPolicyfromtheLondonSchoolofEconomicsandPoliticalSciencesandaPhDinMigrationStudiesfromtheUniversityofSussex.
JonathanClifton isaresearcherintheCitizens,SocietyandEconomyprogrammeatippr.HecompletedanMAasaCommonwealthScholarattheUniversityofBritishColumbiainVancouverandholdsaBAinGeographyfromDurhamUniversity.
JamesMcCormickisanipprResearchAssociateandaco-founderofMcCormick-McDowellResearchPartnership.HeisScotlandadvisertotheJosephRowntreeFoundationandwaspreviouslyDirectoroftheScottishCouncilFoundationthinktank(200207).Hisresearchinterestsincludewelfarereform,thefutureofsecondaryschoolsandapproachestopublicinvolvement.
EleanorMcDowell isco-founderofMcCormick-McDowellresearchpartnership.Shewaspreviouslyalecturer(1995-2008)intheSchoolofLawandSocialSciencesatGlasgowCalendonianUniversity,specialisinginEnvironmentalSociology.SheistheauthorofanewEnvironmentchapterinSociology:MakingSenseofSociety(2009)andco-authorofSustainableWorkingLives,acomparativestudyofflexibleworkinginEurope(2008).
AliceSachrajda isaresearcheratipprwhereshespecialisesinqualititativeresearchmethods.SheholdsanMScwithdistinctioninHumanRightsfromtheLondonSchoolofEconomicsandaBAinLawandFrenchfromtheUniversityofSheffield.
Aboutthecontributors
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WehaveknownforsometimethatthepopulationoftheUnitedKingdomisgettingolderandthatthenumberofpeopleagedover75(sometimesreferredtoastheolderold)isgrowingparticularlyquickly.Encouragingly,healthylifeexpectancythenumberofyearslivedwithoutillnessordisabilityisimprovingonaverage.
Thereisalivelypolicydebateaboutlaterlife,dominatedbyhowtoimprovepensionsandsocialcare,andwhowillfootthebill.Butthereismuchlessinformationaboutpeoplesexperiencesofgrowingolder:theirqualityoflife,theirexpectationsandtheiremotionalwellbeing.ipprsworkonthepoliticsofageingseekstoplugthisgap,and,further,toplaceaclearerfocusoninequalitiesinolderpeopleswellbeing.
Thisreportsetsoutawideragendaforpolicymakersandpractitioners.ItreviewsUK
policiesforolderpeopleandinternationalpractice,aswellastheprioritiesofolderpeopleinurbanversusrurallocations.Itconcludeswithrecommendationsforaction,whichsignalafreshapproachtolaterlifeandseektochallengeoutdatedassumptions.
First,inthisintroductorychapter,wereviewtheexistingevidenceonwellbeinginlaterlife.Weconsiderfiveessentialelementsofwellbeingaswellassomeoftheemergingrisksfacingolderpeople.
Wellbeinginlaterlife
Theevidenceonolderpeopleswellbeingismixed.IntheUK,measuresofhappinessappeartotakeaU-shapeacrossthelifecourse,withbothyoungerandolderpeoplehappierthanthoseinmiddleage.However,thisoffersonlyapartialaccountsincethebest-knownUKstudy(BlanchflowerandOswald2004)doesnotreportdataforpeopleagedover70(Allen2008).Thepatternaftertheageof80isnotconsideredalthoughotherevidence(referredtobelow)indicatesthatintheseyearspeoplecanexpectpoorermentalhealthandlowerlevelsofwellbeing.
Recentevidence(AcademyofMedicalSciences2009)presentsamoreoptimisticviewofageingintheUKthaninthepast.TheconsensusamongBritishmedicalresearcherspointstohealthylifeexpectancyrisingfasterthanitwaspreviouslythoughtitwould.Thishastwoimplicationsforpolicymakers:first,thereisaneedtounderstandtheprotectivefactorsthatmeansomearefaringbetterinlaterlifethaneverbefore;andsecond,wemustaddresstheriskfactorsthatcontinuetomeanothersfacepooremotionalwell-beinginlaterlife.Theseissuesarereviewedinsubsequentchapters.
RecentstudiesintheUnitedStatessuggestthatolderpeopletendtogethappierevenintotheirnineties,exceptforpeoplewithdementia-relatedillhealth(Carstensen2009).Findingssuggestthatolderpeopleincreasinglymakethemostofthetimetheyhaveleft,havinglearnedhowtocopewithlossanddisappointment.Inaddition,theyshowolderpeoplebeingfarlesspronetopersistentnegativemoodsthanyoungadults,moreresilienttopersonalcriticismandbetteratcontrollingandbalancingemotionsastheygotolder.Theadvicearisingfromtheresearchistostartpreparingearly,forexamplebyinvestingtimeinsocialnetworksoutsidethehomeandworkplace.
1.Introduction
JamesMcCormick
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Essentialelementsofwellbeinginlaterlife
Nazrooetal (2005)developedaframeworkaroundthemainfactorsinfluencingqualityoflifeforolderpeople.WehaveadapteditbasedonourreviewofevidencefortheUKandidentifiedfiveessentialelementsofwellbeinginlaterlife.Theseare:
Resilience
Independence
Health
Incomeandwealth
Havingaroleandhavingtime
Resilience
Thesignificanceoflifechangesforwellbeingisclear.Forolderpeople,deterioratinghealth,theonsetofdisability,bereavementandrelationshipbreakdownposethebiggestriskstoemotionalwellbeing(Banksetal 2006).Thesecantriggerlow-leveldepressionandworse.Whatfollowsdependsgreatlyonresiliencethecapacitytocopewithdifficultlifeevents.Havinggoodsocialnetworksandanactivesociallifecanreducetherisks,includingdepression,andthequalityofsocialrelationshipscaninfluencethewaythebrainprocessesinformation(Carstensen2009).
Factorscontributingtoapersonsresilienceare:
Previousexperiencesandthedegreetowhichwearepreparedfordifficulttransitions
Thebreadthofsocialnetworksspanningbothstrongandweakties(familyandfriendsaswellaspeer/self-helpsupportandserviceproviders)
Otherpersonalresourcesforcoping(forexample,incomeandeducationallevels).AlongitudinalstudyinFinlandhasfoundthatpeopleagedaround50andlivingaloneweretwiceaslikelyasthosewhoweremarriedorco-habitingtodevelopdementiabetweentheagesof65and79(Hkanssonetal2009).Theriskforthosewhowerewidowedordivorcedwasthreetimesashigh.Thestudyfollowedpeopleovera21-yearperiodandidentifiedasubstantialandindependentassociationbetween[couple]statusinmid-lifeandcognitivefunctioninlaterlife.Inaddition,furtherresearchbytheKarolinskaInstituteinSwedenfoundthathavinganextensivesocialnetwork,keepingactiveandstayingsociallyconnectedappeartoprotectagainstdementia.Carstensen(2009)citesastudyofmorethan1,000Swedes,noneofwhomhadshownsignsofdementiabeforethestudy.Thosewithastrongsocialnetworkwere60percentless
likelytodevelopsymptomsofcognitiveimpairmentthanthosewhodidnothavesuchsocialties.Butweknowlessabouthowsocialnetworkscanbestrengthenedorrepaired.
Friendshipsandsocialnetworks
Declininghealthanddisabilityharmemotionalwellbeingpartlythroughtheir socialimpact.Forexample,mobilitymaybereduced,leadingtolesscontactwithfamilyandfriendsandlessopportunitytogoout.Thismayincreasefeelingsofisolation,withdrawalandevencauseafearofgoingoutandisonepathwaytodepression.Eightypercentofolderpeoplewhosaytheyareoftenlonelylivealone(Actor etal2002).
However,higherlevelsofsocialcontactandespeciallypositiveinteractionwithfriendsreducetheriskofdepressionevenforthosewithpoorhealthordisabilities.Forsome,
activeinvolvementinfaithcommunitiescanofferasenseofacceptance,purposeandparticipationinasupportivenetwork.Akeyquestionishowsupportservices,irrespectiveofwhofundsanddeliversthem,cantackleisolationmoreeffectively.
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Independence
Housingandhome
Housingisparticularlyimportantforpeopleover75whospendlongperiodsathome.SinglepersonhouseholdsinEnglandaremostlikelytobelivinginnon-decenthomes,including
one-third(34percent)ofsinglepeopleaged60andover(OfficeforNationalStatistics2008).Thereisgreaterrecognitiontodayoftheroleofdesignincreatingtrulyaccessiblehousing,placesandpublicservices.Wearelikelytoseeashiftingbalanceofcarewitholderpeoplestayingintheirownhomesforlonger.Indeed,despiteanincreasingnumberofolderpeoplereceivingcare,alreadyfewerarenowinresidentialandnursinghomes.Enablingolderpeopletoliveathomeforlongerwillrequiresignificantgrowthofpreventativesupportinthecommunity,fromsupportforolderpeopletostayactiveandindependenttosimplehousingadaptationsandmoreintensivesocialcareathome,aswellasgreaterclarityondifferentformsofhousingwithcare(forexample,shelteredhousing).
RecentevidencefromEnglandsuggeststhatwardenserviceshavebecomepatchierwiththewithdrawalofthering-fencedSupportingPeoplebudget.Insomecases,wardensupporthas
beenreducedfromon-sitetoweeklyorlessfrequentvisits.Thismayincreaseanxietyandstressforresidents,breachingtheexpectationofsupportthatencouragedsometooptforshelteredhousing.Manyolderpeoplewhowouldstruggletoliveindependentlymightbenefitfromshelteredhousingbutwouldneedtomovetomoreexpensiveresidentialcareifadequatesupportwerenotavailable.
Environmentandisolation
Theimpactofthephysicalenvironmentonwellbeinghasbeenestablishedinvariousstudies.Livinginahighlyurbanenvironmentcanincreaselow-leveldepressionamongolderpeopleasaresultofpoorerhousingquality,theamountoftraffic,persistentnoise,litterandgraffiti,lackofgreenspaceandcleanair,andfewsocialcontactswithintheneighbourhood(Allen2008).Thesefactorsareespeciallysignificantforolderpeoplelivingaloneandlacking
anactivesociallife.FieldworkfromNorthEastEnglandandLondon(seeChapter5)showsthatisolationunderminesthewellbeingofolderpeopleinsmalltownsandruralareasaswellasthoseinbusyurbanneighbourhoods.Howsafepeopleperceiveanareatobemayalsoimpactontheirwillingnesstogooutandcouldcauseisolation.Whenwalkingaloneinaneighbourhoodafterdark,theproportionofpeopleaged6074whofeltsafewas6percentlowerthanamongadultsasawholeanditwas23percentloweramongpeopleaged75andover1 (ScottishGovernment2008).
Health
InGreatBritainasawhole,youngeroldpeople2 are3to5percentmorelikelythanthenextyoungestagecohorttosaytheirhealthisnotgood.Peopleover75are11percentmorelikelytoreportthesame(Table1.1).Onthismeasure,thepoorhealthgapdoublesaftertheageof75.InScotland,youngeroldpeople3 are9percentmorelikelythanthenextyoungestgroup4 toreportalong-termlimitingillness,healthproblemordisability,buttheover-70sare17percentmorelikelytodothis.Theproportionofpeopleover75sayingtheirhealthisnotgood,orreportinglong-termillnessordisabilityhasnotriseninthelast20years(Allen2008).Butduetotheprojectedincreaseinthenumberofpeopleaged75andover,prevalencerateswouldneedtodroptoavoidasignificantlybiggernumberinthisgrouphavingtheseproblemsinthefuture.
1.Alargernumberoftheoldestrespondents(20percent)saidtheydidnotknow,suggestingtheygo
outseldomornotatallafterdark.
