American official website summarises research on effective interventions with older people with disabilities

http://www.acl.gov/Programs/CDAP/OPE/ADEPP.aspx

Older people should listen to upbeat music to think quicker

https://www.psychologytoday.com/blog/memory-medic/201504/musics-effects-cognitive-function-the-elderly

Another example of an older person being creative in her living.

http://www.housebeautiful.com/design-inspiration/house-tours/a3595/russian-bottle-cap-house/

Life expectancy falls for older people: is it austerity, their smoking history or a blip?

http://www.theguardian.com/society/2015/apr/07/life-expectancy-falls-older-uk-women-public-health-england?CMP=EMCSOCEML657

It's good that younger people take older people out

Another of my street photos, taken at Osterley Park, a National Trust property near London.

Isn't it great how often younger people take an older person out for a good time?

Older people should have a stimulating life even if they need care

An interesting case study of the misuse of a Deprivation of Liberties Safeguards (DoLS) authorisation, which demonstrates the importance of good practice. Care homes and hospitals have to take out these authorisations if they're going to stop you doing things that normally you would be free to do, for example go out on your own if you're unsafe. My view is that it's not good enough just to comply with the safeguards; here you have a man who was legitimately deprived of his freedom, because he was at risk when he was living on his own with dementia. But once admitted to a care home, they did not work at trying to give him as much freedom within the constraints that were necessary, and so lumbered him with a more miserable life than they needed to do. I can't say often enough that just caring for older people won't do, you have to give them a worthwhile life. Even though someone has their freedom curtailed in some respects, it's still possible to give them freedoms in many other aspects of their lives. Social workers should be supporting care staff to do that, even if the managers of the care homes isn't good enough to manage it on their own.

This comes from the annual Care Quality Commission review of the operation of the Deprivation of Liberty Safeguards. The development of these safeguards has been going very slowly, and it is suspected that a lot of care homes and hospitals are breaking the law. It seems that, while there is some good practice, there are still a lot of people who do not know about the safeguards, and so cannot operate them correctly. Although there is confusion about what deprivation of liberty is, what the DoLS scheme does is force you to think it through. The CQC review provides a lot of interesting case studies and citations to recent legal cases, and comprehensive links to guidance.

Link to the CQC review.

Governments don't collect data about older people, so they can't plan for their needs

This interesting map (drawn from UN population data) compares the proportion of the population in different countries that are and will be older people in 2012 and 2030. The proportion is rising almost everywhere. It comes from an interesting Global AgeWatch information briefing which says that governments and others are not collecting data about older people. They concentrate on younger people, so older people get missed out of the planning for policy and services.

Link to HelpAge download site, so that you can look at the briefing.

Help in controlling blood pressure - it's a right that should be available everywhere

Controlling high blood pressure is really important for maintaining older people's health, and avoiding heart disease. Like many older people, I take the statins every day, and it keeps my cholesterol under control, and I take blood pressure tablets also. I know there's controversy continually mediating people in this way, but at least it's right that controlling blood pressure is available. But, according to a recent survey, it's not available in many countries.

Link to the HelpAge report - scroll down for the survey presentation.

Value the character and life experience in the faces of older people

Two pictures of older people on the Soller tram in Mallorca; I took them on holday recently. Aren't they full of character? Aren't these people who are engaged and involved in their local community? Why take only pictures of the young with their life and character still to form?

Big care services can be human, even if they are not small and local

I I'm always irritated by articles by top people in commercial organisations, when the main purpose of publishing it seems to be to promote how enlightened they and their organisations are without of course doing anything vulgar (and expensive) like actually advertising (the puff for the writer's organisation is about halfway down this one). However, this recent article on The Guardian's website makes an interesting point. It suggests that social services departments in commissioning services find it too easy to contract with big providers, rather than smaller, local services that might be a bit more human-sized and responsive to local circumstances. I actually think that it's possible to over-egg the argument about local is best. Expertise, flexibility and responsiveness is best, and professional services can do that if they're well-run, big or small. 

 Link to Guardian social care article

Skill-building for older people, so that they can take control

An experienced social worker in the US (you may be confused that it's about Rochdale, but it's a Rochdale in New York somewhere) talks about how he became interested in working with older people. This is important because a lot of social workers (who of course train when they're young) are mainly interested in working with children and young people. Older people, as a result don't get their fair share of the good social workers - although he makes the point that you have to earn trust, it doesn't come with a degree.  He emphasises supporting and not competing with older people's community organisations and recognising the issues that are important to them - crime in this instance even though most professionals think concern is over exaggerated. Nevertheless, it's a real concern for many older people, and it's important to take it seriously. It's also good to help people feel they can do something about what's happening to them, so they gave observational skills training to the older people, so they could be good witnesses when crime affected them.

