Judith Phillips

The challenge of ageing in tomorrow's Britain

Some 50 years after the creation of the welfare state and at the start of the new millennium, this paper considers the current and future status of older people in Britain. It argues that as the population ages, the situation of older people is becoming an increasingly important element in social policy debates. The first half of the paper critically reviews developments over the last five decades, emphasising the salience of accommodation issues during this period. In the light of recent initiatives such as ‘Better Government for Older People’, the second half of the paper outlines a policy agenda for the early years of the 21st century. We argue unequivocally for an integrated social policy which addresses the broad needs of an ageing society as opposed to narrow age-based interests, or the interests of specific problematised or stigmatised groups. The creation and delivery of such an integrated policy for tomorrows Britain rests, we contend, on three crucial dimensions: an explicitly articulated value base; a consideration of the educational, technological and spatial aspects of policy; and harmonisation of action at both local and national levels.

Older people's experiences of community life: patterns of neighbouring in three urban areas

This paper examines changes to the community life of older people living in three urban areas of England: Bethnal Green, Wolverhampton and Woodford. All three were the subject of classic community studies in the 1940s and 1950s, these providing rich material about the lives of groups such as elderly people. Using this earlier research as a baseline, the paper presents data on how the experience of living in urban neighbourhoods has changed for older people in the intervening years. The article reviews the relationship between elderly people and their neighbours, drawing on quantitative as well as qualitative data. In conclusion, the paper identifies a number of general arguments pointing to the value of a community and locality perspective for understanding the impact of social changes on later life.

Age-Friendly Rural Communities: Conceptualizing 'Best-Fit'

La littérature sur les communautés amies des aînés est axé principalement sur un modèle de vieillissement en un milieu urbain, en omettant ainsi de refléter la diversité des communautés rurales. Dans cet article, nous abordons cette lacune en se concentrant sur la notion de la communauté dans un contexte rural et en demandant ce qui crée une bonne adaptation entre les personnes âgées et leur environnement. Cela se fait grace à (1) comptes autobiographiques et biographiqus de deux environnements géographiques très différents de subsistence: les communautés bucoliques et contournées, et à (b) l’analyse des besoins et des ressources différents des deux groupes de personnes: les personnes âgées marginalisées et actives qui vivent dans ces deux communautés rurales différentes. Nous affirmons que la définition originale de 2007 de l’Organisation mondiale de la Santé (OMS), de “amie des aînés” doit être repensée pour tenir compte des besoins et ressources explicitement différents de la communauté, pour être plus inclusive ainsi que plus interactive et dynamique en intégrant les changements qui sont survenus au fil du temps chez les personnes et les lieux.

Characteristics of outdoor falls among older people: A qualitative study

BackgroundFalls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented.MethodsWe conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses.ResultsForty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week.ConclusionsThis exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.

WORKING CARERS OF OLDER ADULTS

Juggling work and care presents particular challenges to carers and employers. Employers are increasingly under pressure, both from within organizations and from recent government legislation and policy, to develop family-friendly policies to support informal carers in the workplace. Yet existing ‘family-friendly’ schemes and services are still primarily designed for working parents of young children and rarely address the needs of employees who care for older or disabled adults. This paper reports on a study which investigated how working carers and managers in two public sector organizations — a Social Services Department (SSD) and a National Health Service (NHS) Trust — combined their work and caring responsibilities. A multi-method approach was adopted consisting of five phases. First, a profile of the two organizations was established, followed by a short screening questionnaire to all employees to identify who was caring for an older adult over the age of 60. Third, a lengthier postal survey was sent to the 365 carers who had indicated a willingness to participate further. In the fourth and fifth phases, carers and managers were interviewed in depth about their experiences. This paper reports briefly on the survey, but then concentrates in particular on what was said in the interviews about what helps and hinders working carers of older adults. Despite the existence of policies to support carers, our findings suggest that these were far less important than informal support from colleagues and a sympathetic manager in the workplace. Commuting distance between work, home and the older person also posed difficulties for carers, along with inflexible schedules and work overload. Employers are urged to explore these issues further if they are serious about recruiting and retaining employees, and developing the work – life balance agenda to meet the needs of those caring for older and disabled adults.

Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care

Introduction Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. Design Pragmatic cluster randomised trial. Methods and analysis We randomly allocated 25 participating ambulance stations (clusters) in three services to intervention or control group. Intervention paramedics received training and clinical protocols for assessing and referring older people who have fallen to community-based falls services when appropriate, while control paramedics deliver care as usual. Patients are eligible for the trial if they are aged 65 or over; resident in a participating falls service catchment area; and attended by a trial paramedic following an emergency call coded as a fall without priority symptoms. The principal outcome is the rate of further emergency contacts (or death), for any cause and for falls. Secondary outcomes include further falls, health-related quality of life, ‘fear of falling’, patient satisfaction reported by participants through postal questionnaires at 1 and 6 months, and quality and pathways of care at the index incident. We shall compare National Health Service (NHS) and patient/carer costs between intervention and control groups and estimate quality-adjusted life years (QALYs) gained from the intervention and thus incremental cost per QALY. We shall estimate wider system effects on key-performance indicators. We shall interview 60 intervention patients, and conduct focus groups with contributing NHS staff to explore their experiences of the assessment and referral service. We shall analyse quantitative trial data by ‘treatment allocated’; and qualitative data using content analysis. Ethics and dissemination The Research Ethics Committee for Wales gave ethical approval and each participating centre gave NHS Research and Development approval. We shall disseminate study findings through peer-reviewed publications and conference presentations. Trial Registration: ISRCTN 60481756

Critical issues in social work with older people

This timely text highlights the importance of informed and critical practice in social work with older people. With an emphasis on reflection throughout, it argues for the need to rethink how social workers support some of the most vulnerable people in society. The text begins with an exploration of the relationship between gerontology, the study of aging, and social work, and demonstrates that a gerontological approach has long been missing from social work practice. The central chapters consider key issues affecting older people and social work practice, such as: • risk of poverty • memory loss and dementia • palliative and end of life care • loss and bereavement • moving into a care home Bringing together theoretical and research insights, this agenda-setting text provides a sound base for creative practice with older people. All those looking to make a positive and discernible difference to older people will find this text rewarding reading.

Look after yourself: active ageing, individual responsibility and the decline of social work with older people in the UK

The idea of active ageing retains a broad appeal and has a global reach, particularly through the influence of the World Health Organisation (WHO). However, in practice it has been the subject of criticism. In this article, it is argued that the incorporation of active ageing into the policy agendas of the welfare systems for older people should be understood by reference to the perceived effects of demographic trends on demand for services. In the context of the British welfare system, the active ageing agenda has become inextricably linked with the broader policy agenda to reduce older peoples call on public resources in order to manage the increasing proportions of older people in the British population. The implications of these developments for social work are significant.

Planning for an ageing society: voices from the planning profession

The population of the United Kingdom is ageing inexorably, a trend which requires policy-makers, including spatial planners, to be creative and innovative in meeting the needs of older people. The significance of place in the lives of older people has been demonstrated by many researchers (see for example Peace et al., 2006; Gilroy, 2008) and underlines that spatial planners must be age aware. This paper uses qualitative research with planning practitioners to explore the extent of their age awareness and the means by which the opportunities and challenges of an ageing population are factored into their work. This is examined in the context of the wide-ranging multidisciplinary literature on the spatial experience of older people, and concludes that a clearer articulation of the elements of older peoples relationships with place would assist planners in unpicking this complex subject and building locally appropriate age-integrated solutions for our ageing population which reach beyond predominantly physical dimensions of the environment.

Continuity and change in the family and community life of older people

The research reported here examines the family and community networks of elderly people living in three urban areas of England: Bethnal Green (an inner-city area of London), Wolverhampton (a metropolitan borough in the West Midlands), and Woodford (a northeastern suburb of London). These were the locations for landmark community-based studies in the 1940s and 1950s. The present study shows that although most older people still have kinship-based networks, the ways in which kinship is experienced—especially concerning the interchange of care and support—are different. Relationships between the generations have altered, with support more often being located within a framework of equality and mutual reciprocity. Predictably, too, retirement is now more common, with leisure activities being much more central to the lives of older people. The study raises questions about how policy and practice now need to respond to what is a much more complex and dynamic experience of the family and community lives of older people.