Making Shopping more Age-friendly

In 2017, my blog included a series of posts on age-friendly cities and communities. These were linked in to work I was doing for the Office for Seniors on this topic. At the time I did not specifically mention age-friendly businesses, but now I want to make up that omission, prompted by recent interest by local government in New Zealand and reports on initiatives in Australia and the UK, which mainly look at the retail sector.

This is important, not only because of the growing number of older people in the population, but because of their special needs in relation to shopping access and experience.  A proportion of older people face practical challenges, which businesses need to be aware of and accommodate. For example, normal ageing often brings changes, affecting vision, hearing and cognitive skills. Shopping plays a part in social wellbeing for older people.  It is an opportunity to socialise and to be around people, something which many of us missed during the recent lockdown.

Age UK set out a challenge to the retail industry – “What assumptions do you make about older customers, including their lifestyle, consumer preferences, health needs, or abilities?” They also carried out a survey among older people, asking “When you go out to the shops what are the two things you look for above all others, in terms of the shopping environment?” [1]

  • The top two difficulties mentioned were not enough toilets and not enough seats in shops. The first is a major issue for many people, affecting their confidence to leave home and, in some cases, preventing them from doing so. Getting a key or pass code, or finding the toilets, present extra difficulties. Easy access to toilets can determine if seniors will visit a business at all. Sometimes adjoining corridors are hard to navigate because they are used for storage – A thing I encountered when I had a leg in plaster. Many people with mobility problems need a comfortable place to sit and rest while shopping. Seating is especially important near and in fitting rooms and areas where there are frequent queues.

There were other problems – Getting into a shop in the first place can be a challenge. People with limited strength may be unable to open stiff or heavy doors. Once inside, using wheelchairs or walking aids may be a struggle with aisles that are narrow or cluttered with trolleys, boxes of stock or rubbish.

Some people dislike self-service tills and prefer the social interaction of speaking to a cashier, so the recommendation is to have enough manned checkouts. The Age UK survey showed that many older people find the machines difficult or embarrassing to use, making it a stressful experience. When it comes to paying, people sometimes have difficulties remembering their PIN or making mistakes, as shown in a quote –

‘You put an item through and there’s something wrong, you have to call

the staff. It’s embarrassing, it’s as if you’ve been caught stealing. The

machine says “Problem in the bagging area.” I’m terrified of doing the

wrong thing.’

Many other things would make shopping easier and more enjoyable for older people. Some struggle to navigate supermarket or store layouts, remember where certain goods are located, especially when they are moved around, and there are no staff on hand to ask for help. Common challenges are reaching for items on high or low shelves and reading labels or prices in small font sizes. Age UK mentioned that one supermarket in Germany has dealt with this by providing magnifying panels on chains hanging from shelves and trolleys.

These issues revolve around customer service, which affects people of all ages and circumstances. Interactions with shop staff make a huge impact on customers’ experience, both positive and negative. Good customer service is a major selling point. Responding to the survey, people said they value simple things like politeness, patience, understanding, eye contact, and authenticity, i.e. speaking to ‘a real person’.

The need for more age-friendly service extends to telephone and on-line interactions.

Older people have many telephone-based consumer interactions, for example when talking to their energy company, bank, or phone/internet provider. The main problems seem to be long waiting times, poor staff knowledge and frustrating phone menus. Many find it difficult to understand what call handlers are saying because they are not speaking clearly or loudly enough. This does not necessarily depend on nationality, say Age UK. If the call handler was patient and checked that people understood each point, this might take a little longer but would mean that older people felt less rushed, confused, or pressurised.

 Despite these difficulties, some people find the telephone preferable to going online. This applies to me for banking. I appreciate being able to ask questions to a real person. While some older people enjoy getting out of the house for shopping and to speak to others, this must be set against the convenience of shopping online, which was a life-saver for some in the lockdown and a great help for the house-bound.

But security is an issue. Some people do not feel safe banking online or entering their credit card details when shopping, especially when we are warned about scams. Missed deliveries, long delivery times and returning goods in the post can make online shopping less attractive.

 Finally, there are complaints. Good customer service must include the means of resolving complaints or problems quickly and in the right spirit, regardless of the type of shopping access. But some people have difficult experiences trying to find the right contact for complaints and not getting considerate treatment by retailers. This calls for up-to-date, clear and well communicated complaints procedures, so that older people are confident of their rights. As one Age UK respondent said –

‘Everyone should complain. If you don’t complain the shop can’t put it right.’

[1] Age UK (February 2017) Age-Friendly business: Valuing and including older consumers in supermarkets and service companies.

 

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Covid 19 and residential care

Even though older people in New Zealand are not highly over-represented among actual Covid 19 cases to date, all the people who have died of the virus have been more than 60 years old, and more than half lived in aged residential care. Six rest homes had Covid-19 cases, two of which accounted for 16 of the 22 Covid-linked deaths. Once the virus invades these homes, it spreads rapidly, not only to other residents but also to caregivers and nurses. Worldwide, Covid-19 death statistics for older people in residential care are alarming. In Europe, official counts indicate people living in care homes account for 54% of all Covid-19 deaths and it is estimated that the real toll may be much higher. In the UK, an estimated 22,000 people have died in aged care homes – double the official figure. These figures have highlighted shortcomings in aged residential care and how these facilities relate to general healthcare services.

