Older People and Wellbeing

WWW.IPPR.
ORG
OlderPeopleand
Wellbeing
byJessicaAllen
July2008
©ippr2008
InstituteforPublicPolicyResearch
Challengingideas– Changingpolicy
2 ippr|OlderPeopleandWellbeing
Contents
Aboutippr ............................................................................................................................................3
Abouttheauthor .................................................................................................................................3
Acknowledgements.............................................................................................................................3
Introduction..........................................................................................................................................4
1.Age,healthandhappiness ..............................................................................................................6
Demographicandhealthtrends........................................................................................................6
Lifeexpectancyandpopulationgrowth...................................................................................6
Ageingpopulation....................................................................................................................8
Healthylifeexpectancy ............................................................................................................9
Inequalitiesinhealthandlifeexpectancy ..............................................................................11
Trendsinwellbeing ........................................................................................................................12
Definingandmeasuringwellbeing.........................................................................................12
TrendsinwellbeingintheUK ................................................................................................13
Wellbeinginolderpeople .......................................................................................................15
Futuretrendsinolderpeople’smentalwellbeing ................................................................. 17
Summary ........................................................................................................................................18
2.Factorsthatshapewellbeinginolderpeople ..............................................................................20
Socialexclusion,inequalitiesandhealth ......................................................................................20
Povertyanddeprivation .........................................................................................................21
Physicalhealth .......................................................................................................................24
Ethnicity ..................................................................................................................................25
Gender ....................................................................................................................................27
Lackofdiagnosis ofmentalhealthconditions ......................................................................27
Relationshipsandsociallife ............................................................................................................27
Contactwithfriendsandfamily .............................................................................................27
Maritalstatus .........................................................................................................................28
Livingalone............................................................................................................................29
Agediscrimination ..................................................................................................................30
Eventsandtransitionsinlifethatcantriggerpoormentalwellbeing...........................................30
Retirement ...............................................................................................................................30
Bereavement ..........................................................................................................................31
Care:givingandreceiving ......................................................................................................31
Communityparticipation ...............................................................................................................32
Crimeandfearofcrime ..........................................................................................................32
Localenvironment ..................................................................................................................33
Housingquality ......................................................................................................................34
Protectingwellbeing ......................................................................................................................34
Takinganactivegrandparentingrole ....................................................................................34
Exercise ...................................................................................................................................35
Educationandlearning ..........................................................................................................35
Volunteering ...........................................................................................................................35
Personalresilience ..................................................................................................................36
Religion ..................................................................................................................................36
Respect ...................................................................................................................................36
3.Conclusions ....................................................................................................................................37
References ...........................................................................................................................................38
Aboutippr
TheInstituteforPublicPolicyResearch(ippr)istheUK’sleadingprogressivethinktank,producing
cutting-edgeresearchandinnovativepolicyideasforajust,democraticandsustainableworld.
Since1988,wehavebeenattheforefrontofprogressivedebateandpolicymakingintheUK.Through
ourindependentresearchandanalysiswedefinenewagendasforchangeandprovidepractical
solutionstochallengesacrossthefullrangeofpublicpolicyissues.
WithofficesinbothLondonandNewcastle,weensureouroutlookisasbroad-basedaspossible,
whileourinternationalandmigrationteamsandclimatechangeprogrammeextendourpartnerships
andinfluencebeyondtheUK,givingusatrulyworld-classreputationforhighqualityresearch.
ippr,30-32SouthamptonStreet,LondonWC2E7RA.Tel:+44(0)2074706100E:info@ippr.org
www.ippr.org.RegisteredCharityNo.800065
ThispaperwasfirstpublishedinJuly2008.©ippr2008
Abouttheauthor
JessicaAllenisHeadofHealthandCareatippr.HerpublicationsatipprincludeGreatExpectations
(2007)andEquitableChoicesforHealth (2006).ShehaspreviouslyworkedattheKing’sFund,where
sheco-authoredHealthintheNewsandFindingoutWhatWorks,andatLondonSchoolof
EconomicsandUnicef.Shehaspublishedwidelyinnationalpapers,journalsandisafrequent
commentatorinnationalprintandbroadcast.SheholdsaPhdfromtheUniversityofLondonanda
firstclassdegreefromtheUniversityofBristol.
Acknowledgements
Thisreportisthefirstinaprogrammeofworkatipprexploringthe‘PoliticsofAgeing’.
ManythanksareduetotheCalousteGulbenkianFoundationwhohavesupportedthisfirstphaseof
thework,drawingontheirlongstandinginterestinandsupportforolderpeople’swellbeing.Weare
verygratefultothemfortheirsupportandtoAndrewBarnettinparticular.Thanksalsoinadvanceto
theNorthernRockFoundationandtheIntelCorporationwhoaresupportingourfutureworkonthe
PoliticsofAgeing.
Thanksarealsoduetocolleaguesatippr,inparticularJuliaMargo,RuthSheldonandSoniaSodha.
ThanksalsotoJohnCannings,KateStanley,GeorginaKyriacou,CatherineBithellandKellyO’Sullivan.
Allomissionsanderrorsaretheresponsibilityoftheauthor.
Introduction
ThewellbeingofyoungpeopleintheUKhasrecentlybeenthesubjectofunprecedentedattention
andscrutiny.Forexample,aUNICEFreportpublishedin2007causedshockandconsternationby
suggestingthatdespiteadecadeofinvestmentandpolicyfocusonyoungpeople,theUKwasthe
worstplaceinEuropetobeachild.Butwhatofolderpeople?Whiletheirplighthasnotbeenthe
subjectofsuchextensiveanalysisorgovernmentfocus,theUKisnotalwaysagreatplacetobeold
either.
AlthoughtheUKpopulationislivinglongerandisinbetterhealththanever,andolderpeopleare
wealthierthantheywere,liketherestofthepopulation,olderpeoplearenotgettinganyhappier.
Thereissomeevidencethatolderpeoplemaybebecomingdecreasinglysatisfied,lonelierandmore
depressedand,duetodemographicchanges,thereareincreasingnumbersofolderpeople,manyof
whomarelivingwithlowlevelsoflifesatisfactionandwellbeing.Thisisparticularlysoifyouarepoor,
isolated,inillhealth,livingalone,inunfithousingorrundownneighbourhoodsandworsestillifyou
areacarerorlivinginacarehome:andalloftheseriskfactorsapplytoalargeproportionoftheUK’s
olderpopulation.
Thisreport,thefirstinaseriesonolderpeopleandwellbeingfromippr,describessomeofthekey
socialtrendsintheUKandassesseshowthesemaybeimpactingonolderpeopleandtheirwellbeing.
