What is the “Longevity Dividend”

By Judith Davey

I had heard the phrase “longevity dividend” in the literature, and recently thought I should find out precisely what it meant and if it was a useful concept in the study of ageing.

The phrase was coined by Jay Olshansky and colleagues in 2006 to describe “the economic and health benefits that would accrue to individuals and societies if we extend healthy life by slowing the biological processes of aging…… shifting our emphasis from disease management to delayed aging.” [1]

This idea was first raised among medical/biology professionals and a book “Extending the Human Life Span: Social Policy and Social Ethics”, was published by Bernice Neugarten and colleagues in 1977. This asked several questions –

  • Should the science of biogerontology be devoted to improving older people’s quality of life? Or should it extend the lifespan of the human species?
  • If lifespan is extended, what would be its deleterious and beneficial effects on society? 
  • What social and ethical implications would follow from a “magic elixir” that would extend active life expectancy?

Certainly, lifespans have been extended by decades, but, at the same time demographic trends – larger numbers of very old people –  have led to rapid increases in chronic and disabling diseases –  cancer, heart disease, stroke, dementia, arthritis, sensory impairments – and, as a result, an increase in the number and proportion of very old people requiring intensive care. Could life be extended, without extending health?

Changing the Medical Model

The current medical model approaches chronic degenerative diseases one at a time, as they arise. This is on the assumption that all diseases are independent of each other—with their own origins and causes. But many risk factors – such as poor nutrition, poverty, behavioural factors and environmental pollution relate to more than one condition. And even if we make progress against specific diseases, the biological processes of aging continue.

The Longevity Dividend can be seen as an approach to public health based on a strategy of fostering health for all generations through health promotion and disease prevention. It seeks to prevent or delay the root causes of disease and disability by attacking the one main risk factor for them all—biological ageing.

All living things have biochemical mechanisms which influence how quickly they age, and it is possible to adjust these mechanisms —by dietary intervention or genetic alteration—to extend life span and postpone ageing-related diseases (I can go into this aspect later). Slowing down the processes of ageing—even by a moderate amount—could bring dramatic improvements in health for current and future generations, allowing them to live healthier and longer lives. 

Multimorbidity, where people are suffering from several degenerative diseases at the same time is characteristic of very old age. But it is associated with a high treatment burden, reduced quality of life and greater health service use. Co-ordination can be easily lost, leading to fragmented care and we need to know more of the best way to manage groups of diagnoses.  Improving the well-being of older people through better management of complex multi-morbidity would be a way of realising this aspect of the longevity dividend.

Could longevity have economic benefits?[2]

While we can celebrate longer life in social terms, an increase in the older population is often framed as economic burden. As populations age, governments worry about an increasing stress on pension systems and the social care sector, especially with fewer younger people supporting growing numbers of retirees. Ageing has also been framed as a problem for employers, having to cope with less physically capable and less adaptable older workers.

But analysis of international data, published by the International Longevity Centre, suggests that. as life expectancy increases, so does “output per worker, per hour worked, and per capita” in other words, economic productivity. I have previously written about how older workers are and could be valued for their skills and experience and ability to mentor younger people. Many older people are also contributing to social welfare by taking on caring roles such as looking after grandchildren and elderly parents. In these ways they are contributing in economic terms.

The longevity dividend, like most economic benefits, is attainable, but needs to be worked for. Mobilising older workers’ skills, expanding labour forces and fostering intergenerational solidarity will mean that rising life expectancy can be both socially and economically good.


[1] S. Jay Olshansky, is from the School of Public Health, Division of Epidemiology and Biostatistics at the University of Illinois, Chicago.  He wrote about the Longevity Dividend in the March/April 2013 issue of Aging Today.

[2] https://theconversation.com/the-longevity-dividend-how-ageing-populations-could-boost-economic-productivity-102056

Posted in Uncategorized | Leave a comment

Stereotypes and Ageing – How true?