Ageism and Human Rights in residential care

Recent submissions by the EveryAGE Counts campaign to the 2020 Royal Commission into Aged Care Quality and Safety in Australia highlight the issue of human rights and ageism in aged care, especially in relation to the COVID-19 pandemic.[1] Here are the main points made in the submissions, which are worth thinking about in the New Zealand context.

  1. The absence of personal agency and voice of older people in residential age care decision-making during the pandemic

EveryAGE Counts maintains that the voices of older people in residential aged care have largely been absent from public debates on key issues, such as visitor policies, resident movements and the location of medical treatment for COVID-positive residents, while acknowledging that this engagement is not always easy with residents who are frail. Families of residents had only a limited voice in the media – largely associated with the failure of information flows.

The absence of older people’s voices in debates about how to balance safety and wellbeing is seen by the campaign as a clear violation of the sovereignty of older people in the context of care. The submission calls this symptomatic of “infantilising stereotypes” of vulnerability and dependency in which older people become the object of care and not agents of individual or collective decision- making. The result is to entrench public views that it is appropriate to make decisions for and about older people in the residential care setting without their active engagement.

  1. How COVID-19 outbreaks are managed in residential aged care.

The submission criticises the acceptance of a segregated system of care for older people, constructed as a one-way journey, with tighter segregation as the only containment strategy available. They argue that this means that COVID-19 infected residents were not moved from residential care to a hospital. “Residential aged care facilities are homes, not acute medical facilities”. They do not have the medical resources required to deliver acute care, specialised medical equipment, or sufficient levels of personal protective equipment to cope with a significant outbreak. Nor are they funded to enable clinical care to be delivered. The campaign suggests that this illustrates a view that residential care is somehow able to transform itself into an extension of the critical care infrastructure in the tertiary health system, resulting in a denial of the right to proper medical treatment and protection against infection to an entire community of older people.

AGE Platform Europe, a European network of non-profit organisations of and for people aged 50+, has also highlighted this concern. Its Secretary-General argues that aged care lockdown measures in Europe did not aim to save older persons’ lives. Instead, the purpose of those measures was to enable the health systems to cope with the pandemic.

“When we look at the number of people who lost their lives because of COVID-19, half of them were older persons who were never brought to hospital”.

The question then is whether individual residents actively choose to remain in residential care – on the basis of advance care directives and/or discussion with them and their families – and whether the option of hospitalisation is freely available to them. Further, did keeping Covid-19 patients in residential care exacerbate the spread of the virus among a congregated, highly susceptible group of people?

The conclusion reached in the submission is that ageist assumptions are influencing who should receive critical hospital care in a pandemic, treating aged care residents on a collective rather than individual basis and deeming them not suitable for medical treatment in hospital – an option available to older people in the community.

  1. The impact of physical isolation on residents

The issue of visitors in residential aged care during the pandemic presents difficult dilemmas for all involved. People dying in residential aged care have largely been unable to have family with them because of fears of contagion. But blanket bans on visitors have a significant effect on mental health and wellbeing.

EveryAGE Counts calls for a much broader and deeper conversation about balancing mental wellbeing, social connectedness, quality of life and the rights of older people when public health responses rely on isolation as the key protective measure. In other words, individual rights and wishes have to be balanced against a collective approach.  There needs to be an investigation of innovative ways of enabling safe personal contact between residents and visitors and also identifying the impacts of isolation policies and practices.

The submission continues by asking “…how could we build a residential facility that lets people live the way they want to.” To “design out” as much infection risk as possible, “without resorting to strict and prolonged physical and social isolation.”

  1. Reform of the aged care workforce

The pandemic shone a light on the low social value placed on aged care, older lives and working with older people. Hence the need to address significant issues regarding the aged care workforce, and the reforms required for its sustainability, such as remuneration, skill levels and work stress.

Media reports around the world portray older adults as frail, helpless and unable to contribute to society.  There are headlines depicting older people as a threat, needing to be isolated. Age UK, in a recent article, has said that prolonged shielding of older people could lead to victimisation.[2] How much more is this likely in the residential aged care environment?

I also invite anyone to register for the Vision for Ageing In Aotearoa Conference to hear more about the views of Aged Residential Care as part of our panel discussion ‘Taking a Breath: Reflects on Covid-19’, Simon Wallace, CEO of the Age Residential Care Association is a panelist. This conference is a collaboration between Age Concern New Zealand and New Zealand Association of Gerontology.

 

[1] The impact of COVID-19 on the Australian aged care system. EveryAGE Counts Campaign Coalition submission,  29 June 2020.

[2] https://www.theguardian.com/society/2020/apr/28/longer-lockdown-for-over-70s-could-create-sense-of-victimisation

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Why I study older people

Guest blogger: Mary Breheny

Contact: M.R.Breheny@massey.ac.nz

More than ten years ago, I had a freshly minted PhD and was about to launch my research career with a postdoctoral fellowship. My supervisor and I discussed where to next, when she dropped into the conversation: “you will have to do older people, that’s what we are doing now”. I confess, my heart sank. Research on older people was not my idea of an exciting research career.

