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CHAPTER 1
OLD AGE TODAY?
Setting the Scene
Introduction
This chapter begins with two narratives that set the scene as we begin to explore what kind of environment might best help an individual flourish in old age.
The use of experiences is deliberate. Too much of our social policy and cultural attitudes are removed from some of the dimensions of our own intellectual and emotional world. We seem resistant to engaging in an agenda of social change that might improve and develop the quality of life for older people, for reasons that may not be valid or evidenced.
The chapter examines the significance of demographic statistics before identifying some questions and issues raised by an ageing society. It then looks at the challenges posed to older people in living a healthy, engaged and dignified old age. It moves on to discuss the much-contested issue of how best to organise society to deal with the economics of health and social care in later life. In the final section, we shall look at the possibilities of re-imagining old age, acknowledging both the blessing and burden of ageing.
This will complete an overview offering a framework within which we can present and examine the research findings, their implications for the structures and shape of care in old age, and the vital role of personal relationships.
Listening to others and ourselves
JAYNE
Jayne is a 52-year-old librarian who has worked both here and abroad. She is single, independent and enjoys her freedom to choose and organise her professional and private life. She is an extrovert and enjoys keeping busy. The variety of jobs over her professional life has meant that she has never had one pension arrangement with a single employer, and she has tended not to think about any investment in the future through pension payments. She lives in a small flat in Leicester and appreciates easy accessibility to shops and other facilities.
Jayne has never considered what the next 30 years might look like for her especially in relation to her housing. She is resistant to considering what her choices might be and prefers not to think ahead especially when it might involve any consideration of her possible frailty or dependence.
SHARON AND MICHAEL
Michael is now 80 and is looking after his wife in the home that they have shared for the last 50 years. They have six children scattered across the country. Sharon, their eldest daughter, has given up her work to look after her mother and father. Sharon and Michael have lived with a slow progressive deterioration in their loved one, who is suffering from Alzheimer’s. This took some time to diagnose and the support that they have had from the local GP and district nurses has been unpredictable and sometimes unsatisfactory. They have had three very traumatic experiences of hospitalisation in the local district general hospital where the care of their wife and mother was unsatisfactory and at times demeaning. Michael was adamant that none of the family should lodge a complaint about the way in which the hospital looked after his wife.
They are committed to all aspects of care at home including assistance with mobility, eating and personal care. This means broken nights and often periods of coping with distress, anxiety and confusion. The local care home has a bad reputation in the town where they live. They are resistant to exploring options around care elsewhere even though the stress of care is having an effect on their own wellbeing.
An ageing society: what are the facts?
Both globally and in the United Kingdom, we are experiencing a revolution in the opportunities that are offered by a steady increase in life expectancy. The statistics paint a picture that is translated into all kinds of practical realities.
In 2014 there were ten million people in the UK over 65 years old. By the year 2030, this figure is projected to rise to 15 million. By 2050, the number will have nearly doubled to around 20 million. Let us look at those projections from a different perspective: today almost one in ten people are over 60 years old; by 2050, one in five people will be over 60. By then, they will outnumber children aged 0–14.
These facts affect us all directly. A man born in the UK in 1981 had life expectancy at birth of 84 years. For a boy born today, the figure is 89 years, and by 2030 it is projected to be 91. The trend for women is similar. A girl born in 1981 was expected to live for 89 years and one born today might expect to live to 92. Projections suggest a girl born in 2030 might live to 95. We are all living longer and we should expect, in our families and communities, to have increased numbers of older people. There can be few of us who do not know friends or neighbours who are literally ‘living with age’. Each of us will need to anticipate and prepare for living longer.
At this point it is important to bear in mind that the projection of accurate demographic figures is problematic due to variables in fertility and mortality rates. In some parts of the world, gaining accurate information can be difficult and some projections have been based on false assumptions. These variables all have implications for policy makers planning services for older people. However, within this total statistical picture, the number of very old people (over 85) grows even faster. This brings particular challenges to the debate about our provision for meeting their needs. Much of today’s public spending on benefits is focused on elderly people: 65 per cent of Department for Work and Pensions benefit expenditure goes to those over working age, equivalent to £100 billion in 2010/11 or one-seventh of public expenditure. Continuing to provide state benefits and pensions at today’s average would mean additional spending of £10 billion a year for every additional one million people over working age.
Growing numbers of elderly people also have an impact on the NHS, where average spending on retired households is nearly double that for non-retired households: in 2007/08 the average value of NHS services for retired households was £5,200 compared with £2,800 for non-retired. These averages conceal variation across older age groups, with the cost of service provision for the most elderly likely to be much greater than for younger retired people. The Department of Health estimates that the average cost of providing hospital and community health services for a person aged 85 years or more is around three times greater than for a person aged 65 to 74 years.
It looks extremely likely that, in the coming decades, rapidly ageing populations will increasingly strain health, welfare and social insurance systems, putting potentially unsustainable pressure on public budgets.
Some issues raised by an ageing society
Reframing our relationship to time and work
Living longer offers us the chance to reframe our relationship to time and to the various stages of our living. We need to re-think what we believe about the nature of work and the relationship between paid and unpaid activity. Concepts of retirement have changed, with older people beyond 65 feeling that they still have a useful part to play in society. There are issues relating to family and the responsibility that the different generations have for one another, especially when older age presents health and social care challenges.