A positive skill-building approach to working with older people, which recognises they can take control and can build their own contributions to the community; they don't have to have things done to them.

Link to the article.

Granny pods - keep older people in garden sheds

I'm intrigued by the American Association of Retired People promoting the idea of granny pods in your back garden. Yes, it allows older people to 'age in place' as the American jargon has it, but however luxurious this means keeping your older relative in a garden shed. Even more than with a 'granny annexe' it makes them very clearly subsidiary to the life of their younger relatives.

Prevention: free older people's opportunities

You might be interested to see a 'less than 10 minutes' SCIE 'Social Care TV' film about various projects for promoting well-being for older people. There is also some talking-head stuff from Julien Forder at the Personal Social Services Research Unit about what constitutes prevention.

My comment is: we need to think carefully about prevention, because government tends to think of it as being about preventing them coming in for extra expenditure. But what it should be about is helping people attain the right lifestyle according to their own wishes. Is having lots of older people's clubs the right approach? It all looks a bit institutional here. It might be all right for some, but not for all. For some people, promoting involvement in the local pub may be more right. We're still thinking about organising things for people, rather than making it possible to free older people's opportunities.

Link to SCIE 'Social Care TV page on promoting well-being for older people

Sassies (single sexy and sixty or over): plan for the future as well as pulling the men

Trying to sort out my Clipboard site (where I post the odd comments on news of the day) I was reminded of this old Daily Mail article on Sassies: that is single, sexy and sixty (or over). Apparently, in 2010, women of this age were seeking lots of sexy fun.

My comment: I wonder what plans they're making for their possibly less active late-seventies and eighties. I don't want to pour cold water on the Daily Mail's opportunity to publish loads of attractive photos of beautiful women in their sixties, but this is a period when you can be zapping life and also planning for your future.

I recommend lasting powers of attorney, a funeral plan, a will and settling into an adaptable home where you can live well with a greater degree of disability. You can still go on pulling the men for a lot longer than your sixties, as any care home owner knows.

Link to my Clipboard site.

Department of Health needs a broader non-health view on older people's needs

One of the good things about the Department of Health's new Director General for Social Care and blah blah (Jon Rouse) is that he has good experience of social housing - this is a really important link for the Department of Health to make for services for older people. The DH is far to health-oriented - it needs to have a broader view about what is important for older people in the whole range of public services.

Link to Department of Health announcement.

Just because you can make gadgets do complicated things is no reason why you should

Having recently bought a new telly, I can only endorse my son's view, expressed in his blog, that the plethora of information about technical products that you don't really understand makes it hard to make decisions about what to buy. I'm not surprised that older people feel they just don't want to know about all the new gadgets they might buy. My wife said we should get this telly with all the things it can do that make it so much more than a telly, because in a few years' time our grandchildren will not want to come to see us if our equipment will not meet their assumptions about the world. Already, our grandchildren are unable to comprehend why our telly can't just show everything they might want to see just when they want to see it.

Stuart Payne's blog on logistics.

It's a feature of old age that one's children's professional activity in completely incomprehensible worlds begins to eclipse one's own feeling of general social competence; I was never sure what logistics (you see it on the sides of lorries) was in general before my son got a job doing it, and I'm still not sure what he actually does; my mother had the same problem about social work. But I see from the blog that the old Sony telly that we used to watch a quarter of a century ago has formed his retail decision-making, so obviously parental behaviour does have long-term implications. It seems that modern domestic equipment, marvellous though it is in so may ways, is just too complicated even for younger people nowadays to keep up with. This is a sign of the rigidities of old age strike ever younger because today's world is so unnecessarily complicated.

I might worry that this why I've had to take so much stuff back after Christmas. But no, as I said to the young man who said he could help me with my wife's new gadget, it's not that I don't know how to make it work, because I can make my own work. It's just that because modern technology can, modern technology does and then it's made itself too complicated to work

Fuel poverty kills vulnerable people, including older people

I came across an intriguing report about fuel poverty among older people (and other vulnerable people), written in 2011 for Friends of the Earth, the environmental charity, by Sir Michael Marmot. You may wonder why FoE are doing stuff on fuel poverty: their website connects this with energy efficiency contributing to a good relationship between humanity and the environment. You may also wonder how Marmot (a public health medic) comes to be writing all this stuff: of course he doesn’t, he has a team paid for by sucking up research grants from organisations which very broadly fit within his main research theme that tackling health inequalities is a crucial part of improving health nationally and internationally. Presumably, he looks at what they are doing and so his signature on the report gives it added credibility.