I did not think researching older people was provocative or challenging. I imagined all the more enticing topics others were doing: alcohol and medications, poverty and inequality and I thought “I don’t want to research older people!”

More than ten years distant from that reaction, I want to tell you why I do research on older age and ageing. And it is not because of population ageing or funding priorities or pragmatics. It is not because I am stuck or narrow or pedantic.

It is because research on older people has it all. It has humour and pathos and poverty and inequalities and discrimination. It incorporates history and social change. All of that which makes us human, is present in research on older age. And from that vantage point, we can see these universal processes anew.

First, History

It is so easy to ignore history in the examination of the here and now, concern with youth and the media and the constant movement of fake news that evaporates within the blink of an eye. Research on and with older people can never tolerate such dislocated immediacy. The present alone cannot provide a strong foundation to understand the future.

Everything which is, has arisen from somewhere. Nothing is ahistorical or vanishes without a trace. Following change over time establishes direction and momentum, teaching us about where we might be heading. Acknowledging history makes our knowledge of the future more nuanced and more grounded.

Ageism – The exclusion we all come to

Even if we have skated through life relatively unhindered by structural disadvantage, unscathed by gendered violence, disabling health conditions, or ordinary bigotry, live long enough and we all experience systematic exclusion of ageism.

It is less likely to play out in abuse hurled on the streets. Instead it plays out in insidious ways, the patronising dismissal of a life of relevance and expertise. Invisibility, fading beneath the notice of those who once sought out your counsel.

Ageism plays out too in the loss of unique-ness. Values and beliefs and carefully reasoned attitudes, reduced into an amorphous shared identity of old-ness. No longer a creature of layers and subtleties, reduced instead to a caricature.

These reductions teach us both about ageism and about how discrimination functions more broadly, how it is put together, and perhaps how it might be dismantled.

Inequality

Research on older people challenges how we understand equity and equality. When we focus on children and young people, it is tempting to think the goal is to remedy some lack of a level playing field, addressing some unfairness of accident of birth or circumstance. If only we could all start with the same advantages and receive the same resources, then the inequities of the world would not even need to be addressed.

Research with older people teaches us to resist this message. It teaches us that strong communities are not build only on flat ground; they are also built on uneven terrain. Understanding that level playing fields can never be sustained throughout the vagaries of life reinforces that the solution was never levelling the playing field. Instead we learn that how we choose to configure the game shapes who succeeds.

Humour

After years of studying older people, I have observed that older age is not the time for self-conscious seriousness. I read the transcripts of interviews with older people and marvel at the ways they play with words, turn a phrase inside-out, and gently mock that which produces them as older people. They know social conventions well enough to flirt with them, to dispense with them.

One message that researching later life repeatedly teaches me – that which we daily strive for is revealed belatedly as so much noise.

To Finish

I would like to give the penultimate words to the late Professor Oliver Sachs, professor of neurology who described old age in this way:

“At 80, one can take a long view and have a vivid, lived sense of history not possible at an earlier age. I can imagine, feel in my bones, what a century is like, which I could not do when I was 40 or 60. I do not think of old age as an ever grimmer time that one must somehow endure and make the best of, but as a time of leisure and freedom, freed from the factitious urgencies of earlier days, free to explore whatever I wish, and to bind the thoughts and feelings of a lifetime together.”

And this is my conclusion: Proximity to such perspective is the profound gift of research on older age.

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Did you know that 19th November is Worldwide STOP Pressure Injury Day?

We designate many days to celebrate good causes and memorable occasions – probably enough to fill the full year’s calendar – but this is one of the lesser-known ones, in my experience. But not one representing an unimportant or trivial concern.

The aim of the day is to raise awareness of pressure injuries and how to prevent them. Key messages are:

• with the right knowledge and care, pressure injuries can be avoided.

• all health professionals, carers, family/whanau members and patients have important roles to play in prevention.

• skin care matters.

 STOP Pressure Injury Awareness Activities are planned around the country.

The Accident Compensation Corporation (ACC), the Health Quality & Safety Commission (HQSC) and the Ministry of Health are leading a multi-agency approach. These organisations have been working for several years towards a national strategy for monitoring and reducing harm from preventable pressure injuries, starting with the in-hospital and residential care settings. Pressure injuries are often regarded as a marker of quality care because the risk rises when care rationing, understaffing or lack of awareness, results in patients not being regularly moved in bed or having their skin assessed. However, where possible, patients are also encouraged to take steps to prevent pressure injuries and speak to someone involved in their care if they have concerns.

While the exact prevalence of pressure injuries in New Zealand is unknown, it is estimated that they affect approximately 55,000 people every year, resulting in direct costs of some $694 million per annum, according to a KPMG report (2015). Most cases of pressure injuries are preventable – and prevention is a high priority for all the agencies involved. As well as having a significant financial impact on the health system, pressure injuries can have a substantial impact on peoples’ lives and wellbeing.

ACC’s Chief Clinical Officer, Dr John Robson, says thousands of New Zealanders get a pressure injury every year.

 

“We know these injuries can have a huge impact on quality of life for people, often resulting in a long period of bedrest and social isolation, and in extreme cases can cause death,” he says.

