International Longevity Centre - UK

While Oscar Wilde was clearly not contemplating the finer points of identity construction when he penned these celebrated words, they hint at the highly ambivalent, contingent and multiple nature of identity. People can be many different things and yet for older people, one could argue, there is an increasing emphasis on a singular classification of identity based on their age.

In popular discourse older people are generally represented according to their age and are often negatively portrayed. A UK study in 2002 reported that older people felt not only under-represented on the television, but what portrayals there were of older people were ‘marginal’ or stereotypical. Another study in 2004 conducted by TNS for Age Concern revealed a perception among a majority of adults (58% per cent of those aged 16 and over) in Great Britain that newspapers and television portray older people in a predominantly negative way. Such condescending and negative discourse on older people, particularly pervasive in the media  and public parlance,  has led to reductive conceptions of older people’s identity based on the themes of ‘burden’, ’dependency’ and ‘vulnerability’. If we consider the representation of the ageing population more widely, this has also become synonymous with pejorative phrases such as ‘demographic time bomb’ or ’rising tide’, thus giving rise to and engraining discriminatory and negative attitudes towards older people. This in turn has serious consequences for how we treat older people, in terms of age discrimination, in health and social care, equal and fair access to goods, facilities, services and treatment in employment.

This discernible tendency to treat older people as a monolithic entity is  not only a descriptive misrepresentation, but theoretically flawed in that it effectively ignores the plurality of our affiliations and attachments as individuals involving class, gender, profession, language, science, morals and politics. Being old has become an all-purpose explanation eschewing the complex realities of an individual’s myriad attachments and affiliations by the simplifying process of stereotyping. A study for Help the Aged on the ‘voice’ of older people by the ILC- UK supports this view, the report suggests there is little evidence that the widespread perception of the older population as an entity is shared by older people themselves. Such an essentialist view of older people may provide external simplicity to the understanding of identity negotiation, but critically the individuals concerned invariably fail to recognise the prescribed characterisation. Thus at present there is an apparent disconnect between popular discourse on older people’s identity and how older people view themselves. However  with the ‘baby boomers’ we may well see a challenge to this dominant discourse – a  generation at the vanguard of social, economic and political change may well resist and challenge the current status quo.

We seem therefore to be living in a uniquely partitioned society, with a dominant system of classification for older people based on their ‘age’.  Indeed this argument is equally applicable to young people whose identities are often similarly defined by their age through pejorative descriptions such as ‘yobs’, ‘tearaways’ ‘tyrants’ or ‘hoodies’ to name just a few.  Nobel Prize winner Amartya Sen, a philosopher, economist and a social thinker, posits that such reductive descriptions of identity not only dehumanises the innate richness of individuals, but fosters misunderstanding at best and at worse division and conflict. I am not suggesting the young people of today are going to man the barricades against our older generation or let’s not be discriminatory about this vice versa, but without mutual understanding between generations the impact for community cohesion and harmony could be profound. If younger people for example are continually reduced to the singular identity of a ‘hoody’ this will create an exaggerated fear of younger people for some older people.

Such an essentialist and polarised account of British society can also have potentially damaging consequences for policy-making and policy direction. At a time of limited resources and economic uncertainty there is always the potential for discord, with the interests of one group portrayed to be diametrically opposed to and in direct opposition to those of another. Such tension was in evidence last week at a seminar on the older workforce. There was considerable debate on whether resources should be focused on the NEET generation in terms of back to work initiatives as opposed to older people. The interests of the older generation were thus seen by some in the audience to be in direct competition and competing with younger people. However when the statistics behind the current unemployment figures were ‘unpicked’, it became apparent that it was not so much a question of intergenerational conflict, but rather the skills, training and wider life chances of said individuals, regardless of their age. This experience demonstrates that reductive and singular classifications can foster and encourage tension, the fault lines of the debate should not have been based on age and yet it offered to some attendees a credible paradigm to consider the issue of work from.  Perhaps the point is as Makonnen suggested that differences are not important in themselves, but rather it is the significance we attach to them.

