Embed Size (px)
Citation preview
Ageing in place: some lessons from recent research
ODESSA meeting 23 February 2018
Professor Anthea Tinker, Professor of Social Gerontology,
Institute of Gerontology, Department of Global Health and Social Medicine
Personal reflections – not a systematic review and with reference to the recent House of Commons report (next slide)
1. What do we mean by ageing in place?
2. Changing patterns of living: household composition
3. Evidence about the wish of older people to live in a home of their own but the need for realism abut whether this is feasible
4. Evidence about what we know works but is not happening
5. Need for new (?) options including changes in tenure to be explored
6. Taking account of different cohorts such as baby boomers – recent research
7. It is not all about housing – but about places too
8. Putting housing in context – integrated care
Outline of presentation
House of Commons Communities and Local Government Committee ‘Housing for older people’.
February 9th 2018
Useful in bringing together evidence
New report
1. What do we know about ageing in place and older people’s preferences‘The research currently available from developed countries indicates that
older persons’ long-term care preferences and priorities include maintaining close contact with children, remaining at home or ‘ageing in place’, retaining a sense of independence, and having the freedom to choose from a range of options’.
(UN (2008) Guide to National Implementation of the Madrid plan (p. 68).‘ It is important the developing countries avoid repeating the mistakes of the
more affluent countries that simply built numerous institutions for older persons while failing to consider how preferred options such as home-based or community care might be further developed and strengthened’
(Ditto p. 75)The importance of consulting older people in different ways
2. Changing patterns of living: household composition
• More people living alone.
• Reasons include the ageing of the population and related increase in numbers of single people including widows and widowers, and the increase in divorce and separation
• But note the increase in numbers of young people remaining in the parental home
A decline in institutional living
The changes in where people live in the UK
Where people liveLiving arrangements : Levels of institutional living
% Own home: all aged 65+ % Institution
UK 98 2Source: UK Census 2011
Variations across the world with growing emphasis on keeping people out of institutions
• Utilisation of home- vs residential-care (in % of 65+ population)
8Source: OECD health database 2015, Gori et al. 2015
• Data for UK show utilisation is declining
9Source: Health and Social Care Information Centre (2014, 2012, 2007)
- High levels of dementia
- Unsuitability of much housing
- Low levels of support with care at home
- The reality of dying at home
- More very old people
3. Most older people want to live in a home of
their own but how feasible is this?
Percentage of population aged 80**+ as a % of all aged 60*+ in 2012 and projections for 2050
2012 2050
World 14 20More developed regions 20 29Less developed regions 11 17Least developed regions 8 10Asia 12 19Africa 8 10 Europe 20 28
UK 21 30 - more very old people Source: UN 2012* UN definition of an older person ** UN definition of a very old person
A projected increase in the % of very old people
4. Evidence about what we know works but is not happening
• Extensive evidence about aids and adaptations
Some of this dates back 20 years
Highlighted in new House of Commons report including the need to extend Home Improvement Agencies and Handyperson services
12
4. Evidence about what we know works but is not happening
• Extensive evidence about extra care housing including my 1989 study for DOE and now international comparisons by Brian Beach for ILC
House of Commons report on the need for more of all types of housing
13
4. Evidence about what we know works but is not happening
• Extensive evidence about telecare including work presented today
14
The evidence is there so why are some of these low cost options implemented?
15
These need to be explored
Many of these were explored in the research we undertook for the Technology Strategy Board in 2003
5. Need for new/recycled options including changes in tenure patterns
New forms of housing
Co-housing
• Where people decide to live together – with other older people of with those of any age group.
Co-housing in the Netherlands
New (?) forms of housing
Home sharing where a family share a home with an older person or vice versa
Granny flats or linked homes
Another type of specialised housing is Granny Flats
• These can be next to a family house or above or below. They can be purpose built or adapted
• Advantages can include mutual help and, if the older person have moved, releasing a larger property
• Disadvantages can include living too close and problems if the family move or the ‘granny’ dies
New forms of housing
More radical solutions such as hotels and cruise ships
Changing tenure patterns
The drop in owner occupation and increase in private renting in most age groups
See Jenny Pannell and Imogen Blood’s study of a ‘new private rented sector’ 2014
6. Taking account of different cohorts such as baby boomers • Research by Anthea Tinker and Aideen Young on
the 1960s baby boomers who have high levels of education, technological proficiency and a youthful image. They have longer working lives and higher levels of consumption than previous cohorts. They have relatively high levels of childlessness and owner occupation
23
7. It is not all about housing – now encouraging research on the importance of place
The importance of place
• Public Health England/Institute of Health Equity study 2018 ‘Healthy High Streets: Good place making in an urban setting’ which found that healthy high streets can be considered an asset that promotes and improves the health of local residents and the wider local community’.
• The Mobility, Mood and Place study – see next slides
25
Mobility, Mood and Place (MMP) explores how places can be designed collaboratively to make pedestrian mobility easy, enjoyable and meaningful for older people.
We are bringing together researchers, designers-in-training and older participants, including stroke survivors and people with dementia, in focus groups, interviews and interactive co-design workshops, to identify proposals for better living environments
Mobility, Mood and Place is funded by Lifelong Health and Wellbeing, a cross-council initiative addressing the challenges and opportunities of an ageing population.
8. Putting housing in context –integrated care
What is integrated care?
Integration can be between policies, services, organisations and people
Key services: housingThe OECD* say ‘good housing conditions are also
essential for people’s health and affect childhood development (p.81). They say that housing can be measured by objective indicators e.g. numbers of rooms per person, state of repair etc. or by subjective ones such as satisfaction. An OECD study showed that in OECD countries subjective satisfaction is strongly correlated with all the objective indicators of housing’ (p.85)
*Organisation for Economic Co-operation and Development (OECD) 2011 ‘How’s life: Measuring wellbeing’
Key services: housing
The importance of housing being recognised in the new Social Care Green Paper – House of Commons report
New Models of Care
32
Multispecialty Community Providers
moving specialist care out of hospitals into the community
Integrated primary and acute care systems
joining up GP, hospital, community and mental
health services
Acute care collaboration
local hospitals working together to enhance clinical
and financial viability
Enhanced health in care homes
offering older people better, joined up health, care and
rehabilitation services
Urgent and emergency care
new approaches to improve the coordination of services and reduce pressure on A&E
departments
Summary
The Odessa report will help the debate but there is continual need to emphasise the role of housing in policies and services for older people
33