Link to the FoE report by Sir Michael Marmot’s team. 

Link to the FoE website on fuel poverty and energy efficiency. 

It’s mainly a literature review, and it collects up some very interesting figures. Among them, is this graph, which shows the excess deaths in different years from 1999 to 2010 due to cold. The point is that, particularly for older and other vulnerable people, cold is a real health hazard, and therefore fuel poverty is an important issue. The NHS spends a lot of money treating people for disease caused by poor heating in private sector housing, according the a quotation from the Chief Medical Officer of the Department of Health in the FoE report.

You are in fuel poverty if you spend more than 10% of your disposable income on heating and lighting. There are three reasons for getting into fuel poverty. Obviously one is how rich your household is; the rich can afford their fuel. The other two are the cost of fuel and how well-insulated your house is.

Older person too brisk for the young and their mobile phones

Returning failed Christmas  gifts (a Kobo ereader, which acquaintance with their website tells me have a lot of people are experiencing problems with) I am caused to revise my ageist assumptions about how old people are slow in malls and shopping street, always chuntering along without a thought for the busy.

As a older person myself, I'm obviously still too brisk, but this time for the young. I’ve come (I recognise this is equally ageist, but this time against the younger) to be irritated by younger people, halted wherever they have decided they need to adjust their mobile phones, without a thought for the passing flow of pedestrians.

Hospice and palliative care should be part of care for older people, not separate

I’m returning to Byran Driver’s comment, so I’ll mention again how this comes about.

A comment, from Byran Driver, has come in about a post a while ago on 19^th July; the comment is attached to the post, but I’ll reply in this new post:

I have recently been reading your blog and I was wondering if you could expand upon your point that you do not believe in palliative care and the hospice movement?  

The link to the original post. 

What I said was:

I don’t totally believe in palliative care and the hospice movement.

This was as part of one of my musings around the time that I retired from working in a hospice (actually, St Christopher’s, the original hospice of the ‘modern’ hospice movement). Link to St Christopher's Hospice

Yesterday, I talked about the priority I give to social work in my life: this post is about palliative and hospice care. Although until recently I’ve been working in a hospice, I have my doubts about hospices and palliative care. The reasons are that I’m doubtful about hospices because I think people should die in as natural a way as possible as part of their families and community, not in some specially designated place. And I’m doubtful about palliative care because it focuses on a small number of dying people who have a major diagnosed illness so that they can be treated as a separate group, and as a medical specialty it has displaced good community end-of-life care for everyone who is coming up to the end of their lives. And especially older people, who lose out because of palliative care’s emphasis on cancer and other major illnesses, instead of supporting good community provision for all older people that also includes the dying process.

Let’s start with hospices. Hospices started up based mainly on a model of end-of-life care provision which came to be called ‘palliative care’ and, when it became a medical specialty, ‘palliative medicine’. An important strand in the founding their founding was the work of Dame Cicely Saunders at St Christopher’s Hospice, in south London, where I worked. She looked at care of people dying of cancer in hospital and community services during the 1950s and thought it was inadequate. She founded St Christopher’s to demonstrate her ideas. Combined with many other people’s thinking and research at the time, this led to an expansion of palliative care.

In the UK, this led many local volunteers who liked her ideas to campaign and fund-raise for a local hospice. As the creation of many different local voluntary organisations, they come in various shapes and sizes but they all combine this idea of medical and nursing care to manage pain and other difficult symptoms with concern for the psychological, social and spiritual needs of the patients as they go through the dying process. Most of the provision in the UK is still in local voluntary hospices.

The first point to make about this is that it is not the same in many other countries. Many of them do palliative care mainly in hospitals or mainly in the community visiting people in their own homes. There are lots of hospices round the world, but putting up a specialised building is not easy or always the best choice in many situations.

Neither would Dame Cicely be all that keen on a universal adoption of this model. She founded an organisation and a building so that she could experiment outside the main state system of healthcare in the UK. But her aim was to influence all health and social care so that it dealt with the dying process better. Her commitment was to good care of dying people, not necessarily to create hospices.

And to some extent, setting up separate organisations and buildings cuts off care of dying people from the mainstream of services, it almost says: ‘To die well, you need some special place to die in.’ But no health service was going to fund separate places to die in for most people, so this is not the message we want to give. We need to say: ‘The dying process is important to people and their families and we need to handle it well everywhere’. Separating off places to die is unhelpful, but to get finance for an experimental service, it helped to have a building with wonderful facilities, because you have something to show people for their money. It’s an important part of fund-raising. It also came at the time (the mid-1960s) when communes and therapeutic communities were in fashion, so caring for people in special buildings seemed a good idea. Now people are less keen on institutionalised care, and we know it is difficult to keep up a good standard: just look at all the scandals about care in hospitals and care homes.