Notaninevitability
Theover-65s,andparticularlytheincreasingnumbersofpeopleovertheageof80,havebeen
relativelyneglecteddemographicgroups.Toomanyolderpeoplelivewithpreventabledepression,
lonelinessandisolation.Unhappinessinoldageisnotinevitable,evenforthosewithpoorphysical
healthandlimitedmobility.Thisreporthighlightsthesignificanceofsupportinfosteringwellbeing
andsocialandcommunityparticipationforolderpeople,particularlyforthosemostatriskofisolation
andexclusion.Thisanalysiswillbedevelopedinthesecondphaseofthisworkin2008and2009.
Itisworthnotingattheoutsetthattherearesignificantnationaldifferencesinwellbeingamongolder
populations,furtherenhancingthecasefortherebeingnoinevitabilitytothesituationintheUK.For
example,inJapan,whereoldpeopleareaccordedgreatrespect,lifesatisfactionishighestamongthe
over-65s.InHungary,bycontrast,theyoungarethemostsatisfiedandsatisfactionislowamong
oldergenerations(DonovanandHalpern2002).
Thecurrentpolicycontext
Anumberofrecent,well-intentionedpolicydocumentsfromcentralgovernmenthavesetoutwaysof
improvinglevelsofwellbeingamongolderpeople(see,forexample,DepartmentforWorkand
Pensions2005,ODPM2006b,DepartmentofHealth2004).Buttheoverallfocusofnationalpolicy
continuestobechildrenandyoungpeople.Furthermore,someofthesedocumentshavelanguished
afterlaunchandtheproposalshavenotbeenactedupon.Thepoliticalappetitetodrivethrough
proposalssometimesappearstobelacking.
TheSocialExclusionUnit’sreportonendingsocialexclusionforolderpeopleemphasisedtheneedfor
strongleadershiptoprioritisewellbeingofolderpeople(ODPM2006a).Anumberofdepartments
haveaconsiderableimpactonthelivesofolderpeople:theDepartmentforWorkandPensionshas
formalresponsibilityforolderpeoplebuthastendedtofocusmostonissuesaroundbenefitsand
pensions;theDepartmentofHealthfocusesonhealthandsocialcare;andtheDepartmentfor
CommunitiesandLocalGovernmentonhousing,localgovernmentandurbanregeneration.However,
theworkofthesedepartmentsisnotalwayssufficientlyjoinedupandthereisnodepartmentor
officewithsoleresponsibilityforolderpeopleinthesamewaythattheDepartmentforChildren,
SchoolsandFamilieshasresponsibilityforyoungpeople.
TheSocialExclusionUnitreportproposedareviewofplansforanOfficeforAgeingandOlderPeople
whichcouldprovidethekindofleadershipandcross-governmentworkingthatiscurrentlylacking.
However,amoveofthiskindhasnotyettakenplace.Italsopromisedeffectiveactiontotackle
inequalitiesandexclusionforolderpeople,andrecommendedasimilarapproachtotheSureStart
programmethatexistsforyoungerpeople.Whiletheanalysisremainssound,implementationhas
beenpatchyandthereisstillnoSureStartforLaterLife.
Thefirstcross-governmentstrategytofocusonolderpeople,OpportunityAge (DWP2005),contains
manyexcellentproposalsaroundendingdiscrimination,tacklinginequalities,andofferingmore
supportandinterventionsforolderpeople.Someofthespecificproposalshavebeenintroduced,and
pilotssuchasLinkAgePlusarerunning.1 However,aswiththeproposalsintheSocialExclusionUnit’s
report,therehasnotyetbeensufficientimpact.Asthisreportdescribes,toomanyolderpeopleare
stillstrugglingwithpreventablelevelsofunhappinessanddepression,withmanyremainingexcluded,
sufferingfrompoverty,poorhousing,illhealthanddiscrimination.
OneimportantstrandofrecentnationalGovernmentpolicyactivityrelatingtoolderpeoplehasbeen
socialcareandunpaidcare.Careneedsinpeopleaged65andoverareestimatedtoriseby87per
centby2051from2002levelsandby2041thenumberofdisabledpeopleisexpectedtodouble
comparedwith2002(Moullin2008).In2008theGovernmentlaunchedanationaldebate,leadingto
aGreenPaperin2009,aboutthefuturecaresystem.Thesedebatesandstrategiesshowrecognition
thatthecurrentcaresystemisinneedofamajorredrawingintermsoffunding,typesofcaresupport
offeredandwhereandhowcareshouldbedelivered.Theneedforathoroughrethinkofwellbeingin
laterlifeismadeallthemorepressinggiventheprojectedincreasesinnumbersofpeopleover65in
theUKandotherdevelopedcountries.
Structureofthereport
InthefirstchapterwedescribethedominantdemographicandhealthtrendsintheUK,withafocus
onpeopleof65andolder.Healthandwealthareoftenseenasstrongpredictorsoflevelsof
wellbeing.However,asweshowinthesecondpartofthechapter,levelsoflifesatisfactionand
wellbeinghavestagnatedoverthelast40to50years,despitebetterhealthandincreasingwealth.
Somestudiesshowincreasedprevalenceofmentalhealthproblemsanddeterioratinglevelsoflife
satisfaction,particularlyforpeopleover75.Ouranalysisofpopulationstructure,health,inequality
andlevelsofwellbeingprovidesthecontextfortherestofthereport,whichfocusesoncurrentand
likelychangesinthedriversofwellbeingforolderpeople.
Inthesecondchapter,inordertoassessexistingandfuturetrendsinolderpeople’swellbeing,we
discussinmoredetailthemaindriversofwellbeingforthisgroup.Physicalhealthandrelativeincome
levelsaresignificant,butthemostimportantfactorsrelatetosocialinteractionandcommunity
participation.Weassesstrendsinolderpeople’sincome,highlightinglevelsofinequality,despite
wealthincreasesforalmostallofthelast20years.
Wegoontoassessotherimportantdriversofpooremotionalwellbeingandthosethatcansupport
andprotectgoodwellbeing.Thisanalysisisbasedaroundfourprincipalareas:levelsofsocialexclusion
andinequality,relationshipsandsociallife,lifeeventssuchasretirementandbereavementandlevels
ofparticipationincommunitylife.Thereareopportunitiesforpositiveactivitieswhicholderpeople
valuetobebettersupportedbygovernmentandservices,whichcouldinturnreducetheprevalence
ofdepression,isolationandloneliness.
