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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ippr|GettingOn:Wellbeinginlaterlife2

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.

References

ActorC,BowlingA,BondJandScamblerS(2002)Loneliness,SocialIsolationandLivingAlonein

LaterLife,Swindon:ESRC

AllenJ(2008)OlderPeopleandWellbeing,London:ippr,availableat

www.ippr.org.uk/publicationsandreports/publication.asp?id=620

AcademyofMedicalSciences(2009)Rejuvenatingageingresearch,London:AcademyofMedical

Sciences

BanksJ,BreezeE,LessofCandNazrooJ(2006)Retirement,healthandrelationshipsoftheolderpopulationinEngland:The2004EnglishLongitudinalStudyofAgeing,ELSA(Wave2),London:

InstituteforFiscalStudieswww.ifs.org.uk


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BlanchflowerDandOswaldA(2004)WellbeingovertimeinBritainandtheUSA,JournalofPublic

Economics Vol.88,1359-1386

CarstensenL(2009)Along,brightfuture:aginginthe21stCentury,PresentationtoAmerican

PsychologicalAssociation,117thAnnualConvention,8August,Toronto

DepartmentforWorkandPensions(2009)OpportunityAgeIndicators:2008update London:DWP,

OlderPeopleandAgeingSocietyDivision

Foundation66(2009)Foundation66highlightsepidemicoflate-onsetdrinking,pressrelease,14

July

HkanssonK,RovioS,HelkalaEL,VilskaAR,WinbladB,SoininenH,NissinenA,MohammedAHand

KivipeltoM(2009)Associationbetweenmid-lifemaritalstatusandcognitivefunctioninlaterlife:

populationbasedcohortstudy,BritishMedicalJournal339:b2462,2July

NazrooJ,GreenwadlI,BajekalMandLewisJ(2005)EthnicInequalitiesinQualityofLifeatOlder

Ages:SubjectiveandObjectiveComponents,Swindon:ESRC

OfficeforNationalStatistics(2008)SocialTrendsNo.38,OfficeforNationalStatistics,Basingstoke:PalgraveMacmillan

PalmerG(2009) Indicatorsofpovertyandsocialexclusion:somecross-countrycomparisons,York:

JosephRowntreeFoundation

ScottishGovernment(2008)ScotlandsPeopleAnnualReport:Resultsfromthe2007-2008Scottish

HouseholdSurvey,Edinburgh:ScottishGovernment

TriggleN(2009)Dementiadrugusekillingmany,BBCNewsonline,12November,availableat

http://news.bbc.co.uk/1/hi/health/8356423.stm

TurkCharlesS(2009)EmotionalExperienceAcrosstheAdultLifeSpan:AStoryofStrengthsand

Vulnerabilities,PresentationtoAmericanPsychologicalAssociation,117thAnnualConvention,7

August,Toronto

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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


MoullinS(2008)JustCare?Afreshapproachtoadultservices,London:ippr,availableat


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

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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

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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

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Ratherthanseeingdifferentstagesoflifedominatedbyakeyactivity(withyoungeryearsspentineducation,middleyearsinworkandolderyearsinretirementandleisure),weneedtoadapttoamoreintegratedmodelwithelementsofeducation,workandleisurealltakingplacethroughoutthelife-course.

BuiltenvironmentThedesignofhomesandcitieshasnotkeptpacewiththerealityofhowpeoplelivetheirlives.Housebuildingandplanningagreementshavebeenbasedonamodelofnuclearfamilies,theablebodied,workingresidentsandpeoplebeingpreparedtotraveltoaccessservices.Yetitisolderpeoplewhowillaccountforhalfoftheincreaseinhouseholdsbetweennowand2026,meaningtherewillbe2.4millionmoreolderhouseholdsintheUKthantherearetoday(CommunitiesandLocalGovernment2008).Thewaywebuildhomesandcommunitiesmustreflectadifferentreality:thatmanyolderresidentsliveontheirown,arenotworkingandarelessmobilethantherestofthepopulation.

Thereisagrowingappreciationinthedisciplinesofplanningandarchitectureoftherelationbetweenhumansandtheirenvironment.Whilethishastendedtofocusonpeoplesphysicalneeds,muchcanalsobedonetofacilitat

getting on: wellbeing in later life

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