2.Aged6574inOfficeforNationalStatisticsdataand6074intheScottishHouseholdSurvey
3.Aged6069intheScottishHealthSurvey
4.Aged5059intheScottishHealthSurvey
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Wellbeing,mentalhealthanddepression
TheEnglishLongitudinalStudyofAgeing(ELSA)shinesalightonthechanginglivesofpeopleastheygetolder.Anoverallmeasureofwell-beinghasbeenderivedfromit(DepartmentforWorkandPensions2009).Themedianwellbeingscoreforrespondentsaged6579wasonepointlowerthanamongthoseaged5064.However,thescoreamong
peopleaged80andoverwasfourpointslower.Althoughthedifferenceisnotmarked,itappearsthatpeopleinthemiddlestageoflaterlife(6579)aremorelikethenextyoungestagegroupthanthenextoldestintermsofwell-being.
TheEnglishHealthSurveyincludesasetofquestionsonmentalhealthbasedona12-pointmeasure(GeneralHealthQuestionnaireGHQ12).Peoplescoringzeroareconsideredtobefreeofmentalillhealth.Expressedasanaveragefor200406,aroundtwo-thirds(68percent)ofwomenaged6579andahigherproportion(71percent)ofmeninthesameagegrouphadascoreofzero(Table1.2).Peopleinthisagegroupfarebetterthanthenextyoungestrespondents(5064yearolds).Amongpeopleagedover80,theproportionscoringzerofallstojustoverhalf(56percent).Fourintenpeopleinthisagegroupexpressatleastonetypeofmentalhealthproblem.
Thosescoring4ormoreonthismeasureareregardedashavingsomeformofmentalillhealth.Amongpeopleaged6579,10percentofwomenand9percentofmenreachedthisthreshold.Again,theyfarebetterthanthenextyoungestagegroup.Buttherateincreasesamongthoseaged80andover,to15percentofwomenand18percentofmen.Therearesignsthatmentalhealthdeclinesfasteramongmenaftertheageof80.
Bythismeasure,peopleaged6579hadthelowestriskofmentalillhealthofanyagegroup,oldoryoung,whilethoseaged80andoverhadthehighestriskofall.Therearesignsthatmentalhealthdeclinesfasteramongmenthanwomenaftertheageof80.Nonetheless,amajorityofpeopleagedover80appeartostayfreeofmentalillhealth.Aswellasdoingabetterjobofsupportingthosewhoarevulnerabletodepression,weshouldfocusmorecloselyontheprotectivefactorsthatenablemanytoreachthisageingoodmentalhealth.
Isolation,lonelinessandlosscontributetopooremotionalwellbeinginlaterlife.Thismaybeexpressedasreducedlifesatisfaction,low-leveldepressionorworse.Thepathways,farlesstheircauses,arenotrecordedbytheNHS.Asignificantdegreeofunder-reportingofmentalhealthproblemsamongolderpeopleisthuswidelysuspected(Allen2008,UKInquiryintoMentalHealthandWell-beinginLaterLife2007).Thefailuretodetectandtreatmental
Table1.2Averagementalhealth(GHQ12)scoresinEngland,byageandsex(200406)
Women(%) Men(%)
Agerange 1649 5064 6579 80-plus 1649 5064 6579 80-plus
Score0 60 64 68 56 69 68 71 56
Score13 25 20 21 29 21 20 20 26Score4+ 15 16 10 15 10 12 9 18
Source:AdaptedfromDepartmentforWorkandPensions(2009:56-50,Indicator12)
Table1.1Perceptionofownhealthbyagegroup,GreatBritain(2008)andScotland(2008)
GreatBritain(2008) Scotland(2008)
%reportingtheirhealthis: Agerange %reportingtheirhealthis:
Goodorfairlygood Notgood Goodorfairlygood Notgood
4564 85 15 4559 84 16
6574 80 20 6074 81 19
75andover 74 26 75andover 73 27
Source:OfficeforNationalStatistics2008,ScottishGovernment2008
Agerange Agerange
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healthproblemsproperlyaffectsallagegroups,butthedistinctivefeaturesforolderpeoplearethenormalisingofdepressionbysomehealthandcarepractitioners,aswellasthemuchreducedchanceofbeingofferedarangeoftreatmentsincludingtalkingtherapies(UKInquiryintoMentalHealthandWell-beinginLaterLife2007).
Whilerecordedratesofdepressionprovideaverycautiousestimateofthetruepicture,theyindicatethehighestratesofdepressionoccuramongpeopleover75.Between35and40peopleperthousand(3.54.0percent)ofpeopleagedover75areregisteredashavingdepression.Theprojectedgrowthinthenumberofolderpeoplewithdepressionby2025ishighestamongpeopleaged85andover(80percent),followedbypeopleaged6574(40percent)andthenpeopleintheagegroupinbetween,aged7584(33percent)(UKInquiryintoMentalHealthandWell-beinginLaterLife2007).
Depressionratesappeartodoubleamongolderpeoplesufferingillhealthanddisabilityandarehighestofallamongolderpeopleincarehomes.Anestimatedtwoinfiveareinthisposition(Allen2008).Asignificantamountofpreventabledepressionoccursincarehomes,aswellasinappropriate,liberalprescriptionofanti-depressantsandanti-psychoticdrugs,
whichmaydomoreharmthangood.FollowinganexpertreviewitwasreportedinNovember2009that:Needlessuseofanti-psychoticdrugsiswidespreadindementiacareandcontributestothedeathofmanypatients(Triggle2009).Therearealsocasesofcoverttreatment(forexample,administeringdrugsinfood).
Theriskofdepressionishigher,aswell,forolderpeoplewithdementiaandespeciallysoforintensivecarerssuchasoldercarersofpeoplewithdementia.Ratesalsovarybyethnicity:PakistaniandBangladeshiwomeninEnglandandWaleshavethehighestratesoflong-termillnessanddisabilitywhicharelikelytobeariskfactorfordepressioninlaterlife.PakistaniandIndianwomenhavethehighestrecordedratesofdepressionofanyethnicgroup.
Incomeandwealth
Untilrecently,olderagewasstronglyassociatedwithpoverty.Variouschangestomeans-testedbenefitshelpedthepovertyratetofallsteadilyfrom1997to2007,althoughithasstalledinrecentyears.PovertyinolderagefellineverypartoftheUKoverthesameperiod(Palmer2009).ThereductionwasbiggestinScotlandwheretheratehalved,followedbytheNorthEastandYorkshireandtheHumber,twooftheEnglishregionspreviouslywiththehighestpovertyrates.ThesmallestreductionswereintheEastMidlandsandWales.Despitesignificantprogress,in2007oneinthreepeopleaged85oroverwasstilllivingonalowincomecomparedwithoneinfivepeopleaged65to69.Thehighestriskwasamongwomenintheoldestagegrouplivingalone.Moreover,persistentpoverty5 amongolderpeopleinthethree-yearperiod200205wasintherange1315percent.Althoughthiswaslowerthanfiveyearsearlier,olderpeoplewerestill1.5to2.5timesmorelikelytoexperiencepersistentpovertythanworking-ageadults.
Havingaroleandhavingtime
Thelossofstatusandidentitythatcomeswithretirementmaycomeasablowtopeoplewhofeeltheyhavelittleornochoiceoverwhetherandwhentogiveupemployment.ThismaybeaffectedbyemployersobservingtheUKsDefaultRetirementAge,pensionrulesthatdiscourageflexibleworkinginlaterlifeandaphasedapproachtoretirement,orthepressureofhavingcareresponsibilitiesthatcannoteasilybecombinedwithpaidwork.Someolderpeoplefindtheyhavetoomuchunfilledtimeontheirhandsduetoisolationandloneliness.While90percentofpeopleaged60andoverintheUKhavegrandchildren,regularcontactwiththemtendstolessenwithageandwithdistance(Allen2008).Othersmayfindtheyhavetoolittletimetopursueinterestsoutsidethehomeandfamilyasaresultofvery
significantcareresponsibilitiesfortheirpartner,relative,disabledchildorgrandchildren.Carersprovidinganintensivelevelofcarefacethetoughestcircumstancesofall.
5.Definedasbeingonalowincomeforthreeyearsoutoffour
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Olderpeoplecanenhancetheirwellbeingbyhavingaroleoutsidethehomeandfamily,andhavingthetimetopursueotherinterests.Theseincludecontinuingtowork(onaflexiblebasis),pursuingsocialactivitieswithfriends,volunteeringandlearning.However,itappearsthatrelativelyfewolderpeopleareinvolvedinsomeoftheseactivitiesandtherateofparticipationdropssignificantlyamongpeopleover75.Forexample,theScottishHouseholdSurvey(ScottishGovernment2008)showsvolunteeringratesfalling3percentbetweenthepre-retirementcohort(aged4559)andthoseintheearlyandmiddleyearsoflaterlife(6074),butdroppingafurther12percentfromtheageof75.Thesamesurveyshowsparticipationinadultlearningof3percentamong6074yearoldsandjust1percentofpeopleaged75andover.
Emergingrisks
Otheremergingriskstowellbeinginlaterlifehavebeenidentifiedrecently.Thesemaynotbenewrisksforolderpeople,butarebecomingunderstoodmoreclearlyasaresultofbetterevidence.Theyincludethetrendtowardsincreaseddebt,bothunsecuredloansandoutstandingmortgages,andproblematicalcoholconsumption.Oneineightolderpeople
increasestheamounttheydrinkafterretirement,withonethirdofthosewhoaredrinkingmorereportingthatdepressionorbereavementisthemainreason(Foundation66,2009).
Summingup
Theessentialelementsofwellbeinginlaterlifeareincreasinglywellunderstood.Theyspantherelatedfactorsofresilience,independence,health,incomeandwealth,andhavingaroleaswelltimetopursuethatrole.Thebriefreviewofevidenceintroducedinthischapterhighlightstheneedtotakeafreshapproachtolaterlife,especiallywithpeopleover75inmind.Onaverage,peopleintheUKfarerelativelywelluptotheirmid-seventiesasmeasuredbywellbeing,physicalandmentalhealth,levelofpoverty,riskofdepressionandlevelsofparticipation.Inmanyrespects,theyappearmorelikepeopleinthenextyoungest
agegroupthanthenextoldest.Butaturningpointcomesinthelivesofmanyfromtheageof75.Eventhoughmanypeoplecontinuetothrive,theelementsofwellbeingwedescribecandeteriorate,anditisclearthatinequalitiesinlaterlifearegreateramongpeopleaged75andover.
Inthefollowingchapters,weconsidersurveyevidenceonattitudestolaterlifeandapproachestoageingtakenbypolicymakersinthelastdecadeorsoacrosstheUK,aswellasdrawingcomparisonsfromothercountries.WethenturntoexploretheexperiencesandviewsofolderpeoplelivinginruralNorthEastEnglandaswellasinLondonandNewcastle.Weidentifyanumberofeverydayprioritiesdrawnfromfocusgroupdiscussionsintheselocations.Wethensummarisethekeythemeswhichdefineasystemtoimprovewellbeinginlaterlife,addingfurtherelementstothoseintroducedinthischapter.Weconcludewithaset
ofrecommendationsforpolicyandpractice.
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BanksJ,BreezeE,LessofCandNazrooJ(2006)Retirement,healthandrelationshipsoftheolderpopulationinEngland:The2004EnglishLongitudinalStudyofAgeing,ELSA(Wave2),London:
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BlanchflowerDandOswaldA(2004)WellbeingovertimeinBritainandtheUSA,JournalofPublic
Economics Vol.88,1359-1386
CarstensenL(2009)Along,brightfuture:aginginthe21stCentury,PresentationtoAmerican
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PalmerG(2009) Indicatorsofpovertyandsocialexclusion:somecross-countrycomparisons,York:
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HouseholdSurvey,Edinburgh:ScottishGovernment
TriggleN(2009)Dementiadrugusekillingmany,BBCNewsonline,12November,availableat
http://news.bbc.co.uk/1/hi/health/8356423.stm
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Thelevelofwellbeingapersonhasinlaterlifewillinpartbeareflectionofhowsocietyviewsolderpeople,aswellasbeingimpactedbymaterialfactorsincludingincome,healthandsocialsupport.Theattitudesofserviceproviders,employersandthepersononthestreetpresentatougherchallengeforpolicymakersthanthesematerialfactors.Someoftheseproviderscontinuetobediscriminatory(AgeConcernandHelpTheAged2009).InordertoconsiderhowpeopleinBritainviewlaterlifeandoldage,ipprcommissionedasurveyofattitudes.1 Thischapterdiscussesthemainfindings.
