Memorandum by Age Concern
1. INTRODUCTION
1.1 Age Concern England (the National Council
on Ageing) brings together Age Concern Organisations working at
a local level and 100 national bodies, including charities, professional
bodies and representational groups with an interest in older people
and ageing issues. Through our national information line, which
receives 225,000 telephone and postal enquiries a year, and the
information services offered by local Age Concern Organisations,
we are in day to day contact with older people and their concerns.
1.2 Age Concern England includes the ActivAge
Unit which has a number of programmes, including Ageing Well UK,
Age Resource, an Intergenerational Network and support for volunteering.
Ageing Well UK is a health promotion programme which aims to improve
and maintain the health of older people. Its projects include
the provision of health shops where mentors give advice on diet,
nutrition and local health initiatives.
1.3 The Intergenerational Network brings together
younger and older people, promoting mutual understanding and concern.
It helps to tackle issues such as ageism between the generations,
crime, social exclusion and disadvantage. An example is an original
project set up by Age Concern in Warwickshire which has now been
running for eight years. Volunteers offer support to targeted
disadvantaged children. Citizenship courses are offered in schools
exploring age, ageing and community relations to combat negative
preconceptions between generations.
1.4 We welcome the opportunity to contribute
to the Committee's inquiry into the benefits of technology and
how it can be applied to improve the process of ageing. There
are many excellent sources of information and expertise on Assistive
Technology.[3]
In this submission we seek to expand the issue to include older
peoples' needs and rights to quality of life, independence and
control—interpersonal contact, social life and purposeful
social activity being fundamental components of what older people
feel contribute to quality of life.
2. SUMMARY OF
MAIN POINTS
— The main factors that promote
long healthy life are well known but most depend on individuals'
lifestyles; what is missing is knowledge of what affects choices
and how to promote healthy lifestyles.
— Attitudes towards ageing and self-stereotypes
are highly important factors in healthy ageing and this requires
more research. Intergenerational contact is key to combating age-related
prejudice.
— Involving end users (older people)
at the early stages of setting research agendas or in early development
stages will provide essential, valuable information to researchers
and designers.
— An interdisciplinary approach to
research, design and technology is required, particularly the
integration of social science into the other disciplines. This
would greatly aid better coordination of research.
— Current priorities include better
funding for interdisciplinary and user-led research; synthesis
and utilisation of existing knowledge and improving the links
between research, policy and practice to improve quality of life
for older people.
3. THE BIOLOGICAL
PROCESSES OF
AGEING
3.1 Although there are links between ageing and
the onset of illness, there is a large body of evidence to suggest
that very few illnesses are inevitable consequences of ageing,
and most are affected by individual behaviour and lifestyles.
Ageing is a process which brings gains as well as losses, and
recent research shows that attitudes towards the process of ageing,
within individuals and within the wider social climate, are perhaps
the most important indicators of how successful the ageing process
will be.
3.2 The factors that promote good health and longevity
in later life are:
— Physical activity—key in predicting
independence and mortality in later life. Disability and infirmity
may be largely the result of disuse of muscle rather than the
inevitable process of ageing.[4]
— Having a social role and function—Long-term
population-based studies[5]
show that social and productive activities are as important as
physical activity in reducing the likelihood of illness and institutionalisation.
The mechanisms for these effects are unclear, participation in
social activities in itself may reflect social competence and
being in control of one's life; the benefits of physical activity
may derive as much from incidental social and purposeful activity
involved. Whatever the mechanism, the two factors are clearly
related to better health and the delay of onset of illness.
— Good housing and living in a safe
and pleasant neighbourhood.[6]
A key issue in housing is fuel poverty, the UK has a particularly
high number of energy inefficient houses. Other issues include
the promotion of healthy, active ageing, eg by reducing the risk
of falls at home.
— Neighbourhood issues such as crime
and antisocial behaviour3 (or the fear of them), or environmental
concerns such as poor paving and litter which can lead to falls,
can prevent older people from leaving their houses. This reduces
opportunities for social interaction with family, friends, etc
which then impacts on mental and physical health.