Judith A. Davey

16/10/20

When I last wrote a blog post about ageism – in 2015 – I was concerned mostly about ageism in the workplace.  That is certainly not the only place where it exists, so my eye was caught by a report by the Centre for Ageing Better, in the UK (Swift et al, 2019, ageing-better.org.uk). This was based on a literature review summarising what research tells us about the role and impact of language and stereotypes in framing old age and ageing. This got me thinking.

Who is an “Old Person”?
Differing age ranges are used in the discourse. But the Centre for Ageing Better report uses the term ‘old age’ or ‘older person’ referring to people aged 50 and over. This is also the definition regularly used to define “older workers” in the international literature.  But having children well into their forties makes it hard for me to contemplate that they are verging on old age.

What is Ageism?
Ageism is a combination of how we think about age (stereotypes), how we feel about age (prejudice) and how we behave in relation to age (discrimination).

Because groups of people have similar personal characteristics, such as age, gender, or ethnicity, we can easily make assumptions that they are like each other. This process leads to the development of stereotypes. And sometimes we develop negative attitudes towards those we see as different to ourselves, a process that is often called “othering”.

Descriptive stereotypes represent assumptions about what we think certain groups and individuals are like. Positive assumptions about older people may include politeness, kindness and wisdom.

They can also be negative such as notions that older people are less attractive and less physically able.

These stereotypes influence how we behave towards and interact with older people.

Stereotypes of low competence can lead to feelings of pity but may also encourage neglect and exclusion. Even stereotypes of older people which suggest that they need help can be quite patronising even though they do not seem harmful on the surface. Societal attitudes towards older people have been described as “benign indifference” when ageism is manifest indirectly, as a lack of respect.

Prescriptive stereotypes are assumptions about how we think certain groups of people should or shouldn’t behave. Common examples include the notion that older people must pass on power or jobs to younger people; that older people shouldn’t consume too many resources; and that they should not engage in activities that are seen as traditionally for ‘younger’ people. When older people go against these prescriptive stereotypes, they can face criticism and scorn.

Both descriptive and prescriptive stereotypes can become self-fulfilling, as they can affect how older people view themselves. Being labelled as “elderly” (which to me implies frailty) and “vulnerable” (which to me means risk-prone) made me feel that I must have these characteristics when I was labelled as such during the pandemic lockdown (I have to admit to being well over age 70).

Stereotypes about older people are frequently more negative than positive. As I pointed out before, older workers are perceived to be more dependable, loyal and reliable, but also as having lower levels of performance, less ability to learn, and more costly than younger workers.

In health and social care, stereotypes tend to be even more negative, focusing on physical and cognitive decline and death. The first gerontology conference I attended was dominated by papers on falls, dementia and incontinence, and I wondered what I was letting myself in for in entering this area of research. Subsequently, the topics covered in gerontology conferences and research have become much wider and much more positive – ranging not only into paid work but also participation in the arts, sport and community leadership.

Is there any truth in these stereotypes?
Some stereotypes contain an element of truth. We cannot ignore that health issues become more prevalent with age or that functional abilities change over time. The problem is that stereotypes

ignore the variation between people of the same age.This means that wrong assumptions are made based on age, but which are not true for an individual.

The importance of language
Using patronising and infantilising language towards older people can encourage them to conform to negative stereotypes of old age – low competence and high dependence. The impact may be influenced by the language is used or who is using it. The Centre for Ageing Better report suggests this by its title “Doddery but dear”.

Media representations tend to draw on negative stereotypes, reflecting a view that ageing is associated with inevitable decline. Older people are represented as being more of a burden than benefit. Metaphors such as ‘grey tsunami’, ‘demographic cliff’ and ‘demographic timebomb’ present old age in terms of crisis, reflecting a perception of old age and the ‘baby boomer’ generation as a societal burden. “Boomer” itself has become a derogatory term. This can stoke perceptions of conflict between generations. At a personal level older people are dehumanised by terms such as ‘hags’ and ‘fossils.” The worst epithet I have heard applied to older people is “pre-dead”. On the other hand, TV and films often present older people in an exaggeratedly positive light. We have all seen older people portrayed in advertising in youthful and energetic ways – unrealistic to achieve for many. Some “active” and “successful” ageing narratives can be criticised for exacerbating inequalities by excluding and stigmatising older people who cannot achieve the idealised model.