Spendingtimewitholderpeople
Someolderpeopledosufferfromisolation,butonthewholethereisconsiderablecontactbetweentheolderandyoungergenerations(Table2.1).Two-thirdsofrespondentssaidtheyhavecontactwithsomeonetheyknowagedover65atleastafewtimesamonth.Thisincludesalmosthalfwhohavecontactatleastafewtimeseveryweek.Aroundoneinfivehasoccasionalcontact(monthlyorafewtimeseachyear)andoneineighthascontactonceayearorless.Thereis,however,someindicationofadifferencebetweenthegenerations,withpeopleintheirmiddleyearsspendingmoretimewitholderpeoplethanyoungpeopledo.Morethanthree-quartersofthoseaged55andoverhavefrequentcontact(thatis,atleasttwiceamonth)comparedwithjustlessthanhalfof2534yearolds.
Therearealsomarkeddifferencesinlevelsofcontactwitholderpeopledependingon
location.TheleveloffrequentcontactishighestinScotlandandSouthWestEnglandandlowestbysomemargininLondon.ThisislikelytoreflectthecapitalsdistinctiveroleinattractingpeopletoworkfromacrossBritain,manyofwhomhavemovedawayfromolderrelatives.Thereisasmalldifferencebetweenthesexes,withwomen4percentmorelikelythanmentospendtimewitholderpeopleeveryday.
Thehappiestyears
Broadly,wetendtothinkpeoplearehappiestwhentheyareyoungest,whileolderageisleastassociatedwiththehappiesttimesinpeopleslives(Table2.2).Halfofrespondentsthinkpeoplearehappiestbeforetheageof45andjustoveraquarterthinkthatitisbefore25thatwearehappiest.Onlyaroundoneintenthinksthatpeople65andoverarehappiest.
1.AnonlinesurveywascarriedoutbyYouGovforipprinJanuary2009.Thesamplesizewas2189adults.ThefiguresreportedinthischapterhavebeenweightedsotheyarerepresentativeofallBritish
adultsaged18andover.
2.Understandingattitudestolaterlife
JamesMcCormick
Table2.1:Frequencyofcontactwithpeopleyouknowagedover65(%)
Respondentagegroup Frequent Occasional Infrequentornever
1824 58 22 15
2534 47 29 183544 70 16 10
4554 72 18 8
55andover 78 12 10
All 67 18 12
Frequent:daily,afewtimesaweek,orafewtimesamonth
Occasional:monthlyoronceeveryfewmonths
Infrequentornever:onceayear,lessoftenornever
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Thesmallestnumberofrespondentsthoughtthatthehappiestyearscomeafterage75.Theseopinionsaretrueforrespondentsofallages,exceptthoseaged55andover.Slightlymoreofthemthinkpeoplearehappiestaftertheageof45thanbefore,andtheyaremorelikelythanotherstothinkhappinesspeaksateither5564or6574.
Therearecleargeographicaldifferencesinattitudes(Table2.3).AlmostoneinfiverespondentsinboththeSouthWestofEnglandandinWalesthinktheyearsafter65arethehappiest,specificallyfortheyoungeroldagedbetween65and74.MuchsmallerproportionssaythisinScotlandandYorkshireandtheHumber.
Theleasthappyyears
Itiscommonforpeopletothinkthatthetimethatistheleasthappyisinthefirst45yearsofapersonslife(Table2.4).Almosthalfofrespondentsthinkthiswhilejustoverathirdbelievethatitisafterage45thatpeopleareleasthappy.Respondentsagedunder45aremorelikelytothinkpeopleareleasthappybetween25and44yearsofagethanatanyothertimeperhapsthisreflectsthestressesassociatedwiththestageinlifewhenmanypeoplearerepayingstudentdebts,seekingtobuyahouseandhavingchildren.Incontrast,aftertheageof45peoplearemorelikelythanotherstoseetheyearsafter65astheleast
happytwiceasmanyasamongrespondentsaged3544.
Table2.2:AgeatwhichmostpeopleintheUKarethoughttobehappiest,by%ofrespondents
ineachagegroup
Agerangethoughttobehappiest(%ofrespondents)
Respondentagegroup Under25 2544 4564 65+
1824 38 28 17 7
2534 34 23 18 9
3544 29 20 19 14
4554 28 26 27 6
55andover 20 22 28 16
All 27 23 23 11
Table2.3:AgeatwhichmostpeopleintheUKarethoughttobehappiest,by%ofrespondents
ineachregionandnation(rankedby%fromage65+)
Agerangethoughttobehappiest(%ofrespondents)
Respondentlocation Under25 2544 4564 65+
SouthWest 22 25 23 19Wales 18 14 26 17
EastMidlands 34 14 25 15
EastofEngland 29 27 18 12
NorthWest 26 26 23 12
SouthEast 24 19 30 12
London 26 32 20 11
WestMidlands 27 21 20 9
Yorkshire&Humber 30 20 28 8
Scotland 30 26 23 5
All 27 23 23 11
Note:FiguresforNorthEastandNorthernIrelandnotshownasrespondentnumbersarebelow100
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Therearealsosomemarkedgeographicaldifferencesinthewaypeopleperceiveagegroups
thatareleasthappy(Table2.5).PeopleintheEastofEngland,YorkshireandtheHumber,EastMidlandsandLondonconsiderolderagetobetheleasthappytimeoflife.MorethanaquarterofpeopleintheEastofEnglandthinkthis,whereasinWaleshalfthatamountdo.
Moresurprising,giventhedifferingexperiencesofpaidandunpaidwork,healthandlifeexpectancybetweenthesexes,nosignificantdifferenceofopinionappearsbetweenwomenandmen.
Overall,ourviewsofhappinessinlaterlifearemorenegativethanpositive.Aroundoneintenrespondentsthinksthehappiestyearsaretobefoundaftertheageof65,butaroundoneinfivebelievesthisistheleasthappytimeofourlives.Thisgivesanegativebalanceforouropinionofolderage(-11),showninthelastcolumnofTables2.4and2.5.Peopleagedover55takethesameviewoflaterlifeasrespondentstakenasawholegroup.Theviewoflaterlifeismostnegativeamong4554yearolds,whichmayreflectthisgroupsexperienceofcaringforolderrelatives.Onbalance,theviewoflifeafterage65ispositiveonlyamong
peopleaged3544andthoselivinginWales.TheviewismostnegativeofallinYorkshireandtheHumber,followedbyScotlandandtheEastofEngland.
Table2.4:AgeatwhichmostpeopleintheUKarethoughttobeleasthappy,by%of
respondentsineachagegroup
Agerangethoughttobeleasthappy(%ofrespondents)
Respondentage Under25 2544 4564 65+ Netmostorleast
group happyfrom65+*1824 19 29 19 22 -15
2534 20 34 12 16 -7
3544 22 30 16 13 +1
4554 18 18 21 26 -20
55andover 23 18 13 27 -11
All 21 25 15 22 -11
*FordiscussionofthiscolumnseetextunderTable2.5
Table2.5:AgeatwhichmostpeopleintheUKarethoughttobeleasthappy,by%of
respondentsineachregionandnation(rankedbynet%fromage65+)
Agerangethoughttobeleasthappy(%ofrespondents)
Respondent Under25 2544 4564 65+ Netmostorleast
location happyfrom65+
Yorkshire&Humber 24 22 9 27 -19
EastofEngland 16 24 17 28 -16
Scotland 21 23 15 21 -16
NorthWest 15 29 14 26 -14
London 21 22 19 24 -13
EastMidlands 21 18 23 23 -8
WestMidlands 17 25 16 15 -6
SouthEast 23 27 15 17 -5
SouthWest 29 21 14 23 -4
Wales 20 29 14 14 +3
All 21 25 15 22 -11
Note:FiguresforNorthEastandNorthernIrelandnotshownasrespondentnumbersarebelow100
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Contributingtosociety
Unsurprisingly,two-thirdsofrespondentsthinkpeoplemakethegreatestfinancialcontributiontosocietywhentheyareinthemiddleoftheirworkinglives,agedeither3544or4554.Lessthanoneintenthinksthat5564yearoldscontributethemost
financially,andjust1percentoptsfortheyoungerold(6574).Respondentsaged55andoveraremuchmorelikelythanotherstothink5564yearoldsmakethebiggestfinancialcontribution,althoughthree-quartersstillbelievepeopleyoungerthanthemselvescontributemost.Peopleagedover65arethoughttocontributetheleastfinancially.Morethanoneinfourtakesthisview,butyoungerrespondentsaremorelikelythanolderrespondentstoagreewithit.
Whilethoseinthemiddleyearsarethoughttocontributethemostfinancially,thepictureisdifferentwhenwelookatcontributingmostinother(non-financial)ways(Table2.6).Thesewerenotspecifiedinthesurvey,butmightbeconsideredtoincludetheunpaidworkofcarersandvolunteers.Peoplethinkthatthepeakagesforcontributingmostinotherwaysareinthesecondhalfofthelife-course.Peopleintheir
pre-retirementyearsandtheyoungeroldareperceivedtomakeasignificantcontribution.Morethanone-thirdofrespondentsthinkpeopleagedover55contributemostinotherways.Thisrisestoalmosthalfforrespondentswhothemselvesareagedover55.Lessthanaquarteroftheunder-25ssharethisview.Only1percentthinkpeople75andovercontributemost.
Aboutonequarterthinkthatpeopleagedover65contributetheleastinother,non-financialways.Here,peopledistinguishbetweenstagesofolderage:only2percentthink6574yearoldscontributeleastbutoneinfivesaysthisaboutpeopleaged85andover.Overall,respondentsare7percentmorelikelytosaypeopleaged65andovercontributeleastthancontributemostinnon-financialways(Table2.7,nextpage).ThisistrueofpeopleineverypartofBritain,thoughpeopleregardthenon-financialcontributionofthisagegroupmostpositivelyinScotland,andmostnegativelyintheEastofEngland.
Table2.6:AgeatwhichmostpeopleintheUKarethoughttocontributemosttooursocietyin
other(non-financial)ways,by%ofrespondentsineachagegroup
Agerangethoughttocontributemost(%ofrespondents)
Respondent Under25 2534 3544 4554 5564 6574 75+
agegroup
1824 22 15 15 11 10 11 2
2534 7 13 18 17 11 14 1
3544 6 8 17 15 17 14 1
4554 3 5 12 23 25 13 0
55andover 2 5 12 17 26 21 1
All 6 8 14 17 19 16 1
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Summingup
Theipprattitudessurveyresultssuggestthatviewsaboutlaterlifearemorecomplexthanmaybeexpected.Attitudesarelikelytobeformedpartlyfromthecontactpeoplehavewitholderpeople.Theyarealsobasedonwhereapersonisinhisorherownlife-course.Wearelikelytothinkpeopleinthesameagegroupasourselves,ortheonenexttous,makeagreatercontributiontosocietythanothers.Thesefindingssuggestweinterpretthese
questionsthroughthelensofourownandourpeersexperiences.Thereareotherintriguingcluesinthedataaboutvariationsinhowweviewolderage.Forexample,peopleaged4554havetheleastpositiveviewoflaterlifeintermsofhappiness,whilepeopleaged3544makethemostpositiveassessment.Theattitudesof4554yearoldsarelikelytobeinfluencedbytheexperiencesoftheirparentsandrelativesinolderage.Withoutfurtherresearch,wecannotbesureiftheexperiencesoftodaysolderpeopleareleadingtomorenegativeattitudesaboutlaterlifethaninthepastorwhetherthisisaconsistentviewofthisstageinlife.