— Nutrition—barriers to healthy
eating amongst older people include inadequate knowledge of appropriate
diets, poor labelling of foods, and affordability and availability
of healthy foods3. Age Concern is commissioning research from
the London School of Hygiene and Tropical Medicine to identify
and cost the minimum requirements for healthy life in older age.
Part of this project will identify a healthy diet for older people
and the income required to afford it.
— Absence of risk factors such as
smoking and drinking to excess.
— Good mental health and well-being—which
are affected by all the above factors.
3.3 These factors indicate that biological ageing
is greatly affected by psychosocial and economic factors, which
depend to some extent on people's choices and behaviour. Adopting
healthy choices from a younger age is important, but changing
behaviour in later life can also have significant effects on healthy
ageing.
4. PROMISING
AVENUES FOR
RESEARCH
Ageism and stereotyping of ageing
4.1 Recent American research,[7]
suggests that social stereotyping of ageing and the extent to
which it is "internalised" by individuals can have significant
effects on longevity. Out of a sample of 660 older people, follow-up
showed that people with more positive self-perceptions of ageing,
measured up to 23 years earlier, lived 7.5 years longer than those
with less positive self-perception of ageing. This effect remained
after age, gender, socioeconomic status, loneliness and even functional
health were allowed for as confounding factors. This effect is
greater than the physiological measures of low systolic blood
pressure and cholesterol, and also greater than the independent
contribution of lower body mass index, no history of smoking and
a tendency to exercise.
4.2 The authors identify that, unlike race and
gender stereotypes which people encounter while first developing
group identities, people acquire age stereotypes several decades
before they themselves become "old". Therefore they
are most likely to accept stereotypes without question in earlier
life and as they age, will be less able to challenge this stereotyping.
Self-stereotypes can operate without older individual's awareness.
The effects of this can be mitigated in some groups who can be
shielded from stigmatising through, for example, positive intergenerational
contact throughout the lifespan. There is evidence to suggest
that older deaf people report more positive attitudes toward ageing
than do hearing individuals. Older members of the deaf community
tend to participate in intergenerational activities to a larger
extent, in which they are given equal or higher status. This kind
of intergenerational contact may be a source of "insulation"
from mainstream negative stereotypes. Personality types may affect
receptivity to stereotypes.
4.3 Research is now needed to explore this phenomenon
further, including effects of multiple stereotyping on older people
from minority groups, together with the factors which can help
to mitigate the effects of society-wide denigration of ageing
such as intergenerational contact.
The social psychology of ageing
4.4 More research needs to be done exploring
social models of ageing. Better understanding of the psychology
of prejudice and social stereotyping, and the impacts of these
on older people's well-being, capabilities, performance at tasks
and longevity would be useful for policy development in all areas
affecting older people, particularly in health and social care,
and employment, education and training.
Mental health in ageing
4.5 The potential to provide a cure or delay
onset of dementia would have an enormous impact on the quality
of older people's lives. In addition, depression is the most common
psychiatric disorder in later life, 10-15 per cent of the population
aged 65 years or over suffer from significant depressive symptoms.
Age Concern and the Mental Health Foundation have launched a three-year
Inquiry into mental health and well-being in later life. An initial
part of this Inquiry has been a review of the literature and policy
on the promotion of mental health and well-being.
Choosing health
4.6 Research is now needed on what affects lifestyle
choices across the lifespan and into later life, and how people
can be encouraged to adopt healthy choices. The role of technology
in providing accurate information and supporting individuals to
maintain healthy diet and activity regimes could be explored.
Diversity
4.7 A better understanding of diversity in the
older population is required among researchers. The ESRC's Growing
Older Programme,[8]
which recently came to a close, highlights many important issues
of diversity in the older population. Other important, key questions
are: why do women live longer? What are the racial differences
in ageing? Which are biological factors and which are cultural,
lifestyle-related? Personality characteristics may also be important
when it comes to attitudes towards own ageing, susceptibility
to ageism, and differences in coping strategies.
Promising approaches to research
4.8 The breaking down of barriers between disciplines
when it comes to addressing ageing issues in research is welcomed.