Later life needs to be recognised as a time of diversity, just like any other age. One of the ways to do this is to readdress the balance and encourage more realistic depictions of ageing in traditional media, social media and policy-making circles, but, overall, without stereotypes.

Posted in Uncategorized | 1 Comment

Older People and pet animals – benefits and challenges

Dr. Judith Davey

Interacting with an animal or pet is widely thought to have health-related benefits for older people.

Physical health

Having a pet, especially a dog, can increase exercise and physical activity opportunities. Maintaining an active lifestyle helps to maintain overall health. It is associated with a decreased risk of falls, a decline in bone density and muscle strength. It can also support agility, like climbing stairs, bending, and kneeling. Some studies conclude that caring for a pet can help reduce stress and thereby lower blood pressure and high cholesterol levels.

Social activity

Daily walks with pets, as well as adding structure, routine, and purpose to an individual’s day can increase the likelihood of engaging with others, increasing a sense of community, thus developing a stronger social network,. This effect was widely recognised during the recent Covid 19 lockdowns when older people ordered to stay home could still interact with neighbours in their immediate locality.

Emotional health

Positive emotional attachments between people is a well-recognised component of healthy development. Similarly, human‐pet interactions can foster feelings of happiness, love, security, and a sense of responsibility and satisfaction with life. Hence pet ownership can counteract a lack of social support and be protective against feelings of loneliness, provide emotional support, and give people something to talk about with family, friends and caregivers.
Pets need a routine of feeding, walking, etc., this can provide a daily routine. These activities can even be extended into regular personal daily memory tasks such as “remembering to take your medicine”, which have been shown to improve when people are caring for a pet. Studies have shown that elderly people who own pets tend to take better care of themselves.

In summary, pets can provide stimulation, a sense of purpose and protection for their owners, and provide non-judgemental acceptance which ultimately helps older people to live longer, healthier and more enjoyable lives. In most cases, older people make very responsible pet owners and have more time to give to an animal which is mutually beneficial for both pet and their owner. Pets can fill an empty space in the lives of older people, and many spend a great deal of time interacting and talking to their pets, which can be therapeutic. For people who can go days without talking to or seeing another person, the presence of an animal can be hugely beneficial.

But……
However, academic research, looking at the effects of animal interaction on the wellbeing of older people has had mixed results . Many other factors may influence social isolation or loneliness. The relationships that are established between humans and animals are diverse and may depend on a person’s beliefs, personality, and attitudes. Much like human relationships, human‐animal interactions can vary in intensity and form and depend on the behavioural characteristics of the humans and the animals involved, and sometimes on the cultural context. For instance, dogs and cats are thought to develop closer relations with humans than other animals, such as reptiles and fish, because they share more similar “social organisation” and “communication” systems.

Challenges

Pets are not right for everyone and for some people pet ownership can be stressful, expensive and even dangerous.

• In particular, older people may be less mobile and more likely to have balance issues and eyesight problems. So pets and their accoutrements, such as pet beds and food bowls, can be tripping hazards and can cause serious accidents.
• There may also be concerns about getting infectious diseases from a pet, although if older people are in good health they are not necessarily at any greater risk than others.
• For people on a low income, the costs of pet ownership may be prohibitive, or they may elect to spend money on a pet at the expense of food or other items for themselves.
• Changes in health or circumstance sometimes means that an elderly owner may struggle to provide adequate care for their pet, or may need to give up their pet, which can be enormously distressing for both parties.

• Friends and family may try to discourage seniors from getting a pet due to concerns about who will take care of the animal if the person moves into residential care or dies.

• Seniors with pets may also delay moving into residential care, even past the point when they are able to live independently, because care homes do not take pets. One of the people I visited through Age Concern’s service took a very realistic toy cat with her into the rest home.

• Finally, emotional difficulties that pet owners may experience when a pet is ill or dies can rival the effects of caring for a sick family member or coping with the trauma of the death of a close relative.

