Later life should be a time of enjoyment and growth, but with cuts in local authority spending on older people and continuing pressures on the NHS, the picture often painted is a bleak one. In recent years resilience and self-care have become buzzwords around older peoples services, but are they just code for “cuts”, or is there something more to this movement? If we know what ageing well might look like, what can we put in place in the way of resilience and self-care that can make that a reality?
Firstly, some definitions…
What do we mean by resilience? There are two types here that are relevant to older people. Firstly there are the networks and mechanisms around daily life, so how they interact with the community, whether they have family nearby, income and expenditure. We might define this type of resilience as how much change has to happen for there to be a problem.
For example, if income is £200 a week and expenditure is £190 a week, it only takes prices to rise by £10 a week and suddenly there is a problem.
The second type of resilience for me is around, what actually happens in a crisis? Carers are a good example here. I have seen 85 year olds whose sole carers are their spouse, and very often the spouse is 88. So if there is a crisis with the carer (many of whom aren’t exactly well either), then because there is reliance on just one person we have two people in difficulty, not just one. What happens then?
So for me, resilience is around preparedness for ageing in terms of looking ahead and planning, and around crisis management.
Self-care is an interesting one – the Self Care Forum in the UK talks about
“The actions that individuals take for themselves, on behalf of and with others in order to develop, protect, maintain and improve their health, wellbeing or wellness”
And they talk about self care empowering the individual and reducing the reliance on stretched services. Interestingly they say that 80% of people in the UK self care on a regular basis and the average person deals with 4 ailments a week themselves, largely things like headaches, tiredness, colds etc, without needing to access professional care. When self care breaks down, we see an increase in accessing healthcare professionals – they quote 57million GP appointments a year for minor ailments.
So what does it mean to age well? What should we be encouraging older people to aspire to?
The World Health Organisation defines Healthy Ageing “as the process of developing and maintaining the functional ability that enables wellbeing in older age”. Functional ability is about having the capabilities that enable all people to be and do what they have reason to value. This includes a person’s ability to:
- Meet their basic needs
- Learn, grow and make decisions
- Be mobile
- Build and maintain relationships
- Contribute to society
What should this mean for our actual older people in our community, and what are the barriers that need to be overcome?
1. Meet their basic needs
We also need to be preparing future generations for ageing well – in the future, the policy of automatic enrollment into a pension will be seen as a massive step forward in reducing pensioner poverty.
2. To learn, grow, and make decisions
Whilst many older people are financially okay (not rolling in money but comfortable), there are those for whom finances are a major source of worry. Age UK have run a “Heat or eat?” campaign highlighting the decision that some older people face about paying fuel bills or buying food – this isn’t something that any older person should face in 21st Century Britain. But there are benefits and support available; the key problem is getting that support to those who need it most. Age UK London and local Age UKs in London have previously worked supported the Mayor of London’s “Know your rights” campaign to address this, but it is a constantly needed piece of work.
As we are living longer, later life is no longer the bit between work and death – it is increasingly seen as another phase. But what to do with it? Organisations such as the University of the Third Age are vital in giving older people the chance to continue new interests or explore new ones, and there are many other avenues for this through volunteering.
Some older people will not have much of a choice – caring responsibilities or their own medical conditions will limit the amount of learning and growing some older people can do. But aren’t they probably the ones that need it most? When even the smallest improvement can mean a lot, there is clearly scope for recognizing and fulfilling this need in older people.
3. To be mobile
Being mobile means the opportunity of getting out of the house, seeing and experiencing other things and feeling the boost to wellbeing that this brings.At a time in their lives when many older people report that most of the people they know are dying, this seems to become what is expected – but what about new relationships? Again I think it comes down to viewing later life as another stage of growth, and ensuring the opportunities are there.
4. To build and maintain relationships
Transport is huge issues for communities and local service providers. As the chief executive of a local Age UK I knew there were older people in need of activities, and I knew we ran what they wanted but there was no way to get them from their homes to my services that didn’t involve expense or other issues. Age UK are highlighting these issues with their “Painful Journeys” campaign, and it is great that the Mayor of London is working through TFL to increase the accessibility of more rail and tube stations in London.
We also need to think about the changing nature of “the family”
Families are more fragmented now, not uncommon for a local Age UK in London to get a call from a daughter or son in Doncaster wanting some support for their mother in Enfield. Also need to consider that with divorces and remarrying, some grandchildren can have up to 8 grandparents – what are the implications there on the ability of the next generation to help older people?
But we also need to acknowledge that the way in which families and friends connect is changing – we at Age UK London use our “Techy Tea Parties” to work with older people on digital communication. And whilst Facebook and Skype cannot be seen as a replacement for face to face personal contact, but it is and will be another way for older people to stay in touch and to create new relationships and interests.
5. To contribute to society
There are, of course, other barriers that get in the way of older people living the life they want. Health issues become more prevalent in older age and they often come to dominate a person’s life.
Attitudes towards “the system” can also be a barrier. Pretty much all of the health and social care professionals in Local authorities, NHS, and the voluntary sector I’ve ever met have been dedicated to the role that they have taken on. You don’t go into these roles to make money or for the glory. And yet, there is a perception in the public eye that patients/clients seem to take second place to processes and policies. Now you have to have some form of structure, but do we have a situation where the tail wags the dog? Does the bureaucracy perpetuate itself at the expense of the very people it is supposed to serve?
