Critical Discourses of Old Age and Telecare Technologies

Gizdem Akdur

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780367504724
• eBook ISBN: 9781000075458
• Edition: 1
• Topic: Social Sciences
• Subtopic: Ethics in Medicine
• Index: Social Sciences

This book makes an enquiry into policies surrounding old age and telecare. It contextualises telecare within the wider history of health and social care in England to build the case that there are grand narratives of old age embedded in policies.

Divided into four sections, the book covers:

• Connecting old age with telecare

• A general review of old age and telecare

• A critical enquiry into discourses and the identity of old age

• Conclusions and future directions.

The author highlights the manifestation of old age discourses in care policies, how they have been perpetuated yet also transformed in the context of telecare, and what this means about older people. The book will be of interest to students and academics in the fields of gerontology, sociology, old age studies, philosophy, social policy, health and social care policy, information systems, and critical theoreticians

1    Introduction

Connecting old age with telecare

Old age has a history of problematisations in Britain, through which certain narratives of old age have been produced and sustained. In the early 1900s, ageing was “discovered” as a social issue, and “old age” was created as a separate group (Phillipson, 1998). Until the 1920s, older people formed an emerging group that was differentiated based on their poverty as well as their status in relation to work. Starting in the 1940s, the vocabulary around ageing expanded because the welfare state established post-WWII, from 1945 onwards, started offering pensions for those of retirement age, as well as offering healthcare services for older people in a distinct way via the newly founded National Health Service (NHS) (founded in 1948). With medical and technological advancements extending life spans over the century, by the 1970s, an optimistic view of retirement was created that considered it as a major stage in life; depictions of this age group as endowed with leisure time, energy, and spare funds for activities and luxuries led to the emergent conceptualisation of a new kind of target demographic: the “gold in grey” consumers (Minkler, 1991).

These coincided with Thatcher-era policies, in the 1980s, which encouraged increased privatisation (e.g. of homes and various services), cuts to government spending on social care, and the dismantling of strong unions, of which NHS staff had been a large part. In the 1980s, public interest in ageing issues was growing alongside anxieties about the funding crisis of the welfare state (Gilleard and Higgs, 2014). Old age was seen as an economic burden, with the dichotomising vision of struggling young working people funding older dependents developing. In the 1990s, the status of older people faced destabilisation due to uncertainty about the provision of pensions. Old age was increasingly interpreted via financial justifications in an era of demographic constraints and increased outsourcing to private sector providers. Today, old age faces similar interpretations, which are carried forward by the dominant historical discourses.

The making of the aged body and the older population into the central focus of scientific knowledge and political practices has its origins in the period during which age became a regulatory theme in family, schooling, work, and retirement. The existing discourses of old age are thus products of the ways in which bodies and populations have been historically problematised through the regulation of age. Three grand narratives of old age have been identified by critical gerontology and old age studies, which are still relevant in the postmodern life course. These are: (1) the biomedical model that perceives ageing as a pathological problem and ties ageing to those discourses of decline, abnormality, deterioration, and dependency; (2) the consumer culture that perceives older people as a new group of homogeneous, financially secure, and powerful consumers; and (3) managerialism in social work that perceives older people in terms of risk (Featherstone and Hepworth, 1989; Phillipson, 1998; Phillipson and Biggs, 1998; Biggs and Powell, 2001; Powell and Biggs, 2004).

This book combines two distinct subjects of research: (1) old age and (2) telecare technologies, which are known as the remote care services for older people. Due to the challenges presented by ageing populations and the consequentially increasing demand for health and social care services, technological care has seen a global rise in recent decades. In the UK, the scope of telecare services has been growing since the 1990s through the increasing number of government policies and strategies created about these technologies. In the past decade, the UK Government has been advocating the widespread adoption of telecare services, and the technology industry has been presenting new technological innovations to enhance well-being and health as the population ages. Large state-sponsored trials of telecare were conducted in the early 2010s, from which ambiguous results were published in medicine studies about the effectiveness of telecare (Cartwright et al., 2013; Henderson et al., 2013, 2014; Hirani et al., 2013; Steventon et al., 2012, 2013). Nevertheless, the pervasiveness of telecare services has been consistently growing, and more local authorities have been offering these services to their residents. Telecare information systems occupy a greater part of public social care policies, and thus they create a new domain in which old age narratives can find their place. Older people are the primary users and stakeholders of telecare technologies, and are processed, interpreted, classified, and organised within these information systems.