Pet therapy – otherwise known as Animal Assisted Therapy for seniors may be an alternative to full-time ownership. This is often used in residential care and day centres for older people. Canine Friends Pet Therapy Inc. is a national organisation of volunteers who regularly visit residents of rest homes, as well as patients in hospitals and hospices with their well-behaved dogs. The volunteers are currently visiting 363 rest homes, 16 hospitals, and 12 hospices across the country. Even a few minutes interacting with an animal can be beneficial and improve quality of life.

[1] https://www.bupa.co.nz/life-at-bupa/five-health-benefits-of-owning-a-pet-for-elderly-people/

[1]National Academies of Sciences, Engineering, and Medicine 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press.

[1] See also – https://www.psychologytoday.com/nz/blog/fellow-creatures/201906/the-challenges-and-benefits-pet-ownership-seniors

Elderly people and pet ownership, by  Trina Cox, Social Worker, Age Concern Canterbury In  “KEEPING ON”,  May 2016.

Posted in Uncategorized | Leave a comment

COVID-19 indicators for older people

Dr Judith Davey

In February 2020, the Office for Seniors released a set of indicators to track the outcomes of the Better Later Life – He Oranga Kaumātua 2019 to 2034– report[1]. These were later adapted to track the impact of COVID-19 on older people. Indicator data have been reported on in July and August 2020.

Limitations on the  interpretation of trends recorded so far must be acknowledged, e.g. the short time frame, difficulties of comparing this new data to established data sets such as the General Social Survey (last reported in 2018) and small sample sizes which limit disaggregation by age, gender, location and ethnicity. The age group covered is 65 plus, except for the work-related indicators which include people aged 50 plus – which has become us general definition for “older workers”.

The intention was to examine the social and economic consequences of COVID-19 self-isolation requirements and border restrictions, concentrating on the areas where older people and older workers were expected to be most affected. For each area a rationale is provided – quoted below. I have included here only broad conclusions from the findings.

Unemployment of older workers (aged 50+) – percentage of people in the labour force who are not working, are available for work and actively seeking work. 

Rationale: older workers who lose their job are more likely to become unemployed long-term than younger workers.

The official unemployment rate for workers aged 50 plus did not increase in the June 2020 quarter[2]. Theproportion of older workers supported by the original Wage Subsidy (WS) and the COVID-19 Wage Subsidy Extension (WSX) was similar to the support levels for employees of all ages – round about half.

Male job holders  aged 50+ are more likely than women to be in jobs supported by the WS (66% for men and 46% for women aged 50+) and WSX (17% of men aged 50+ versus 11% of women aged 50+). [3]

Jobseeker Support and other benefit take-up (for those aged 50+) -from MSD administrative data.

Rationale: The number of people on income support is expected to increase as people lose their jobs and earn less from investments, and investment balances reduce. Some people who lose their job due to COVID-19 may take up the COVID-19 Income Relief Payment (CIRP)[4].

The number of people aged 50+ receiving Jobseeker Support (JS) and CIRP increased over the period. More people over 50 are also receiving other benefits and supplementary assistance, for example Accommodation Supplement and Disability Allowance.

Loneliness – percentage of older people feeling lonely at least some of the time. The primary data source for this is likely to be the HLFS COVID-19 supplement.

Rationale: Loneliness and social isolation may be a particular risk for those aged 70+ or with compromised immune systems who were asked to stay home for longer, and for those who are unable to connect with family and friends digitally.

The proportion of people aged 75 plus who have felt lonely at least some of the time in the previous four weeks was higher in the June 2020 quarterthan the equivalent measure collected in the 2018 General Social Survey (GSS). [5] 

Discrimination – percentage of seniors experiencing discrimination, including ageism, from Stats NZ’s HLFS COVID-19 supplement.

Rationale: Perceptions that lockdown and the associated economic impacts were only to protect older people, and that older people are vulnerable, may increase ageism.

The proportion of people aged 65-74 who experienced some form of discrimination in the previous 12 months increased in the June 2020 quarter[6]. But these comparisons do not exactly cover the COVID-19 period. Older women are more likely to report loneliness and discrimination than men. But on most measures young people remain the most likely to experience these risks to mental health.