Sally-Marie Bamford

Speech and language therapy (SLT) is not an area which often attracts a lot of attention in older people’s policy yet it is an area of potentially significant concern. Around 2.5 million people in the UK have a speech or language difficulty and whilst the most likely users of speech therapy services are younger people, the figures below show that the over 75s are also major users of SLT services. 

55 NHS cases per 1000 children aged 3-4 
18 per 1000 children aged 0-2 
17 per 1000 those aged 5 to 9 
1 per 1000 16-54 year olds 
18 per 1000 75 to 84 year olds and 
42 per 1000 over 85s 

Every year, an estimated 150,000 people have a stroke and a third of them are left with a communication disability as a result. But it’s not just victims of stroke who could benefit from speech and language therapy. Older people with a variety of other impairments (including neurological impairments such as dementia and conditions such as cancer of the head, neck and throat), also benefit from speech therapy. Many older people will also have life-long persisting conditions which need on-going support such as learning disabilities. 

We’ve seen growth in the numbers of speech therapists over recent years and it has been estimated that there are in total, around 10,000 practicing SLTs in the UK (7000 within the NHS in England). But there has also been a significant growth in the number of episodes of care (over the fifteen years between 1988 to 2005).  And evidence suggests there are a large number of ongoing issues facing SLT services.

In October 2008, the Unite union described the services as ‘heading towards crisis’. They claimed that they were seeing longer waiting and referral times for patients, while the workforce was becoming more stressed and demoralised. In addition, I CAN have argued that there is a mismatch between the number of speech and language therapists employed by the NHS (approx 7000) and the needs of children with SLCN (over 1 million). 

Over the last ten years, SLT has attracted a degree of policy interest from politicians and Government. We’ve seen debates in Parliament, Government commissioned research reports and good advocacy from the sector.  We’ve also seen championing of the cause by a number of MPs including the now speaker of the House of Commons, John Bercow MP. 

In September 2007, the Secretaries of State for Children, Schools and Families and Health asked John Bercow MP to lead an independent review of services for children and young people with Speech, Language and Communication Needs. On publication of the final report, the Government announced that it accepted the key recommendations and would invest up to £12 million to lead action to take them forward. (They published ‘Better Communication: An Action Plan’)  

So progress seems to be being made in terms of the issues faced by children. But with an ageing population with increasing levels of disabilities, it can be hypothesised that major growth in demand in the future for speech and language therapy is likely to come from the older population. There are some indications that current NHS SLT services are struggling meet the needs of an ageing society.

In March 2008, for example, the Royal College of Speech and Language Therapists noted that people who survive stroke are not receiving the speech and language therapy they need to help them cope with their severe communication problems. Their survey of 500 recent stroke victims found that:
 *Two-thirds said speech and language therapy had allowed them to remain independent   
* Three-quarters said that it helped them to understand and be understood by their family and friends   
* But less than one in five of respondents said they received therapy in the first month following their stroke.   
* Half said they had to wait over two months for their speech and language therapy to begin.   
* Three-quarters of the stroke survivors said they only received speech and language therapy for six months or less
* More than half felt they did not receive enough speech and language therapy. 

And whilst not ignoring the importance of the Stroke Strategy in this area, it seems that adults and older people have not had the same attention as younger people from policymakers in terms of SLT. With this context surely it’s time for another Bercow style Review to consider the issues facing SLT in terms of adults and older people. 

Earlier this year an Adult Communication Coalition England, was created to pull together a group of over 25 charities (including Royal College of Speech and Language Therapists, Mencap, Scope, the Stroke Association, the National Autistic Society and UK Connect. The coalition is calling for calling for a review into services for adults with speech, language and communication needs).   

Certainly on the surface, it appears that unless health authorities consider some of the challenges facing SLT, the service is likely to struggle and not meet future needs. 

David Sinclair
 

This blog post was extracted from a larger piece of work commissioned by ATcare with a view to providing tools to assist with the problem.