Intheconcludingchapterwerecommendthatmoreneedstobedonetosupportolderpeople’s
wellbeingandsetoutourintentionsforphasetwoofippr’sworkonthepoliticsofageing.
1.ThereareeightLinkAgePluspilots,whichaimtogiveolderpeopleaccesstomoreintegratedservices,
includinghousing,transport,healthandsocialcare,work,andvolunteeringopportunities.
1.Age,healthandhappiness
Thischaptersetsthecontextforouranalysisofageingandfuturelevelsofwellbeingforolderpeople.
Weexploredemographictrendsthatshowthatagrowingsectionofthepopulationwillbeover65in
yearstocome.Therehavebeenstrikinggainsinlifeexpectancyandsomegainsinhealthylife
expectancy,whichmeanthatweareallexpectedtolivelongerandinbetterhealth,althoughthisnot
universalacrossallsocialgroups.
Inthesecondhalfofthechapterwegoontoexaminehow,despiteincreasesinwealthandadvances
inhealth,therehavenotbeencommensurateimprovementsinnationalwellbeing–infact,onsome
indicationswellbeingisdeteriorating.Thisstagnationordeclineinwellbeinghasbeennoticedwithin
governmentandbyotheranalystsandtherearesuggestionsthatinsteadofusinggrossdomestic
productasameasureofprogress,levelsoflifesatisfactionorhappinessshouldbeused.Wedescribe
possiblefuturetrendsinolderpeople’slevelsofwellbeingandsuggestthatthenumbersofolder
peoplewithlowwellbeingmayberising.Thismaybetheresultofanincreasingprevalenceofmental
healthproblems,aswellasdemographicchanges.
Demographicandhealthtrends
Lifeexpectancyandpopulationgrowth
The20thcenturybroughtdramaticgainsinlifeexpectancyintheUK.In1901,babyboysborninthe
UKcouldexpecttoliveforaround45yearsandgirlsfor49years.By2006babyboyscouldexpectto
livefor77yearsandgirlsfor81years.Furtherincreasesareexpectedasmedicalinnovationcontinues.
Figure1.1illustratesrealandprojectedgainsinlifeexpectancyformenandwomen.Thecohortlife
expectancyprojectionstrytotakeaccountoffuturehealthandmedicalimprovements.
Figure1.1.Male
andfemalelife 100 Male
expectancy
Female
atbirth,UK,
1981-2056
Source:
Government 95
Actuary’s
Department
(www.gad.gov.uk/
Demography_data/ 90
Life_Tables/docs/2
No.ofyears
006/2006UKeolb.
asp)
85
80
75
2041
2045
2049
1981
1985
1989
1993
1997
2001
2005
2009
2013
2017
2021
2025
2029
2033
2037
2053
However,despitestrikingoverallgainsinlifeexpectancyforeverybody,thereremainsignificant
differencesinlifeexpectancybetweensocialclasses.Professionalclasseshavelongerlifeexpectancy
thanallothersocialgroups.Despitegovernmenttargetsandinterventionsthegapcontinuestowiden
withlatestfiguresshowinga2percentincreaseininequalityformenand11percentforwomen
between1995-7and2006-7(DepartmentofHealth2008).
Figure1.2.Male
lifeexpectancyat
birth–manual 80
andnon-manual 78
occupations, 76
Englandand 74
No.ofyears
Wales,1972-2005
72
Source:Officefor 70 Non-
NationalStatistics manual
68 Manual
2007a
66
64
1972-76 1977-81 1982-86 1987-91 1992-96 1997-01 2002-05
Figure1.3.
Femalelife
expectancyat 84
birth–manual 82
andnon-manual
80
occupations,
78
No.ofyears
Englandand
Wales,1972-2005 76
Source:Officefor 74 Non-
NationalStatistics manual
72 Manual
2007a
70
1972-76 1977-81 1982-86 1987-91 1992-96 1997-01 2002-05
Theincreaseinlifeexpectancyamongolderadultshasbeenparticularlydramatic,andasFigure1.4
shows,at65peoplecanexpecttogoonlivingforanincreasinglylongtime.Between1980-82and
2004-06lifeexpectancyatage65intheUKincreasedbyfouryearsformenand2.8yearsfor
females.Thegapbetweenmaleandfemalelifeexpectancyisnarrowing(Figure1.4,nextpage).
By2031theUKpopulationisprojectedtoincreasefromits2006levelof60.6millionto71.1million,
accordingtoestimatesfromtheOfficeforNationalStatistics(ONS2008b),agrowthofjustunder11
millionpeoplein25years,oraroughaverageof0.4millionpeopleperyear.
Figure1.4.Life
expectancyat 20
age65
Source:Officefor 19
NationalStatistics
2008a
18
17
16
15
14
Male
13 Female
12
1981 1984 1987 1990 1993 1996 1999 2002 2005
Ageingpopulation
AstheUK’spopulationisgrowingitisalsoageingandby2020,oneinfivepeopleintheUKwillbe
aged65andover,morethanthenumbersunder16.Asthepopulationislivinglongertheabsolute
andrelativenumbersofolderpeopleinthepopulationareincreasing.TheageingoftheUK
populationposeschallengesintermsofcaringforolderpeopleandfinancingsupportforpeopleover
65(Moullin2007,2008).In2006therewere3.3peopleofworkingageforeverypersonofstate
pensionage;thisfigureissettofallto2.9peopleby2031(ONS2008c).
AnageingpopulationisanissueformanyofthememberstatesoftheEuropeanUnion.IntheUK,16
percentofthepopulationwereaged65oroverin2007,lowerthantheEUaverageof17percent.
SomeEuropeancountries,suchasItalyandGermany,havehigherdependencyratiosof19.9and19.8
percentrespectively(Eurostat2008).
Figure1.5depictstheagedistributionoftheUKpopulation.Itshowsthatby2020amuchlarger
shareofthepopulationwillbeover75.
Theproportionofpeopleover75isprojectedtoincreasefasterthananyotheragegroup,whichis
unsurprisinggiventheparticularlyrapidrecentincreasesinlifeexpectancyforpeopleover65.The
highestagegroup,theover-85s,isalsoprojectedtorisesubstantiallyfrom1.9percentin2004to2.7
percentby2020.Andby2031estimatesindicatethattherewillbenearly3millionover-85s
comparedwith1.2millionin2006andaround0.6millionin1981(ONS2008b).