There has been a cohort of research about care technologies from different fields, such as information systems, health services research, medicine, and sociology. The sociological studies of old age and care technologies have been mainly influenced by Michel Foucault’s school of thought, and they reflect on such topics as governmentality, control, surveillance, and ethics (Powell and Biggs, 2004; Schermer, 2009; Guta et al., 2012; Sorell and Draper, 2012). Foucauldian theories and frameworks have been influential in the domain of old age studies; power and discourse analysis has been the focus in this area of research. This is because discourses concerning old age are available in the structures and institutions found in everyday life, including the policies and politics of the governments. With regard to this, there are certain narratives of old age that can arise out of policies that concern telecare. These texts and practices reveal “explicit and implicit ways of positioning older people” (NCPOP, 2009, p. 4), meaning that older people are given particular identities.

Outline

In this book, I will systematically demonstrate how an old age identity is constructed based on discourses emerging from telecare-related national policies and how these discourses are closely linked with the historically existing grand discourses of old age. I will explore those enactments or alterations of the grand discourses of old age in relation to telecare, and explain the effects that discourses of old age have on the old age identity. The question, ‘How is the identity of old age constituted in relation to telecare technologies?’, is essential to guiding the critical enquiry undertaken in this book.

Chapter 2 reviews the literature of gerontology and old age studies, and it creates an association between old age and telecare. Telecare is placed in the field of information systems and other fields, and theoretical insights are revealed with regard to how these technologies can be linked to the problematisations of old age. A set of concepts and constructs are also defined in Chapter 2. Telecare information systems are recognised as complex systems that consist of technological, political, social, and economic components. Finally, the chapter also introduces analytical tools and contextualises Foucault’s modes of objectification and discourse analysis to guide the critical enquiry of government policies in the next chapter.

Chapter 3 presents the history of the NHS and telecare policies to contextualise the state of social care services in England. It answers the question outlined earlier by applying the modes of objectification to the policies. The chapter presents the discourses of old age and structural relations that are mediated through policies related to old age and telecare. Then, these are placed within the grand discourses of old age to reflect on how the grand discourses have been sustained and expanded. At the end, old age identity is defined by reflecting on the discourses and processes that are historically sustained, emerging, disrupted, or dissolving.

Chapter 4 presents an overview and concluding remarks whilst discussing how contributions can be made to policy. Finally, possibilities for future research are outlined.

2 A general review of old age and telecare

This chapter starts with the introduction of the premises upon which the problematisations of old age were built, and which narratives of old age are produced and sustained. Then, I reflect upon telecare technologies, their relation to older people, and different approaches used in telecare research. And finally, I introduce my analytical ‘toolbox’, which will make the analysis of government policies possible.

Ageing and old age

A brief history of old age in Britain

The idea of old people as a separate group and the creation of the old age pension are the products of the late 1800s. In Britain, state pensions began in 1870s, and non-contributory pension legislation came into effect in 1908. Prior to this period, provision for older people was not differentiated from provision for people with sicknesses (Slater, 1930). The political environment at this point considered old age as a problem that required new social policies. In the early 1900s, ageing was ‘discovered’ as a social issue. Until the 1920s, older people formed an emerging group that was differentiated based on their poverty as well as their status in relation to work. Poverty and marginalisation were common occurrences in the lives of older people, which led to the construction of a framework of older age that was based on similar occurrences and experiences. Consequently, old age was constructed around “harsh or softer versions of dependency” (Phillipson, 1998), such as the concept of older people as a problem population, or of older people as deserving of a reward for their past contributions to society.

