Older People are working longer – where, what and how?

Judith A. Davey 8/09/17

In a previous blog I talked about how the population may change in future, looking at Statistics New Zealand projections. One important trend is the increased participation of people aged 65 and over in the paid labour force. In 2015 I published quite a few blogs on this as I was then involved in a project called Making Active Ageing a Reality.[1] But these did not present information on the industries which older people are working in, their occupational categories or hours of work.

I won’t go over general trends again, but look at industry and occupation data for people 65 plus and full-time/part-time participation from census data.

Industry categories

Older workers, 65 plus, are spread over a wide range of industries, few of them reaching 10% of the total. The largest grouping is in agriculture, forestry and fishing – 14%. This is nothing new and mainly reflects the fact that farmers, most of whom are self-employed, tend to “stay on”.  They can regulate their own working hours and bring in labour for tasks which they cannot or do not want to continue doing themselves. There has never been compulsory retirement in the farming sector.

The next highest category is health care and social assistance – 11% of workers 65 plus. This includes doctors, nurses and allied health workers, as well as paid carers and support workers. This is significant given the importance of these groups for the ongoing health and wellbeing of our population. If these workers are ageing there may be shortages of skills when they leave the workforce. According to a Health Workforce New Zealand report,[2] 40% of doctors and 45% of nurses in this country are aged 50 or over. And 54% of the “non-regulated” health workforce – care and support workers – is in the 45 to 64 age group.

A number of further industry categories account for about 6% each of the 65 plus workforce – education and training; retail trade; manufacturing; professional, scientific, and technical services.

Occupation Categories

Older workers are also found in all occupations, mostly in skilled categories. They are clustered in the following table.

Workers 65 plus Number %
     Managers and executives 25044 22.1
     Professionals, including health and education 22896 20.2
     Clerical and admin workers 12180 10.7
     Machine, stores, drivers 11385 10.0
     Labourers and factory workers 11199 9.9
     Skilled technicians and trades 10854 9.6
     Care and service workers 10731 9.5
     Sales workers 9030 8.0
100.0

Source: 2013 Census of Population

The largest categories tend to be managers and professionals, likely to have qualifications and to work in an office environment. These are the “choosers” – see later.

 Full-time and part-time work

The image of older workers tends to be that they will work part-time. This is not totally borne out by the figures. While women are more likely to work part-time than men, there have been some interesting movements in patterns of work over the last three censuses (see table). For both men and women there have been increases in the proportions working full-time. This increase was especially marked in the 2006-2013 period. The proportion working part-time has correspondingly dropped for both men and women.

Full-time and Part-time percentages – Workers aged 65 plus, by sex

Groups % 2001 Census 2006 Census 2013 Census
Full-time Male 54 57 62
Female 32 34 40
Part-time Male 46 43 38
Female 68 66 60

As might be expected, the proportion of full-time older workers decreases with age to only 9% for women at 85 plus. But it may surprise some that one in four men who are working at the age of 85 plus are working full-time, probably farmers again.

Percent of total employed working full-time, by age and sex, 2013 Census
65-69 70-74 75-79 80-84 85 plus
Female 48 33 20 14 9
Male 72 54 38 30 25

The characteristics of people who are working after the age of 65 in New Zealand reflect categories which were suggested by the Centre for Research into the Older Workforce (CROW) in the UK.[3]

Choosers – this group is the most amenable to staying on in work. Most are managers or professionals, predominantly male, with high incomes. They often have choices whether to work or not, may do so mainly out of interest and can often stipulate their working conditions.

Survivors – who are motivated strongly by the need for an income. This group typically have few or no qualifications and are in routine and semi-routine jobs. They have little control over their working lives or leverage with employers. If they continue to work it may be in a lower paid and possibly insecure job.

Jugglers – “jugglers” are balancing domestic and caring roles (responsibilities to older parents/relatives and caring for grandchildren) with paid work. Almost all of them are women.  They are likely to work in intermediate occupations and to work part-time.

[1] Davey, J. (2014) “Paid Employment.” In Koopman-Boyden, P., Cameron, M., Davey, J. and

Richardson, M., Making Active Ageing a Reality: Maximising participation and contribution

by older people. Report to the Ministry of Business, Innovation and Employment. National

Institute of Demographic and Economic Analysis, University of Waikato, Hamilton.