Questionsarise,aswell,aboutthepatternsthatdonotappearnotably,thatthereareonlysmalldifferencesbetweentheviewsofwomenandmendespitetheirbeingsignificantdifferencesbetweenthesexesinlifeexpectancy,theprobabilityoflivingaloneandofliving
withpoorhealthoradisability.
ImportantvariationsarealsoseenacrossBritain,rangingfromarelativelypositiveviewofhappinessinlaterlifeinWalestomorenegativeviewsinYorkshireandtheHumber.Itwouldbeunwisetospeculatetoofaronwhatmightunderpinsuchdifferences,althoughitmaybethecasethattheolderagestructureoftheWelshpopulationandthe10-yearstrategyforolderpeopleintroducedbytheWelshAssemblyGovernmentmayhavehadamodestinfluenceonattitudesthere.
Finally,viewsdistinguishclearlybetweenthestagesofolderage:theyearsbetween65and74areviewedmuchmorepositivelythanthoseaftertheageof85.Thisboundarymaybemovingupwards.Intermsofcontributingtosocietyinnon-financialways,peopleaged
6574areregardedasbeingmorelikethosewhoareaged5564thanpeopleover75.ThecoreaimoftheUKGovernmentsstrategyonageingistocreateasocietyforallages(HMGovernment2009).Legislationtotackleagediscriminationwillhelpinthismission,but
Table2.7:Perceptionsofother,non-financialcontributiontosocietyofpeopleagedover65,by
%ofrespondentsineachregionandnation
%respondentswiththeviewthat:
Respondentlocation Aged65+contributemost Aged65+contributeleast
London 16 23
NorthWest 13 23
Yorkshire&Humber 14 19
EastMidlands 16 25
WestMidlands 17 23
EastofEngland 19 29
SouthEast 19 23
SouthWest 19 24
Wales 16 24
Scotland 22 25All 17 24
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thetaskofchangingoutdatedassumptionsaboutlaterlifegoesfarbeyondtheremitofpolicymaking.SocialmarketinginitiativessuchasSeetheperson,nottheageinScotland(200809),employer-ledapproacheslikeAgePositiveandincreasedcontactbetweenthegenerationsthroughschoolsandsocialcaresettingshighlightthewideragendainvolved.Takingfurtherstepslikethesetoimproveourunderstandingofattitudes,andtochallengethemwherenecessary,willbeessentialinanageingsociety.
References
AgeConcernandHelpTheAged(2009)OneVoice:ShapingourageingsocietyLondon:AgeConcern
andHelpTheAged
HMGovernment(2009)Buildingasocietyforallages,Cm7655,DepartmentforWorkandPensions,
Norwich:TheStationeryOffice
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Thischapterconsidersthechangingpolicyandpracticelandscapeforolderpeopleoverthelastdecade.Inparticular,welookathowfarpolicymakershaveaimedtoimprovewellbeingforallolderpeopleorwhethertheyhaveonlytargetedsome,basedonneed,incomeorstagewithinolderage.Notethatthereisnoconsistentdefinitionofwhoolderpeopleare.Somestrategiesapplytoeveryoneagedover50,someareaimedattheover-60s,somearebasedonstatepensionage,andotherstargettheolderold,agedover75or80.
Wedonotknowverymuchyetabouttheimpactsofprogrammestoimproveolderpeoplesqualityoflife.Evaluationofpoliciesforolderpeopleispatchy,butvariouspatternscanbeseen,nonetheless.
Asaresultofdevolution,variouspolicyaimsforolderpeoplehaveemergedacrosstheUnitedKingdom.Wesetoutthekeypointsinrelationtothisbelow.(SeeMcCormicketal
2009forafullerdiscussion.)1 Broadly,policiesinvolvingcashpayments,employmentandequalitieslegislationapplyacrosstheUKwhileotherservices,suchasconcessionarytravel,warmhousing,healthandcare,applytoEngland,withseparatedevolvedpoliciesintheothernations.
OlderpeoplespolicyintheUKandEngland
TheUKGovernmentsageingstrategy,BuildingaSocietyforAllAges,waspublishedinJuly2009(HMGovernment2009).ItfollowstheOpportunityAge strategy,whichintroducedacomprehensivesetofindicatorstomeasureprogressforolderpeopleandpresentedtheraftofpolicyreformsmadesince1997(summarisedinBox3.1).
1.ipprsDevolutioninPracticeseriesoffersawiderassessmentofhowthethirdtermofdevolutionis
affectingkeypolicyareas.Seewww.ippr.org.uk/ipprnorth/research/teams/project.asp?
id=3354&pid=3354
3.Policiesforpeaceofmind?
JamesMcCormickandEleanorMcDowell
Box3.1.Keypolicyreformsonageingsince1997 PensionCreditincludingGuaranteeintroduced
BasicStatePensionincreasedby7percentoverinflation,pluschangesmadetoeligibility(totakeeffectfrom2010),creditsforcarersofchildrenuptoage12(2011)andTurnerrecommendationsincludingauto-enrolmentinpensionschemesandlinkingofBasicStatePensiontoearnings(from2012)
Freeprescriptions,sighttestsandoff-peakbustravelinstatedthroughoutEnglandforover-60s
Helpwithcentralheating/insulationtargetedtoPensionCreditrecipientsandfreeenergyefficiencymeasures/insulationintroducedforover-70s
FreeTVlicencesprovidedforover-75s
WinterFuelPaymentsmadetoallhouseholdsthatincludesomeoneaged60-plus(higherratefor80-plus)
Agediscriminationandharassmentatworkoutlawed(2006).IntegratedEqualityBilltoincludenewprotectionagainstharmfulagediscriminationingoodsandservices,andadutyonpublicsectoragenciestoage-prooftheirpolicies.
Source:GovernmentEqualitiesOffice(2009)
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InadditiontothereformsidentifiedassignificantbytheGovernmentEqualitiesOffice,thegoalofpersonalisation insocialcareserviceshasgrowninimportance.Legislationpassedin1996authorisedlocalauthoritiesthroughouttheUKtomakedirectpaymentstocareusersinplaceofprovidingservicesdirectly.In2003,newregulationsrequiredEnglishcouncilstoofferdirectpaymentstoalladultsusingcommunitycareservices,whilesimilarguidancecameintoforceinScotlandandNorthernIrelandaroundthesametimeandlaterinWales.TherehasbeenamarkedgrowthinthenumberofclientsreceivingdirectpaymentsinEnglandinthelastdecade.Despitegrowingsupportinthedevolvednations,take-uphasbeenatabouthalftherateofEnglands(Riddelletal2006).
TheEnglishframeworkforadultsocialcareservices,PuttingPeopleFirst(DepartmentofHealth2007),gavefreshimpetustothedebate,introducingtheideaofpersonalbudgets.Thesecanbetakenasadirectpayment,orthelocalcouncilcancommissionaserviceinagreementwiththeserviceuserandcarer,oracombinationofbothispossible(Moullin2008).Theframeworkalsointroducedindividualbudgets,coveringalargerrangeoffundingsourcesincludingSupportingPeople(apartnershipoflocalgovernmentserviceusersand
supportagencies).Theresultsofpilotingin13Englishcouncilsin200607weregenerallypositive,butolderpeoplesupportedbyadultservicesweremorelikelytoreportnotwantingtheadditionalburdenofplanningandmanagingtheirowncare(IBSEN2008).Olderpeopleareahighlydiversegroupandthusfurtherevaluationwillbeneededtoimproveourunderstandingofwhomtheseapproachescanworkbestfor.
Wheretonext?TheUKGovernmentsageingstrategysetsoutthevisionofasocietyforallages.Itseekstochallengeoutdatedstereotypesaboutlaterlifeasatimeofdependencyanddeclineandcreateasocietywherepeoplearenolongerdefinedbyage(HMGovernment2009).TheEqualityBill,tobeintroducedinApril2012,willextendlegalprotectionagainstnegativeandunreasonablediscriminationinconsumerservices,followingequalitieslegislationcoveringemploymentin2006.
Butthedefaultretirementageisstillunderdiscussion.TheUKGovernmentrecognisesconcernaboutenforcedretirementatthestatepensionageandhaspledgedareviewfor2010(earlierthanoriginallyplanned).ipprendorsesscrappingthedefaultposition.
Thetougherculturalchallengeofchangingattitudesandexpectationsaboutlaterlifealsoremains.Whilethisisrecognisedingovernment,thebulkofthe2009strategyfocusesonearlyinterventiontoenablemorepeopletostaywellforlonger,andisgroupedintothethemesof:
Wellbeingthroughactiveageing
Familyandcareroles
Alocalfocusonprevention
Advocacy,scrutinyandinvolvement.
Wediscussthesethemesbelow.
Wellbeingthroughactiveageing
TheBuildingaSocietyforAllAges strategynotesthatwellbeingisreducedbyinactivityandloneliness,whichresultfromnottakingadvantageofopportunitiesavailable.Policymakershavegraspedtheneedtoreducecliff-edgeeffectsassociatedwithage,wherepeoplelapsefromactivityastheygrowolderwhentheywouldprefertocombinesomepaidandunpaidworkwithsocialactivity.Thereisalsorecognitionofthescaleofuntappedmarketopportunitiesrepresentedbyconsumersagedover50,forexampleinleisureandlearning.
Aswellasexpandingtherangeofopportunitiesforolderpeopleandpromotingtheirinvolvement,acleareranalysisisneededofthebarriersthatreduceinvolvementforpeopleindifferentstagesoflaterlife.Weneedabettergraspofthedynamicsofageing,toimprove
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ourunderstandingofwhatiseffectiveatreducingbarriersovertime.Forexample,weknowthatratesofinvolvementinvolunteering,leisureandlearningdeclinesignificantlywithage.Thisreflectsamixofconstraintsaswellaschoiceandleavesasizeableminorityofpeoplewhowouldliketocontinueorreturntotheseactivitiesbutlackthesupportorinformationtodoso.
WhatstepsinthisdirectionareincludedintheGovernmentsstrategy?AnActiveat60programmeisproposedfrom2010,bringingtogethernationalinformationonpensions,benefitsandotherentitlementswhiletestingoutwaysofmakinglocalinformationavailablethroughcouncils.InformationwillbeprovidedtoallpeopleapproachingstatepensionagebythePensionService.Pre-retirementcoursestoimproveawarenessoffinancialeducation,adultlearningandvolunteeringopportunitieswillbeexpandedthroughCitizensAdviceandvoluntarysectorpartners.Othersourcesofinformation,adviceandguidancewillbeexpandedaswell,coveringmoneyguidance,housingandcare.
Allofthisraisesthequestionofhowtodeliverinformationinaformatandatatimewhenitislikelytohavemostimpact.Olderpeopleplaceahighvalueongettingholdofgood,
accurateinformation.Thiscanhelppeoplestayindependentandincontroloftheirlivesforlonger,especiallyiftheyneedtodealwithcomplicatedsystemstoaccessessentialservices(Horton2009).ThereisongoingworkinNewcastle,forexample,focusedoncreatingastrongerlocalsystemforinformation,adviceandadvocacybyimprovingawarenessandsign-postingratherthancreatingshort-lifeprojectsornewservices.ThekeyfindingsfromthatprojecttodatearesummarisedinBox3.2.ipprrecommendsfurtherresearchtoexplorewhatisthebestmixofapproaches(includingface-to-face,writteninformation,telephoneadvicelinesandwebsites)forolderpeopleaccordingtotheirindividualcircumstances.
