Emerald Group Publishing Limited
Redrawing the boundaries of active provision in older life
Article Type: Editorial From: Quality in Ageing and Older Adults, Volume 15, Issue 4
Combined demographic, cultural and socio-economic changes are encouraging us to change how we see ourselves in older life and, also, how and whether we recognise what needs to be provided, and, by whom, in younger and older age. This challenges not only existing views of who existing provision should cater for, but who should actively inform that provision. This issue of the journal offers evidence and policy commentaries which engage with some of the issues raised by these challenges to suggest that boundaries of provision and boundaries of oversight for such provision are being, and should be, redrawn.
There are questions to be asked about what makes some groups of older people less visible than others and what this may mean for our claims for making adequate healthcare provision for those who may especially need it. The ageism involved in clinicians and policymakers failing to recognise and provide for specific and varying health needs of older people is identified and its consequences is picked up in the study reported by Tinker et al. These issues are amplified in several ways in the other articles in this issue.
The interplay of organisational factors can be strongly implicated in systematic failures to recognise and respond to the specific needs which constitutes respectful treatment in the long term care of older people. The knowledge synthesis findings of Hyde et al. identify five key organisational factors which contribute to abuse and loss of dignity in these settings. This study combined rapid review of the literature in this area with the involvement of panels of older people, carers and providers to develop and refine the narrative synthesis. The importance of examining how infrastructure, culture and management procedures for ensuring appropriate quality care is underlined.
Attempts to redraw boundaries of provision and its management have included developing personal care budgets intended to increase the range of choices for people using home care services. Rabiee and Glendinning have explored how far this may be the case when personal budgets have been offered by councils to older people, in comparison to the apparently more limited choices offered by traditional care management systems. Their more detailed study of factors affecting the delivery in three councils of personalised home care for older people. Whilst they found that most older service users welcomed the prospect of more choice and flexibility in using their budget the realities of practice and lack of knowledge and funding continue to constrain their potential for reshaping available provision.
People living with dementia have been especially disadvantaged within the forms and range of health and social care provision in which a range of factors affecting their cognition and communication have limited their ability to actively self-advocate for their needs. Wright's study of the potential contribution of audiologists in effectively addressing aspects of cognitive dysfunction related to hearing loss flags up the potential of clinicians to contribute to a better understanding of dementia and its consequences. She identifies potential means for audiologists to play their part in mitigating some of the “wicked issues” posed by incomplete evidence by taking a more active role in training, assessment and more integrated multidisciplinary working.
Dehydration in longer-term care provision is an issue often raised as an obvious sign of neglectful conditions. But Hooper and Bunn argue that dehydration may not be a good indicator of poor care. Their commentary seeks to encourage a more nuanced understanding of the balance of factors, including support for decisions made by older residents themselves, perhaps relating to their health conditions, which may lead to individual cases of dehydration.
Other challenges to mid-twentieth century preconceptions about the place of contribution of older people in wider society have come as older people both increasingly extend their working lives but are also actively encouraged by policymakers and wider society to extend their paid and unpaid working lives as employees and as family carers and volunteers and students. Phillipson argues that if working lives are not only to be extended but be ‘fuller’ then this means addressing class, health and gender inequalities which may otherwise make the experience of working insecure and reducing rather than enhancing quality of life.
A final contribution to a more inclusive re-imagining of old age is offered by Gilleard and Higgs who advocate, the need to recognise and resist the place given to dementia in shaping our “collective fear about ageing and agedness”, particularly for later old age. They oppose the inevitable linking of dementia with various forms of frailty, disability and rights to be recognised as members of society and point up the need for practical tactics for resisting this.
Determining the ideal shape of future provision can therefore be seen as now becoming better informed about the diversity of potential forms of provision and support. Some of these forms of provision and the ideals underpinning them may seem almost unrecognisable if compared to a perhaps commonplace, notion of offering standardised support for a predictable and retiring population of older people. The articles in this issue will question whether this can possibly be the case.