[2] Health of the Health Workforce 2015, Wellington, Ministry of Health 2016

[3] McNair, S., Flynn, M., Owen, L., Humphreys, C. and Woodfield, S. (2004) Changing Work in Later Life: A study of job transitions. CROW, University of Surrey.

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Forecasts, estimates, projections and prognostications – how can we look into the future?

Judith Davey 3/7/2017

Statistics New Zealand (SNZ) is clear that it makes projections about the future, not predictions. Its projections are the outcomes of “various combinations of selected assumptions about future change in the dynamics of population change.” We can assume that trends will continue along the lines which they have established in recent times. Or we can factor in new directions based on emerging trends, overseas experience or “best guesses”.

We can’t be sure about what will happen in future with respect to –

Fertility      – (how likely is another baby boom?) SNZ thinks fertility will remain low.

Mortality     – linked to longevity, in which we hopefully expect further gains.

Projections cannot take into account factors such as catastrophes, epidemics, wars and government decisions which affect population trends. What about migration? There have been marked variations in movements in and out of NZ in recent years. Governments have some control over this, but what if all the expatriate Kiwis choose to come home?

I recently looked at projections related to the ageing of the populations – a trend which is very likely to continue. Here are some of my findings.

Changes in the age structure

We are likely to see a shift in the balance of children and older people in our population (see diagram). There are still more people under 15 than over 65. But the projections show that the lines will cross in about 2028 – just over 10 years from now. If the 65 plus age group continues its rise, by 2068 the NZ population will be made up of 28% under 15s; 24% aged 15 to 64; and 48% 65 and older.

Actual and projected figures for the under 15 and 65 plus populations

 Capture

What will this mean for “dependency rates”?

These compare the proportions in the so-called “dependent” age groups with those of “working age” – 15-64. This is a somewhat outdated measure as people are staying in school or tertiary education for longer at the lower end (school leaving age is now 16) and people are remaining in paid work in greater numbers after the age of 65. Would 20 to 75 be a more realistic definition of the working age population? These changes will have implication for future labour and skills supply, which will have significant social and economic implications.

Change in the ethnic composition of the older population

In 2013 the age group 65 plus was dominated by Europeans (88%) and this is likely to continue into the future although in a less marked form (see table). All other ethnic groups will increase their share, with the Asian group rising to a percentage higher than that for Maori – 14% Asian and Maori 9%.

Population 65 plus by ethnicity, 2013 and projected 2033            

Ethnic group 2013 % 2033 %
European 88.3 77.3
Maori 5.8 8.9
Asian 5.1 13.9
Pacific 2.6 3.8

Note: The census allows more than one ethnic affiliation to be recorded, so the sum of these categories will be higher than the overall total.

Life expectancy at birth and age 65

It is important to distinguish between life expectancy at birth and at age 65. Life expectancy at birth has increased from 67 to 80 for males between 1950-52 and 2014-16. The corresponding increase for females is 71 to 83.

The increases are even more striking for life expectancy at 65. Life expectancy at 65 is higher than at birth as individuals reaching that age have avoided dying from illness and accidents which happen to younger people.

Life expectancy is expected to continue to increase, but there are many uncertainties. SNZ suggests that for people born in the mid-2010s perhaps 11% of males and 17% of females will reach the age of 100.

Falling home ownership

At present, home ownership peaks in the 60-74 age group, but has fallen for all age groups over the last three censuses, except for the age group 85 plus (see diagram). In the middle age range – 35-54 – the percentage of homeownership has fallen by 10 or 11 percentage points. Over the total population it has fallen from 74% in 2001 to 64% in 2013.

