Attitudes and aspirations of older people: a review of the literature
A hard copy of this report summary can be obtained by contacting Paul Noakes & #160;[E-Mail: Paul.Noakes@dwp.gsi.gov.uk] or by writing to him at the 'Social Research Division, Department for Work and Pensions, 4th Floor, Adelphi, 1-11 John Adam Street, London WC2N 6HT'.
Research Report No. 101
By Annette Boaz, Carol Hayden and Miriam Bernard
This report presents a review of existing literature on the attitudes and aspirations of older people, focusing on UK literature produced during the last 10 years. It forms the first stage of a programme of research, commissioned by the Department of Social Security, and carried out by the Local Government Centre, the University of Warwick, to inform the work of the Inter-Ministerial Group on Older People. The second stage of this research consisted of a qualitative study of the attitudes and aspirations of older people which is published in a companion volume (Research Report No. 102) titled ‘Attitudes and aspirations of older people: a qualitative study’.
The main findings from the literature review are:
- Older people are a diverse group with wide ranging attitudes and aspirations. However, some common themes emerged from the review:
- Many older people are involved in and contributing to society. For example, older people are involved in work, volunteering and reciprocal relationships with others, both offering support to friends and relatives, and receiving it.
- Older people seek an active older age in which they can continue to participate in society. However, the ways in which people choose to get involved are very varied and can change over time.
- Older people wish to remain as independent as possible for as long as possible, whatever their personal circumstances and living situations. They want access to appropriate and affordable health, care and other services to help them remain independent.
- The themes examined in the review are inter-linked. For example, transport was identified as essential to active ageing (including learning and volunteering), to remaining independent, for access to health services and to participating in consultations.
- While there is an existing literature on the attitudes and aspirations of older people towards health and social care, there is much less literature on the views of different groups of older people towards active ageing, and on their attitudes to involvement and consultation.
Background
This report presents a review of existing literature on the attitudes and aspirations of older people, focusing on UK literature produced during the last 10 years. It forms the first stage of a programme of research, commissioned by the Department of Social Security, and carried out by the Local Government Centre, the University of Warwick, to inform the work of the Inter-Ministerial Group on Older People. The second stage of this research consisted of a qualitative study of the attitudes and aspirations of older people which is published in a companion volume (Research Report No. 102) titled ‘Attitudes and aspirations of older people: a qualitative study’.
This literature review identifies existing literature on the attitudes and aspirations of older people. The literature review and qualitative research focussed on the following themes identified by the Inter Ministerial Group:
- Active ageing - including employment, retirement, age discrimination, mentoring, volunteering, life-long learning, peer support and intergenerational activities.
- Health and care - health and social care as well as housing, transport and other services which are important in promoting independence.
- Consultation and involvement - particularly how government can involve older people more in decision making at a local, regional and national level and older peoples’ views on how they are represented.
Methodology
This descriptive review focuses on literature from 1988 to 1998. The review identifies quantitative and qualitative research on the attitudes and aspirations of older people. While research on attitudes indicates the ways in which older people are likely to respond to current and future policy, research focusing on aspirations provides insights in to older people's hopes for the future. For this research older people were defined as those over the age of 50, although the studies included often focus on specific age groups within this, such as those who have reached retirement age.
The search was carried out in several complementary ways. A computer and personal search of published material was used as a basis for the review. Databases of unpublished literature were also searched.
The researchers also wrote to those researchers and practitioners who are known in the field and asked for copies of any as yet unpublished research and papers. This method has been used in previous research and yields a rich source of current thinking which is not yet widely available. For all the above methods clear inclusion and exclusion criteria were developed as appropriate to the aims of literature review.
The literature was reviewed paying particular attention to consensus and inconsistencies in outcomes between the different studies. The main reasons for excluding papers were that the research was not UK based or the study was not concerned with the attitudes of older people themselves. This report does not attempt to review in detail the methodologies of the included studies. However, methodology has been taken into account when decisions were made as to whether or not, and to what extent, papers were included in the review. 68 papers were identified for inclusion in the review. The key findings are summarised below.
Active ageing
The research highlights a concern amongst older people that they are discriminated against in the workforce in a variety of areas, including recruitment, promotion and training. Studies suggest that older people have very varied attitudes to retirement and to being retired, just as people experience work very differently. It is evident that choice in whether or not to retire, income level and gender, all have an impact on these attitudes. Attitudes to retirement also change over time as older people experience declining health or loss of mobility.
Research indicates that though many older people had planned financially for their retirement, others had not. This is especially significant as a number of studies identified finance, along with declining health and mobility, as a key concern of older people. Fewer people had thought about how they would like to spend their leisure time in retirement.
Older people tend to express a high degree of satisfaction with their current level of activity in retirement. Attitudes towards leisure activities are very varied and declining health, mobility, the loss of a partner and changing economic circumstances can all affect participation. A good infrastructure, including transport, information and a secure environment, is identified as a further important factor influencing participation in leisure activities. Older people are often interested in getting out of the house to visit friends and family, to attend a local club or day centre, or to do some shopping. A recent study concludes that wherever older people wanted to go they needed safe, accessible, reliable and affordable transport to get there (Help the Aged, 1998a).