Elder abuse – numbers of calls to the Elder Abuse Hotline and numbers of approaches or cases received by Elder Abuse Response Services.

Rationale: Some older people may have become more vulnerable to elder abuse due to increased family stress (including financial stress) and being unable to leave their home environment.

Calls to the Elder Abuse Hotline this year were lower than in the same period the previous year. Any firm conclusions about these data must await a longer time series.

Housing – number/percentage of older people on the Public Housing Register. Also, data from the Ministry of Housing and Urban Development on older people in motels due to COVID-19 and data from their rental survey.  

Rationale: Reduced incomes may affect some older people’s ability to fund rents and mortgages. Older people are least likely age groups to be in severe housing deprivation and least likely to be on the public housing register.

The number of people aged 65+ on the public housing register continued to increase[7] as did the number of seniors receiving emergency housing grants from MSD

Material hardship – percentage of older people with low material wellbeing from Stats NZ’s Household Labour Force Survey COVID-19 supplement.

Rationale: Material hardship may increase due to reduced employment earnings, reduced income from investments (including interest) and impacts on investment balances (including KiwiSaver).

Seniors are less likely to be in material hardship than younger people, but some are experiencing financial difficulties according to Commission for Financial Capability online survey[8] Ministry of Justice’s COVID-19 Justice Sector Survey[9].

[1] http://www.superseniors.msd.govt.nz/about-superseniors/ageing-population/indicators/better-later-life-indicators.html

[2] This must take into accounthow unemployment is measured in official statistics. To be counted as officially unemployed, a person must have been actively seeking work in the last four weeks and be available to start a job. While the country was in lockdown, fewer people who did not have a job were actively seeking and available for work. As New Zealand moved through less restrictive COVID-19 alert levels, the unemployment rate rose.

[3] These figures exclude sole traders.

[4] People who qualify for NZ Super may be eligible and people on other benefits may choose to switch from a benefit to the Income Relief Payment.

[5] Some caution is needed in comparing these survey results. The GSS collects data across a full year via face-to-face interviews from people aged 15 and over, while the HLFS supplement collects data for the quarter, primarily via phone interviews, from people aged 18 and over.

[6] 2018 data from the GSS, more recent data from Stats NZ’s COVID-19 supplement.

[7] https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/statistics/housing/index.html

[8] CFFC, 2020. Impact of Covid-19 on Financial Wellbeing. https://cffc.govt.nz/news-and-media/news/covid-19-exposing-new-zealanders-financial-vulnerability/.

[9] https://www.justice.govt.nz/justice-sector-policy/research-data/covid-19-justice-sector-survey/

Posted in Uncategorized | Leave a comment

Music: For Good or Ill.

Doug Wilson

Written by guest blogger, Doug Wilson

There are few people who don’t have happy or sad memories based around music. It appears to be a fundamental, almost primeval emotion. Primitive tribes, unsullied by exposure to the choruses of great music from other civilisations, each have their own music and dances, based on rhythms, drums and singing. We interpret the sounds of whales as songs, even if they might be communication vehicles. Old people remember hit songs of their youth far better than hot music of today. Patients with dementia frequently are roused by musical memories, and temporarily break from their locked in shells.

The power of music. At its best it uncovers deep honest emotions, even many years after an event often recalled in curdling clarity. In June 1968 Bobby Kennedy was assassinated. After the death of his brother Jack it seemed the world desperately needed a new leader of hope, and maybe that was Bobby.

I’d recently met some American Rhodes scholars based at Oxford University. Bobby had just visited them and they were converts. Two day later we had tickets to a concert by the great African American soprano Leontyne Price in the 10,000 seat Albert Hall in London. She was booked to sing with one the great London orchestras. An opening announcement said she was a close friend of Senator Bobby Kennedy, and wished to honour his memory by singing, unaccompanied, 3 spirituals. She asked that there be no applause.

As the huge audience sat on their hands and sniffed tearfully this great opera singer filled the historic hall with her peerless voice. She sang from the very bottom of her soul, tears streaming down her face, the orchestra still and silent behind her, heads bowed. Ten thousand captured by the intertwined magic, drama and tragedy of the event ached to stand and clap. But silence was a far more powerful conclusion. The power of music.

