Paul Higgs

A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19).

Quality of life is the subject of much research. However it lacks an agreed theoretical basis. In studies with older populations (ill) health has been used as a proxy measure for quality of life (QoL). We have developed a needs satisfaction measure of QoL in early old age. Our measure has four ontologically grounded domains: control, autonomy, pleasure, and self-realization. The measure was piloted with focus groups, a self-completion pilot, and cognitive interview testing. This produced a 22-item scale that was included in a postal questionnaire and sent to 286 people aged 65-75 years. A 92% response rate was achieved. The scale was reduced to 19 items on the basis of statistical analysis. The domains have Cronbachs alphas between 0.6 and 0.8. Correlations between the four domains range from 0.4 to 0.7. A second order factor analysis revealed a single latent QoL factor. The scores for the 19-item scale are well distributed along the range although they exhibit a slight negative skew. Concurrent validity was assessed using the Life Satisfaction Index--well being. A strong and positive association was found between the two scales (r = 0.6, p = 0.01). The CASP-19 appears to be a useful scale for measuring QoL in older people.

Researching Quality of Life in Early Old Age: The Importance of the Sociological Dimension

Measurement of quality of life has become a major feature of much social and epidemiological research in health and social care settings. It is seen as an important alternative to more process-based outcome measures but remains poorly defined. A major weakness is the absence of any coherent theoretical underpinning whether sociological, psychological or philosophical. Into this conceptual vacuum proxies for quality of life have been introduced. Quality of life [QoL] research into older populations has focused on measures of health and illness as equivalents of QoL. This paper argues that this response is inadequate as it reduces old age to a dimension of health, disability and disease. Instead, we argue that it is necessary to create a theoretically based measure of QoL in early old age which relates to those aspects of later life that are not defined by health. We present a model of QoL that is derived from aspects of contemporary social theory as they relate to the ontology of late modernity. In particular, we utilize a model based upon needs satisfaction. The model contains four domains: Control, Autonomy, Pleasure and Self-realization. The measure consists of a 19-item scale. The four domains load on to a single latent QoL factor. We argue that the CASP 19 scale offers an approach to QoL that integrates a sociologically based model of quality of life with a meaningful and valid research instrument.

Aging without agency: theorizing the fourth age.

This article looks at the “fourth age” as a manifestation of the fragmentation of “old age”. We argue that the fourth age emerges from the institutionalization of the infirmities of old age set against the appearance of a third-age culture that negates past representations of old age. We outline the historical marginalization of old age from early modern society to the contemporary concentration of infirmity within long-term care which makes of old age an undesirable “social imaginary”. As “old age” fades from the social world, we liken this to the impact of a “black hole” distorting the gravitational field surrounding it, unobservable except for its traces. Within this perspective, the fourth age can be understood by examining not the experience itself but its impact on the discourses that surround and orientate themselves to it.

The third age: class, cohort or generation?

In this paper we consider some of the ways that the third age can be thought about and studied. Taking the work of Peter Laslett as our key source, we explore his ‘aspirational’ approach toward redefining post-working life and look at some of its limitations as both definition and explanation. There is a need for a more sociologically informed approach to the third age, and we outline three potentially important structures that might better explain it – class, birth cohort, and generation. Whilst it might seem attractive to see the third age as a class-determined status, based on the material and social advantages accruing to people who have retired from well-paid positions in society, the historical period in which the third age has emerged makes this explanation less than adequate. Equally a cohort-based explanation, locating the third age in the ‘ageing’ of the birth cohort known as the baby boom generation, fails fully to capture the pervasiveness and irreversibility of the cultural change that has shaped not just one but a sequence of cohorts beginning with those born in the years just before World War II. Instead, we argue for a generational framework in understanding the third age, drawing upon Mannheim rather than Marx as the more promising guide in this area.

The Impact of Age, Place, Aging in Place, and Attachment to Place on the Well-Being of the Over 50s in England

This study uses data from the English Longitudinal Study on Ageing to explore the extent and significance of the influence of “age,” “place,” and “aging in place” on the attachment to place in a large representative population of English adults aged 50 and over. It then examines the contribution of age, place, aging in place, and the attachment to place to scores on the CASP 19, a measure of well-being designed to measure some of the key sentiments and experiences of the “third age.” The results indicate that age, aging in place, place, and the attachment to place interact in complex ways to affect levels of “third age” well-being.