Ageing is a process which is biological, but also psychological
and social. Scientists and designers need to work with social
scientists, psychologists and ergonomists to provide services
and products which will be useful to older people. The objectives
behind EPSRC's EQUAL (Extending Quality Life) initiative and the
ESRC's new programme The New Dynamics of Ageing, are welcomed
as approaches to interdisciplinary work.
4.9 Participatory approaches to research and
development which involve the end user (in this case, older people)
are badly required. It can be too easy to "over-technologise"
problems and solutions, without considering the psychosocial aspects
or needs of the user. We welcome the development of research bodies
which are focussing on these new approaches which involve older
people as equal partners in research, for example the Cambridge
Interdisciplinary Research Centre on Ageing (CIRCA). Features
of CIRCA's research strategy are; an interdisciplinary approach,
a life course perspective, emphasis on positive well-being and
involvement of older people in setting the agenda.
5. BENEFITS TO
OLDER PEOPLE
AND DELAYING
ONSET OF
LONG-TERM
ILLNESSES AND
DISABILITIES
5.1 As research from the Growing Older Programme
and other studies confirms, the factors that sustain quality of
life for older people (adequate income, living in a safe neighbourhood,
practical services, having social roles and participating in voluntary
and social activities) are also likely to improve health and physical
functioning. These are identified by older people themselves as
key aspects of their quality of life.
6. DIFFERENCES
BETWEEN THE
SEXES, SOCIAL
GROUPS AND
ETHNIC GROUPS
IN THE
UK
The ESRC Growing Older programme of research provide
useful recent data on many aspects of diversity including gender
differences; the impact of partnership status; differences between
ethnic groups in terms of biological ageing; intersection of social
status/other factors.
7. THE APPLICATION
OF RESEARCH
IN TECHNOLOGY
AND DESIGN
7.1 An interdisciplinary and participatory approach
is key in the efforts of designers and technologists to improve
the quality of life of older people. Social scientists and, in
particular, older people themselves should be involved and consulted,
as has been identified in the EQUAL initiative by EPSRC. In general,
good design should be inclusive for all, and specific "assistive
technologies" considered only when inclusive solutions are
not possible.
7.2 There are many examples of high- and low-technologies
which maintain independence and afford older people a greater
level and sense of control over their lives. The important factors
to consider are their usability, their acceptability to older
people and the likely effects on their social functioning and
sense of control over their lives.
Existing and new technologies
7.3 A recent report[9]
explores the costs of providing assistive technology to enable
older people to live independently compared with what might be
required in terms of human care. It looks at the adaptation of
buildings, including Smart Home technology whereby different
devices interact and are controlled by a central computer; and
at Assistive Technology (AT) where there is confusion about terminology,
lack of information for users and for housing providers and staff,
and a certain need for demystification of the concept. The report
concluded:
— "There were considerable variations
in AT provision between respondents.
— There is a need to listen to older
people. They are quite clear about their needs, but very much
less clear about what AT is there to help them, how they can access
it and what they have to pay.
— Older people want to be able to
control as many day-to-day routine activities as possible and
AT can help them with this.
— Older people welcome AT when it
addresses a FELT need.
— Older people have variable access
to AT and therefore variable help from AT. They often have unmet
needs.
— Installation of AT is not usually
a problem, but the on-going reliable operation of the AT is essential."
8. HOW EFFECTIVELY
IS RESEARCH
CO-ORDINATED?
8.1 Research could be better coordinated for
the benefit of older people. Although recent initiatives have
begun to address the problem, coordination and true interdisciplinary
research is still problematic. It is difficult to fund except
through specific initiatives such as those mentioned above and
the Research Assessment Exercise still does not specifically reward
academic research bodies sufficiently for the considerable extra
time and resources required to carry out work across disciplines.
8.2 If sufficient time, funding and commitment
are not given to involving older people in research and development,
initiatives to do so often fail. For example, EPSRC's EQUAL (Extending
Quality Life) initiative set out to promote links between academics
and organisations that provide or represent a service user perspective.
