International Longevity Centre - UK

Over recent decades, rates of childlessness have increased substantially in many European countries, including the UK.  The percentage of British women remaining childless has risen since it was at its lowest level for women born in 1945 (9%), doubling to approximately 18% for women who are currently completing their childbearing years. 

Most studies of the consequences of this phenomenon have tended to focus on the psychological effects for the individual of having no children, on levels of life satisfaction, the risk of social isolation and the potential shortfall in informal care and support.  However, an important area of research recently examined in a series of journal articles[1] considers the issue of intergenerational transfers: what childless people give to their families and to society, both through transfers to next-of-kin relatives and investments in non-family networks and voluntary and charitable organisations.

Clearly, social and psychological consequences of childlessness will depend upon its causes.  For example, voluntary childlessness has very different outcomes than not being able to find a partner, infertility, surviving the death of one’s children, or being socially childless through divorce. Marital status and gender tend to mediate the consequences of childlessness, as does education, income and health.  Nevertheless, this group is often viewed as homogenous and, from the point of view of policy-makers, as a cause for concern.

In England, most informal care for older people is provided by spouses or adult children (Pickard et al. 2007).  Current policy recognises the role of the family and explicitly relies on its continuance.  A decrease in informal care provided by either of these two groups is likely to result in increases in formal care and consequently large rises in expenditure on long-term social care.  Projections indicate that care by spouses will probably increase in the future, predominantly because improvements in male mortality will mean that there will be a fall in widows (ONS 2005).  However, there are a number of reasons why care by children may decline in future years, including rising levels of childlessness.

Conversely, Kohli & Albertini (2009) looked at the flow of giving not in the form of care from children to parents, but considered how childlessness may affect intergenerational wealth transfers from the older to the younger generation.  For obvious reasons, most of the large studies of intergenerational transfers have focused on those with children, and there is a paucity of detailed information about transfers to other family members and to friends, neighbours or charitable associations.  There are also issues about levels of consumption amongst childless older people compared to those with children: are childless individuals less likely to save in their lifetime (or retirement) and therefore have less (as a proportion of lifetime wealth) to pass on to the next generation?

In ‘traditional’ family systems, childless adults usually passed on any wealth to next-of-kin – nephews, nieces or other relatives.  More recently, however, evidence suggests that giving to public or semi-public welfare organisations is increasingly important amongst the childless population.  And the church, traditionally the beneficiary of many of these donations, has now been joined by many other favoured institutional recipients.  Many of these provide a service specifically for children or young adults, and so giving to them can be seen as a specific form of intergenerational wealth transfer and optimisation of the donation environment through policies may help to foster people’s charitable giving and civic engagement.

There is no consensus on forecasting trends in future childlessness, although it seems unlikely that there will be a dramatic decrease in levels.  However, childless people are a heterogeneous group, and policies for long-term care or wealth transfers should reflect the changing demographics of our older population.

The issue of increasing levels of childlessness raises more questions than answers. And there is certainly a need for more research into the impact of childlessness in an ageing society, both for childless older people and for society at large. Looking to the future, this is an issue which policymakers must begin to engage with.
 

Laura Stoll, January 2010.
Researcher in Demography at the London School of Economics

The earthquake which struck Haiti last week has been devastating for all Haitians, but has had an especially severe impact on the older population. In this initial response phase the priority has been efforts to rescue trapped people and emergency aid to the injured. However it is also urgent to reach the most vulnerable – children, people with disabilities and older people - who need immediate help. You may have seen news reports of older people in nursing homes in desperate need. We are concerned for the immediate welfare of the residents of the Port-au-Prince Municipal Nursing Home, and have alerted the Mayor of Port-au-Prince to their plight as well as doing our utmost to get emergency supplies there immediately.

However other residential homes have also been severely affected, and HelpAge International is working to support the older residents in these homes too. Over the coming days, our local partner NGO is providing two doctors and four nurses to all the residential homes most in need in Port au Prince. We will also supply much-needed transport to get sick older people into the nearest available hospitals. 

Our partners in Haiti have been working with older people for many years, but they themselves have been severely affected by the earthquake. However some are starting to work again, and in one case have received support from the HelpAge partner in the Dominican Republic, which is sending to mobile medical units to Haiti. In addition to supporting our own partners, in the we are also be working with the major humanitarian organisations and other NGOs to ensure that they also make the protection of the most vulnerable older people a priority.

HelpAge International will also be providing direct assistance. The emergencies teams from the UK and Jamaica have had difficulties getting here, but have now arrived. They are assisting those desperately in need immediately. More of our team are coming in from the Dominican Republic, bringing emergency supplies of food, water and basic items, which are going directly to the residential care homes.