We are all contributing to society in some way, whether through our work, our taxes or other activities, and through this we feel part of something. If older people do not feel they are contributing to society then in effect they feel more disconnected than any purely physical isolation. Many older people already give something back to their community through volunteering or through caring responsibilities, but how do we get the message across to all older people that they are valuable?
And whilst there is affection for the NHS, there is certainly a reluctance among some older people to engage with it or local authorities. I’ve met many older people who will come to Age UK for help but won’t go to the local authorities, because they fear being caught up in “the system”, and that somehow they will lose their power of control over their lives. It is a perception, but an important one.
There are other aspects to consider about older people being resilient
There is a particular problem with those older people who, for various reasons, are ageing without children or other family support.
Ageing Without Children (AWOC) highlight that the numbers of people over 65 without adult children are set to double from 1.2 million at the present time to 2 million by 2030. At the moment 92% of informal care is provided by family and 80% of older people with disabilities are cared for by either their spouse or adult children. The older a person is, the more likely they are to be cared for by their adult child. This year for the first time, more older people need care then there is family available to provide it.
“As the baby-boomer generation ages, a growing ‘family care gap’ will develop as the number of older people in need of care outstrips the number of adult children able to provide it. This is expected to occur for the first time in 2017”
– The Generation Strain, Institute of Public Policy Research 2014
Gender can be a factor too – older men are significantly worse than older women in maintaining social networks and asking for help, and this is why the Men In Sheds movement has been such a success where it has been set up.
Issues around being LGBT can be exacerbated by becoming older – if you feel vulnerable because you are getting frailer, then this potentially is going to get worse if you are facing discrimination and prejudice.
We certainly have a lot to learn from some BAME groups – I’ve had Sikhs look very oddly at me when I ask about how they look after their older people – they just do it. It is so ingrained in their outlook on life that they take it as read as the way things should be.
So having looked at what ageing well should be and some of the barriers – how does this apply to the concept of resilience and self care.
Firstly there seems to be the need for a mindset change, not just amongst older people but amongst the general public. Age is one of the Public Sector Equality Duty strands, but I would argue it is different to homophobia or racism, though in its own way no less damaging. Older people do not tend to get shouted at on the street in the same way that, say, members of the LGBT, BAME or disability communities will get verbally and physically abused.
Ageism tends to be subtler and more implied than obvious – for example we hear the phrase “bedblockers” used during times of pressure in the NHS – older people aren’t blocking the beds, they don’t stay in hospital by choice. “Bedblocking” is systemic failure not a patient choice, and yet the implication is that the older person is the cause of the problem. So there needs to be a challenge to this insidious form of ageism because it automatically paints older people as a burden on society. And how demeaning is that – to tell someone that they are a drain on resources, that they are no longer have value in the eyes of the community?
If we value older people, whatever their circumstances, then they are less likely to feel vulnerable and more likely to take a more active part in the community, more likely to feel engaged and positive, and therefore be more able to cope with ageing.
But we need to go further than that.
In her book “Disrupt Ageing” Jo Ann Jenkins, CEO of the American Association of Retired Persons (AARP) says
“Our ability to live longer, healthier, more productive lives is one of mankind’s greatest accomplishments. But aging is also one of life’s great contradictions. It’s everyone’s dream to live to a ripe old age, but many people fear growing older. Aging is often viewed as more of a problem than an accomplishment.”
So how about seeing later life as being a time to celebrate and share that experience? Think of the expertise and experience that older people have – think of the number of mistakes they have made and the lessons they could pass on! And how do we capture all that for the good of our communities? I’ve had experience of running intergenerational projects, and the power of those interactions is huge – for both sides.
Well, a lot of this is already happening – residents associations, neighbourhood watch, trustee boards, enter and view teams on the local Healthwatch – but is it valued enough? Is it recognized for the impact it has on building stronger communities?
By valuing older people in a better way, we create a culture where older people feel more able to contribute to society and are recognized for it, and as a result we have an upward spiral of improving communities.
Secondly, all of us we need to be thinking about later life as another phase, and thinking early about who we are going to be in this phase. We need to prepare for the practical things like wills and pensions, but also look at where we can find value for ourselves. Volunteering is a good one. Travel? Writing that novel? It doesn’t matter! But having some sort of goal that contributes to self worth is vital.
But lastly, how do local health and social care services this?
The big problem here is that the very services that support resilience and self-care are not statutory, so when it comes to funding pressures they will be the first to be cut.
But this is a false economy – prevention really is better than cure, and it is better to give that little bit of help to keep older people away from the health and social care system, than to wait until they are in desperate difficulty and need more serious and costly interventions.
So if we want resilient older people, who are ready to age well and able to cope with this, then we need:
- Society to value older people more
- Older and “pre-older” people to view retirement as another phase of life
- Social and healthcare services that support prevention and wellbeing rather than crisis management
I leave you with a concept of what I think our approach should be – to enable older people to make their own decisions and be there for them when things go wrong, we need to think of health and social care as the ladder and the safety net. The ladder to encourage them to continue to grow and be valued, and the safety net to catch them when they fall.