So in the future we can foresee more people moving into later life without owning and house or, given the rise in house prices, without having paid off a mortgage. This is likely to mean higher housing costs for them and more difficulty in achieving a good standard of living once out of the workforce.

ownership tender

Labour Force Participation

Over the last three census dates there has been strong growth in numbers of older people remaining in the workforce, especially in the 65-69 age group, and especially for men. These trends are expected to continue with people living longer and healthier and no compulsory retirement.

males vs females

Between 2015 and 2068, the total labour force is projected to rise from 2.5 million to 3.3 million. These projections suggest that the number of workers aged 65 plus will increase from 183,500 to 428,300 – by 174%, rising from 6% to 13% of the labour force.  At the same time the total workforce will increase by only 31% and the numbers aged 15-24 (new workforce entrants) will decrease by nearly 1%. From this I suggest that employers will have to acknowledge necessity of keeping their older workers on and providing them with the working conditions which suit them, such as flexible hours, recognition of eldercare responsibilities and ergonomic improvements in offices and factories.

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Implications of an Ageing Population – the view from 1982

Judith Davey

11/08/2017

In another of my nostalgic moments, trying to winnow down my mountain of paper, I came across notes from a seminar in 1982.  This was a report-back by the New Zealand delegates from the World Assembly in Ageing, held in Vienna. They included the well-known names of Margaret Bazley and Margaret Guthrie.

The audience of about 70, including me (in the early stages of my interest in ageing) broke up into discussion groups, after material from the World Assembly had been presented. The groups reported some far-sighted conclusions. In some areas we have seen action in over 30 years, but others still need attention. Here is a summary, with my comments.

Could there be investigation of postponing receipt of universal superannuation (New Zealand Superannuation) beyond age 60, with increased increments at a later stage?

 The age of eligibility increased from 60 to 65 in the early nineties. Now a further increase from 65 to 67 has been announced, but only in increments from 2037 (20 years and almost 7 parliamentary terms away). Deferring receipt for a higher pension has been periodically suggested, but there are questions about fairness. Managerial and professional people would find it easier to defer and would end up with higher retirement incomes. Those not in a position to work longer would have a lower NZS and possibly hardship.

The well elderly need stimulation, recreation and education and places to socialise. NGOs could be funded to facilitate schemes using both voluntary and professional workers.

 The “young-old” are well represented as volunteers, but staying in paid work longer may limit this activity. There is little to encourage voluntary work and tighter regulations, such as police checks, may put some people off. In parts of the USA volunteers are rewarded by discounts on property taxes (rates) or given vouchers for education which can be transferred to other family members.

There is very little in the way of lifelong learning, re-training and re-skilling for older people.

We need flexibility in the mandatory age for retirement, because “people vary in their ability and interest in work”. What about flexible working hours and job-sharing?

 There is no more compulsory retirement here. The Human Rights Act came into effect in 1999. Section 22 forbids employers from discriminating against suitably qualified job applicants on the grounds of age and outlaws compulsory retirement. So it annoys me when people, often the media, talk about “the age of retirement”. I want to shout to them that there is no such thing. They usually mean age of eligibility for NZS.

 The Employment Relations (Flexible Working Arrangements) Amendment Act 2007 came into force in July 2008. This provided employees responsible for the care of any person with the right to request flexible working arrangements (variation to their hours, days, or place of work). The amendment was later reviewed, and the provisions extended to all employees. Of course, it still depends on the employer’s agreement.

Women over 50 need better financial support when they are often looking after their families and elderly parents or relatives.

 The treatment of working carers is an emerging labour force issue. Many people in their fifties and sixties still have parents alive, many of whom need care and support. In some countries family carers receive payments through the benefits system. But although it has been raised here, it has not become policy. There is no change in the fact that more women than men take on (or are expected to take on) eldercare responsibilities and this may affect their earning ability.

In an ageing population, we need to avoid stereotypes and accommodate differences in expectations of roles and accommodation standards. There is still a negative attitude towards ageing, so there should be lifelong preparation for the later period of life.

 The Human Rights Act may officially ban age discrimination, but it remains widespread through stereotypes and expectations that older people will lose their mental and physical capacity and become dependent. The Positive Ageing strategy and the Healthy Ageing Strategy contain exhortations about giving older people respect and dignity, but you only have to look at the birthday card selection for people 60 plus to see that negative attitudes are alive and well.

“The elderly” should have increased participation in their own decisions (I think we know what they mean). One group appealed for full integration of older people, regardless of disability or special needs, in all parts of life, with community support.

