Editorial

Citation

Poland, F. (2020), "Editorial", Quality in Ageing and Older Adults, Vol. 21 No. 1, pp. 1-2. https://doi.org/10.1108/QAOA-03-2020-067

Quality in ageing and older adults

Considering and addressing growing complexity in older lives

Changes in the demography and situation of older people mean that we need continually to develop new and different arrangements adapting and innovating from current forms of provision and support. This “regular” issue provides ample evidence of how the international sharing of dilemmas posed for living and caring in relation to the complexities increasingly seen in older populations in many societies. We also see increasing recognition across many societies of the need for appropriate support to be made appropriate by being flexibly tailored to the diverse circumstances and characteristics of older peoples’ lives today.

The challenges of complexity are recognised in the reporting of two surveys ten years apart, of English local authorities carried out in 2007 and then in 2017, of commissioning residential home care for older people, by Davies, Hughes et al., have tracked some of these changes. They have found trends shaped by older peoples’ more complex care needs, changes in market management changes, expectations of more flexible, diverse and personalised services, more training and better pay for staff including care workers and of more collaboration between health and social care partners and stakeholders aiming to promote wellbeing. They suggest their findings point to the need for more meaningful local collaborations between commissioners of care and other stakeholder to address these “wicked” problems.

A qualitative study by Miskelly, Kerse and Wiles draws on group discussions in New Zealand involving staff and students working in ten general practices in primary health care to draw out the complexities posed by managing patients in older age entailing multi-morbidities and polypharmacy. Discussions recognised opportunities as well as challenges arising from the fragmentation of communication and services they encountered. Findings have suggested the importance of addressing such fragmentation using the kinds of information and service coordination enabled by modern communications including health hubs, IT platforms and role re-modelling to improve flows of activity and information between primary and tertiary services.

A more traditional assumption being increasingly challenged is that of the inevitable passivity of much older people experiencing frailty. Atad’s quantitative, cross-sectional study compared the effect of physical activity on the quality of life of frail and non-frail older adults in an assisted living facility, in this case in Israel. The study tested hypotheses about whether physical activity was associated with better quality of life, improved their perception of their physical health or even could have protected against decreased quality of quality of life. The findings appear to bear out the possibility of their perceiving physical activity to be a protective factor despite experiencing frailty.

Being a person living with dementia may raise challenges if they are admitted to hospital, for having their unmet needs recognised. Crowther suggests that increasing staff awareness of distress may increase recognition of their need. He reports on a mixed methods study of development and feasibility testing of a Distress Recognition Tool (DRT) over 52 days to help recognise in two hospital wards, which may offer a way to recognise these. Results from stakeholder interviews and from observations of using the DRT indicated it was easy to complete, did increase awareness of patient distress on the ward and might support improvements in the hospital care of this group of patients.

Craven-Staines also reports on English hospital care provision in the context of people living with dementia, but in this case also reflects the growing recognition that it may be important also to attend to the needs of the family carer, in this case of their relative being admitted to an organic inpatient ward. This qualitative constructivist study of interviews with a small purposive sample of relatives and staff members examined the kinds of carer needs for reassurance, information and accessible responses that might need to be recognised in relation to barriers to getting these effectively met, relating to loss, time pressures and communications issues.

In all of these examples of issues of complexity in community and hospital support for older people, we can see how variety in research can offer wider contextual understandings and more transformative conceptual reframings to take into account the needs of the many different groups for understanding, insights and practices that may need to underpin collaboration needed to engage successfully with such complexity which is the reality of ageing today.