Allison Smith

Social exclusion of older people in deprived urban communities of England

Addressing the causes and consequences of social exclusion represents a key theme in European social policy, reflecting growing awareness of the social costs which arise when individuals, families and communities become cut off from wider society. Conceptually, however, social exclusion remains underexplored in gerontology. The article suggests that exclusion represents a useful means of exploring the situation of older people in different environmental settings. Social exclusion in old age is conceptualised as a multi-dimensional phenomenon comprising of: exclusion from material resources; exclusion from social relations; exclusion from civic activities; exclusion from basic services; and neighbourhood exclusion. Drawing on a survey of 600 people aged 60 and over in deprived neighbourhoods of three English cities, the article develops indicators to represent each dimension of exclusion and seeks to assess the nature of social exclusion faced by older people in deprived neighbourhoods. Results reveal a considerable proportion of older people experiencing social exclusion in at least one form. The sample fell into three categories: 33% were not excluded on any of the five domains; 31% experienced exclusion on a single domain; 36% were vulnerable to the cumulative impact of multiple forms of exclusion. Multiple social exclusion was significantly correlated with respondents’ ethnic origin, educational status, housing tenure, perceived health status and quality of life. It is concluded that social exclusion represents a useful means of depicting disadvantage experienced by older people living in deprived urban neighbourhoods, and that it would be useful to extend the analysis to other types of residential setting.

Determinants of quality of life amongst older people in deprived neighbourhoods

This article analyses the determinants of the quality of life in a sample of 600 people aged 60 or more years living in deprived areas of three English cities. Data were collected by means of a face-to-face administered questionnaire. Two standardised measures, the ‘Satisfaction With Life Scale’ (SWLS) and the ‘Philadelphia Geriatric Center Morale Scale’ (PGCMS), and a single-item question were used to produce outcome measures of the quality of life. Using a conceptual model of quality of life factors, 21 socio-demographic, objective and subjective variables were correlated with each of the measures. Thirteen of these variables were subsequently entered in three multiple regression models. Subjective variables correlated significantly with all three quality of life measures, but socio-demographic and objective life condition variables correlated less strongly. Regression analysis revealed perception of own health, perceived ability to cope financially, perception of poverty over time and loneliness to be important determinants of the quality of life across all three quality of life measures. Variables that described characteristics of the urban environment had limited direct influence on the quality of life. The findings support the conceptual framework and highlight the key role played by subjective variables in determining the quality of life of older people in deprived urban areas.

Older peopleis perceptions of the neighbourhood: Evidence from socially deprived urban areas

Neighbourhoods contribute significantly to shaping their residents’ identities. For older people, the neighbourhood may be even more important than for younger people. Ageing can be associated with an intensification of feelings about locality and space, and the neighbourhood may contribute significantly to older peoples quality of daily life. Within the context of a study that examines the concerns of older people living in areas of England characterised by intense social deprivation, the article explores perceptions of the local environment. Findings are reported from an empirical study conducted in nine socially deprived neighbourhoods across three cities. Data collection consisted of a survey of 600 people aged 60 and over, and in-depth interviews with 130 people of the same age group. The article focuses on older peoples views in relation to both positive and negative aspects of their local environment. It concludes with a discussion of three key themes: first, the question of older peopleís attachment to their neighbourhood; second, the issue of variation between areas; and third, the impact of place on the quality of older peoples daily life.

Urinary and faecal incontinence: prevalence and health status

Incontinence is a common and distressing condition of later life. Prevalence studies have reported rates of urinary incontinence from about 3% to 60%, depending on how incontinence is defined and the type of population studied. There is much less information about the prevalence of faecal incontinence. However, some studies have found approximately 2% of the general population and about 60% of the nursing home population to be incontinent of faeces. Although some studies have examined the impact of urinary incontinence on health status, the impact of faecal incontinence has not been investigated previously. Quantification of the prevalence and specific impact on health of common disorders such as incontinence will help commissioners and providers in the prioritization of diagnostic and therapeutic services for this distressing condition. With this in mind, we report the relevant results of the Tipping the Balance Survey, which quantified the prevalence and impact on self-perceived health, anxiety and depression of both faecal and urinary incontinence.

Domiciliary visits to the old and the mentally ill: how valuable?

Summary In the early days of the British National Health Service, domiciliary visits were a continuation of the tradition whereby general practitioners (GPs) met consultants in the patients home. The nature of domiciliary visits, which still attract a special fee, has since changed. We analysed the effectiveness of all domiciliary visits undertaken in a NHS trust providing primary care, mental health and elderly care services to a population of 470 000. Data were obtained from domiciliary visit claim forms and from questionnaires completed by the consultant, the referring GP and consultant peer reviewers. The largest number of visits (total 234) was in geriatric medicine 48.9%, followed by old-age psychiatry 44.9%. Geriatric medicine was more likely than psychiatry to admit patients to hospital (19%) after a visit. All domiciliary visits in old-age psychiatry were done during the day (9 am to 5 pm). Only 2% of GPs stated that they attended any of the domiciliary visits; almost all thought that the outcome of domiciliary visits was of value. Old-age-psychiatry peer reviewers believed that all visits in that specialty were appropriate; in geriatric medicine this figure was 77% and in other psychiatric specialties 65%. The findings indicate that domiciliary visits were not being used routinely as a pathway to hospital admission, though they were often used to expedite admission or gain a quick consultant opinion; the visits were valued by GPs. The practice of domiciliary visits differs greatly from the definition in NHS terms and conditions of service. One or other should be altered.