In the fourth in a series of blog posts on the experience of living with frailty, we discuss research findings on how people are supported to maintain independence and where at times this support is lacking.
If ever there was a demonstration that chronological age is a weak indicator for care and support needs, it was our oldest participant in our recent research that needed the least hands-on support.
At 92, there was little sense of the so-called “burden” to health and care services that is so often used to characterise an older and ageing society.
The main change in Phyllis’ life was to move to sheltered accommodation, which gave her the confidence that should anything happen to her, someone was on hand to help out.
The nature of the support and resources available to the older people we worked with varied hugely. Through the personalisation agenda, there is a limited acceptance that everybody’s health and needs will be different.
EVERYONE IS DIFFERENT
However, this often doesn’t begin to account for the range of differences involved. Income; housing; social networks; local environment; cognitive health; life experiences; personalities; and expectations all play a massive role.
Merle’s daughter, Bridget, was concerned that local support services did not ‘take into consideration … the cultural differences. Not everybody goes to the same groups; not everybody wants to do the same thing.’
Different people derived support and confidence from services that did not work for others. Betty spoke of the extremely positive impact of her local day centre, somewhere she had been going to for many years:
‘My daughter says I look totally different [since coming to the day centre]. You can tell. I didn’t want to come, but coming here is lovely. I didn’t like it when I first came because I have problems with my memory and I couldn’t remember the people, but I know them now, so I’m happier.’
Haydn, on the other hand, was much less interested in day centres, though he was still able to pursue other activities with the support of his family.
In both cases, the net effect was that the support they received helped them to maintain confidence while accounting for their changing needs. However, gaps in support can start to have a big impact on people’s lives.
GAPS IN SUPPORT
Donna and Edward came across a number of challenges in having their needs met. Donna was in hospital after a fall and was becoming increasingly low and withdrawn. She could not easily go home because there was not a safe way to negotiate the stairs to her flat.
On balance, Donna and Edward eventually decided she would be better at home and would find a way to struggle on with the stairs. However, they were then faced with formal carers that often arrived late and who spent too little time in the house.
This made it very difficult to plan and maintain a routine and they eventually cancelled the service.
Another participant, Annie, found similar challenges with a GP. Her neighbour had fallen and damaged his knee. It was also apparent that he had recently developed problems with continence.
When the GP came to see him, after a lot of persuasion, they just provided pain killers and did nothing to address his continence problems. This may be a classic of example of where time in front of a health professional is under-utilised and problems which could reach crisis later are ignored.
And this despite the fact that avoiding admissions to hospital is a key priority for health and care policy.
A final observation from the research was that the households that took part had very little evidence of computer technology. Smart phones, tablets, laptops, were almost entirely absent.
In the rush to establish such tools as a means of supporting people, we must not forget that this technology is still not a meaningful part of many older people’s lives.
Next time we will look at loneliness and isolation.