 

“They also put pressure on our health system by occupying hospital beds and utilising valuable resources. These injuries can largely be prevented – that’s why we are encouraging health professionals to have conversations about prevention with patients who might be at risk.”

 

Pressure injuries (also known as ‘pressure ulcers’ or ‘bedsores’) can range from a blister to a deep open wound, which can be difficult to treat and might take months to heal. In extreme cases surgery is required to treat and repair the skin and tissue damage.

 

Pressure injuries are caused when people stay in one position for too long and develop where the body takes weight and where the bones are close to the surface. Anyone can get pressure injuries, but they are most common for people who are sitting or lying for long periods, using a wheelchair, or medical equipment that has contact with the skin. Therefore, older people with chronic health problems are especially susceptible.

 

These injuries can be prevented by regular shifting in position when sitting or lying and by careful bedding arrangements, such as positioning of pillows and cushions. Nurses and other carers need to be alert to the dangers as well as the people directly involved.

 

A tangible evidence of all this activity can be seen in notices prominent in hospitals and rest homes. This is the SSKIN initiative – recommendations to reduce the risk and impact of pressure injuries.

Surface –ensure a supportive and pressure-relieving surface (mattress) is available

Skin inspection – undertake regular checks for discolouration and pain on bony areas (such as hips and heels) and under or around medical devices

Keep moving – change position often

Incontinence – keep skin dry and clean

Nutrition – eat healthily and drink plenty of fluids.

 

 

Other sources

 

In October 2016, the HQSC published its report ‘Developing a National Approach to the Measurement and Reporting of Pressure Injuries” informed by a multidisciplinary advisory group. The New Zealand Wound Care Society Inc: (www.nzwcs.org.nz) and the Nursing Council of New Zealand: (www.nursingcouncil.org.nz ) are also involved.

 

“Guiding principles for pressure injury prevention and management in New Zealand Review” Accident Compensation Corporation May 2017

 

Ministry of Health – HealthCERT Bulletin ‘Pressure Injury Prevention and Management’ (MoH) (www.acc.co.nz/assets/provider/acc7758-pressure-injury-prevention.pdf

 

Pressure injury prevention resources, which include a patient-focused flyer in 15 languages, posters, and a classification chart for clinicians are available on the NZ Wound Care Society website and printed copies can be ordered at no cost from ACC’s online ordering system

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Looking forward to “retirement” how it differs between countries

Dr. Judith Davey

What retirement means in an ageing population has thankfully shifted from the literal meaning of the word as “withdrawal’ and “exit” to a more positive view. The “disengagement theory” of ageing has been superseded by “activity theory”, which suggests that individuals find new activities to replace career work, and “continuity theory” which views retirement as transitional, with continuity of lifestyles and values. This acknowledges the complex interactions between individuals, their family circumstances, health, and institutional contexts, which develop throughout life.

The change in thinking was acknowledged in a study on retirement expectations, carried out in Italy, the UK, and the USA, which questioned older workers about to retire.[1] What interested me particularly was how local circumstances, culture and policy settings affected retirement planning and expectations.

Italy has a “Mediterranean” welfare regime, based on a culture where the role of the family is central. Child-care and elder care are predominantly delegated to the family and formal care arrangements are less developed. On retirement, people become a resource for caring roles. An Italian employee must leave their employment to become eligible for the pension..

England and the USA have liberal welfare models, where individuals are generally expected to be independent of their families. The UK tax, benefit and pensions systems permit individuals to work whilst drawing state and/or private pensions, providing a financial incentive to continue working beyond pension age and making a shift to part-time employment attractive (as in NZ).  In both countries compulsory retirement has been prohibited, providing a strong pro-work incentive.

Paid Work orientation

The US interviewees showed a continued orientation towards work – with less emphasis on a retirement exclusively of leisure. For those with less generous pensions the additional income from work was a key reason for them to remain employed.

Many of the UK interviewees had employment-oriented plans for retirement, suggesting they would be returning to some form of paid work either with their former employers under new arrangements (perhaps working fewer hours), in a new job, or on a self-employed basis. This suggested that their work–life balance had shifted into a ‘gradual retirement’ trajectory.

By contrast, the desire for paid work was much less evident in the retirement plans of the Italian interviewees. The main explanation for this was that, having worked all their lives, they wanted other activities. Many saw stepping aside as a duty, to make room for unemployed young people.

The research certainly showed how the experience of ageing and retirement can vary between countries, reflecting their welfare regimes and pension policies. Whereas paid work was a dominant expectation for US interviewees, for Italian respondents retirement was considered a one-time, permanent break from paid work, explained in large part by the Italian policy settings.

Voluntary work

Almost all the interviewees anticipated doing voluntary work. For some, this would continue on from their pre-retirement roles, with an increase in intensity. Others were considering volunteering as a means to develop skills or use existing skills, to engage socially and maintain a routine in their lives.

Caring

A family orientation was particularly strong among both men and women Italian interviewees. They looked to retirement in relation to supporting family, spending more time together or helping adult children. Many had grandchildren or older relatives in need of care. Although gradually changing, family-oriented relationships and co-dependencies are still culturally taken for granted, and structure daily life.