We have seen some progress in this area, with the setting up of Elders’ Councils and advisory committees of older people in many local authorities. The movement towards “age-friendly cities and communities”, if the WHO vision is adopted, should improve urban environments for older people, and for everybody. Again the Positive Ageing and Heathy Ageing Strategies call for greater participation for elders. After all, the “giving back” of wisdom is one of the psychological “tasks” of later life.

The seminar passed a unanimous recommendation to the Prime Minister asking government  to set up a Commission of Inquiry into the implications of an ageing population and to develop integrated policies concerning: income maintenance; housing; health, employment; social services; education and any other relevant matters.

In closing, the chair, Professor McCreary, noted similarities between these recommendations and the findings of the 1955 Conference on “the Ageing”. Some things do not seem to change, but we can hope!

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Older People and Alcohol in New Zealand

Judith Davey

What do we know about alcohol drinking among older New Zealanders?

Very little, according to the Health Promotion Association (HPA).[1]

The 2012/13 New Zealand Health Survey showed that around 82% of 55 to 64-year-olds, 79% of 65 to 74-year olds and 66% of people 75+ drink alcohol.[2] The highest rates are for Europeans/Pākehā – 77%, followed by 58% of Māori, 21% of Pacific peoples and 52% of ‘other’ ethnic groups.[3]

Wine is the most popular tipple among older people, followed a distant second by beer and spirits. Port or sherry drinking is now comparatively rare. When asked, older people say they drink to be social, to enhance social situations or special occasions, or to relax or unwind. Most link alcohol with food, many drinking around meal times. Older people mainly drink at home or when visiting friends or family. As they move into their sixties and seventies, older people tend to drink less alcohol than before. For some, especially older men, their drinking evolves into a pattern of daily, or near daily alcohol use, but at relatively low levels of consumption per drinking occasion – ‘a little but often’.

What are the reasons for these changes?

They may include reduced social activity, lower incomes, the onset of health problems, or a combination of factors. Alcohol aggravates health conditions such as liver problems, high blood pressure, diabetes and depression. People with these conditions may be advised by their doctor to reduce their drinking.

Health problems may disrupt usual patterns of socialising, making it harder to go out or limiting energy. Some older people also tone down their drinking in response to physiological changes that increase their sensitivity to alcohol’s effects. Of course some maintain or even increase their alcohol consumption as they age. They may have more opportunities to socialise and fewer family and work responsibilities.

What are the effects of drinking for older people?

While many continue to drink in old age, some older people drink in ways that are potentially unsafe. Apart from obvious effects such as intoxication, alcohol dependence or abuse, a wide range of health conditions have been linked to drinking, including liver disease, pancreatitis, cancer, stroke and high blood pressure. Some of these may result from the cumulative effects of a lifetime of alcohol use.

Also, many older people take medicines that are incompatible with alcohol, such as antihistamines, sedatives and antidepressants. Drinking alcohol may exaggerate the effects of drugs, increasing the risk of injury from falls or other mishaps.

Alcohol itself may be the cause of accidents suffered by older people, which often occur at home. Falls are a particular risk and may have long-term consequences.

Because of decreased tolerance, older people show certain effects of alcohol at lower doses than younger people. This is why older people can have the same drinking pattern for many years and only have alcohol problems when they are older.

On the other hand, a number of studies identify associations between low alcohol use and reduced risks for a few health conditions, such as coronary artery disease. Do the negative effects of alcohol outweigh the positive effects? The experts are still not sure.

How many older people drink hazardously or harmfully?

The majority of older men and women drink safely. The Health Survey found that only 11% of 55 to 64-year-old drinkers, 7% of 65 to 74-year-old drinkers and 3% of 75+ year-olds drinkers drank hazardously or harmfully. But, given older people’s greater vulnerability to the physical effects of alcohol, their greater risk of chronic medical conditions and use of medicines incompatible with alcohol, perhaps hazardous drinking thresholds should be lower for older people.

Categories of older problem drinkers

‘Early-onset’ problem drinkers are those who have been drinking harmfully for much of their adult lives, and continue to do so.