Pathways to early retirement: structure and agency in decision-making among British civil servants

The context of this paper is the changing nature of later life in the United Kingdom. It examines some of the broader issues of early retirement. While there has been considerable debate about the restructuring of employment during the latter part of the 20th century which led to a shake-out of older workers from the labour force, less attention has been given to those who take voluntary early retirement. Given the importance of early retirement to the economy and to social policy, it is important to find out how individuals make retirement decisions. The paper examines the results of a semi-structured interview study of the decisions made by a purposively drawn sample of British civil servants who are participants in the Whitehall II study. The sample included participants who chose early retirement and those who did not. From the interview data, ideal types of possible routes into retirement have been constructed. Illustrating these ideal types, individual life histories are drawn upon to show how responses to the issues surrounding retirement feature in peoples lives. It is argued that decisions about early retirement are not made in a vacuum, neither are they free from pressures or inducements. Some are to do with organisational restructuring, some are about financial offers, and some are influenced by the opportunities for leisure and self-fulfilment that early retirement offers. The paper concludes by arguing that early retirement needs to be studied as a process involving the interplay between structure and agency.

Stratification, Class and Health: Class Relations and Health Inequalities in High Modernity

This paper starts from a critique of the dominant and largely empiricist paradigm within which sociologists have approached the relationship between social class and health. Referring to the transformational model of social activity and the relational model of society advanced by Bhaskar, the nature and reality of class relations and the preconditions for their theorisation are discussed. A neo-Marxist theory of class relations owing much to Clement and Myles is outlined. The relevance of this theory for a revised and more sociological consideration of health inequalities is then explored and some pointers offered for future empirical enquiry. The authors contend that this theory may throw some light too on the theoretical and political timidity medical sociologists characteristically show in their current research on health inequalities.

Ageing in a consumer society : from passive to active consumption in Britain

Social change and later life The historical evolution of the third age Cohort, generation and time Consumption and the changing nature of the household in later life Later life in consumer society Income, expenditure and inequalities in later life Consuming health in later life Health and social policy: a moving target Conclusion.

The effects of pre-retirement factors and retirement route on circumstances in retirement: findings from the Whitehall II study

Retirement has traditionally been seen as the beginning of old age. It has been depicted as mandatory expulsion from the workforce and seen to mark the transition to a period of ill health and poverty. Such ideas and associations are however being challenged in the developed world by socio-demographic changes in retirement and old age. People in the United Kingdom as elsewhere are living longer and healthier lives, and many older people have access to non-state incomes that afford them a reasonable standard of living in retirement. There is however still concern that inequalities persist into old age. Data from two waves of the British Whitehall II study have been used to assess the relative effects of occupational grade, psychological and general health during working life, and retirement patterns or pathways on activities, attitudes to health and income in retirement. The results show that the majority of the sample reported good health, financial security and overall satisfaction with life, but with observable inequalities. Regression analyses demonstrate that pre-retirement circumstances generally had a greater effect on later life than the retirement route or pathway. Retirement no longer represents a drastic break between working and post-work life but rather, the results suggest, there are continuities between the two periods. It is concluded that the main causes of inequalities in retirement are work-based rather than in retirement itself.

Not just old and sick - the 'will to health ' in later life

ABSTRACT The end of the ‘Golden Age’ of welfare capitalism in the 1970s was the prelude to a period of greater individualisation within societies and was accompanied by an increase in the importance of consumption as a way of organising social relations. During the same period there was also an expansion in the discourses aimed at enhancing the government of the autonomous self. One such discourse operates around what has been termed the ‘will to health’: it suggests that health has become a required goal for individual behaviour and has become synonymous with health itself. The generational groups whose lifecourses were most exposed to these changes are now approaching later life. We explore the extent to which social transformations related to risk, consumption and individualisation are reflected in the construction of later-life identities around health and ageing. We examine how the growth in health-related ‘technologies of the self’ have fostered a distinction between natural and normal ageing, wherein the former is associated with coming to terms with physical decline and the latter associated with maintaining norms of self-care aimed at delaying such decline. Finally, we consider anti-ageing medicine as a developing arena for the construction of later-life identities and discuss the implications of the social changes for researching later life.