In contrast, among UK interviewees there were no examples of individuals choosing to retire in order to care for older relatives. There were instances where people contemplated balancing caring roles with leisure activities but, similar to their views on paid work, on their own terms. They really enjoyed being grandparents but did not wish to be relied on except on an intermittent, occasional basis. This view was also reflected by USA respondents.

Expectations to provide informal care for others could therefore be seen as an accepted responsibility (as in Italy) or as an obstacle to other preferred activities. Concerns were expressed that retirees would become expected to perform caring roles on a routine basis once they left the labour market.

Independent living

Independent living in older age entails empowering people to remain in charge of their own lives for as long as possible. This covers maintaining healthy lifestyles and adequate incomes.

Plans for healthier lifestyles, improved diets and increased physical activity, were commonly expressed by interviewees in all three countries. Many hoped to pursue a wide range of sporting activities, motivated by a desire to maintain or improve health after retirement, or as a useful means of occupying newly freed time. It was also acknowledged that sport is a good source of social activity.

Income adequacy

There was a wide range of incomes in the three samples and an expectation that, once retired, incomes would be reduced. Some US and UK respondents were worried about their income during retirement (aligning with their expectations for continuing work), whereas this theme was not identified by Italian respondents. They felt that money is less important than family and good health, and they would “get by”. Plans to improve retirement income were not common.

The costs of health problems in later life were not raised by UK or Italian interviewees, reflecting universal coverage of tax/national insurance-funded health services.

Social connection

Interviewees in all three countries saw retirement as providing an opportunity to re-prioritise relationships and increase social networks through volunteering, sports or educational activities, as mentioned. Losing touch with work colleagues once they were retired, however, was raised by Italian respondents.

Lack of retirement plans

Most of the individuals in the study had clear ideas about the shape of their lives after retirement. But some had given little thought to the changes to come and how they would occupy their time. Some were anxious about the future. A number of interviewees expressed concerns and fear of becoming isolated. This fear encouraged many to consider ways to maintain or nurture new social relationships.

Suggested action

The paper concludes by suggesting actions to meet some of the concerns brought up in the pre-retirement survey. These include

initiatives by employers to help their staff make the transition to retirement and which could help both sides, for instance, keep-in-touch schemes to help retirees to maintain contact with old friends and colleagues. At the same time this could provide employers with a link to experienced ex-employees who may be interested in work on a casual or consultancy basis.

Awareness of retirement preparation events or courses was non-existent among the Italian interviewees and most provision in the UK and USA is focused on financial planning. More tailored programmes could be provided in the public sector, or by companies for their workforce.

 

[1] Andrea Principi, Sara Santini, Marco Socci, Deborah Smeaton, Kevin E. Cahill, Sandra Vegeris and Helen Barnes (2016) Retirement plans and active ageing: perspectives in three countries. Ageing and Society / FirstView Article / August 2016, pp 1 – 27. Published online: 22 August 2016

 

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“Giving Back” A Role for Older People

The term generativity was coined by the psychoanalyst Erik Erikson in 1950 to denote “a concern for establishing and guiding the next generation.” He first used the term while defining his theory of the stages of psycho-social development. Later additions to this theory included a concern for one’s legacy or even an “inner desire for immortality”. It all boils down to  concern for the future, a need to nurture and guide younger people and contribute to the next generation.

Erikson first argued that generativity usually develops during middle age, but then, having experienced old age himself, he suggested that generativity has a more important role in later life. Generativity involves answering the question “Can I make my life count?” People can contribute to the next generation through caring and teaching in their own families and local groups. They can also contribute more widely, engaging in creative work and philanthropic pursuits which contribute to society as a whole.

When trying to assess generativity, individuals are asked to agree or disagree with questions such as –

“I try to pass along the knowledge that I have gained through my experiences.”

“I have a responsibility to improve the neighbourhood in which I live.”

“In general, my actions have a positive effect on other people.”

In assessing the concept of generativity, psychologists have concluded that it can spring from selfish desires – to be remembered, and also altruistic motives – to help others. Generativity differs in how it is expressed between individuals and across cultures, but there is general agreement that it promotes psychological well-being. Hence, generativity is an important component of successful ageing. If we agree with this, the aim should be to maximise opportunities for generative activity and altruistic behaviour among older people.

Although we had not overtly included it in the scope of our “older entrepreneurs” research, which I have mentioned before in my blog posts, generativity and altruism did come through in the narratives of the people we interviewed. Here are some examples.

A retired public servant, said, “I like to feed back to the community, and I have long- term roles with voluntary organisations”. He estimates that  40% of his consultancy work is unpaid.

A Maori woman, also a policy and business consultant said – “I support women coming out of prison (often with gang connections) who need some help to set up their business. I’ll write their business plan for them and help them navigate their way around”.

An older man with several interests in the primary sector – “You don’t go into business to make losses.  But it is a joy when you make money. If you want to give some away to charity, you can. There’s a lot of little things that we can help our community with.” He is involved in trusts supporting community youth initiatives.