‘Late-onset’ problem drinkers may have used alcohol at mild or moderate levels when younger, but, as they age they may start to drink much more heavily, for reasons often associated with grief and loss, anxiety, depression, boredom, isolation, loneliness and chronic pain.  Sometimes they are advised to have a “nightcap” to help with sleeping difficulties, which can lead on to dependency.

Future challenges

Would it be useful to stipulate age-specific safe drinking guidelines for older people? How can we identify and help older people who may be drinking hazardously or harmfully? And how can we help people cope with bereavement, retirement, loss of independence and physical and cognitive impairments?

Alcohol abuse and dependency may remain undetected in older people because many are socially isolated.  They are less likely to get in trouble with the law and less likely to be noticeably drunk in public. Older people with alcohol problems are often wary of accessing treatment because of associated stigma and shame.  It is important that these people have regular social contact, and receive non-judgemental and unconditional treatment.

 

[1] Ian Hodges and Caroline Maskill (October 2014) Alcohol and Older Adults in New Zealand. Health Promotion Agency, Wellington.

[2] New Zealand Health Survey 2012-2013, Ministry of Health, Wellington.

[3] Percentage of people 64 plus who had consumed alcohol in the previous 12 months.

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The Case for Life-long Education

Judith A. Davey

Interest in lifelong education, which was the culminating point of my last blog, is not new. It developed through the 1960s and 1970s with the increasing pace of economic, social and technological change, and the perception that existing education, training practices and provisions were inadequate to cope.

Writers at the time, such as Freire and Illich, saw lifelong education not only as a mechanism for adapting the individual to change but also for transforming society. The concept of a “Learning Society” was defined as one in which citizens could continue to participate in education and training throughout their lives. This would not only improve the quality of life and wellbeing for the whole community, but would promote better health in its most holistic form, and social integration, as well as economic success.

Promoting lifelong learning and a learning society- but how?

Assuming that the state should be involved, there are three options:

A market model – education as a commodity subject to the forces of supply and demand. Education would be closely aligned to the needs of the economy. This could exacerbate inequalities in access and lead to the exclusion of non-vocational education.

A welfare model – where the state would intervene to target underprivileged and vulnerable groups such as long-term unemployed and welfare beneficiaries as well as special groups, such as Maori and Pacifica.

Progressive-liberal models aim to promote active citizenship and equal opportunities for all. Education to enrich individual lives and for self-improvement would be encouraged and supported.

There was early support for lifelong learning in New Zealand. It was emphasised by the National Council of Adult Education Working Party on Ageing and Education in 1989:

New Zealanders must go on learning. It is crucial for the individual and the country that we have a qualification subsystem which encourages people to gain further skills and knowledge….. people may have to change their jobs and learn new skills several times in a lifetime.

Lifelong education has a vital role to play, but on the way to the vision of a Learning Society there are both opportunities and challenges.

Opportunities

• We need a flexible and skilled workforce, capable of learning and adapting as knowledge rapidly becomes obsolete.

• High unemployment resulting from de-skilling is a waste of human resources.

• The declining proportion of young people in the population means there may be surplus capacity in the education system, which could expand facilities for adults.

• For people who are not in paid work, education offers the potential to gain knowledge and acquire skills in finding productive and meaningful roles outside the market place. The largest and most important of these groups is older people.

• New social movements – asserting human rights in all their forms (consumers, patients, indigenous rights) call for more informed and creative participation. This could include resistance to ageism.

• Educational programmes can help support community development. Older people often take the lead in these developments, such as in the Age-Friendly Communities movement and response to natural disasters.

But there are also Challenges

• It may be difficult to challenge the “education-work-retirement” life course model and the view that education is something only for the under 25s.

• People may be unwilling to shift away from long-term specialisation even if it opens up new employment opportunities.

• There may be institutional barriers that prevent adults from realising their wish to participate in education – entry requirements, timing of courses, financial support.

• Credentialism is a danger. Is a workforce with qualifications the same as one with skills?

• Existing patterns of participation in adult education are strongly related to high levels of initial schooling and higher socio-economic status. Will encouraging life-long education simply reinforce educational inequalities?

• Employers may react to the need for upskilling by substituting younger employees, limiting the opportunities for less-qualified older workers to retrain.