Oneofthemostpromisingdevelopmentsappearstobeall-in-onesmartcards.ConcessionarybuspassesinEnglandtypicallyusesmart-cardtechnology,whichcouldbeadaptedforotherpurposes.ThisisbeingconsideredbytheWelshAssemblyGovernment
forolderpeopleinWales.BuildingaSocietyforAllAges notesthatthishasalreadybeenextendedinDerbyshire,wheresmartcardsareusedforlibraryregistrationandtogiveaccesstobothcentralandlocalgovernmentservicesaswellasdiscountswithvariousbusinesses.
Box3.2.Creatingastrongerinformation,advice
andadvocacysystemforolderpeopleexample
ofNewcastle
Insteadofcreatingnewprojectsandservices,thefocus
inNewcastlehasbeenonhowexistingsystemscanbemademoreolderpersonfriendly,efficientandeffective.Thisemphasisonsystemchangeisespeciallypertinentinthecurrentpublicspendingenvironment.
Thereisacentraldatabaseofinformation,whicholderpeople,carersandstaffcanaccess.Thisiskeytoensuringuniversalaccesstoinformationandadvice.Outreachtoolderpeopleisundertakenbyfrontlinestafffromvariousagenciesthatpromoteandmakeuseofawebsitededicatedtoolderpeople.Briefingsareconductedwithfrontlinestaffincludingnurses,
socialworkers,librarians,carehomeactivitycoordinators,shelteredhousingofficersandCitizensAdvicevolunteers.
Amulti-agencysignpostingschemeisbeingdeveloped*.Thisiscoordinatedthroughonecentralpointthatsharesinformationfromvariousagencies.Itbuildsthesignpostingroleoffrontlinestaff,enabling
olderpeopletoaccesspreventativeservicesthroughasinglepointofcontact.
Essentialfeaturesincludegivingolderpeopleavarietyofwaystosharetheirexperiencesandviewsandusingtheirfeedbacktoimproveservices.NewcastleEldersCouncilhelpedgathertheviewsofisolatedgroupsincludinghouseboundolderpeopleandblackandminorityethniccommunities.Anetworkoffrontlinestaffandolderpeoplewasdevelopedtoensuretheycontributetochange.TheCouncilmeetstwiceayearandgathersfeedbackonreal-lifesituations.
*NewcastlesapproachissimilartotheFirstContactinitiativeinNottinghamshire(Horton2009).
Source:Horton(2009)
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shinealightonhowprogressismadeorfrustrated.SuchapproachesareattheforefrontoftheTreasurysthinkingaboutmakingsavingsaswellasincreasedhealthandwellbeinginlaterlife.
LinkAgePlusLinkAgePlus(LAP)isledbytheDepartmentforWorkandPensionsinEngland.LAPprojectsaredescribedasprovidingthatlittlebitofhelponaday-to-daybasistopromotewellbeingandindependenceandreducetheneedformoreintensivesupport.LAPhasbeenadaptedbymostlocalauthoritiesinWalesbutnotinScotland.LAPhelpsorganisationsworkonpartnerships,capacity-buildingandtheinvolvementofolderpeopleinservices,to:
reduceduplication
achievedeliveryofmorerelevant,tailoredandpreventativeservices
increasesatisfaction
increasecosteffectiveness.
Amongthedesiredoutcomesfromthepilotsare:amorepositiveviewofageinginsociety,greaterconfidenceamongolderpeople,improvedqualityoflife,andfinancialbenefitsforindividualsandsociety.
AnevaluationhaslookedatthecostsandbenefitsoftheLAPpilots(Wattetal2007).Itestimatedthebenefitsintermsofpreventativesavingsfromupstreamactivity,notablyfromdelayedprogressiontomorecostlyresidentialcareandareducednumberofemergencyadmissionstohospital.ThereviewauthorsnotedthatifLAPinitiativesachievedthesethingsin5percentofcases,majorsavingscouldbeachieved:forexample,theunitcostoftreatingahipfractureismorethan25,000whiletheaveragecostsofLAPcontactsaresmall.
ThefocusofLAPactivityhasvaried,fromlinkingupservicesandsignpostingtowardsother
existingsometimesmainstreamservicesaswellasextraprovision,forexamplenewapproachestomaximisebenefittake-upamongolderpeoplenotclaimingtheirfullentitlements,homesecurityandinstallationofsmokealarms,andopportunitiestosocialisemore.Inmanycasesitwasfoundthatextrasupportinthecommunitywasavailablebutnotaccessed,reflectingpatchylevelsofawarenessamongserviceprovidersaswellasolderpeople.Supportwasusedtohelpvoluntarysectorpartnersattractextrafundingandvolunteers.
Amongthebenefitsforolderpeoplehighlightedinafurtherinterimreport(Daly2009)wereenhancedsafetyandpeaceofmind(achieved,forexample,aftertakinguphandymanservices);physicalandmentalhealthbenefitsarisingfromschemestoaddresstheinactivityandisolationthatacceleratepreventableillhealthanddependency(forexample,walking
groups,befriending,peervolunteering);financialsecuritythroughincreasedbenefituptake;andmobility,throughcommunitytransportinitiativeswhichrecognisethatolderwomenaremuchmorereliantonpublictransportandmorelikelythanoldermentoreportdifficultiesaccessinglocalservices.Initiativesusuallyconcentratedonpeopleatlowormoderateriskoffallingorbeingadmittedtohospitalasanemergency.Somepilotsalsofocusedonsomeminorityethnicgroups,oldermenandruralcommunitiesaswellasinner-cityneighbourhoods.
OtherpositivefindingsfromDaly(2009)includebetterinter-agencyworkingwhichhasledtosingleaccesspointsforservices,servicegapsbeingfilledandsomepositiveworkwithprivatecarehomes(forexampletoinstallexerciseequipment).Thesefindingsfocusmoreoninputsthanevidenceofoutcomes,oraclearviewofthepathwaysthatmightlinkthem.
However,aseparatebusiness-caseassessmentoftheLAPpilots(citedinHMGovernment2009)showedsubstantialaddedvalueusingreturnoninvestmentmeasuresforspecificelementsincludinghomeadaptationsandhomesecurityimprovements.Suchservicesmorethancoveredtheircosts.
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Afurtherreport(WillisandDalziel2009)analysedhowtherangeofLAPinitiativescontributetoaframeworkforcapacity-building.Itconsideredtheevidenceacross10dimensions,includingenhancedstaffskillsresultinginbetterwaysofworkingwithinexistingservices;efficiencygainsthroughreducedduplication;holisticviewsofolderpeoplesqualityoflifeleadingtoperson-centredapproachestocommissioning;andmultipliereffectswhereolderpeoplehavebeenengagedinpolicydevelopmentandservicedesign.Theauthorsconclude:
ThereisemergingevidencethattheworkofLAPpilotsisfosteringa
radicalchangeawayfromtraditionalneedsorservice-centred
approachestowardsstrategiccommissioningfoundedonapeople-
centredapproach.Thefocusofsuchworkisonimprovingoutcomes...
andnotsimplyensuringimprovedaccess,integrationorpartnership
working.(WillisandDalziel2009)
Thisisahopefulassessment.Althoughtheremaybeadegreeofover-claimingthesuccessoftheLAPprogramme,itappearstohaveaddedmuchtoourknowledgeofpreventative
workforolderpeoplelivingatlowtomoderateriskofneedingacuteinterventionsandshowsthatlocalpartnershipworkingcanshiftthefocusofservicecommissionersandprovidersontobetteroutcomes.
PartnershipforOlderPeoplesProjects
LedbytheDepartmentofHealthinEngland,PartnershipsforOlderPeoplesProjects(POPP)bringafocusonearlyinterventiontohealthandcareinthecommunity.TheunderlyingaimofPOPPis:
tocreateasustainableshiftinresourcesandcultureawayfromthe
focusoninstitutionalandhospital-basedcrisiscare,towardsearlierand
bettertargetedinterventionsforolderpeoplewithincommunity
settings.(PersonalSocialServicesResearchUnit[PSSRU]2008)
MostoftheprojectswereduetocompletepilotworkbyMarch2009.Thefindingsdiscussedbelowaredrawnfromaninterimevaluationoftheperiod200608(PSSRU2008).Itfoundthatalmost100,000peoplehadreceivedaservicevia470projectsin29locationsacrossEngland.
Sevenoutoftenprojects(71percent)werefoundtoofferuniversalservices,aimedatallolderpeopleandtheircarers.Theseincludedhandymanschemes,gardening,shopping,leisureandsignposting,suggestingoverlapwithLAPactivity,thoughindifferentlocations.
Aboutoneinsevenprojects(14percent)offeredadditionalsupport(forexample,medicinesmanagement,fallspreventionandtelecareservices)toolderpeopleatriskofhospitaladmission.
Asmallernumber(8percent)providedspecialistsupport,includinghospitalathomeandintensivesupportteams,tothoseatseriousriskofimminenthospitaladmission.
Afurther7percentofprojectswerefocusedoncapacity-buildingratherthanservicedelivery,coveringstafftrainingandneedsmapping.
POPPappearstohavebeensuccessfulinreachingpeopleover75:almosttwo-thirdsofserviceuserswereagedover75andalmostone-thirdover85.Preventativeandearlyinterventionworkcanoccuratvariousstagesofolderagesincethetriggerpointsforescalatingneed,illhealthorfrailtyappearatvaryingtimes.Almosthalfofthoseinvolvedin
servicedeliverywerethemselvesoldervolunteers,andinaquarterofcasesolderpeopleweretrainedtoundertakeresearch,thoughitwasmorecommonforvoluntaryorganisationstospeakonbehalfofolderpeopleratherthanengagingwithotherswhodonotusuallygetinvolved.
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TheimpactofPOPPwasassessedagainstfivecriteria(PSSRU2008).Keyfindingswere:
Cost-effectiveness:Pilotsiteshadacleareffectonreducinghospitalemergencyadmissionscomparedwithcontrollocations.Forevery1spent,anaverageof73pwassavedonthemonthlycostofemergencyhospitalbed-days.3 Onthismeasure,
POPPinitiativescameclosetopayingforthemselves.Theauthorsnotethatthistypeofcost-effectivenessneedstobecomparedwithbeneficialoutcomestoolderpeople.Therewouldbelittlepointinreducingtheuseofacutehealthcareifcasesweremerelydeferredandpresentedtohospitalsinamoreseverestate.
Serviceusechange:Savingsfromtherebeingfewerovernightstaysinhospitalwerefoundtosignificantlyoutweighthecostofgreateruseofprimarycareandhomeservicessuchasmealsonwheels,socialworkandcommunitynurses.Anetaveragesavingof410perpersonwasestimated.
Qualityoflife: Projectsappearedtohaveapositiveeffectonqualityoflifeperceptions,includingbettermobility,lessanxietyandlesspain.Evenontheleastfavourableassumptions,costsrelatedtothesebenefitswereestimatedtobeone-thirdbelowtherecognisedbreak-eventhreshold.
Culturalchange: Projectsaimedtochangeworkingculturesinhealthandcareaswellasshiftingresourcesintothecommunity.Theevaluationnotedthatgreaterfocusonpreventativeservicestoimprovewellbeinghasreinvigoratedlocalityworkingwitholderpeopletoidentifyneedsandinformcommissioningprocesses.Projectswerethoughttohaveacceleratedjointcommissioninginhealthandsocialcare,especiallybetweencouncilsandthevoluntarysector.ButreformstoPrimaryCareTrustsandthelackoffullinvolvementofGPsremainedobstacles.