Figure1.5.Actual
andprojected
agedistribution,
UK,1981-2056
Source:ONS2008b
Healthylifeexpectancy
WhiletheUKhasagrowingandageingpopulation,withmarkedincreasesinlifeexpectancy,notall
theyearsgainedarelivedingoodhealth.Forolderpeople,asforallagegroups,goodphysicalhealth
isimportantformentalhealthandwellbeing.Thereisplentyofevidenceshowingthatchronichealth
problemsanddisabilityoftenresultindepressionandothermentalhealthproblemsforolderage
groups.ThisisdiscussedinmoredetailinChapter2.
Examiningtrendsinhealthgivesussomestrongindicationsofolderpeople’swellbeing.Healthylife
expectancy,thatisexpectedyearsoflifein‘good’or‘fairlygood’health,islowerthanoveralllife
expectancy.IntheUKin2004,babyboyscouldexpectatbirthtoliveingoodhealthfor67.9years
andtobefreeofdisabilityfor62.3years(whiletotallifeexpectancyin2004was76.6).Therefore
boyscouldexpect14.3yearswithadisabilityand8.7yearsinpoorhealth.Girlsbornin2004could
expecttolive81years,with70.3yearsingoodorfairlygoodhealth,10.7yearsinpoorhealthand
justover17yearswithadisability.(SeeTable1.1.)
Table1.1.Lifeexpectancy,healthylifeexpectancyanddisability-freelifeexpectancyintheUK,bysex,2004
Males Females
Atbirth Atage65 Atbirth Atage65
Lifeexpectancy 76.6 16.6 81 19.4
Healthylifeexpectancy 67.9 12.5 70.3 14.5
Yearsspentinpoorhealth 8.7 4.1 10.7 4.9
Disability-freelifeexpectancy 62.3 9.9 63.9 10.7
Yearsspentwithdisability 14.3 6.7 17.1 8.7
Source:ONS2008c
Table1.2showshowinGreatBritainin2004,justunderaquarterofmenand28percentofwomen
over75consideredtheirhealthtobepoor.Forwomeninparticulartheperiodover75ismarkedbya
significantdeclineinhealth,butforbothmenandwomenover75athirdofpeoplearestillingood
healthandnearlythreequartersareingoodorfairlygoodhealth.
Thereareclearimplicationsforwellbeing.Forthoseover75poorhealthaffectedoveraquarterofall
people,makingthatgroupparticularlyvulnerabletodepression,socialisolationandexclusion.
Table1.2.Self-reportedgeneralhealthinGreatBritain,bysexandage,2006(%)
Good Fairlygood Notgood
Males
0–15 85 12 2
16–24 83 14 3
25–44 74 20 6
45–64 58 28 14
65–74 44 36 19
75andover 33 43 24
Allages 68 23 9
Females
0–15 87 11 2
16–24 78 18 3
25–44 70 21 8
45–64 59 26 15
65–74 43 38 19
75andover 33 39 28
Allages 66 23 11
Source:ONS2008c
Overall,theproportionofpeopleinGreatBritainreportinganillnessordisabilityhasnotchanged
since1995.Thisisperhapssurprisinggiventheincreasesintheproportionofolderpeopleinthe
populationandsuggeststhatanageingpopulationdoesnotnecessarilybringproportionatehealth
challenges.
Table1.3.Proportionofpeoplewhoreportedalimitinglongstandingillness,disabilityorinfirmity,Great
Britain(%)
Year 1975 1985 1995 2005 2006
Percentage 15 17 19 19 19
Source:ONS2006a
However,thereisstillinsufficientevidenceintheUKtodeterminewhetheryearsgainedthrough
longerlifeexpectancywillbematchedbyyearsofgoodhealth.Thereisanongoingdebateasto
whetherfuturegenerationswilllivelongerbutmoredisabledlives,or,alternatively,livesthatare
increasinglyhealthy(ipprTrading2007).IntheUnitedStatesthereissomeevidencetoshowthatthe
periodoftimeduringwhichapersonexperiencesdisabilityisbecomingshorterandthatthereisan
increaseinhealthylifeexpectancy(Jaggeretal 2006).However,theresultsofstatisticalprojections
dependgreatlyonthedefinitionsofillnessanddisabilitythatareused.
Box1.1setsoutprojectionsonlevelsofdisabilityunderthreedifferentscenariosofhealth
expectancy:acompressionofmorbidity,thatis,lessillness,anexpansionofmorbidity,meaningmore
illness,andacombinationofboth.
Box1.1.Levelsofdisability–threescenarios
Withacompressionofmorbidity,thereisapronouncedreductioninprevalenceratesofthemore
severelevelsofdisability.Forexample,infemalesaged60to79,theprevalencerateforserious
disabilityfallsfrom2.0percentto1.6percentbetweentheyears2004and2020.
Withanexpansionofmorbidity,theprevalenceratesformoreseriousdisabilityincrease,withthe
situationdeterioratinguptotheyear2020.Forexample,theproportionoffemalesagedover80
whoareinthehighesttwodisabilitycategoriesisprojectedtoincreasefrom14.7percentto16.0
percent.
Withacombinationofcompressionandexpansionofmorbidity,theproportionoflivesprojectedto
bewithoutdisabilityincreasesbetweentheyears2004and2020(withacorrespondingdecreasein
theproportionoflivesexpectedtobedisabled).
Source:Rickaysen2005,citedinipprTrading2007
In2002,peopleintheUKenjoyedmoretimewithoutadisabilitythanpeopleinmanyotherEuropean
countries.Formen,onlySweden,Finland,Portugal,HungaryandFrancehaveahigherpercentageof
yearslivedwithoutadisability,andforwomen,onlySweden,Finland,theNetherlandsandHungary
(Eurostat2002).
However,simplybecausethenumbersofolderpeopleareincreasing,thenumbersofpeoplewitha
disabilityorpoorhealthwillincreasedramatically.TheKing’sFundestimatesthatwithnochangein
theprevalenceofdiseasesortheageofbecomingdisabled(anunrealisticassumptionbecausehealth
needsandtreatmentschangerapidly),therewillbea67percentincreaseinthenumbersofpeople
withadisabilityoverthenext20years.Thenumberofpeopleover85withadisabilitywilldoubleand
thenumbersexperiencingoneofthekeydiseasesconsideredinthestudywillhaveincreasedbyover
40percentby2025(Jaggeretal 2006).Thenumberspotentiallyfacinglow-levelmentalhealth
problemsandpooremotionalwellbeingasaresultofpoorhealthanddisabilitywillalsorise
significantly.
Box1.2.Definitionofdisability
‘Disability’referstothedisadvantageexperiencedbyanindividualasaresultofbarriers,including
physicalandattitudinalbarriers,thatimpactonpeoplewithmentalorphysicalimpairmentsand/or
long-termillhealth.