In disasters like this, but also in political emergencies, it can be a struggle to get the needs of older people recognised and response is therefore inadequate. “Time and time again, HelpAge sees this awful situation repeated. Those who are most vulnerable are last to receive aid,” says HelpAge Haiti Emergency Programme Officer, Bertin Meance. “They cannot queue for hours for food and emergency items. Nor are they the loudest demanding to know when aid will come”.

HelpAge therefore takes on a dual role – working with our partner NGOs to deliver immediate aid on the ground, but also drawing the attention of other agencies to the situation of older people. Their needs may range from appropriate food to medications for chronic conditions, and agency staff  need to be responsive and sensitive. Shock and mental trauma  are also likely to have a huge impact on older people. However over time experience shows that older people can be very resilient too, and as the rehabilitation effort gets underway can be invaluable community resources.

That though is for the future. The immediate need remains to identify and reach out to the vulnerable older people in this disaster.

Mark Gorman HelpAge International, Director of Strategic Development

If you want to support the work of HelpAge International in Haiti you can donate to the Disasters Emergency Committee appeal by clicking on the link on the HelpAge International website www.helpage.org.

Today (14 January 2010) saw the launch of the Kids In Museums Manifesto (http://www.kidsinmuseums.org.uk/our-manifesto/) which sets out 20 ways to make a visit to a museum family friendly. Amongst other things, they talk about the importance of a friendly welcome, the need to reach out to communities, and that the sector should engage younger people in the design of the services provided.

Almost all of the calls in the Manifesto would also benefit older people. In 2008, Help the Aged published Lost in the Money Maze (http://bit.ly/8MhLe0). The report set out a checklist for advice agencies and credit unions to help make themselves more accessible to older people. Whilst this report was aimed at providers of financial advice, the checklist is relevant for other services targeted at older people. Amongst other things the checklist highlighted a similar list to the Kids In Museums Manifesto: including the provision of toilets; the need for a friendly welcome; the design of promotional material; the accessibility of the building; and the importance of outreach.

Speaking at the launch Secretary of State for Children, Schools and Families, Ed Balls MP, emphasized the benefit to all ages, noting that adults would also benefit from the proposals in the Manifesto.

One of the most common observations when I’ve spoken to people about older people in museums is “We don’t need to worry. Our museums are full of older people”. But the reality is that (as the DCMS Taking Part Survey shows) there is a big drop off in participation in the cultural and heritage sector when we reach.

There is some great practice out there. A Manchester museum, for example, recently decided to introduce portable lightweight chairs which people could carry around and rest on when they needed. They found that older people (and other ages) stayed in the museum for longer. But despite the increasing recognition of the ageing of our society, it seems that the sector has been (in the main) slow to respond.

But even those museums who are active in terms of outreach for older people, few would claim to be taking a strategic approach. There must be a bigger role for Government (particularly DCMS) and the Non-Departmental Public Bodies to encourage the cultural sector to take a strategic approach to an ageing society.

This isn’t and shouldn’t be about one age group verses another. As the Manifesto shows, some basic initiatives can make museums more accessible for all.

To be fair, we have over the years seen significant progress with accessibility of museums. Speaking at the launch, Mariella Frostrup argued that it wasn’t long ago that taking kids to museums was akin to a trip to the dentist (painful).

It does however, remain sad that such basic (not even good!) practice is not widespread and that we need Manifestos to push private, public and voluntary sector organisations to deliver even the simplest of improvements to accessibility. Let’s hope that the 2011 Manifesto highlights further progress!

David Sinclair

Since the 1990’s many advanced welfare states have moved away from the delivery of home care services and towards alternative ‘cash-for-care’ schemes. This move towards self-directed care has formed the heart of the Government’s personalisation agenda and has become emblematic of Labour’s restructuring of the relationship between the citizen and the state in respect of welfare services and support. More recently the Government has also contemplated the potential of personal health budgets, which would permit individuals to buy their own health care.

Direct payments and personal budgets are viewed by many as a panacea for delivering greater choice for social care users, while at the same time containing the costs of long term care and chimes with private and third sectors expansion in developing markets in care services. Self-directed support heralds a significant shift in service provision, but also necessitates establishing a culture, support structures and processes to support it.

This new paradigmatic shift in social care has prompted concern and questions across the health and social care arena. Self directed support per se is a relatively new concept and as yet the long term implications and potential benefits/disadvantages have yet to be fully explored. The move to extend this form of self-directed support to people, who were previously not considered suitable, also merits greater attention. In particular there is a significant absence of research examining the potential challenges and consequences for people with dementia.