A man with a high level of technical skills – “My ambition is not to start my own business. That’s not my primary goal. My goal these days is I want to do things that are interesting and creative and for the public good. And I really enjoy the satisfaction of knowing that I’m doing something that’s going to help other people’s lives.” He is trying to pass on responsibility for developing a new product to younger people. “If it becomes successful, I will be creating jobs for other people, not just myself.”

A self-employed handyman in his seventies– “I try and give three hours a month somewhere where I know that somebody needs it.  At the moment I’ve been working for a lady who lives nearby. And I do it for free.  So that’s my way of giving something back to the community because this lady is very sick. “

A very experienced technician was made redundant about the age of 50. His brother and nephew had a business in the auto trade, but this was not well managed and was struggling. He stepped in with funding and expertise. Eventually the business was back on its feet and family members paid out. Now he is mentoring a niece to take it over.

When he settled in NZ, another interviewee bought a business, but in his fifties he became interested in the development of alternative energy sources and has secured funding to work with a university in this area. He sees this as his potential contribution to save the planet and, on a personal level – “If I’m lucky enough to have grandchildren and they say, “What did you do?” I want to be able to say something.”

I selected these snippets hopefully to illustrate some of the points about generativity which I outlined above.

 

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Telehealth for older people – beyond the Covid 19 environment

When we think of digital technology, we tend to think of younger people using their smartphones and other digital devices. But this picture doesn’t necessarily apply to telehealth. Older people have been taking up digital technology, especially during the recent lock-downs. Through this, they are able to use telehealth to improve their access to care and this may assist ageing in place, which is the preference of most older people, who prefer at-home support to moving to residential care.

Assisting ageing in place

Even if there are informal carers who can help with in-home care, these still need the advice and support of the healthcare community. Telehealth can also reduce the burden on family members who undertake care for their older members.

Many informal caregivers will have responsibilities of their own, from raising children to holding down a job. If they can consult with the doctor in question from the comfort of their own home, they won’t have to spend as much time and money shuttling the person they care for to and from the doctor’s office or for hospital visits. At-home healthcare providers can quickly gain valuable insight and knowledge from remote consultations, improving the quality of care for the dependent person, improving satisfaction and wellbeing for both parties and probably enhancing the quality of care.

Value of telehealth

With population ageing, the number of older people with functional and cognitive impairments, who require assistance from others, will increase. Consequently, planning for their care calls for higher-quality and more cost-effective care, as well as better integration of health care and social support services. To help achieve these goals, telehealth services are increasingly included as a component of community-based care for chronic conditions, mental health, and even palliative care. These have the potential to keep older people independent longer.

Self-reporting

One example relates to diabetes sufferers. They can use tablet devices to share information on their physical, emotional, and psychological health through regular sessions with their doctors. They can track their daily food intake on a smartphone; upload their health data, such as weight, blood pressure, and glucose levels, and transmit these data to health professionals. This gives a much more complete view of health status and allows earlier, proactive care. This type of tele-messaging can help people with chronic conditions to learn self-management skills that allow them to take control of their diagnosis and monitor their condition at home.

Activity monitoring

Activity monitoring includes passive technologies—cameras, sensors, or other devices embedded in a home, and even on clothing — which allow an older person to be monitored without requiring them or another person to operate them. Such devices can monitor mobility and risk factors such as smoke and water leaks. We already have medical alert devices worn to detect falls. Alerts can be sent to caregivers if anything unusual occurs.

Barriers and Drawbacks of telehealth

If an older person feels confident using a computer or smartphone, they’ll be more likely to try telemedicine than one who feels computer anxiety. They must believe that they’ll be capable of successfully using this new technology.

Social context also affects whether or not telehealth services will be used. Older people who are surrounded by friends and family members using communication will also be more likely to adopt the practice. They’ll also be much more likely to try it if their doctor recommends it.

Telehealth must also be seen as safe and reliable. Older people must believe that their health information will be kept private and secure. If online financial transactions are viewed with suspicion, for instance, the same may go for telehealth. Reassurance from trusted people is essential.

Even though telehealth is often more convenient, some older people may prefer a traditional visit to the doctor. And, providers may insist that a face-to-face visit is the best way to diagnose and treat illnesses. So, telehealth is often best used as a supplement to in-person healthcare, rather than a replacement.

 Many critics argue that telehealth may negatively impact continuity of care built up by long-term partnerships with doctors who are familiar with life-long health histories. Receiving care from an unfamiliar doctor through a video app may not be a long-term solution for managing all chronic health problems.

Because telehealth is such a new field, there’s also limited data on its effectiveness as compared to traditional medicine. And there is still a long way to go before home telehealth is widely available, despite its use in the pandemic lock-down. As technology progresses and more care is delivered via telephone, video and other telehealth methods, more research will be needed to identify the models of care that provide the highest quality with the best consumer access, taking into account diverse needs and also demonstrating telehealth’s usefulness and cost-effectiveness.

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Telehealth for older people in the Covid 19 environment

Since the start of the Covid 19 lock-down, which began for me on 23 March, I have had the need twice to talk to medical professionals about health matters – once to my GP and once to a specialist doctor. Both consultations took place on the phone. I realise that this was the beginning of my participation in telemedicine and it made me start to think about how this approach could be useful for older people, not only in the current pandemic, but also in the longer term.