Sustainability:Long-termservicereformwillrelyonsavingsfromacute/residentialcareandmainstreamingsuccessfulPOPPapproaches.Itispromisingthatonly4per
centofprojectssaidtheydidnotintendtocontinuetheserviceafterDepartmentofHealthfundingfinished.However,themainbarrierwasprojectsbeingunabletocapturesavingsfromacuteservices.Onthismeasure,POPPwasnomoresuccessfulthanearlierapproaches.4
Inspiteofthegoodpracticeandsavingsidentified,itappearsthatthepainstakingworkofpartnershiponlygetsussofarbeforefailingtomoveresourcesintopreventioninthecommunity.TheCommunityHealth&CarePartnerships(CHCP)modelinScotlandincorporatestwoorganisationalcultures(fromtheNHSandlocalgovernment)withinstatutorypartnerships,buteventhisissomewayremovedfromhavingasinglesetofobjectivesandresourcestodeployforolderpeople.Abolderconclusionisthatintegrationofhealthandcareservicesintoasingleagencyisrequiredifdecision-makingistobecometruly
responsiveinanageingsociety.
Lookingahead,theevaluationauthorsconcludethatcommissioningshouldfocusonvalueformoneyandreturnoninvestment.Someinterventionswillproducenetsavingsandotherswillimprovequalityoflifeatanetcost.Whileitishardtomeasuretheimpactoflow-levelpreventativeservices,betterestimatescanbemadeusingmoreappropriatesurveyandinterviewmethodswithpeopleatdifferentstagesofoldage.
Advocacy,scrutinyandinvolvement
TheestablishmentofaUKAdvisoryForumonAgeingwasannouncedbytheDepartmentforWorkandPensionsinFebruary2009(HMGovernment2009).ItwillworkwiththeGovernmenttoidentifyadditionalstepstoimprovewellbeingandindependenceinlaterlife.
TheForumwillincludeministersfromthedevolvednationsandofficialsfromtheEnglish
3.Theassumedcostwas120perday.
4.Thisfindingistrueattheinterimstage.Findingsfromthefinalevaluationmaydiffer.
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regionsaswellasvoluntarysectorstakeholders.TheUKGovernmentwillreportonprogresstowardsachievingthevisionsetoutinitsrecentageingstrategy(ibid)toaCabinetCommitteeonAgeingandtothisnewForum.AtthisstageitisnotclearhowfarthenewForumwillplayascrutinyoraccountabilityrole,asdistinctfromanadvisoryrole.However,ithasthepotentialtoserveasavaluablevehicleforlearninglessonsonpolicyandpracticebetweenthefourcountriesoftheUK.
Intermsofadvocacy,theUKGovernmentappointedaVoiceofOlderPeople,DameJoanBakewell,inNovember2008.Theroleisindependentfromgovernment,servingasaninformedadvocateonissuesthataffectolderpeopleslivesacrosstheUK.Oneaimistoraisetheprofileofageequalityissuesandencouragepublicdebate,particularlyastheEqualityBillprogressesthroughParliament,aswellasgivingviewsonotherkeypolicies.Theroleisdescribedasuniquewithingovernment.Itmaybeusefulintermsofraisingawarenessandinfluencingdebate,butrepresentsadifferentapproachfromtheOlderPeoplesCommissionerandAdvocaterolesestablishedinWalesandNorthernIrelandrespectively(McCormicketal2009).TheWelshrole,inparticular,offersmorescopetoholdgovernment
andpublicserviceproviderstoaccount.Summingup:policyonageingintheUKandEngland
Theapproachestopreventativeworkingdiscussedherearerelativelymodestinscope,butinterimevaluationspointtosomeveryeffectivepracticethatshouldnowbeconsolidated.Mostoftheinitiativesattendtolocalqualityoflifeissuesofhighimportancetoolderpeople.Manyhavebrokennewgroundincommissioningofservices,engagementwitholderpeopleandcapacity-buildingandaredemonstratedtobecost-effective.Yetitislessclearhowtomakepositivechangesstickinthelongertermnotably,howtodivertbudgetsavingsintheNHStoinvestmentincommunityservices.Justlikechangingoutdatedattitudesinsocietyasawhole,thechallengehereisoneofculturalproportions.Noamountofgoodpartnershipworkislikelytodeliverthekindofintegratedplanningandresource
flexibilityneeded.Itishardtoescapetheconclusionthatasingleagencyspanninghealthandcareservicesisthemodelmostlikelytoachievethis.
Devolvedpoliciesforolderpeople
Inthelastdecadesustainedprogresswasmadeinreducingpovertyinolderage,althoughthishasstalledsince2005andhasreversedinsomepartsoftheUK.PoliciestotacklepovertyhavebeenledbytheUKGovernment.TheyspantargetedmeasurestoboostlowincomessuchasthePensionCreditGuaranteeaswellasuniversalpaymentssuchastheWinterFuelAllowancetoaddresstheimpactofhigherfuelcosts,anduniversalage-relatedmeasuresforpeopleover75,suchasfreeTVlicencesfortheover-75sandalargerWinterFuelAllowancefortheover-80s.Thedevolvedadministrationshavefewpowerstoactdirectlyinthisarea,buthavetakenstepstoreducethecostsassociatedwithpublictransportandwarmhousing.
Variationsinthesepolicieshavebeenmodest,withtheexceptionofScotlandsFreePersonalandNursingCarepolicy.
Theageofentitlementtoafreebuspassis65inNorthernIrelandbut60intherestoftheUK.TravelonanyrouteatanytimeispermittedinScotland,butrestrictedtooff-peakjourneyselsewhere.ConcessionaryrailtravelhasbeenpilotedinpartsofWalesandconcessionarytravelhasbeenproposedinNorthernIreland.Freeswimmingfortheover-60s(EnglandandWales)andaccesstoculturalfacilities(Wales)havebeenintroducedmorerecently.
Localauthoritiesmayalsodecidetoreduceorremovecostsforolderpeople.InWales,thishasmeantvariationsinhomecarecostsbetweencouncilsbeingreducedandthethresholdatwhichchargesbecomepayablebeingraisedtohelpolderpeopleonmodestincomes.
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References
AgeConcernandHelpTheAged(2009)OneVoice:ShapingourageingsocietyLondon:AgeConcern
andHelpTheAged
AuditScotland(2009) Scotlandspublicfinances:Preparingforthefuture,Edinburgh:AuditScotland
DalyG(2009)LinkAgePlus:Benefitsforolderpeople,ResearchReport554,London:Departmentfor
WorkandPensions
DepartmentofHealth(2007) PuttingPeopleFirst:Asharedvisionandcommitmenttothe
transformationofadultsocialcare,London:DepartmentofHealth
DepartmentofHealth(2008)Carersattheheartof21stcenturyfamiliesandcommunities:Acaring
systemonyourside,Alifeofyourown, London:DepartmentofHealth
GovernmentEqualitiesOffice(2009)Creatinganage-friendlysociety(Factsheet),London:
GovernmentEqualitiesOffice,availableatwww.equalities.gov.uk/pdf/age%20fact%20sheet.pdf
HMGovernment(2009)Buildingasocietyforallages, Cm7655,DepartmentforWorkandPensions,
Norwich:TheStationeryOffice
C.Horton(2009)Creatingastrongerinformation,adviceandadvocacysystemforolderpeople,
Solutions:Lessonsforpolicyandpractice,York:JosephRowntreeFoundation
IBSEN-IndividualBudgetsEvaluationNetwork(2008)EvaluationoftheIndividualBudgetsPilot
Programme:SummaryReport,York:SocialPolicyResearchUnit,UniversityofYork
McCormickJ,McDowellEandHarrisA(2009)PoliciesforPeaceofMind?Devolutionandolderage
intheUKLondon:ippr,availableat
www.ippr.org.uk/publicationsandreports/publication.asp?id=704
MoullinS(2008)JustCare?Afreshapproachtoadultservices,London:ippr,availableat
www.ippr.org.uk/publicationsandreports/publication.asp?id=605
PersonalSocialServicesResearchUnit(PSSRU)(2008)NationalEvaluationofPartnershipsforOlder
PeoplesProjects:InterimReportofProgress,Canterbury:PSSRU,UniversityofKent
RiddellS,PriestlyM,PearsonC,MercerG,BarnesC,JollyDandWilliamsV(2006)DisabledPeople
andDirectPayments:AUKComparativeStudy,Leeds:ESRC/LeedsUniversity
WattPandBlairIwithDavisHandRittersK(2007)TowardsabusinesscaseforLinkAgePlus,
DepartmentforWorkandPensionsWorkingPaperNo42,London:DWP
WillisMandDalzielR(2009)LinkAgePlus:Capacitybuildingenablingandempoweringolder
peopleasindependentandactivecitizens,AresearchreportbyINLOGOV,Universityof
Birmingham,DepartmentforWorkandPensionsResearchReportNo.571,London:DWP
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Britainisnotaloneinfacingthechallengesofanageingpopulation.WhatusedtobeanissueforEuropehasnowbecomeachallengefornearlyeverycontinent.By2050onefifthoftheworldspopulationwillbeagedover60.ThefastestincreasesinageingwillbeseeninAsiaandLatinAmerica,wheretheproportionofthepopulationagedover60willdoubleinlessthan20yearsfromnow.
Whilepopulationageingiscommonacrossmanycountries,theexperienceofgrowingoldvariesdependingonthecontextinwhichithappens.InJapanforexample,lifesatisfactionishighestamongtheover-65s,whereasinHungarythisagegroupistheleastsatisfied(DonovanandHalpern2002).AcrossEurope,ratesofdepressionamong
olderpeoplevaryinAmsterdamtheyarehalfwhattheyareinMunich,forexample(Copelandetal2004).Andinter-continentally,afifthofAmericansintheirseventiesarestillworking,comparedwithjust1percentinFrance(Harper2009).
Theseinternationalvariationsdemonstratethatdeclineanddisengagementfromsocietyarenotinevitableconsequencesofolderage.Variationsinculture,policy,services,environmentandattitudesmeantheexperienceofageingisdifferentdependingonwhereyoulive.Itisopentochange.
Thischapterprovidesexamplesofpoliciesandprogrammesthathavebeenintroducedinothercountriestorespondtotheissueofolderpeopleswellbeing.Itfocusesonpolicyareasbeyondthetraditionalrealmofhealthcareandpensionslookinginsteadatthe
fourthemesofrelationships,work,learningandthebuiltenvironment
1
.TheaimisthatthesecasestudieswillinspirenewresponsestoageingintheUK.
Relationships
Tacklingisolationandsocialexclusionshouldbethebedrockofanyattemptstoimproveolderpeopleswellbeing.LonelinessandisolationarecloselylinkedtopoormentalandphysicalhealthaparticularproblemwhenonethirdofolderpeopleintheUKsaytheyarelonelyandafifthfeelisolated(Leadbeater2009,Actor etal2002).Anewagendaforgovernmentinthecomingyearswillbetohelpolderpeoplemaintainanddevelopsocialnetworks(Oancea2008).
Thecasestudiesonthenextpagedemonstratedifferentapproachestoolderpeoples
wellbeingthatfocusonbuildingandharnessingpeoplesrelationshipswiththosearoundthem.
Discussion relationships
Targetingrelationshipsandsocialtieswillbecentraltoimprovingolderpeopleswellbeing,eveninthepresenceofotherbarrierstotheirqualityoflife.Thiswillrequireadifferentphilosophyfromthestatemovingawayfromcentralisedprogrammesthatdeliveraserviceinisolation,towardsenablingandharnessingeverydayrelationships,asseenintheexamples.
1.Foramoredetailedreviewoftheliteratureoneachofthesefourthemesandhowtheyinfluenceolder
peopleswellbeing,seeClifton2009.
4.Lessonsfromabroad:ageingandwellbeinginaninternational
context
JonathanClifton
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Japanspopulationstructureisoftentalkedaboutin
crisistermsgiventhatthecountryhasoneoftheworldsmostrapidlyageingpopulations.Thefactthatitssocialcaresystemisalmostentirelypubliclyfundedmeansageingcouldputaparticularstrainonpublicfinances(OECD2005).