With the ageing of the UK population and the demand for all forms of personal long-term care in the UK expected to rise, it is imperative policy-makers have a clear understanding of the effect and consequences of extending direct payments to older people. This is particularly pertinent with regard to people with dementia given the specific issues and challenges in respect of consent, mental capacity and safeguarding. While there seems to be broad support for the proposal to extend direct payments to people with dementia from health and social care professionals, and third sector bodies and user groups, there must be clearer evidence, information and support on how self-directed support can work more generally for people with dementia and their families.

Until relatively recently, few people with dementia were eligible for direct payments. According to a NAO report in 2007 (http://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx), this was partly due to barriers within the system and the inherent complexities embedded within it.  Implicit within this are the attitudes and culture of social care professionals, who are considered by some to be reluctant to explore how direct payments can work for people who lack capacity. It is not only a question of education and training to support professionals, but how the system can be adapted and modified to respond to the needs of this specific cohort of users.

If we are to impose such a radical vision for social care, it will also be necessary to engender a sea change in thinking amongst older people and their families. As a SCIE report (2004) pointed out, it cannot be assumed that older people and their families will automatically consider autonomy, choice and control an attractive proposition.

There are also a number of wider questions that need to be addressed, namely: How would direct payments need to be adapted to be suitable for use by individuals with dementia? What are the barriers and challenges that hamper individuals with dementia using direct payments? And what criteria would need to be adopted to facilitate people with dementia using direct payments? Unless we answer such questions we are in danger of following a path with no real understanding of just where it may lead…

Sally-Marie Bamford

If two hands are better than one, how about four paws? Such an opening gambit may seem nonsensical, but the psychological, social and functional benefits of canine-human interaction are slowly being acknowledged in the health and social care arena. Across the generations, the therapeutic value of man’s best friend is well attested, with a notable emphasis on the emotional and positive aspects of this interplay. Today, however canine and more generally animal interaction is perceived to yield wider benefits not only for the individual, but potentially for the public purse.

The benefits of ‘animal interaction’ for more vulnerable sectors of the populace has been the subject of academic exploration for over 20 years and pet ownership in particular has been perceived to be important for older people (See McNicholas et al, 2005). The psychological advantages are numerous, including: providing companionship; facilitating social interactions and providing a sense of routine and purpose.  Pets can also promote physical activity. Geriatric researchers from the University of Guelph in Ontario, Canada, demonstrated that older people who own pets are more active than those who do not, scoring higher in their ability to carry out normal daily activities.

Furthermore pet therapy has proven to be effective for older people suffering from some forms of dementia. Interaction with the animals has shown to reduce behavioural disturbances like agitation and aggression and inflections of mood like anxiety, apathy and depression (See Colombo et al, 2006). Furthermore it has also been suggested pet therapy can stimulate psychological and mental residual functions like long-term memory (through the evocation of memories related to past pets) and non-verbal and verbal communication.

The introduction of pets in residential care has also proven psychological, emotional and physical benefits, a report by the Joseph Rowntree Foundation in 1993 found that pet ownership was largely neglected by policy makers and managers of care facilities, with many older people being forced to give up their much loved pets. Approximately 2.75 million older people currently requiring residential care are pet owners and yet over 60% of care facilities for older people require them to give up their pets. The consequent distress caused by the loss of a pet is evident, with several surveys of care homes reporting older people suffering from depression and grief as a result.

However beyond the associated health benefits, dogs in particular can also provide invaluable functional support for disabled and vulnerable people in their everyday lives’. Assistance dogs have thus not only been shown to enhance the confidence and general social interaction of the owner, but have served to act as social catalysts and facilitators. Indie, a Labrador from Surrey, provides daily support to Wendy Plus from Surrey, who pays for Indie through direct payments. Until recently, Surrey County Council along with other councils refused to recognise dogs as carers. However Surrey Council relented and now Indie is part of Wendy’s official care package, with the estimated potential savings to Surrey Social Services to be as much as £23,000 a year (this includes the £8.50 a week in food and vet bills!)[i].

So if the Government continues to move towards self-directed care in the form of direct payments and individual budgets, will there be a demand for more assistance dogs to offer support and independence to not only disabled people but perhaps older people as well? Assistance dogs can not only carry out and assist with everyday living - their skills include: loading and unloading washing machines, picking up items on command and paying for shopping - but also and critically for older people aid and promote confidence and social interaction. A study of fifty seven recipients of ‘Dogs for the Disabled’ (Lane et al 1998) reported almost all owners, over ninety two percent, experienced substantial improvement in integration as a result of being with their assistance dog. Furthermore owners reported that the increased interactions differed qualitatively from those experienced when not with their dog. Overall over a third felt their social life had developed as a direct result.

Evidently pet therapy, pets in general and assistance dogs are not a panacea for the wider perennial problems experienced by disabled or older people. Nevertheless for certain individuals in certain circumstances their role can be truly transformative and may in the process, even save a few coffers for the public purse…

 Sally Marie Bamford