Telehealth

This is the wider concept – it is defined by the Ministry of Health as “the use of information and communication technologies to deliver health care when patients and care providers are not in the same physical location.” Telemedicine includes telecare and telemedicine.

Telecare

This relates to technology that enables patients to maintain their independence and safety while remaining in their own homes. It includes mobile monitoring of vital signs – such as ECG or blood pressure (this may require patients to have their own recording devices but taking a pulse can be easy). Continuous remote monitoring of patients enables the tracking of fluctuation in the medical condition of an individual over time as well as highlighting alerts relating to real-time emergencies.

Telemedicine

Telemedicine, which is what I have been experiencing, involves remote doctor-patient consultations which can enable diagnoses and evaluation of patients; remotely prescribed treatments and medication (or alternations to medication). This may be done over the phone or through a video conference.

A number of different types of consultations can take place using telehealth, from initial assessments to multidisciplinary team meetings and arrangements for therapy/treatment appointments. In my case this involved referral for a radiological procedure.

Telemedicine can also mean two-way, real-time conferencing between providers. It can be used by a physician seeking a consultation from a specialist in another location; tests being forwarded between facilities for interpretation. Taken further, telemedicine could include robotic surgery occurring through remote access and physical therapy done via digital monitoring instruments with live feed.

 

What are the benefits?

  • For patients: Faster access to care and shorter wait times, making consultations more convenient and reducing travel and transfers for older patients.
  • Less time spent travelling for doctors; closer working relationship between specialists and primary care, allowing for accessible referrals and second opinions.
  • Allied health workers: Rehabilitation and physiotherapy can take place via videoconference, meaning less time and budget spent on travel.
  • As well as doctors and patients, patients’ family and whānau can be involved in a telehealth consultation. It is possible for a number of people to take part in video-conferences. For example, a consultant might be with a medical student at one site, while a patient, members of their whānau and a rural nurse specialist are at another site.

How does this relate to the Covid-19 Response?

It has been extremely important to continue to provide health services safely throughout the pandemic, especially for older people, and those who may be especially vulnerable. In the wider view this includes emphasis on the need to keep patient contact information up to date to facilitate contact tracing.   A significant amount of information has been found to be missing or out of date.

The Ministry of Health has provided advice to health professionals and also to all users of health services. Uppermost has been the need to keep physical distance from each other as much as possible. This is where telehealth can come in. It provides a way of having an appointment with a doctor, practice nurse and other health providers without seeing them in person. It may involve emailing, texting or having a phone or, where possible, video communication where you can see your health provider and talk about your condition just as you would if you were in the same room. The benefits, in the Covid 19 situation, include:

  • removing the risk of catching or spreading germs
  • reducing time and costs involved with travelling to an appointment
  • not having to leave the house when you are in lock-down or feeling unwell.

 

The main drawback is that the health professional will not be able to have a hands-on examination. But people can sometimes examine themselves or at least indicate the location of a problem. Sometimes a family member, friend or other health professional can help.

If the consultation is through a private healthcare facility, such as your family doctor/GP, you will be asked to pay for the health professional’s time. This will differ by health professional. I was charged a lesser fee than usual for the telephone consultation with my GP, and was told, in no uncertain terms, that I would be receiving a bill from the specialist.

There seems to be a lot more to say about telehealth for older people, so I will continue in my next blog post.

 

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Social Distancing/Isolation – how are older people coping?

I am happy to admit that I am over 70 – and for the last six weeks I have been told incessantly that I am “elderly” and “vulnerable”. This is not really how I see myself, but the messages have been so pervasive that my self-image has been dented. I have been told that I should stay at home and have whatever I need brought to me. I must admit that I have been well cared for by my two daughters, for which I am very very grateful – phone calls, Facetime sessions and food drops – but I have had to obey their well-meaning admonitions not to go to the supermarket, swab and sterilise!

So, I was pleased to be able to take part in a webinar put out by Charles Sturt University and the Australian Association of Gerontology, presented by Belinda Cash and entitled “Exploring the Impact of Social Distancing on older adults”. There was apparently a large global audience, estimated at 500, showing that this is an issue which has been widely noticed.

Countries around the world have adopted similar strategies to break transmission of the Covid 19 virus – isolation, quarantine, safe distancing, no non-essential movement away from home. This is easy to accept but the timeframes for distancing have been uncertain, which certainly doesn’t help anxiety and apprehension. The extra restrictions for older people are justified on the basis that the virus presents a special danger to them and they are disproportionally affected. From data presented in the webinar (and elsewhere) it can, however, be argued that chronological age is not the best basis for recent measures.

The webinar-provided figures for Australia, at the time, were 6720 cases of Covid 19 infection: the highest numbers in the 20-29 age group and the median age for them 48. Admittedly, for deaths from the virus the age effect is clearer – the median age of deaths from Covid 19 in Australia 79, with none under 40. Recent figures from New Zealand[1] are 1474 cases, with only 8% in people aged 70 plus; deaths 17 out of 19 are of people 70 plus.