These are all background considerations when talking a closer look at older people and education.

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Education in an ageing society – why is it important?

Judith A. Davey

Looking through my list of blog topics, I notice the absence of education. Yes, there
is such a subject as educational gerontology. I was into this a good few years ago now
when I co-edited and contributed to a book called Living and Learning . This drew on
the findings of research among older students at Victoria University. Before going
into the findings I want to set out why education is important to everyone in our
changing world.

The ageing trend is important but is only one of many major changes and these require people to have more information and skills – more education. And older people should be part of this; their lives are changing too.

Health technology has revolutionised everyday life. It contributes to increased life expectancy – not only high-tech surgery and medicine – but also better preventive and diagnostic measures, including vaccination and body scans. Better water supplies and food hygiene also play their part.

Communication – an explosion of global communication through the internet, satellite telephone and television links. So information travels fast and social media is often first in spreading the news.

Computers have transformed our personal lives, by producing labour-saving devices at home, cost-saving processes in offices and factories, not to mention new forms of entertainment and recreation, from virtual reality interactive games to 3D printers and new materials for golf clubs and skate boards.

Technological change is speedy, with rapid obsolescence of goods, services and the skills to develop and deliver them. “De-skilling” is a consequence for many workers, but at the same time these changes create complex and difficult tasks requiring different, and higher levels of skill.

The labour market – technological development has produced economic changes and brought about greater flexibility in work processes and work locations. Swiss companies are using Singaporean finance to produce computer mice in Shanghai for the Chinese market; cars designed in Italy are built in Japan with components from all around the Pacific Rim. In a word, we have the globalisation of production and distribution.

Financial transactions have also been globalised. Financial markets have been called the “gaming tables of a world casino”. Venture capital is footloose and will shift to where conditions are favourable, where cost structures and labour supply are attractive. Countries must compete for the attentions of entrepreneurs and investors.

All these changes have destabilised labour markets around the world. Many jobs can no longer guarantee long-term occupational stability. A “dual labour market” has developed with a smaller highly qualified workforce with stable work prospects alongside a larger marginal workforce that experiences more and more short-term employment and uncertain work prospects – the so-called “precariat.” This pattern inevitably leads to a widening of income disparities.

Political change: we are all aware of shifts in superpower strengths and hegemony. The status of the nation state has been challenged by political alliances, economic trading blocs, even multi-national corporations and interest groups. Economic rationalism and “free market “policies have undermined the traditional welfare state. These policies have exacerbated labour market instability and produced uncertainties in many areas of life.

Social change – new social movements have developed, working against sexism, racism and other forms of discrimination, championing human rights and freedom of expression. Society is becoming more diverse and more accepting of a variety of value systems, although we still have a way to go. Traditional sex roles have been challenged, breaking down the stereotypical male breadwinner role. Greater instability in sexual partnerships and other economic imperatives have seen most women moving into paid employment.

Life course change– traditionally, people moved through stages of development in a fixed order and at relatively fixed times – education-work-retirement – or Shakespeare’s”seven ages of man” (As you like it, Act 2). But this analysis of human development is too rigid and deterministic. We now talk about “destandardisation of the life course” and “cyclical patterns” in which people move in and out of education, work, family responsibilities, retirement and other roles over their lifespan. Fewer and fewer people will follow the life patterns of earlier generations. Cohabitation is almost the norm for young and not-so-young couples. We have “blended” or reconstituted families. Children may have an array of parents, step-parents and de facto parents, not to mention the same variety of grandparents.

Peter Jarvis sums up the implications of these changes and makes the link with life-long education:

The traditional division of life into separate periods – childhood and youth devoted to schooling, adulthood and working life, and retirement – no longer corresponds to things as they are today and corresponds still less with the demands of the future. Today, no one can hope to amass during his or her youth an initial fund of knowledge which will serve for a lifetime. The swift changes taking place in the world call for knowledge to be continuously updated…..

  1. Davey, J., Neale, J. and Morris Matthews, K. (Eds.) (2003) Living and Learning: Experiences of University after Age 40. Wellington, Victoria University Press.

2. Peter Jarvis (1997) Ethics and education for adults in a late modern society.      Leicester, National Institute of Adult Continuing Education.

