Centre for Health and Social Care

1
Centre for Health and Social Care LEEDS INSTITUTE
OF HEALTH SCIENCES
The Preventive Agenda in Services for Older
People What Can Research Contribute?
Mary Godfrey 29 June 2007
2
Themes of presentation

• What is prevention in the context of older age
• Diversity of the ageing experience
• The values and beliefs that underpin a good old
  age and the strategies people employ to manage
  the process
• Risk, vulnerabilities and resources in later life
  to inform preventive initiatives and
  interventions
• Some illustrative examples of what works, how,
  for whom and in what contexts
• Taking prevention forward the limits of
  research evidence and the challenges and
  limitations of prevention

3
What are preventive services? What do they
prevent?

• Focus on the perspective of ageing well or
  securing a good life in older age
• Life course perspective
• Dynamic conception of ageing
• Shifting balance of opportunity and loss over the
  ageing process
• Diversity and commonality

4
Ageing well macro level

• Higher mortality rates among those in the lowest
  fifth of the wealth distribution compared to
  those in the highest fifth
• Greater wealth accompanied by better health for
  those under 75, particularly for men in their
  50s weaker association between health and wealth
  over 75 years
• Marked differences in loneliness by wealth with
  the poorest reporting double or greater the rates
  of feeling lonely than their wealthiest
  counterparts across the older spectrum.
• (English Longitudinal Study on Ageing (ELSA))

5
Micro-level What matters to older people?

• Independence and reciprocity
• Having a role/purpose
• Social networks and relationships
• Healthy minds and bodies
• Social activities (stimulating, fun, rewarding,
  interesting)
• Material resources for a comfortable life
  (personal and social comparison)

6
Risk and resources

• Risk
• Objective and subjective experience of ill-health
  and disability
• Loss of intimates through bereavement
• Frustration of daily hassles
• Poor physical/social fabric
• Crime fear and actual
• Inadequate/inaccessible service provision
  
• Lack of engagement
• Inter and intra-group mistrust.

• Resources
• Quality and flows of exchange through social
  networks and relationships
• Sociability, companionship, intimacy personal,
  emotional and instrumental support, stimulation,
  enjoyment)
• Nature of community networks (composition,
  linkages, density, heterogeneity)
• Normative ties (trust, reciprocity,
  co-operation)
• Quality of physical environment
• Quality of services housing, transport,
  availability of, and access to services and
  support

7
Preventive interventions example of intermediate
care

• Interventions to support recovery service,
  content and process of delivery
• Evidence of substantial progress along path of
  recovery
• Securing and sustaining independence affected by
• Circumstances prior to illness/intermediate care
  episode
• Illness onset and trajectory
• Multiple health problems in advanced older age
• Types of recovery trajectory
• Complete resumption of previous life routines
• New onset of chronic illness/disability
  challenge of management and adjustment
• Incomplete getting back and keeping going

8
Logic of intervention in IC

• Key point of transition from illness to
  resumption of life routines
• Timeliness and appropriateness to effect the
  transition

9
Social networks and relationships

• Primary Prevention Information about, and access
  to, wide-ranging opportunities for socialisation,
  developing and sharing interests, learning and
  skills development, public participation, formal
  and informal volunteering, combating age
  discrimination
• Secondary Targeted on those at risk of loss
  programmes aimed at strengthening social networks
  at points of vulnerability such as onset of
  disability (neighbourhood network schemes)
• Tertiary Focus on those who have experienced
  loss of relationships (befriending, dementia
  cafes etc)

10
Logic of intervention networks
11
Preventive strategies for a good old age

• Not only focused on older people or even those in
  their middle years but cutting across all age
  groups
• Action and interventions for a good old age
  applies equally to those in the latter part of
  their lives
• Needs to embrace inter-generational solidarity
• Not just a strategy for service delivery in
  health and social care

12
Beyond conception of low level prevention

• What contribution do specific initiatives/services
  play in optimising gains and compensating for
  loss in later life?
• Level of initiative national, neighbourhood/local
  ity, individual
• Whose responsibility and where should costs lie

13
Modest claims of research evidence

• Contributing to how social interventions are
  chosen, designed, implemented and targeted
• Reducing some areas of uncertainty in some
  respects not incontrovertible proof
• Flying the Tattered Flag of Enlightenment
  (Pawson, 2005)

14
Contact

• m.godfrey_at_leeds.ac.uk
• Website www.leeds.ac.uk/hsphr/hsc/research