In Britain, several social rights were gained with the start of the post-war (after WWII) period welfare state, with a growing idea of social inclusion. Starting in the 1940s, the vocabulary around ageing expanded, because the welfare state was offering pensions and health services in a distinct way compared to the previous periods, when old age had been constructed around poverty and dependency. Until the 1950s, old age was a social status of white heterosexual able-bodied men. In the institutionalised life course of this society, the modernist model of social structure provided the boundaries of the labour force – and chronological age, rather than corporeal age, was taken as the legitimised means through which men could exit this labour force. The state was the main provider of support when this chronological limit was reached, enabling men to be freed from labour. Therefore, men’s lives were more or less divided into two frames of status: (1) one of ‘working age’ and (2) the other ‘old age’, which was inevitably framed by the former (Phillipson, 1998). This strict marking of men’s lives by their chronological age did not follow the same fashion for the women’s life course. A woman’s life was defined by individual circumstances, her health status, and personal relationships (marriage, motherhood, widowhood, etc.) rather than by the economic system, as was the case for men (Gilleard and Higgs, 2014).

In the post-war welfare state period, the modern government was given the central responsibility over older people for the first time, and it did so in a novel way through developing a moral framework. The identity of older people was influenced by this framework, and it evolved in various ways with emerging ideas such as ‘active retirement’. Retirement as a positive experience took time to spread beyond a certain class and group of retirees. At the beginning of the post-war period, retirement was seen as a psychosocial crisis, with increased morbidity and mortality rates (Phillipson, 1993). These could have been the consequence of loss of work-based relationships and loss of self-esteem with age. However, by the 1970s a more positive view of retirement was created. The understanding of retirement as a major stage in life with active lifestyles was fostered in this period.

In the 1960s, after the high point and subsequent dissolution of the ‘first modernity’ were experienced, a new ‘normativity of diversity’ (Beck, 2007; Gilleard and Higgs, 2014) started to replace the former cultural arrangements. The body started having other possible identities, and new embodiment types – new forms of social agency – were realised upon the features of the corporeal. This made possible alternative lifestyles as distinct from the standardised lifestyles of the first modernity. With respect to the identity of older people, the society now found itself in a period of crisis. Between the 1950s and the early 1970s, the institutions of the welfare state and retirement were the main enabling forces that were considered to secure old age. By the 1980s, however, the development of earlier retirement plans caused the state financial distress. This situation was exacerbated by the stagnating growth of the welfare state in the mid-1970s. Contributing factors such as a rise in inflation and unemployment as well as a slow economic growth challenged the principles of spending on the welfare state. Following this, the older people’s welfare state started to erode in the late 1980s. The expansionist welfare reforms of the 1960s and 1970s shifted towards plans to privatise the provision of pensions, and to separate the better off from the poorest by targeting the resources on the poor.

The nature of discussions revolving around old age in the Britain of the 1980s was influenced by such factors as growing public interest in ageing issues, the crisis of funding for the welfare state, and concerns regarding its future. These factors made old age enter an arena of ambivalent points of debate: on the one hand, growing old signified liberation; on the other, older people were seen as a marginalised group of the population (Phillipson, 1998). The problems with public spending were more openly constructed around old age as an economic burden, and the restraints in social services and healthcare expenditures were increasingly justified through this. By the 1990s, several crises were observed that were related to the status of older people in this society, arising from doubts surrounding the system of retirement and from views challenging the assumptions about the welfare state. These changes started to gradually result in ideologies that defined older people as a burden to society (Phillipson, 1998).

The welfare state and old age

The nature of demographic change has always been a concern for Western societies, and it has been problematised with costs and burdens that these changes would bring. Increasing expenses of healthcare services, and the ageing population becoming an unwelcome burden on society were the kind of doubts that arose with demographic changes in society. In the Uni...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• List of tables
• Acknowledgements
• 1 Introduction: connecting old age with telecare
• 2 A general review of old age and telecare
• 3 A critical enquiry into discourses and the identity of old age
• 4 Conclusions and future directions
• References
• Appendices
• Index