For those of us able to recall the 1960s, there were the phenomena of Elvis Presley and the Beatles. Rock music burst from the steady jolly beat of 1950s pop music, into the wonderful 1960s wild world of rock, and the extraordinary creativity of 4 guys from Liverpool. The impact was global for these overlapping influences. TV, radio and film built them into musical, almost religious cults. From then and since the popular music world has found its stars and super stars.

Longevity is reserved for the very few, like Elton John, Michael Jackson, Stevie Wonder, Rolling Stones, Prince, and Bruce Springsteen. Others on records, movies, TV clips and you tube have outlived their lead singer, like AIDS victim Freddie Mercury of Queen, and their visit to Wembley stadium. Some of these older musicians are now star turns as they reprise their great days of decades before. I have friends, 60 years and plus friends, who are Rolling Stone groupies, and try and attend as many international concerts as they can, and love it. Those were their days.

The power of music to bless. It converts most everybody to happy and warm emotions, when the stars align. For the older community these memories don’t disappear; they may fade but play their favourites and the memory banks light up, and smiles and glowing harmony abound. Play for the poor sufferers with dementia and see how they respond. Amazing are the stories of individuals suddenly emerging from the dementia fog, to reprise a tiny view of themselves decades before. Glen Campbell was one of those; he could play and sing, but not recognise close friends, causality from his Alzheimer’s. Play for those who struggle with vision and support their hearing, their major alternative sense.

Various countries’ national anthems can stir the blood, even of their opponents at large sporting events. The French La Marseillaise, and Wales Land of my Fathers sung by 70,000 locals is are classic calls for patriotism, tears and country.

At my high school it was tradition for the entire school to sing the Messiah, the great oratorio of Handel, with the Hallelujah chorus as the star. Five hundred boys, as loud as each was able, a few wonderful voices, many shrill sopranos, the crackling of pubescent voices, the newly minted basses and tenors, the blazing roar of the organ at full blast, and we glowed and loved this thrilling event, boys enthralled and captured with 18 Century religious music. That must have brought in the faithful in the mid-1750s. It certainly still does today around the world.

Once, in the 1990s my wife and I attended a great restaurant in Paris. The maître d, learning we were from New Zealand declared he was a rugby aficionado. Zey recently had ze All blacks to dine. They sang these Mori songs, fabulous. Can u sing? My wife Adele, with her great voice, sang unaccompanied the Maori Po Kare. The restaurant was silent, the boss directing them to hush. Then they customers stood up hollering, cheering with joyful French élan. We were friends of the city. The maître d, with tears in his eyes kissed my wife and thanked her and presented a fine cognac. Who ever suggested the Parisians were not friendly.

The power of music over the generations builds communities of certain ages where they gather and share their emotions, learnt with the common love of music which had burgeoned in their time, their musical highlights, genres and performers. Behind that are the great music of the classical and operatic traditions. Even today an aria like Nessun Dorma from Puccini’s Tosca, and Beethoven symphony 9, the great choral symphony, can attract thousand even hundreds of thousands together to share, love and enjoy.

But the power of music is not always reserved for the good and the joyous. The Nazis in Germany were masters of the huge assemblies, big bands and Wagnerian tributes to supremacy of the Fatherland. William Sargant, a 1960s English psychiatrist, author of a book on brain washing: Struggle for the Mind, proposed that many robust religious groups, laudable music events, but also evil assemblies were brought together by various contrived musical performances and rhythms. He showed films of such disparate groups as Mayfair drug parties, fundamental Christian church services with wailing and speaking in tongues, voodoo rites in Haiti, Nazi rallies and rock bands. Rhythms were a major common factor, but all could engender similar states of ecstasy and escape and, if needed, unsavoury objectives. Ah the power of music.

Music is for everyone, just about. Treasure its power to entertain, to lift spirits when they are low, to move, and to give visible face to deep emotions, and as haunting accompaniment for permanent farewells, where the shared music and emotions tie close friends and loves together for ever.