Sure, chronic health conditions and co-morbidity are risk factors, but many older people can manage with some success. And, as Belinda Cash and many others have pointed out, older people are not all the same. The determinants of their vulnerability vary by gender, socio-economic status, education and employment, location and culture. Low incomes among older people, especially older women, mean they are less able to manage when price gouging appears and when they cannot make their own decisions on the “best buys” at the supermarket.

What then are the social distancing/isolation issues which especially affect older people?

  • Their usual family and social connections are disrupted. Many do not have close family living nearby or able to provide support – how many have children and grand-children living overseas who could not get home?
  • Routine activities are also disrupted, and this can cause anxiety. The maintenance of routine activities can benefit social, physical and cognitive wellbeing.
  • Those who are caring for spouses or others at home may be especially affected when they are disconnected from support.
  • Many older people have poor digital skills and are less able to use new technology. Or they cannot afford the hardware, software and connectivity required. The webinar noted that 57% of people aged 70 plus in Australia have low or no digital literacy; 62% of those 50 plus have never made a video call. The digital divide has not been spanned.
  • Social isolation and loneliness are increased. These are already major risks. Loneliness, for all age groups has been linked to other emotional responses – depression, anger, sadness, vulnerability, suicide. Good social connections provide protection against such risks.
  • Too much information about the pandemic, which has dominated the news for weeks, heightens anxiety and can be overwhelming. (I still find if difficult not to tune in to the National Programme several times a day). It is best to limit this exposure, like screen time just before bedtime.
  • The tendency of older people wanting not to be a burden can be heightened when we hear about how overwhelmed the health services are. We do not want to make it worse. As Belinda Cash said – “Tell them it is OK to have home care.”

I heartily agree with the webinar conclusions and I suspect so would Age Concern and our Minister for Seniors: –

  • Do not underestimate the individual resilience of older people; some adjust well.
  • Looking forward, do not make ageist assumptions.
  • Do not make age the sole determining indicator for restrictions, rather look at health conditions.
  • Do not let the label “vulnerable” come to mean less valuable.

Webinar PPT slides available at:

https://csu.ap.panopto.com/Panopto/Pages/Viewer.aspx?id=ba8899a2-21e9-42e7-8d7a-abab006bf211

[1] Article by Charles Waldegrave, Dominion Post 30.3.20 https://www.stuff.co.nz/national/health/coronavirus/121309735/coronavirus-elderly-need-balance-between-protection-and-isolation)

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Can redundancy be a silver lining?

We hear a lot about the plight of older people who are struggling to get into or return to the workforce. Only recently there was a Stuff headline – “How employers are freezing the over 50s out of the job market”.

The article reported stories about unexpected redundancy and failure to find work even after sending out dozens of applications. The people involved included many who had had successful careers and listed transferable skills. They were frustrated and embarrassed and many did not want to be identified for fear of jeopardising their situation even further.

It would be easy to share these feelings and point to this as proof of “ageism in action”. Redundancy is almost universally portrayed as a negative event. However, about the same time as reading this Stuff article I came across an academic paper – “Ageing and redundancy and the silver lining of entrepreneurship “which threw a different light on the situation.[1]

The authors found that, while redundancy and old age can have negative effects and outcomes, starting up a business enterprise can be something positive for people in later life. They concluded that both age and redundancy may be spurs to entrepreneurship that might ultimately prove positive and contribute in lifestyle terms for older workers: “a silver lining effect”.

“Entrepreneurship can be triggered by events, positive or negative, that shake an individual from their status quo to start a venture” and there are specific appeals of entrepreneurship facilitated and enhanced, not reduced, by older age”.

 Therefore, entrepreneurship may be considered as a reasonable alternative to employment. Redundancy may be a way to secure capital for business if a severance payment is involved. In a different context, I personally know of an example where a person took voluntary redundancy to acquire funds for a house purchase after a matrimonial settlement left him homeless!

As I have pointed out before, there are many advantages for older people starting up their own businesses. Entrepreneurship may be attractive in providing an opportunity to do something for interest, lifestyle and income which was not possible in previous stages of life. Where once income may have been prioritised, other rewards may be gained, such as free time, family time, and new/existing interests.

 All this comes through in some of the stories we were told when we interviewed “senior entrepreneurs” for our current research on workforce ageing. It emerged that many of our interviewees had experienced redundancy from paid work at some stage in their working lives. Many of the older ones, who had reached pension age, agreed that income from their businesses was supplementary for lifestyle rather than basic need.

 Along with the authors of the British paper, we have found a variety of motivators and drivers of entrepreneurship.

  • The desire to continue to contribute and apply skills and experience.
  • The lifestyle-based attractions of working for oneself, flexibility, being one’s own boss. independence, freedom, satisfaction and growth.
  • The opportunity to fulfil other roles too – such as caring for older relatives

From the British study the conclusion was –

“Entrepreneurship was perceived as an opportunity, but this opportunity was less about being an entrepreneur and more about the lifestyle advantages perceived of independent business in the context of older age and circumstances.”

We are thinking about this in the context of our research – would we agree that “redundancy a blessing in disguise?” Perhaps for some.

 

 

[1] Rebecca Jane Stirzaker and Laura Galloway (2017) Ageing and redundancy and the silver lining of entrepreneurship. The International Journal of Entrepreneurship and Innovation, Vol. 18(2) 105–114.

 

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