Older people identify a range of reasons for getting involved in voluntary activity including identification with the cause, a desire to help others and an interest in meeting people. However, older people also feel that volunteering takes up a lot of time and that sometimes the contribution of volunteers is not appreciated. Again declining health and mobility could make it difficult to maintain involvement in voluntary activities.
Health and social care
The research identifies a concern amongst older people about state provision of health and social care. State agencies such as local councils and social security offices are seen to be far worse at dealing with older people than, for example, post offices and shops.
Lack of co-ordination in service delivery also emerges from the literature as a strong theme. Older people, and particularly older people from ethnic minorities, seem to have a low level of awareness of, and lack of information about, the health and social care options available to them. Where there are costs for services, they are seen to be prohibitive and confusing by many older people.
Family continues to be seen as the main source of care, support and information for older people, followed by friends and neighbours. Older people, particularly older women, also provide care and support for their families and friends.
As people get older their housing needs become increasingly intertwined with their health and care needs. Older people want to stay in their homes for as long as possible, but the infrastructure needed to support this choice is often inadequate. Studies report a need for help with routine tasks such as gardening, household maintenance and housework. Older people identify a need for flexible home care, which puts the needs of the older person at the centre of a care package. Other services, such as a good transport system, are also seen to be important to people living in their own homes.
Older people who have made the move to residential care often feel that after a period of adjustment they could identify advantages with their new homes, including the safe environment, the care they received and the company of others. However, it is evident that moving in itself, not just the prospect of residential care and loss of independence, was unattractive. Residents in care homes express a desire not to have to move again.
Consultation and involvement
The limited published research on older people's attitudes to involvement and consultation demonstrates that older people share the disaffection of the wider population with politics and politicians. However, older people feel that it is important that they should stand up for their rights, although older respondents (those in their late seventies and eighties) are less keen to "get involved" in older people's issues. It is interesting that respondents in their 50s are also less interested as they do not consider themselves to be older people.
Older people feel that they are not well informed about issues that affect them and this seems to be especially true of ethnic minority groups. Older people seem to be keen to be kept informed and to be consulted, but the research identified a number of barriers to more active participation. Older people are concerned that their opinions would not be of interest, or that they would not be able to maintain their involvement due to poor health and don't want to take on commitments they can not meet. There is also a concern that time is valuable and involvement must be for a purpose. There is an issue of powerlessness among those in residential care who do not want to offend the care providers, on whom they are likely to have to rely for their future care.
It is clear that the methods of involvement need to take into account the health status and low self-esteem of many older people. Novel methods of consultation such as postal forums and telephone discussion groups have been explored. The research identifies a desire for non-prescriptive, consultative agendas, through which older people can discuss issues that are important to them. Older people derive benefits from active involvement including a sense of fellowship and mutual support, access to information and a chance to stretch the mind. However it is important to participants that their input will have some effect and the participants are not wasting their valuable time and their limited reserves of energy on a fruitless exercise.
The literature search on the three themes above, as defined by the Inter-Ministerial Group, identified three further cross-cutting themes as discussed below.
Participation
The majority of older people prefer to be described as senior citizens. This may be because it is a positive, valuing label. For older people an active old age seems to be one in which they can participate in society. How people participate is seen as a matter of individual choice. Older people participate in a variety of ways. These encompass democratic participation through traditional political activity or newer representative processes (e.g. forums, panels etc.), involvement in their local communities as active citizens, and through their family and friends. Older people have a contribution to make, as friends and sources of care and support, as well as voluntary workers and members of clubs and groups. The literature on volunteering shows that where older people do get involved they are very committed. However, older people also stress that ill health, limited mobility, lack of money and poor infrastructure can influence their ability to participate.
Participation requires a two-way process. Information needs to flow from government and other organisations to older people. The research suggests that information is not flowing effectively to older people, despite the strong demand. Older people have lots of ideas that could be used to devise more dynamic information that is appropriate and useful and can be accessed by older people, their families and carers. Television, local newspapers and GPs (or other individuals with whom they are in regular contact such as community leaders and health visitors) are some of the suggestions for information dissemination.
The need to involve and consult older people is evident from the research findings on health and social care. The lack of information and advice received by older people, and their lack of involvement in decisions that directly affect their health and social care, reflect a system that is not seen to be centred on the older people. There is a need for more research and practice which seeks to involve and consult older people.
Involving and consulting all citizens is a priority at local and national levels. The priorities of the Inter-Ministerial Group and the aims of the Better Government for Older People Programme reflect this. New forms of involvement are also being developed. The Local Government Management Board, for example, has sought to involve local people in decision making through citizens juries (LGMB, 1996). The particular issues involved in consulting older people, such as limited mobility and low self esteem, necessitate innovative approaches.
More research is required on the mechanisms by which older people wish to be involved and consulted by government. There is particular concern about how to access "difficult to reach groups", such as housebound older people. The diversity of opinion identified in this research, in terms of differing experiences, priorities and interests, must be reflected as must the varied ways in which people choose to organise and express themselves.