The voluntary/charity/3^rd sector organisation of hospices is also unhelpful.  They have to raise funds (the National Health Services only provides a small proportion of the costs – it varies but can be 30% or less). So they have to harp on about how special they are, when really what we should be doing is making the experience of dying special wherever it is. And they have to sell themselves by claiming how important their role is, when really they should be cooperating with the NHS to ensure that their role disappears.

Added to that, the selling process sentimentalises and separates dying. It’s not normal life: it’s medical and that means it requires professional help rather than being part of the normal life of the family. And it has to be lovely, in a nice environment, with specially caring people. Instead of which, the message should be, it’s a natural part of our lives that we should prepare for and, given the proper community nursing and medical care, any family can and should participate in the process in as natural a way as possible.

Having hospices as charitable organisations also allows the government to sentimentalise what ‘all these wonderful people’ do in this special way, and allows them to avoid responsibility for ensuring that a really good general service to help with the dying process is part of our health and social care system. So it allows the Conservatives to tell us that the voluntary principle is valuable, and part of the ‘big society’ that the Prime Minister likes to go on about. Really what they mean is they love not having to pay for most of it.

Now I turn to palliative care.

Palliative care, and palliative medicine, as the medical speciality is called, is a well-established form of healthcare practice, building on the pioneering work of hospices. The assumptions underlying it are that in advanced illness, expert management of symptoms, particularly but not only pain, allows people to have the highest possible quality of life and fulfil their life aims in the time they have left. I don’t object to that, but I’d like to point out what it implies.

First, it creates a medical specialty around the care of people with ‘advanced illness’, so that other doctors are expected to hand over their patients once they are close to dying because the important thing becomes caring for them sensitively, rather than active treatment. In this way, medicine is avoiding the issue of balancing care as you die with treatment for your illness, as though they were different things, whereas hey are actually two aspects of people's lives who are living with serious illness. Some doctors can go on saying what they do is cure, because they can leave the death bit to other doctors. It’s an example of the medical profession dividing people up into specialities for their convenience, rather than treating people in the round, so that they are not being realistic about what is happening to their patients, and not listening to what their patients are experiencing. Then there are disputes about handing over or not. But more important, it means that patients on the other side of the divide are not listened to with a curative mind in play. They are to be made comfortable, but any wish of more treatment is ignored as unrealistic. Some people are not happy that artificial nutrition and hydration (food and water) are withdrawn, but this is presented as a technical issue: in palliative care, once a patient is defined as having reached that stage, the policy is to withdraw feeding and hydration tubes. It’s not that I disagree with that policy, it’s that the division between the caring and treating is so sharply made, instead of one medical team taking the responsibility for balancing the whole of their patients and their family’s needs.

Second, palliative care as a healthcare specialty becomes divided from care at the end of people’s lives. Palliative care specialists in social and health care all tend to assume that this distinction is not important: end-of-life care is really just a branch of palliative care. But palliative care comes from the wrong direction. It’s about ‘advanced illness’ (that is, a diagnosable illness that has got so bad they can identify the characteristics of an end stage). A lot of government policy focuses on end-of-life care being provided in the last year of life. But nobody knows when you’re going to die, so how is care provided for people in this situation? Only if healthcare professionals can say to themselves that within a year you are likely to be dead. This is called the ‘surprise’ question: ‘Would you be surprised if this patient was dead in 12 months?’ If they would not be surprised, you are regarded as in the end-of-life category and might get some services.

But most people have not got a clear diagnosable illness, and this stops all kinds of other services including the end of life into their broader work. So social workers arranging for you to have some community care at home don’t think about the reality, which is that if they’re providing this help you are coming into that group of the population that ought to be thinking about and planning for their deaths. Again, it encourages the separation out of some special group as ‘end-of-life care’, instead of all the services balancing the whole of your needs, including end-of-life, but also thinking about how you want to carry on with your life tasks and whether the services they are providing are helping you with that, rather than just parking you until you come into the end-of-life category.

So for me, palliative care does not incorporate end-of-life care, it obstructs end-of-life care achieving the kind of balance that it ought to have in services for older people.

That’s why I have my doubts about hospices and palliative care: their separation and sentimentalisation obstructs good end-of-life care for everyone in the community.

Wrinkes are where the smiles were

A happy sentiment for older people, from the Facebook page: I speak female. Link to the page.