This is one in a series of blogs and articles from Aston’s researchers and other contributors including ExtraCare staff and senior colleagues in housing, health and policy organisations.
Aston University researchers Rachel Shaw & Karen West share their thoughts...
Research with older adults is growing in significance as the population ages.
We hear about the ageing population on the news often these days, but what is its impact? It doesn't only affect 'patients' of course, i.e. those in receipt of healthcare, but also their families and those delivering care.
Furthermore, as more people care 'informally' for their relatives at home, this doesn't only impact on the NHS and local authorities' ability to deliver health and social care services but it also impacts on thousands of families in terms of their housing needs, their finances, and their well-being.
The ageing population - and its associated issues - is a relatively new phenomenon and so we need to do research with older adults and their families so we can begin to understand what their experience is like and how it is affected by things like government health and social care policies but also to identify how we might improve things for them.
One way we can try to improve things for families is to emphasise a preventative approach to health. This means equipping people with the knowledge and techniques they need to manage their own health. Prevention depends on people understanding the benefits of a healthy lifestyle and their ability to maintain one.
Of course, people can only act within their means; in other words, people have freedom to make lifestyle choices (about diet, exercise, medication) within the constraints of their living circumstances.
This means we need to study people within their context; we need to understand what life is like for them, what their home life is like, what financial resources they have access to, where they live in relation to transport links, and access to local health and leisure (gyms, parks etc.) services. In essence, we cannot judge a family's ability to manage their health effectively - and prevent their risk of developing lifestyle related diseases, like diabetes, cardiovascular diseases - without understanding their personal situation.
Thus, much of our research explores people's experiences in-depth, both on an individual level and in relation to their family and community context, so we can work out how we can best facilitate their engagement in preventative health. Only by gauging the acceptability and feasibility of health and social care services can we begin to think about how to design and deliver integrated care that meets the needs of real people.
Of course, the benefit of adopting a healthy lifestyle is multifaceted.
Benefits for families are relatively obvious in that their risk of developing lifestyle-related diseases is minimised. This also means fewer carer responsibilities as relatives age which impacts on a family's ability to work, invest in their future, and remain living in their own home for as long as possible. The effect of this is borne out through massive savings in the NHS as unplanned admissions to hospital and emergency department visits are reduced; fewer patients require treatment for long-term conditions; and the 'complications' that can arise as a result of 'poor management' of long-term conditions will also reduce (e.g. diabetes can lead to retinopathy which leads to vision loss).
However, some long-term conditions are difficult to predict and many people will already be living with them. For this group it is essential that appropriate services are available and accessible to people in the community. One way of doing this for older adults is to provide residential communities with care and support services attached.
The ExtraCare Charitable Trust is one provider which has done this; it has created retirement communities in which older adults can live in their own home (with a range of purchase/let agreements available) in an environment which is accessible even for those whose mobility is challenged. There is a 'take what you need and leave the rest' approach in that residents can decide how much (or how little) of the services available they take up. It is also up to them whether they become involved in activities and events organised centrally in the retirement communities by resident volunteers.
In our research we have worked collaboratively with ExtraCare to investigate whether there is a financial benefit of offering these services, i.e. whether there is a cost saving for the NHS through things like reduced emergency department visits and unplanned hospital admissions.
Changes at the individual, family, community, service provider, and policy levels are required for the benefits of preventative health to be felt by the public purse but also in terms of the well-being of ageing communities. These are not small steps; working with individuals within a healthcare and political system is complex and requires a multi-perspective approach.
Our research has made some inroads in making sense of older adults' experiences of living in a retirement community with care services available. It has also given us some understanding about how living in this setting might impact on the health and well-being of older adults, in the form of their cognitive functioning, i.e. their ability to make sense of the world around them, and in their ability to take care of activities of daily living, i.e. dressing, washing etc.
We were also interested in whether this kind of living makes them happier. Does it bring them new friendships and new meaning in life?
Key findings from this research have told us that older adults can take a while to settle into a new community which requires careful negotiation in terms of developing new relationships and friendships and getting involved in group organised events. We have also found a sort of 'honeymoon effect' in relation to getting involved in activities; people tend to show enthusiasm for group activities and display signs on improvement in health and cognitive tests early on but this effect tends to diminish over time.
In the individual and group discussions we held with residents we found the same sort of thing and some spoke of being at a crossroads in terms of whether to continue to manage their health and activities of daily living independently or to seek the care services on offer. There was a sense from some residents that they were having to come to terms with increasing incapacity over time which was challenging in a number of ways, not least in terms of pride.
Of course, what research needs is a receptive ear. It doesn’t matter what we find if it is not acted on. This is one of the benefits of working with an organisation like ExtraCare that has a history of commissioning and acting on academic research.
We are looking forward to working in partnership with ExtraCare over the coming years to track the difference that this research makes.
Find out more about Aston University's research with ExtraCare!