InresponsetothischallengeJapanintroducedahealthcarecurrency,orhureaikippu in1991.Thisiseffectivelyatimebankschemewhichisdedicatedtocaringfortheelderly.Peoplewhovolunteergaincredits,thenumberofwhichdependsonthetimegivenandthetypeoftask,withmoreoneroustasksearningmorecredits.Thecreditsarestoredinthesamewayassavingsthecurrencyissimplyinhoursinsteadofyen(Kent2001).
Theschemeoperatesinthesamewayasabank.Thismeansthatcreditscanbebankedforthefutureasaformofsocialcareinsurance,sowhenapersonneedssupportshecandrawonthecreditsshehasearned.Creditscanalsobetransferredtoothers.Manypeopleprovidehelptoanelderlypersonneartothem,and
thentransferthecreditstheyearntoanelderly
relativelivinginadifferentpartofthecountry.Inthiswaytheycanensuretheirrelativesreceivesupportwithoutactuallymovingtolivenearthem(Aldridgeetal2002).
Theschemehasbeenprovedtoprovideahighstandardofcare.Whatsmore,themajorityofelderlypeopleactuallypreferreceivingsupportunderthehureaikippu schemethanpayingbyyen,becausetheybuildbetterrelationshipswiththeircarers.Theyalsopreferittoservicesprovidedbycharities,whichmakethemfeeldependent(Lietaer2001).
Thiscase-studydemonstrateshowJapanhasrespondedtothechallengeofprovidingsocialcarebyfocusingoneverydayrelationships.Ratherthaninnovatingservicesprovidedbythestate,Japanhasrespondedbyinnovatingmethodsofexchangeandpayment.Thesehavestrengthenedsocialtiesandencouragedfamiliesandcommunitiestoplaymoreofarole.
StartedinaruralIrishvillagein1988byMaryNally,anursedespairingofthelackofsocialservicesavailableforolderpeoplelocally,theSummerhillActiveRetirementGroupnowhasaninternationalreach(Intel2009).
Nallygatheredretiredpeopleintheareatogethertoformtheirowngrouptorespondtothe
challengesofbeingolderandlivinginaremotesetting.TheirActiveRetirementGroup(ARG)wasgrantedsomelandandaPortakabinbytheIrishHealthService,andsetaboutorganisingtheirownactivitiesandfundraisingtoenablethemtogrowandemploystaff.
ThePortakabinhasmeetingrooms,alaundry,alibrary,internetcafeandofficesandaimstoprovideawelcomingenvironmentforall.Thegrouporganisesanumberofservicesandactivitiesincludingexerciseclasses,alaundryservice,achoir,regulardaytrips
andholidays,outreachtoresidentsofanursinghome,monthlyvisitsbyachiropodist,visitingspeakers,firstaidcourses,ITclassesandconcerts.
Theyarealsopoliticallyactivebothonissuesrelatingtoolderpeopleandotherexcludedgroups.TheirMillenniumBusprovidesdoor-to-doortransportforthosewhoneeditensuringpeoplecanbebroughtintothecommunity(www.thirdage-ireland.com).
Withthehelpofasocialentrepreneur,theSummerhill
ARGhasdevelopedtwonationalorganisationsincludingatelephonehotlineforolderpeoplethatissoontoexpandinternationally.Thephonelineisstaffedbyoldervolunteersandprovidesalisteningearfortheisolatedandlonely.
Summerhillhasbeensuccessfulbecauseitgreworganicallyinresponsetoalocalneedandolderpeopleruntheprojectthemselves.Thefocusisonbuildingrelationshipsandactivities,ratherthandistributingresourcesandservices.Itenablesolderpeopletocontributeandbeactive,ratherthan
passivelyconsumeservices.Asasocialenterpriseithascreatedadditionalresourcesbycollaboratingwiththestate,not-for-profitsandcommunities.
Casestudy:HureaiKippu,Japan
Relationshipsandwork
Casestudy:SummerhillActiveRetirementGroup,Ireland
Relationships
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Publicserviceshavetendedtoassumethatmeetingbasiccareneedsshouldcomefirst,andthatstrongrelationshipsareasecondaryeffectofbeingwellprovidedforinotherareas.Infactitisoftentheotherwayaround.Relationshipsprovidepeoplewithaccesstothebasiccaretheyneed(Leadbeater2009:55).Asthecasestudiesabovedemonstrate,ifpeoplehavestrongrelationshipsandsocialconnections,accesstomanyoftheresourcesandservicestheyneedwillfollow.
IntheexamplesofJapanandIreland,serviceswereredesignedtobedeliveredthroughlocalpeopleandsothatcommunitiesbuilduparoundtheservice.Theydonotjustprovideaservicetomeetaneed,butcreateaspaceinwhicholderpeoplecancontributetoarelationshipaswell.Thewayinwhichsupportisgiventoolderpeopleisthereforeasimportantastheactualsupportbeinggiven.Servicescandoalottomasknecessityaschoice.ForexampletheRuralTransportationServiceinIrelandisanessentialserviceforolderpeople,withoutwhichmanyofthemcouldnotliveindependently,butitmarketsitselfasaregularbusservicewhicholderpeoplecanchoosetouse(Roberts2009).
Afocusonrelationshipsindeliveringservicesandimprovingwellbeinghasnottraditionally
beenthepreserveofprogressivepolitics.Itwillrequireadifferentinfrastructure,skillsetandscaleofapproachthanserviceprovidersandlocalauthoritiesaregenerallyusedto.
Work
Whilethemainargumentforpeopleworkinglaterinlifehasbeenthatitisasolutiontoaloomingpensionsgapanddecliningproductivity,changingthewayweworkandretirecanalsoimprovehealthandwellbeing.Formanyretirementisahappytimeofrelaxation,butforothersitisachallengingeventthatleadstolongperiodsspentaloneorinactive,feelingworthlessandhavingnopurpose(Allen2008:30).
Workinglaterinlifecanhelpmitigatemanyoftheseproblems,allowingpeopletomaintainasenseofpurposeandtheirsocialrelationships,andengageinproductiveactivities(Calvo
2006).Thecasestudiesbelowprovideexamplesofwherebothpaidandunpaidworkhavebeenencouraged.
Workingin23cities,ExperienceCorpsisoneofthelargestsocialenterprisesforolderpeopleintheUS.Itengagespeopletypicallyovertheageof55tovolunteerastutorsandclassroomassistantsinprimaryschools.
ExperienceCorpsisbuiltonamodelofintensivevolunteering.Memberscommitto1015hoursofworkaweekforawholeschoolyear.However,thereisflexibilityintimetabling.Volunteersareprovidedwithtrainingandsupportandreceiveastipendofaround$100300amonth.Despitethehighworkload,nearlythreequarterswhostarttheprogrammecompleteit(seewww.experiencecorps.org).
IndependentresearchonthebenefitsofExperience
Corpshasfoundthatitgeneratesimprovedphysicalandmentalhealth,leadingsometoclassifyitasapublichealthinterventionforolderadults(Barronet
al2009:649).Ithasallthehallmarksofasuccessfulschemethatpromoteswellbeingamongolderpeople:itisameaningfulandvaluedactivity;itprovidescognitiveandphysicalstimulation;anditenablessocialinteractionacrossagegroups.
AnumberoffeaturesofExperienceCorpscontributetoitssuccess:
Stronginfrastructure.Paidstaffandprofessionalsystemsoverseerecruitment,coordination,trainingandsupervisionofvolunteers.
Volunteersreceiveastipend.Thestipendenablesagreaterrangeofpeopletovolunteerandtodosoformorehourseachweek;ensurespeoplearecommittedtoseeingtheprogrammethrough;andservesasapublicrecognitionthattheworkisvalued(CentreforSocialDevelopment2008c).
Cont.nextpage
Case-study:ExperienceCorps,UnitedStates
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Effectiveinformationcampaigns.ExperienceCorps
hasworkedhardtoovercomeinformationbarriers,forexamplebycontactingpeopledirectlyinareasnearschoolsandaskingthemtovolunteer(CentreforSocialDevelopment2008a).Itcarefullytargetsitsmessage,talkingaboutexperienceratherthanageandreferringtojobtitle(e.g.tutor)ratherthancallingthemvolunteer(ExperienceCorps2005).
Flexibleworkroutinecoupledwithfirmcommitment.Themixtureofaskingvolunteerstocommittoayearsservicebutallowing
flexibleworkscheduleshasenabledpeopleto
volunteerandensurestheytaketheschemeseriously.
Teamenvironment.Supportisprovidedfromothervolunteersandstaffintheschoolswheretheyarelocated.Workinginateamprovidesmoresupportandsocialnetworks.
Worksinpartnership.PartnersincludeAARP,apowerfulgroupforolderpeople,whichspreadsinformationaboutExperienceCorpstoitsmembers,andElderhostel,auniversityforolderpeople,whichoffersfreecoursestothosewhovolunteerwithExperienceCorps.
ExperienceCorps,UnitedStates cont.
Norway,likemanyEuropeancountries,strugglestoretainworkersintheirsixties(RiskuandVidlund2008).Peoplefacelongperiodsinretirementandasuddencut-offfromwork.In2010itwillintroduce
changestothepensionsystemtopromotelongerworkinglivesandphasedretirement(HolmoyandStensnes2008,RiskuandVidlund2008).
Theaimistocreateasystemthatgivespeoplemorechoiceoverwhenandhowtheyretire,butthatencouragesthemtoworklaterinlife.Itbreaksawayfromthenotionthatretirementisasingle-stageeventatafixedage,reshapingitassomethingthatcanbephasedinovertime.
Themainwayitwilldothisisbykeepingtheminimumretirementageas62,butadding
significantfinancialincentivestoworklater.Byremainingintheworkforceforlongerapersonsstatepensionwillincrease,andviceversa.Theannualpensionwillincreasebyabout7.5percent
foreachadditionalyearspentinthelabourforcewithoutdrawingapension.Therewillbenoupperlimitonpensionage.
Theotherkeychangeisthatpeoplewillbeableto
drawontheirpensionwhilestillworking,withoutthepensionbeingreduced.Thiswillallowthemtocoupleelementsofworkandretirement.
Pensionswillalsoadjustwithlifeexpectancy,creatinganactuarialsystem.Thismeansiflifeexpectancyincreasesbyoneyearanindividualwillhavetoworkanadditionaleightmonthsinordertoreceivethesamepensionentitlement.Someonebornin1983,forexample,willhavetoretireatage71iftheywanttoreceivethesamelevelofpensionassomeonewhoretiresaged67today.
Inrecognitionthatindividualswillneedtocovermorecaringresponsibilitiesincomingdecades,pensionentitlementswillalsobeaccruedforunpaidcarework.
Case-study:Phasedretirement,Norway
Work
Discussion work
Longerworkinglivescanhelpolderpeoplemaintaingoodwellbeing.Increasingthepensionagewillnotbeenoughtoensurepeopleworklaterinlife,andonitsowncouldberegressiveasitreducesthecontrolpeoplehaveovertheirlives.Thechallengeistoinnovatenewapproachestoworking,thetransitiontoretirement,andwhatretirement
itselfconsistsof.Thecasestudiespresentedheredemonstratewaysinwhichthisisbeingdone.InNorway,thecentralstatehasnotraisedthepensionage,buthasgivenpeoplemore
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incentivestoworklaterandtheabilitytophaseoutofworkgradually.Thismeanstheycanfitworkaroundothercommitmentsanditpreventsasuddencut-offfromthelabourforce.Theyhavemorecontroloverthiskeytransitioninlife.