A‘disabledperson’isanyonewhoisdisadvantagedbythewayinwhichthewiderenvironment
interactswiththeirimpairmentorlong-termhealthproblem.Thismayvaryovertime.
Inequalitiesinhealthandlifeexpectancy
Goodhealthisnotspreadevenlyacrossthepopulationandhealthissignificantlyrelatedtosocio-
economicstatus,ethnicity,genderandgeographiclocation.
Figure1.6(nextpage)showsdifferencesintheincidenceoflong-termillnessanddisability,measured
byethnicgroupandgender,inEnglandandWales.PakistaniandBangladeshimenandwomenhave
worsehealththanotherethnicgroups.Chinesemenandwomenhavethebesthealthandwhite
groupsalsofarerelativelywell.
Figure1.6.Age-
standardisedrates
oflong-term White British Males
illnessordisability Females
thatrestrictsdaily White Irish
activities,by
ethnicgroupand Other White
sex,Englandand
Wales,2001 Mixed
Source:Dunnell
2008 Indian
Pakistani
Bangladeshi
Other Asian
Black Caribbean
Black African
Other Black
Chinese
Other ethnic groups
0 5 10 15 20 25 30
Percent
Whiletherehavebeenincreasesinlifeexpectancyforeveryone,inequalitiesinlifeexpectancyand
childmortality,measuredaccordingtosocio-economicstatus,haveactuallywidenedinthelast
tenyears(DepartmentofHealth2008).Asthereisanassociationbetweenpoorphysicalhealth
andpooremotionalwellbeing,thereisastronglikelihoodthathealthinequalitiesarelikelyto
translateintowideningwellbeingandmentalhealthinequalitiestoo.
Trendsinwellbeing
Havingbegunbyexploringtrendsinpopulationstructureandhealth,inthissectionwediscuss
thegrowingdrivetomeasurewellbeing,anddescribesomeofthemainmeasuresused.Wegoon
todescribelevelsofmental-healthproblemsandwellbeingintheUKamongolderpeople.While
levelsofhealthandalsowealthgivesomeindicationofwellbeingthereisevidencethatabovea
certainlevel,increasingwealthandhealthdonotleadtomatchedimprovementsinfeelingsof
wellbeing.
Definingandmeasuringwellbeing
Thenotionthatanation’slevelofwellbeingorhappinessismoreimportantthanitswealthhas
beguntogaincredencewithinpolicyandacademiccircles(althoughthismaybechallengedin
economicallytoughertimes).Thisinterestreflectsthefindingthatwhileincomeandwealthmay
continuetoescalate,levelsofwellbeingstagnatewhenoneobtainsanannualincomelevelof
£20,000.Thisistheso-calledEasterlinparadox,namedafteratheorypostulatedbyRichard
Easterlinin1974.
IntheUKLordLayardhasbeenaleadingproponentofthedrivetoconsiderhappinessratherthan
GDPasanindicatorofprogress,stating:
‘…GDPisahopelessmeasureofwelfare.ForsincetheWarthatmeasurehas
shotupbyleapsandbounds,whilethehappinessofthepopulationhas
stagnated.Tounderstandhowtheeconomyactuallyaffectsourwellbeing,we
havetousepsychologyaswellaseconomics.’(Layard2003)
TheGovernmenthasacceptedthatwellbeingandlifesatisfactionareimportantmeasuresofprogress
(DonovanandHalpern2002),andnotesthatthepublicalsosupportsthisnotionofprogress.
Despitetheincreasingimportanceattachedtosociety’swellbeingorlifesatisfactionthereisnosingle,
definitivemeasureused.InternationalbodiessuchastheOrganisationforEconomicCooperationand
Development(OECD)arepromotingdebateaboutwhatprogressmeansandhowasharedviewof
societalwellbeingcanbeproduced,basedonhigh-qualitystatistics.IntheUKtheOfficeforNational
StatisticsandotherGovernmentofficesareexploringthemeasurementofsocietalwellbeingdrawing
onarangeofindicators(Allin2007,DonovanandHalpern2002).
Howeverimpreciselydefined,Governmentstudieshaveusedmeasuresofhappinessandsatisfaction,
asreportedbyresearchrespondentsthemselves,tocomparelevelsofwellbeingbetweenvarious
groupsofpeople.Theredoesseemtobeconsistencybetweenthefindingsandageneralconfidence
inthemeasuresofwellbeing.TheGeneralHealthQuestionnairesurveysareanimportantand
frequentlyusedmeasureofwellbeing.Thequestionstrytoestablishlow-levelmentalhealth
problems,particularlythoserelatingtostress,feelingsofhopelessnessandlowself-esteem.
Box1.3.Howdowedefinewellbeing?
Inthisreport,wetakeabroaddefinitionofemotionalwellbeing.Wedonotincludeseriousmental
healthproblemssuchasdementiaorpsychoticmentalillnessessuchasschizophrenia.Thisis
becausethecausesandtreatmentofseriousmentalhealthproblemsaresignificantlydifferentfrom
thecauses,preventionandpossibletreatmentoflower-levelmentalhealthproblems.Mostpeople
andorganisationsworkinginmentalhealthdistinguishbetween‘neurotic’orcommon‘low-level’
mentalhealthproblems,andpsychoticorseriousmentalhealthproblems,suchasdementia,
schizophreniaandhallucinations.
Wethereforeincludeasanindicatorofemotionalwellbeingtheincidenceoflow-levelmentalhealth
problemssuchasdepression,anxiety,stress,panicattacks,phobiasandobsessive-compulsive
disorders.Butemotionalwellbeingisbroaderthanjustthepresence(orabsence)ofcommon
mentalhealthproblemsandsowealsoincludelifesatisfactionandlevelsofhappiness.
Inthesecondphaseofippr’sworkonolderpeople,wewillrefineanddevelopadefinitionof
wellbeinginolderpeople,basedonoriginalresearchwitholderpeople.(Meanwhile,inthisreport
wedrawonexistingresearchtoindicatelevelsofmeasuredwellbeinginolderpeople.)
TrendsinwellbeingintheUK
LevelsofwellbeingandlifesatisfactioninBritainhavestayedfairlyflatsincethe1950s(beforewhich
theyhadbeenrising);seeFigure1.7,nextpage.
ThesefindingsarereproducedintheUS,Japanandmanyotherdevelopedcountries(Layard2003).
Althoughinternationalcomparisonsaredifficultbecauseinterpretationsoflifesatisfactionvary,surveys
showthatintheUK,lifesatisfactionin2001wasjustabovetheEUaverage;seeFigure1.8,nextpage.