Thank you to Ryman Healthcare and Doug Wilson.

You can listen to their Ageing for Beginners Podcast at:
https://podcasts.apple.com/nz/podcast/ageing-for-beginners/id1470331734

Posted in Uncategorized | Leave a comment

Making Shopping more Age-Friendly 2 – Pointers for Shops

Dr. Judith Davey

My previous blog looked at Age-Friendly retailing from the customers’ point of view, reporting on the views of older shoppers. Various countries and urban centres have developed guidelines and checklists aimed at retail businesses to encourage age friendliness, offering them no-cost and low-cost tips to engage with this growing market. Some of the good ideas are looked at below, coming from the City of Joondalup in Australia and Wales in the UK . Again your comments and suggestions are welcomed.

Marketing

Marketing materials should be attractive and inclusive, including older people in images promoting products or services (without stereotyping them – like always showing photos of young-old couples, ignoring the fact that the majority of older people, especially women, are unpartnered). The design of marketing materials should aim to be
easy to read with plenty of space, high contrast colours, 12-point font or higher and in simple language to
ensure the message is clear to a broad audience.
Promote your business as age-friendly, offering senior discounts, which could be linked to the Super Gold Card.

Ambience

Retail premises should be well and evenly lit, especially entrances, exits and hallways. It should be a quiet environment avoiding outside noise and, if music is used, ensuring this is from different eras and styles. Some useful market research could be done to see what pleases older shoppers. Audio loops will assist customers with hearing aids at service counters. Regular “quiet hours” for shoppers are a good idea.
Access Safety, comfort, and visibility

There needs to be clear signage in and around businesses, clearly marking stairs and inclines, ensuring that
pathways and car parks are clearly lit and physically accessible. Cars parks reserved for seniors should be provided and well-marked as well as “disability” spaces.

There should be sturdy handrails in staircases, lifts and ramps, Doors should not be heavy and ideally automatic, allowing time for people with walkers and wheelchairs to safely come in and out.
Floors should be smooth and non-slip. Mats should be level and edges secure so that they do not create a tripping hazard. Edges of rugs can be secured to guard against tripping.

Customer Service

Ensure that service desks are clearly visible so people can ask for help. At least one counter should be accessible for customers using wheelchairs and scooters. Ask for feedback from older customers – What do they like about your business? Do they experience any issues or barriers with staff, products, or environment?

Dementia Friendly

I have written earlier about making environments dementia friendly and this is also an aspect of Age-Friendly retail.
It is very important that retail staff are aware of dementia and Alzheimer’s and how it effects people. They need to offer understanding and reassurance, speaking clearly and calmly, letting the customers take their time and responding to them if they appear to be having difficulty. If someone forgets what you’ve said, repeat it as if you were saying it for the first time. If someone isn’t sure or can’t remember how to do something, offer to do it with them rather than doing it for them.

Visual clues are useful for examples of product options and colour contrast in interior design will help people living with dementia to navigate the business. Additional assistance should be available if someone seems unable to read signs or written information.

There is further information on the Office for Senior website on becoming an age-friendly business.
http://superseniors.msd.govt.nz/about-superseniors/ageing-population/age-friendly-businesses/age-friendly-business.html
In addition, the Age-friendly Business initiative. linked in with the World Health Organisation provides practical information to help businesses become more age-friendly and attract older customers. In collaboration with Alzheimer’s Association, a module on dementia provides information on the detection, treatment and promotion of autonomy for customers with dementia. Participating businesses receive a window sticker with the slogan “We are friendly” and they will be included in an Age-Friendly Business Guide and in the web-based Age-Friendly Places Map.
ihttps://extranet.who.int/agefriendlyworld/afp/age-friendly-business-2/#:~:text=The%20Age%2Dfriendly%20Business%20initiative,assessment%20materials%20to%20participating%20businesses.

Posted in Uncategorized | 1 Comment

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.

 

Posted in Uncategorized | 1 Comment

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

Posted in Uncategorized | Leave a comment

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.

Posted in Uncategorized | 1 Comment

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

Posted in Uncategorized | Leave a comment