CitationDownload as .RIS
Emerald Group Publishing Limited
Older people as producers, consumers and decision makers
Article Type: Editorial From: Quality in Ageing and Older Adults, Volume 15, Issue 2.
The economic consequences for wider society associated with the increasing costs of providing services for the greater numbers of older people surviving to older age stimulate some controversy. These highlight difficult decisions to be made by policymakers and by families, rather than the continuing activity of older people themselves, both in lifelong decision making in general and as economic contributors (as producers and consumers) in particular. The papers in this issue alert us to a variety of types of decisions for everyday living which older people are making while living, not only in the community, but also in residential care, even when vulnerable to ill-health or other limitations. They shift our attention to a scale of contribution from older people, at which we may not have be used to look for them, for instance, as a significant group in employment. They also turn the tables on our assumptions about inherent limits set by the ageing process on our capacity for decision making and self-determination.
The idea of an economics of ageing may appear to be relatively new. However, Meiners’ important paper identifies how well-established a contribution this is now making to the work of research institutes worldwide and how vital it is in studies of age and ageing that they can adequately reflect the increasing proportion of older people in the global population and the increasing impact of their demands as consumers. Meiners highlights the concept of the “silver economy” which developed economies may not currently make very visible but nonetheless has great significance for those same developed countries where older people can be seen as seeking higher quality and possibly more expensive and newer services and products, These insights have many applications still to be explored, not least in recognising promoting the multiple ways in which older people are able to judge quality and to apply those judgements in their choices and decisions as consumers.
The impact and relevance of an ageing economics is immediately reinforced and mirrored in the important challenge offered to easy assumptions about the reduced economic role in production by the exemplar offered by Srinivas et al.. They have examined the relationship in India between older peoples’ employment and thus as producers, their chronic health problems and their use of medical care. They highlight the importance of work to health and health to work in a developing country as two-way. Again, resonating with Meiners’ specific focus on older people as consumers, the monetary security gained through employment is seen to enable older people in India to increase their healthcare purchasing power. The findings in this paper can therefore offer help for policymakers to identify the balance of needs for employment and for health support of more vulnerable and disadvantaged older people and to seek ways to appropriately and respectfully respond to them.
Contemporary expectations are shifting to assume that frail older people living in the community should and will be actively taking more of the decisions which shape their lives, while they adapt to various life changes; yet some of these changes may threaten opportunities for continued self-determination. The phenomenographic study reported by Ekelund et al. takes the approach that the views and experiences of older people themselves on self-determination are needed to fully inform professionals who may want to support self-determination for this group. The views examined here affirm the importance of ensuring person-centred approaches while also identifying the relevance of promoting health literacy and of ensuring security and trust in relationships with carers. These findings offer a more nuanced stance to self-determination which present it as conditional on being socially affirmed and consistently supported.
Seeking to broaden understandings of what participation is and who can participate, Beatrice Godwin's study examines innovative approaches to enhance the participation in their care of more-often excluded, people with dementia, who are more likely to be challenged by the need to verbally articulate. She reports a case study of the skilled use in one specialist care homes of colours evidenced as most-easily seen by older people. The multi-modal interventions she reports may offer even those with fragmented or lost speech the means to be consulted and to contribute to decisions about their care. De-emphasising verbal communication by combining visual aids, observation, activity and non-verbal communication, achieved higher than expected participation, suggesting that greater inclusivity in participation may be an attainable goal.
The papers in this issue, therefore, may offer materials and means to help us review what factors in the social, cultural and economic environment might be limiting the capacity of older people to play an appropriate part in important decisions affecting their lives and in important activities through which they may retain the means to determine and deliver quality in how they live their lives.