Thevariationsinlifesatisfactionarepartlyrelatedtohowunequalsocietiesare.PortugalandGreece,
forexample,havehighlevelsofinequalityandtheircitizensarelesssatisfiedthanthoseinotherEU
countries.TheWorldValuesSurveyin2007attemptedtocorrelatelevelsofinequalityandlife
satisfactionacrossselectedcountriesworldwideandfoundthatthemostunequalcountrieswerethe
leastsatisfied.ThesurveyfoundthatBritainranksinthebottom-halfofOECDcountriesforboththe
averagelevelofsatisfactionandinequalitiesinthedistributionoflifesatisfaction,ranking17thforthe
leveloflifesatisfactionand18thforequalityofGDPpercapita.TheGovernmenthasacknowledged
thattheseinternationalcomparisonssuggestthereisscopetoimprovelifesatisfactioninBritain,and
forittobemoreevenlydistributedacrosstheBritishpopulation.
Figure1.7.British
lifesatisfaction 180
andprosperity GDP per
170 capita
Source:basedon
PMSU2007 160 % very
or fairly
150 satisfied
140
130
120
110
100
90
80
1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
Figure1.8.Life
satisfactioninEU
Portugal
memberstates, Not
2001 Greece Satisfied
Source: France Fairly
Eurobarometer Satisfied
Italy Very
Germany satisfied
Belgium
Spain
EU 15
Finland
Austria
UK
Ireland
Luxembourg
Sweden
Netherlands
Denmark
-60 -40 -20 0 20 40 60 80 100

ThereissomecontroversyovertrendsinmentalhealthintheUK,withstudiesidentifyingthat
measuredincreasesinprevalencearesometimesduetotheresimplybeingmorediagnosis.However,
therearesomeindicationsthatmentalhealthintheUKisworsening.Usingmeasuresofmental
healthproblemsin2001,theOfficeforNationalStatistics’PsychiatricMorbidityReport foundthat
oneinfourBritishadultsexperiencesatleastonediagnosablementalhealthprobleminanyoneyear,
andoneinsixexperiencesthisatanygiventime(ONS2001).
Therewasalsoanincreaseintheproportionofpeoplereportingmentalillnessesandbehavioural
disordersasthemedicalreasonunderlyingclaimsforincapacitybenefitandseveredisablement
allowance,growingfrom33percentin2001to41percentin2007(Dunnell2008),asshownin
Table1.3.Furthermore,aStrategyUnitreportonlifesatisfactionshowedariseintheincidenceof
mentalhealthproblemsforbothmenandwomenbetween1993and2000(PrimeMinister’sStrategy
Unit2007).
Table1.3.Combinedincapacitybenefitandseveredisablementclaimants,measuredbytypeofmedicalreason,
GreatBritain,2001and2007
2001 2007
Mentalandbehaviouraldisorders 33% 41%
Physicaldisorders 67% 59%
Totalclaimants(millions)=100percent 2.8% 2.7%
Source:Dunnell2008
Figure1.9.
Average 11.30
psychological
11.25
distresslevels
overtimein 11.20
Average GHQ - 12 (Likert*)
Britain:
1991–2004,based 11.15
onGeneralHealth
Questionnaire 11.10
Source:Oswaldand
11.05
Powdthavee2007a
11.00
10.95
10.90
1991 - 1994 1995 - 1999 2000 - 2004
*Likertscaleisapsychometricresponsescaleoftenusedinquestionnaires
OswaldandPowdthavee(2007a)reportthatmentalwellbeingisworseninginBritain.Figure1.9
showsforrepresentativesamplesofBritonsthatGeneralHealthQuestionnairepsychologicaldistress
scoresrosefrom1991onwards.AndLordLayardhasarguedthatalltheevidencesuggeststhat
incidenceofclinicaldepressionhasincreasedsincetheSecondWorldWar(Layard2003).
Wellbeinginolderpeople
MostolderpeopleintheUKarehealthyandhappyandmakevaluablecontributionstosocietyandto
theeconomy.Infact,oldage,definedasover65years,isoftenseenasatimeofrelative
contentment,althoughthereissomedebateaboutlevelsofwellbeinginolderpeople,justasthereis
forthepopulationasawhole.Inthissectionwediscusssomeoftheoftencontradictoryevidence
aboutlevelsofmentalhealthproblemsandwellbeinginolderagegroups.
Manyofthecontradictionsarisebecausesomanymentalhealthproblems,particularlyforolder
people,remainundiagnosedanduntreated.Therehasbeenatendency,includinginGovernment,to
viewolderpeopleasahomogenousgroup.However,theperiodafter65isnotexperienceduniformly
andpeopleover80suffersignificantlyandgraduallyworseoutcomesthan‘youngerold’people.A
singlegroupingbasedontheover-65shasthusledtoratherover-optimisticassessmentsofthestate
ofwellbeingformanyolderpeople.Therearealsowiderinequalitiesinolderpeople’swellbeingthat
relatetolevelsofpoverty,health,education,familycontactandsocialandcommunityparticipation,
whicharediscussedinChapter2.
Inaninfluentialstudyoftheagedistributionoflifesatisfaction,BlanchflowerandOswald(2004)
showedthatpeople’slevelsofhappinessfollowedaU-shapedcurve,withleasthappinessinmiddle
age–apatternthatwasconsistentin72outof80countriestheystudied.Forbothmenandwomen
intheUK,dissatisfactionpeakedataroundtheageof44,afterwhichlifesatisfactionimprovestoits
highestlevelduringthelifecourse.
Figure1.10.
Averagelife 5.6
satisfactionscore
5.5
byagegroup
Source:Oswald 5.4
Average life satisfaction score
2007
5.3
5.2
5.1
5.0
4.9
4.8
4.7
15 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70
Age group
However,theassumptionsmadebytheU-shapedcurvefindingsarenotapplicabletoolderage
groups.Theredoesseemtobeclearevidencethatthepost-80periodismarkedbyincreasing
depression.Zaritetal (1999),whofocusedonpeopleover80,foundthatdepressivesymptoms
increasedovertime,andthatthiswasassociatedwithpoorhealth(referredtoinSurretal 2005).A
BerlinAgeingStudydrewsimilarconclusions(Wernickeetal 2000)andfoundthatthe‘youngerold’
(70-84)reportedconsistentlyhigherpositivewellbeingthanthe‘olderold’(85+)(referredtoinSurr
etal 2005).