ThecaseofExperienceCorpsintheUSdemonstrateshowanot-for-profitorganisationis
reshapingretirementbyencouragingolderpeopletocommittointensivevoluntarywork.Theevidencesuggeststhatifpeopleareactivelyaskedtovolunteer,iftheirworkisproperlymanagedandflexible,andiftheyreceiveastipendandrecognitionoftheircontribution,thentheirexperiencecanconsiderablyimprovetheirwellbeing.
Thewaytheworkplaceisorganisedisalsoimportant.Relativelysimplechangescanenablepeopletoworklaterinlife.Theseincludeprovidingolderpeopleaccesstotrainingopportunitiessotheykeepupwithdevelopments,allowingflexibleworkingsotheycanfitworkaroundtaskssuchascaringforlovedones,adjustingtaskstoonesthatolderpeoplearebettersuitedto,andusingbetterdesignedfurnitureandfittings.
Rethinkingworkandretirementisnotjustataskforgovernment.AstheOrganisationforEconomicCooperationandDevelopmentsays,Itwillrequiretheco-operationofgovernment,employers,tradeunionsandcivilsocietytoadoptandimplementanewagendaofage-friendlypoliciesandpractices(OECD2006:14).
Learning
Whileeducationhastraditionallybeenthepreserveoftheyoung,thereisagrowingmovementtowardsamodeloflifelonglearning.Learningcanconsiderablyimproveolderpeopleswellbeing(Field2009).Itbuildsself-esteem,asenseofagency,increasessocialinteraction,developsskillstohelponecopewithlifeschallengesandstimulatesinterest.
However,stereotypesthatpaintageingasaprocessofcognitivedeclinemeanolderpeopleareoverlookedinthelearningagenda.Adulteducationisskewedtowardstrainingforthelabourmarket.Asaresult,onlyaminorityofolderpeopleintheUKtakepartinformallearning(Jamieson2007).Thoseolderpeoplewhoareinvolvedinlearningtendtobemiddleclassandhavepreviousexperienceoffurthereducation.Thereisthereforeaneedtoreducetheinequalitiesinaccesstoadultlearning.
Thefollowingcasestudiesdemonstratehowbothgovernmentsandnon-governmentalorganisationshaveencouragedlifelonglearninginothercountries.
In1976,followingaconferenceonthepotentialofInformationTechnology(IT)toinfluencethelivesofolderpeople,SeniorNetwasborn.Itsaimistoprovideolderpeoplewithaccesstocomputertechnologiesandbridgetheso-calleddigitaldivide.
Ithasgrownenormously,nowteaching20,000studentsinlearningcentreseachyear.100,000participantsuseitswebsiteeachmonthanditreliesonthehelpof4,000volunteers(SeniorNet2006).
SeniorNethasestablishedlearningcentresinavariety
oflocations(suchaslibraries,collegesandcommunitycentres).Coursesaredeliveredbyvolunteerinstructorswhoarethemselvesolderpeopleand
rangefromsimplecomputerfundamentalstomoreadvancedcoursessuchasbuyingandsellingoneBay.Theemphasisisoncreatingalow-pressureenvironmentandprovidingtheopportunitytopractice.
TheSeniorNetwebsiteitselfisaresourceforthosewhoareunabletoattendlearningcentres.Thewebsitehostsonlinecourses,distancelearning,chatroomstoshareinformationandmeetpenpals.
AnexampleofoneofitsservicesistheBooksand
Cultureareaofthewebsite,whichhostsaninternationalbookclubadministeredby27volunteersCont.nextpage
Case-study:SeniorNet,UnitedStatesandworldwide
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fromaroundtheworld.ThisprojectalsosparkedSeniorNetsPrisonLibraryProject,whichisrunbyvolunteerstocollectneworusedbookstodonatetoprisonlibraries,creatingaspill-overofbenefitsasaresultofempoweringmemberswithtechnologyandlinkingthemwithlike-mindedindividuals(SeniorNet2006).
Strengthsoftheprogramme
TheSeniorNetprogrammehasbeenwidelyrecognisedwithawardsandpositivereviewsinthemedia(seeforexampleNewYorkTimes 2007).Keystrengthsinclude:
Thefocusisonempoweringolderpeoplethroughtechnology,notapaternalisticfocusonteachingandimpartingknowledge
Thecoursesseektobringpeopletogetherintoacommunityratherthanindividuallearning
Themethodologyofseniorsteachingseniorshas
provedveryeffective,asthetutorshaveagoodunderstandingofolderlearnersneedsandfears
Learnerparticipationindesigningandrequestingcoursesensurestheclassesarerelevant,meetlearnersneedsandareinteractive
Thestrongfocusonusingvolunteersenablesskillstobeharnessedandolderpeopletomakeacontribution,andkeepscostsdown
Classesarededicatedtoolderpeoplemeaningtheycanbedevelopedwithspecificneedsinmind,for
example,creatingalesspressuredenvironmentandarelaxedpace
Amaximumof16participantsonacoursewiththreetofourinstructorsensurespersonalattention
Locally-basedcentrescantapintolocalnetworksofvolunteers,sponsors,studentsandsoonwhilegettingsupportfromnationalheadoffice.
SeniorNetcont.
EnglishLanguagePartnersisNewZealandslargestsettlementagencyformigrantsandrefugees.TheorganisationgrewuporganicallywithinindividualcommunitieswhonoticedaneedforhometutoringamongmigrantswhocouldnotattendformalEnglishlanguageclasses.Volunteersabouthalfofwhomareoverage55actashometutors(ESOLHomeTutors2008).
TheworkofEnglishLanguagePartnersisbuiltona
philosophyoflifelonglearning.ThosereceivingtuitionaregenerallyadultssomeofwhomareoldermigrantswhohavecometojointheirchildreninNewZealand.Thebenefitsforthetuteesincludeacquiringlanguageskills,buildingsocialcontacts,asenseofpurposeandasenseofachievement.Asa95-year-oldRussianenrolledintheprogrammeexplained:thisislikemyfamily,Ilookforwardtocominghereeveryday(Joshua2009).
Learningisalsocentraltothetutors.Thevolunteersreceive20hoursofteachertrainingandareawardedaqualificationrecognisedbytheNewZealandQualificationsAuthority.Learningcontinueswellbeyondtheinitialtrainingcoursesasvolunteersgointopeopleshomesandlearnaboutnewcultures,dealingwithotherpeopleandputtingtheirteachingtechniquesintopractice.
EnglishLanguagePartnershasthehallmarksofa
successfulsocialenterprise:harnessingsocialcapital,buildingrelationshipsbetweenpeople,buildingindividualscapabilitiestoliveindependently,effectivemonitoringandimprovementmechanisms,beingresponsivetolocalneed,andenablingtheparticipationofthepeopletheyareserving.Underpinningtheworkofboththetutorsandtuteesislifelonglearning.
CaseStudy:EnglishLanguagePartners,NewZealand
Learning,workandrelationships
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Discussion learning
Learningcanbeanimportantdriverofwellbeinginlaterlife,thoughpublicattitudesandmaterialbarriersmeanitisoftenseenassomethingforyoungergenerationsbeingtrained
fortheworkforce.Thecasestudiespresentedaboveallchallengetheassumptionthatageingischaracterisedbycognitivedeclineandlowmotivationtolearn.
Thesuccessoftheapproachoftheexampleprojectsisdownto:
Olderpeoplebeinggivensupporttolearninacommunalenvironment
Theuseofpeer-to-peerteachingmethods
Olderpeoplebeingempoweredtoparticipateratherthansimplybeingimpartedknowledge.
Theseprogrammestapintopeoplesneedsandwantsdeliveringopportunitiesforlearningthatarebuiltaroundpeoplesdailylives,beitlearninghowtousedigitalphotostokeepin
touchwithfamilyandfriendsorhowtoteachsotheycanhelpsettleimmigrantsintotheircommunities.InthecaseofChina,weseehoweducationinstitutionscanbebuiltandadjustedtoencouragelearninginolderage,shiftingtheirphilosophytoassumethatolderpeoplearepartoftheirtargetaudience.
LifelonglearningisnotaforeignconcepttotheChinese,whohavealonghistoryofeducationthroughoutthelife-course(Kai-Mingetal 1999).ItsculturalandpoliticalattitudetowardsadulteducationhaspermeatedChinasresponsetoitsageingpopulation.
Chinahasintroducedasystemofuniversitiesfortheelderlyandcommunityeducationdesignedspecificallyforretiredpeople.Itboasts26,000institutionsofhigherlearningforolderpeople,withatotalenrolmentof2.3millionstudents.In2006itpromisedthat10,000moreseniorcitizensuniversitiesandschoolswouldbeestablishedacrossthecountry(ChinaDaily2006).Theeducationsystemforolderpeopleisbuiltonaviewthatseeslearningopportunitiesforolderpeopleaswelfareaswellaseducationtheoverallobjectiveistomakelivesafterretirementmeaningful(Kai-Mingetal1999:128).
Since2000Chinahasalsodevelopedaprogrammeofcommunityeducation.Communityeducationworksbyopeningupresourcessuchaslibraries,
museumsandsportsclubsintoanintegratedlocalnetworklinkedtocentralcollegesandschoolsforsupport.Branchesarerunbylocalcommunities,byamixtureofpaidteachersandvoluntarystaff.Classesrangefromartandcalligraphytohealthandforeignlanguages.
UnderlyingChinasdevelopmentsineducationisafocusonlifelonglearning,equalityofprovisionforallcitizensandtheaimtosatisfyculturalnotjustlabourmarketneeds.Forexample,theConstitutionofthePeoplesRepublicofChinaemphasisesthatallcitizenshavetherighttoreceiveeducationandthe2004ActionProgrammeforVitalizingEducationtalkedofbuildingasystemoflifelongeducation(CNCU2008:911).
Chinaisrespondingtoasetofuniquechallengesrelatedtorapideconomicandsocialdevelopment,notleastthatofhavingalargenumberofelderlypeoplewhodidnothaveaccesstoeducationintheiryouth.Despitethis,itsresponsetotheissueofageingandlearningisinstructivetoothercountriesforanumberofreasons:
Itdemonstrateshowaculturalattitudesupportiveoflearningacrossthelife-coursecaninfluencepolicyandthedesignoftheeducationsystem
Itprovidesanexampleofaninstitutionalresponsetothechallengeoflearninginlaterlifebuildinganentireeducationsystemofschoolsandcolleges
forolderpeople
Theaimsoftheeducationsystemgobeyondsimplytrainingyoungpeopleforthelabourmarket.Thereisalsoanemphasisonequalaccessforallcitizenstoeducationopportunitiesandonthebenefitsoflearningtoculture,societyandwellbeing.
Casestudy:UniversityoftheElderlyandCommunityEducation,China
Learning
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Ratherthanseeingdifferentstagesoflifedominatedbyakeyactivity(withyoungeryearsspentineducation,middleyearsinworkandolderyearsinretirementandleisure),weneedtoadapttoamoreintegratedmodelwithelementsofeducation,workandleisurealltakingplacethroughoutthelife-course.
BuiltenvironmentThedesignofhomesandcitieshasnotkeptpacewiththerealityofhowpeoplelivetheirlives.Housebuildingandplanningagreementshavebeenbasedonamodelofnuclearfamilies,theablebodied,workingresidentsandpeoplebeingpreparedtotraveltoaccessservices.Yetitisolderpeoplewhowillaccountforhalfoftheincreaseinhouseholdsbetweennowand2026,meaningtherewillbe2.4millionmoreolderhouseholdsintheUKthantherearetoday(CommunitiesandLocalGovernment2008).Thewaywebuildhomesandcommunitiesmustreflectadifferentreality:thatmanyolderresidentsliveontheirown,arenotworkingandarelessmobilethantherestofthepopulation.
Thereisagrowingappreciationinthedisciplinesofplanningandarchitectureoftherelationbetweenhumansandtheirenvironment.Whilethishastendedtofocusonpeoplesphysicalneeds,muchcanalsobedonetofacilitat