The consequences of an ageing population present society with major issues of public policy: critical questions that face both the voter and those seeking a mandate to govern. These questions are in part related to finance and are wide ranging. For example, who should be responsible for pensions and other income support? How do we provide the best health care for older people within the limitations set on NHS spending, particularly given the increase in those living with dementia-related conditions? Can the State always be expected to meet the needs and associated costs of social care? How and where should older people live and how innovative are we in the provision of suitable housing?
The physical and spiritual dimensions of growing older also present some real anxieties and fears. In an individualistic, consumerist and materialistic world, is it possible to affirm that we are blessed by the presence of older people? Indeed, as we face the prospects of ageing what are we to make of the negative images and stereotypes of old age? How far do these representations shape our sense of what age means or are we shaped by the denial of ageing in twenty-first-century Britain?
Transforming attitudes towards old age
What is needed is a fundamental change in how we as a society think and feel about old age. In other words, we should listen more carefully to the experiences of Jayne, Michael and Sharon, alongside our own. What might it mean to work towards human flourishing in our own old age and in the ageing of others? This is a core theme in our shared commitment to the nurture of the common good in our communities.
However, in order to realise this vision there will need to be some shifts in social, ethical, financial and political thinking to enable old age to fulfil its potential in us, and through us, in society.
What are the challenges that older people face?
Older age can bring a range of challenges to maintaining independence. These might include physical frailty, pain and cognitive issues. A small proportion of older people have to accept the need for help from relatives and neighbours. Some may need to have paid carers to help with basic tasks of living, while others may need to accept a transition into residential care. Age can bring with it some cognitive impairment and even dementia. These and other factors combine to make this age group vulnerable to isolation, depression and sometimes abuse and neglect.
Our experience has indicated that loneliness often besets many older people. This may be caused by the way in which an individual’s social networks shrink. Family members, including children, may well live at a distance. Isolation may be the result of the death of a partner or indeed of children.
The context and culture within which ageing takes place are significant shaping influences for older people. Grandchildren are important for grandparents but often grand-parenting takes place at a distance or in the context of family breakdown. Older people can sometimes find it difficult to cope with the gaps and differences in values and ways of living (for example, the reliance on modern technology and social networking as part of keeping in touch). They may express their concerns, especially about the economic fortunes of their families, as all live with the reality of differences in property and income.
Ageing is also an inner journey as there are emotional, psychological and spiritual tasks to be faced. Older people need to come to terms with their lives as they reflect on its shape and fortunes, and there may be a need to face bad and often traumatic memories. There is infinite value in this process. The inner work done in later life can be the means by which the treasure of wisdom can be passed down to younger generations. There is a need for the elderly to consolidate their identity, which will include a healthy acknowledgement of mistakes and the aspiration to leave a legacy of something worthwhile after death.
Older adults, like people of all ages, will have to find their own way of dealing with death. Some may deny it, resisting at all costs any open conversation about understandable fears of living and dying alone. Some will even avoid any preparation for death that takes the shape of planning and paying for a funeral. There can be few, however, who do not wonder what shape their death might take and what chances there may be of dying with dignity. It remains our shared responsibility to embrace the realities of death through encouraging a more open approach to conversation, reflection and preparation for dying and death. This may also mean a clearer sense of what the choices and decisions are around the end of life.
Finally, we should not understate how the prevalence of negative attitudes towards older adults affects them. These attitudes include indifference (many older people feel invisible and unvalued), pity, resentment and fear, which could even lead to a stigmatising and stereotyping of mature adults as out of date, and at worst greedy and selfish.
Financial and political issues
The statistics that concern ‘population ageing’ give rise to a number of stories about increased longevity and often have a number of things in common – it is bad, it is new and it will overwhelm us all. The major fear is the burden of cost and caring that having greater numbers of older people in society will create.
We should note that ‘population ageing’ has been taking place for almost two centuries in the UK. We should also note the diversity of the ways in which people age and the interconnectedness of culture, economic status, housing, employment and the provision of health care. Some, though not all, would add that a person’s spiritual and religious world also impacts significantly on how they age. It will be important to ensure that those who generate public policy include within their vision a holistic view of human personhood and the intrinsic value of all stages of living and dying as we seek to make the best provision for the common good.
In this context, far too much of the ‘care debate’ has concentrated on the important but rather narrow agenda of whether we shall be able to ‘afford’ ageing. This is a significant debate and still largely unresolved, and was little dealt with in the political debates during recent general elections.
We would do well to attend to the way this debate is conducted. In order to make choices, we need information. Too many of the conversations that take place about older people are simply inaccessible to the general public. The more politicised the discourse, the less we are able to negotiate the contested areas of policy. These debates (necessary as they are for democracy) often fail to place the issues into a broader and wiser historical and cultural horizon. To pick up the image of that man in the wing mirror of my car, we fail to make the connection between older people, the fabric of our lives and the prospects for our own ageing.
The Dilnot Report as a way forward for funding care
There have been a number of attempts to offer solutions to reform the funding of the care of older people. Recent discussion has focused on and around the proposals outlined in the Dilnot Report.
The Report’s main findings were:
1. Public policy must face the fact that state expenditure in Engla...