A2008King’sFundreport(McCroneetal 2008)suggeststhatreportedrelativelylowratesofmental
healthproblemsforolderpeoplemaybeduetoinsensitivediagnostictoolsusedinthemostoften
referred-tosurveyofmentalhealth,thePsychiatricMorbiditySurvey(ONS2001b).Arecentreport
fromAgeConcernandtheMentalHealthFoundationalsoshowsthatratesofdepressionactually
increasewithage(Lee2006).
TheKing’sFundanalysisfoundthatthereisnoreductionindepressioninolderage;infactforboth
menandwomendepressionisathighestlevelsatthispointinlife.Thestudyshowssignificant
numbersofolderpeoplewithdepression,andformentherearerapidincreasesinprevalenceover75.
Figure1.11.
Prevalenceof 45 Male
Female
depression,by
genderandage 40
group
Source:McCroneet 35
al 2008
30
Cases per 1000 people
25
20
15
10
0
15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+
Age group
Depressionisthemostcommonmentalhealthprobleminlaterlife.Estimatesvarybecausemuch
depressionisunrecorded,butitislikelythat20to25percentofolderpeopleexperiencedepression
thatimpactssignificantlyontheirqualityoflife(Lee2006).Inaddition,therearemanymorepeople
whoexperiencepsychologicaloremotionaldistressassociatedwithisolation,lonelinessorloss.These
problemsarenotrecordedbythehealthormedicalcaresystembutcontributetopooremotional
wellbeingandlowlifesatisfaction.Thenumbersofolderpeoplewithpooremotionalwellbeing,aswe
havedefinedit–includingothercommonmentalhealthproblemsandpoorlifesatisfaction–are
likelytobemuchhigherthantheestimatesof20to25percentofolderpeoplewithdepression.
Someseriousmentalhealthproblems,particularlydementia,haveahighlysignificantimpactonolder
people.Dementiaisparticularlysignificantbecauseitaffectssomanyolderpeople,asmanyas25per
centover85,andbecauseitaffectsfamilyandfriends.Peoplecaringforpeoplewithdementiahavea
muchhigherlikelihoodofbeingdepressedthemselvesandsorisingnumbersofpeoplewithdementia
arelikelytohaveadoubleimpactonwellbeing.
Futuretrendsinolderpeople’smentalwellbeing
Depressionandanxietydisordersaresettobecomemoreprevalentinthenext20yearsdueto
increasingnumbersofolderpeople,accordingtoMcCroneetal (2008),withthesuggestionthat
increasesinprevalencewillbedrivenbydemographicsalone(seeFigure1.12,nextpage).
However,thesomewhatoptimisticassumptionthattheprevalenceofmentalhealthproblemsis
notincreasingforolderpeoplecontradictsotherevidenceweoutlinedearlierthatsuggeststhat
mentalhealthproblemsarebecomingmoreprevalentacrosstheUKpopulation.Additionally,as
wehavediscussedthenumberofolderpeoplewillrise,onitsownleadingtoasubstantial
increaseinthenumberofolderpeoplewithmentalhealthproblemsandgeneralpooremotional
wellbeing.CurrentlyaboutthreemillionolderpeopleintheUKsufferfromamentalhealth
problemandthisisexpectedtorisebyonethirdoverthenext15years(Andersonetal 2008),
andthereareestimatedtobecurrently2.4millionolderpeoplewithdepressionsevereenoughto
impairqualityoflife.Thesefiguresarelikelytobeunderestimatesasonlyonethirdofolder
peoplewithdepressiondiscusstheirsymptomswiththeirGP(Chew-Grahametal 2004).
Figure1.12.
Projectedchange 200
innumberof 15 - 44
peoplewith 45 - 64
depression,2007
180 65 - 74
to2026 No. of people with depression (index, 2007 = 100)
75 - 84
Source:McCroneet
al 2008 85+
160
140
120
100
80
2007 2009 2011 2013 2015 2017 2019 2021 2023 2025
Year
Additionally,forpeopleagedover80therearefurtherdownwardtrendsinwellbeing.And
althoughseriouscasesofmentalhealtharenotthefocusofthisreport,itisworthnotingthatthe
numberswithseriousmentalhealthproblemsanddementiaaresettorisesubstantiallyas
numbersofolderpeople,andthoseagedover85inparticular,grow.Thiswillhaveawideimpact
asincreasingnumbersofcarers,familyandfriendsfindtheirqualityoflifemayworsenasaresult.
Forfourreasons,then,wecanexpecttoseeasignificantincreaseinthenumbersofolderpeople
withpooremotionalwellbeing:
1.Mentalhealthproblemsmaybebecomingmoreprevalentacrossthelifecourse.
2.Thenumberofoldpeopleissettorisemarkedly.
3.Thenumberandproportionofolderoldpeoplearealsoincreasing.
4.Therewillbeariseinthenumberofcarers,whoareathigherriskofdepressionthantherest
ofthepopulation.Manyofthesecarerswillbeolderpeople,caringforspousesoreven
parents.
Summary
TheUK’spopulationisageingbecausethebirthratehasbeenfallingforthepast30yearsandlife
expectancyandhealthimproving.Thenumbersofolderpeople,bothinabsolutenumbersand
proportionately,willincreasesignificantlyandmorepeoplewillsurvivepasttheir85thbirthdayand
manypasttheir100th.Thereissomeevidencethatpeoplearealsolivinglongerinbetterhealth–
althoughbothhealthandlengthoflifecorrespondcloselytosocio-economicstatusandalsoto
ethnicity.
WhiletherehavebeenstrikinggainsinhealthandwealthintheUK,thesehavenottranslated
intoimprovementsinlifesatisfactionandhappiness,incommonwithothercountries.Indeed,
thereissomeevidenceofworseningtrendsinmentalhealthproblems.Wellbeingisbecomingan
increasinglyimportantmeasureofprogressandontheavailableevidenceprogressseemstohave
stalledintheUK.
Thereissomedebateovertheprevalenceofmentalhealthproblemsamongolderpeople.However,it
doesappearthatprevalenceofmentalhealthproblemsincreaseswithage,particularlyforthoseover
75,andthattheprevalenceofpoorwellbeingalsorises.
Futuretrendsinwellbeingarealsodisputed,butasthenumberofolder oldpeopleincreasesthere
islikelytobeacorrespondinggrowthintheincidenceofmentalhealthproblemsandlevelsof
poorwellbeing.
2.Factorsthatshapewellbeinginolderpeople
Manyolderpeopleenjoylife,butasignificantproportionstrugglewithloneliness,isolation,low-level
mentalhealthproblemslikedepressionorevenmoreseriousproblemsthatleadtosuicide.Certain
groupsofolderpeopleareatmoreriskofpooremotionalwellbeingthanothers:thesearetypically
thepoorest,theveryelderly,someminorityethnicgroups,themostisolated,thosewithworse
physicalhealth,and,themostsignificantthoughoftenneglected,thosewithoutanactivesocialor
communitylife.