This was thought to be a very positive approach. In practice,
however Age Concern staff who attended initial meetings felt that
user involvement was seen as an "add-on" within the
programme, there was insufficient funding for participation of
voluntary organisations representing users which was not part
of the core research funds, and end users were not involved enough
in the early stages of setting the research agenda, which was
done by the groups of academics.
8.3 Involving end users (older people) requires
considerable resources in terms of time, money and commitment
on the part of researchers to hear the viewpoints being expressed
by older people. Research funders are not always aware of or sympathetic
to resources required, and researchers themselves do not always
appreciate what it will mean to relinquish some control over their
domain.
9. HAVE THE
CORRECT PRIORITIES
BEEN IDENTIFIED?
9.1 Initiatives toward greater collaboration
between disciplines are welcomed. Further priorities would be:
— focusing on synthesis and dissemination
of existing knowledge;
— prioritising a user-centred, interdisciplinary
approach (which especially included social science) to new research
or development of new design ideas;
— further exploring the link between
research, policy and practice, facilitating a more "knowledge-based"
approach to policy-making and putting more resource into applying
the current knowledge from research into scientific and technological
development;
— preventitive strategies to reduce
or delay onset of illness;
— good design which is inclusive,
specialist design only where it really is required.
9.2 As mentioned previously, the bio-medical
model or disease model of ageing has received more research funding
and academic interest than other models. For example we now have
better evidence on what is likely to maintain good health throughout
the life span, but very little information on how people make
choices over their health-related behaviour and how to influence
them to make better choices which emphasise positive well-being.
10. IS RESEARCH
BEING USED
TO INFORM
POLICY?
10.1 Research could be much better utilised within
policy-making, particularly in the sphere of social science but
also in other disciplines. Barriers to effective uptake of research
information into policy making are complex and deep-rooted. The
Australian experience[10]
yields the following barriers to the utilisation of research to
inform policy, which summaries UK experience also:
— "A complex bureaucratic and
political environment, which may impact on the take-up of evidence-based
research.
— Research can involve a lengthy process
and the research and planning cycles need to be synchronised.
— Researcher's limited knowledge and
understanding of the policy-making context means that research
findings often have little impact on policy.
— The problem of information overload,
translation of information and difficulties in accessing and sharing
information. This raises the need to ensure that overload is minimised.
— Overcoming barriers to cross-governmental
approaches to Evidence-Based Policy Making (EBPM).
— The absence of an overarching framework
for EBPM and the need to strengthen the long-term strategic planning
approach."
11. CONCLUSION
The potential for good, inclusive design to greatly
improve lives is enormous but is balanced by the risk of increasing
use of technology to socially isolate older people and result,
paradoxically, in their feeling even less in control over their
lives and environments. This needs to be carefully managed through
holistic, interdisciplinary and user-led approaches.
September 2004
3 Eg www.fastuk.org Back
4
"Effects of physical activity on health status in older
adults", Annual Review of Health, 1992, reported in Choosing
Health response. Back
5
Age Concern, (unpubl), "Preventive Service for Older People:
evidence from the research-Research Briefing No 6", February
2004, Research and Development Unit, Age Concern England, London. Back
6
Age Concern (unpubl), "Age Concern's response to the Department
of Health consultation, Choosing Health?", May 2004, Policy
Unit, Age Concern England, London. Back
7
Levy, B R, Slade, M D, et al, (2002), "Longevity
Increased by Positive Self-Perceptions of Ageing", Journal
of Personality and Social Psychology, 83, (2), 261-70. Back
8
ESRC, "Growing Older Programme-Project Summaries",
Swindon: ESRC. Back
9
King's College London and the University of Reading (2004), "Introducing
Assistive Technology into the Existing Homes of Older People:
Feasibility, Acceptability, Costs and Outcomes", Institute
of Gerontology, King's College, London. Back
10
Bartlett, H and Findlay, R, (2003) "Linking the Ageing Research
and Policy Agenda: towards a strategy for Queensland", University
of Queensland Australasian Centre on Ageing. Back
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