Independence
Continuing to choose their independence and inter-dependence is essential to older people. Older people stress their reciprocal relationships with others, which involve offering support as well as receiving it. Older people seek to deal with changes in their health status and mobility in ways that do not compromise their independence. There is a concern that they remain independent of requiring ongoing care from family and friends, but also from the state for as long as is possible. This preoccupation of older people with not becoming a burden may well affect their expression of needs. Studies conclude that service providers should be sympathetic to this and foster services that support independence rather than dependence. Likewise it is stressed that service providers should not see the low expectations of many older people as reflecting a lack of need.
It is evident that older people want a variety of options from which to make real choices. They want information and advice when making decisions and support to make their choices possible. Domiciliary services seem to be seen as a source of unfulfilled potential for the majority of older people who prefer to stay in their own homes. The aspirations of older people for support to remain in their own homes include help with housework, gardening, home maintenance or alterations, and shopping. There is still a role for sheltered housing, residential and nursing home care for those older people who do not feel able to stay in their own homes.
Meeting these aspirations requires that the assessment of the needs of older people is centred on the older person. The current lack of co-ordination in service delivery is also seen as unsatisfactory, for example a number of studies reported that older people had been discharged from hospital without any consideration of their ability to cope or of the support available to them. Improved integration of service planning and delivery is therefore identified as an important issue for government to address. Aspects of the local infrastructure such as public transport play an important role in fostering independence and interdependence of older people, for example by supporting them in their efforts to visit and maintain relationships with friends and family.
Diversity
One of the common themes in each of the areas explored in this review is the diversity of attitudes and aspirations of older people. Age alone is an inadequate predictor of attitudes and aspirations; many other factors come in to play. Wealth, health status, gender, mobility and living status (alone or with others, in residential care or in the community) each mediate the effect of age. These factors in turn influence each other; for example the ability to get out and about can be influenced by whether or not someone lives alone or whether they can afford to take part in social activities.
It is evident that older people are a diverse group in all respects. Midwinter (1991) concludes that many of the concerns and interests of older people are those of society in general and may, in many cases, be more effectively treated as such. This integration of older people into more mainstream social policy decision making may help to combat ageism.
The key aspiration of older people seems to be an old age in which they are included in society rather than marginalised and excluded because of their age. An acknowledgement of their reciprocal roles as sources as well as receivers of care and support rather than a focus on dependence is central. It is evident that the three themes explored in this review are inter-connected. Older people who are involved and consulted are likely to become more independent, active, healthy and cared for citizens.
Coverage of the research
Although there is a growing body of research on old age, there is less research on the attitudes and aspirations of older people in each of the areas reviewed. The voices of older people should be more prominent in future research. Apart from three major national surveys the majority of the research presented in this review has focused on specific geographical areas. There is a need for further national research to explore the attitudes and aspirations of older people. This data could be used, for example, to explore disparities in access to support and care across the country and to identify good practice.
The current research should inform the content of national surveys to ensure that appropriate and relevant questions are asked of older people. There is also scope for further qualitative research which values the contribution of older people, adds meaning to quantitative results and allows for a more in depth exploration of areas of interest.
There is a significant disparity in the body of research associated with each of the three themes. The literature on health and social care, for example, is larger and contains more data on the attitudes and aspirations of under represented groups such as ethnic minorities. The review identified more research on active ageing than on consulting and involving older people, but there is scope for involving the perspective of older people further in the literature, focusing in particular on older people with significant care needs, ethnic minorities and older people living on low incomes. Research on older workers and retirement could also be strengthened if it included the perspective of older people themselves. This theme is particularly important as it stresses the positive contribution older people can make to society.
Older people's views on involvement and consultation have attracted less attention from researchers and practitioners. This imbalance in the literature reflects broader social perceptions of older people as in need of care and support, rather than as active people, involved in their communities and consulted about the broad range of issues that affect them.
Future research should seek to redress the imbalance by exploring the attitudes and aspirations of older people to being involved and consulted. There also needs to be more research such as that conducted by Thornton and Tozer (1994) which explores ways of overcoming the specific barriers that prevent older people from being involved and consulted. Researchers could also seek to involve and consult older people at all levels of the research process.
It is also important to note that there are a number of initiatives underway that will add to our understanding of the themes discussed in this report. Important initiatives include the ESRC Growing Older Research Programme on Extending Quality of Life, the Nuffield and European Union 5th Framework research programmes and the Better Government for Older People Programme.
Relevant publications
Other publications on older people:
Costigan, P., Finch, H., Jackson, B., Legard R. and Ritchie, J. (1999) “Overcoming Barriers: Older People and Income Support” (Department of Social Security Research Report No. 100) Leeds, CDS (£29.00)
Disney, R., Grundy E. and Johnson, P. (1998) “The dynamics of retirement” (DSS Research Report No. 72) London: The Stationery Office (£36.00)
Finch, H. and Elam, G. (1995) “Managing money in later life” (DSS Research Report No. 38) London: HMSO (£22.00)
Hayden, C., Boaz, A., Bernard, M. (1999) “Attitudes and Aspirations of Older People: A qualitative study” (DSS Research Report No. 102) Leeds: CDS (£29.00)