 

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Frailty – what does it mean and how could it be measured?

     Judith Davey

16/06/2017 

“Frail” and “frailty” are words often used in relation to very old people. Looking them up in the Shorter Oxford Dictionary gives us “likely to be broken, perishable’ when applied to objects and “weak, liable to err or yield to temptation” when applied to people. Probably not too helpful! Are these concepts which can be useful in examining the situation and wellbeing of older people? Or is “frail” just another stereotype, often association with “elderly” – another term with connotations of inevitable decline? So I looked around for current definitions.

Biomedical definitions

There is a growing consensus among experts that frailty does exist as a distinct syndrome in a subset of older people who are at increased risk of hospitalisation, dependency and whose life expectancy is reduced.  But there is no overall agreement on indicators of frailty or how it should be defined. A common measurement is based on five specific criteria indicating adverse functioning, which include both self-reported and performance-based elements. Those who meet at least three of the criteria below are defined as “frail”, while those not matching any of the five criteria are defined as “robust”.

  • Low physical activity
  • Muscle weakness
  • Slowed performance
  • Fatigue or poor endurance
  • Unintentional weight loss

It seems more helpful to clinicians to identify frailty on the basis of physical rather than psychosocial factors as these are more tangible, more objectively confirmed and are more likely to be treatable by medical means. This approach is intended to help “the development of screening tools for health workers to identify vulnerable older people and inform interventions and preventive strategies.”

But what about psycho-social factors?

Should frailty be defined purely in terms of biomedical factors? Go to:

Psychological, social and environmental factors may be important contributors to frailty and very influential in terms of care policies and service provision.

In the Survey of Older People in New Zealand (SOP) in 2000 the authors defined frailty as “a complex syndrome of underlying problems” resulting in “vulnerability to environmental challenge”.  Put another way – medical, physical or mental health problems could compromise the ability to carry out key activities – washing, dressing, getting about, housework, keeping records, etc. In this concept frailty resulted from the interaction between bodily conditions and functioning.

Prevalence of frailty by personal characteristics

The findings of SOP, not unexpectedly, were that frailty increased with age, especially after 85 years. Prevalence was slightly higher for females than males and increased sharply for women from age 87.

The prevalence of frailty among Maori was higher than for New Zealand European and Pacific Island people. There was the same prevalence of frailty among Maori aged 65-70 as there is among non-Maori aged 81-84 years. This suggests a 10 to 15 year difference in the onset of frailty.

Marriage appeared to have a protective effect, with higher frailty figures for the widowed, divorced or separated. This illustrated the influence of the social environment on an older person’s ability to continue to maintain activities and functions associated with independent living. Complementary roles and coping patterns between partners develop over long periods of time together. This fits with the finding that there was a greater prevalence of frailty among older people living alone.

An interesting finding was the clear association between income and frailty– those with lower incomes had a higher prevalence of frailty – another link between health status and socioeconomic status. This highlights the cumulative effect of life events. Older people who are frail are more likely to be those with histories of lower incomes, less secure housing and social isolation. Does this suggest that home ownership has an important protective effect? “Addressing declining rates of home ownership for all groups throughout the lifespan can also be seen as contributing to housing security and wellbeing in later life, with associated health benefits.” This conclusion was arrived at getting on for 20 years ago!

 Intervention

Most studies on preventing frailty have been conducted after acute events such as strokes or fractures. Relatively few studies have been undertaken on intervention once frailty has developed. But these show that it is possible to prevent further functional decline.

The beneficial effects of exercise in the older population have been widely publicised. Given that inactivity and muscle weakness are major determinants of frailty, it is not difficult to imagine a simple and cost‐effective exercise‐intervention measure that may slow or reverse the process.

Positive psychological states may also be beneficial in the prevention of frailty. It has been suggested that the concept of positive health is more than simply the absence of disability or disease. Thus, approaches aimed at the production of a positive psychological state in those at risk of frailty may strengthen other interventions aimed at stopping functional decline.

Clearly, the definition and measurement of frailty cannot rely solely on bio-medical factors. The life history and environment of very old people are equally important, if not more so.

 

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