Thischapterassessestrendsinthekeydriversofolderpeople’swellbeing–boththosethataffectit
negativelyandthosethatcanimprovewellbeingandprotectolderpeopleagainstdepression,
lonelinessandisolation.Wecontendthatthereisfarmorethatpolicymakerscandotoprotectand
fosterabettersenseofwellbeingfortheUK’sgrowingnumberofolderpeople.
Socialexclusion,inequalitiesandhealth
Levelsofwealthhaveincreasedforalmosteveryone,butnotequallyandthereisevidenceof
wideningincomeinequalitiesbetweenthetopandbottomgroups.Forolderpeopleincomeand
wealthhaveincreasedmorethantheaverage,although2006-7figuresshow300,000more
pensionersinpovertythanthepreviousyear,perhapsindicatingareversalofthistrend.Over-75sare
faringrelativelybadlywithlowerincomesthanthe65-74agegroup.
HouseholdwealthmorethandoubledintheUKbetween1987and2006andpeoplearespending
twoandahalftimesmoreongoodsandservicesthanin1971(Dunnell2008);seeFigure2.1.Over
theperiod1987to2006realhouseholddisposableincomeperheadrosebyaround60percent.
Figure2.1.Net
250
wealthperhead
(from1987
baseline=100)
200
Source:Dunnell
2008
150
100
50
0
94
4
87
89
90
91
92
93
95
96
97
98
00
02
03
05
6
0
8
0
19
20
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
Therisesare,however,unequallydistributedandtheshareofwealthofthewealthiest1percentof
thepopulationwas21percentin2003,havingrisenfrom17percentin1991.Incomeinequalitywas
atitshighesteverlevelin2006-7(Breweretal 2008).IncomeinequalityintheUKishigherthanthe
Europeanaverage.IntheUK,thetop20percentoftheincomedistributionreceives5.4timesgreater
ashareoftotalincomethanthatreceivedbythebottom20percentofthepopulation,comparingto
anEUaverageratioof4.8(Eurostat2007).
Thisissignificantbecauselevelsofinequalityinincomeandwealthareveryimportantinshaping
levelsofsatisfactionandwellbeingamongthegeneralpopulation.Wideinequalitieshavebeenfound
tobedetrimentaltowellbeing,causingstressandunhappiness(PickettandWilkinson2007).
Povertyanddeprivation
Forpensioners(menover65andwomenover60),realincomeandshareofnationalincomehave
risensignificantlysince1979;andthegrossincomeofpensionerfamiliesaveragedoverallagesand
familytypesroseby37percentinrealtermsbetween1994/95and2005/06,comparedwithan
increaseofabout17percentinrealaverageearnings(ONS2008c).
Figure2.2.Real
incomeof
pensioners,
1979-1996/7and
1994/5-2004/5
(from1979
baseline=100)
Source:ONS2006b
Pensioners’averageincomerosefasterthanyoungerpeople’searningsbetween1996/7and2004/5
(25percentcomparedwith15percent).Theserisescamefromincreasesinoccupationalpensions,
investmentsandbenefits.
Theeffectoftheserisesinpensionerincomeshasbeenamovementofpensionersuptheoverall
incomedistributionladder.Theproportionofpensionersineachfifthoftheincomedistributionin
1979and2004/5isshowninFigure2.3.In197947percentofallpensionerswereinthebottom
Figure2.3.
Pensioners’ 50
positioninthe 1979
45 2004/5
overallnetincome
distribution,1979 40
and2004/5
35
Source:ONS2006b
30
Percent
25
20
15
10
0
Bottom fifth Next fifth Middle fifth Next fifth Top fifth
fifth,asmeasuredbeforehousingcosts,andby2004/5thisproportionhadalmosthalvedto25per
cent.However,thisstillmeansthataquarterofpensionersareinthebottomfifthforincomeand
nearlyathirdmoreareinthesecondfifth.
Althoughthefiguresforpensionerpovertyshowsignificantimprovementsince1990,in2005/6just
overafifthofallpensionerswerestillreceivinglessthan60percentofthemedianincome.This
increasedto23percent(afterhousingcosts)in2006/7.Thereisalsoanagegradienttopensioner
povertywith18percentof65-to69-year-oldsreceivinglessthan60percentofmedianincome,
comparedto32percentoftheover-85s(DepartmentforWorkandPensions2008).
Table2.1.Individualslivinginhouseholdsbelow60percentofmedianhouseholddisposable
incomeintheUK(%)
Years Children Pensioners Peopleofworkingage
1990–91 27 37 15
1991–92 28 32 16
1992–93 29 28 16
1993/94–94/95 27 24 15
1994/95 25 24 15
1995/96 24 24 14
1996/97 27 25 15
1997/98 27 25 15
1998/99 26 27 15
1999/2000 26 25 15
2000/01 23 25 15
2001/02 23 25 15
2002/03 23 24 15
2003/04 22 23 15
2004/05 21 21 14
2005/06 22 21 15
Source:ONS2008c
Themostrecentfigures,for2006-7,showaworseningtrendforrelativepensionerpovertyand
between2005-6and2006-7therewasanincreaseof300,000inthenumberofpensionersinrelative
povertyafterhousingcosts,bringingthetotalto2.1million.In2006ratesofpovertyamongolder
peopleweremuchhigherintheUKthaninmanyotherEuropeancountries.TheUKpovertyratefor
over-65scomparesunfavourablywiththe2006EUaverage(Eurostat2007).
Lookingatawideragegroup,in2006theSocialExclusionUnitfound3.4millionpeopleover50lived
inrelativepovertyand1.2millionpeopleover50inEnglandfacedsevere,exclusion(ODPM2006a).
Aroundhalfofpeopleover50suffereddisadvantagewithrespecttooneaspectoftheirlife.
Povertyhasaclearrelationshipwithpooremotionalwellbeingacrossthelifecycleandworsening
incomeinequalitiescompoundthat.Andtheevidencethatpovertyatanearlyage,evenprenatally,is
astrongpredictorofoutcomes,isclearandunequivocal(Bamfield2007).Asthefirstreportfromthe
UKInquiryintoMentalHealthandWellbeinginLaterLife states:
‘Disadvantageinchildhoodorearlyadulthoodoftenleadstoimpairedphysical
andmentalhealthinlaterlife.Earlyvulnerabilitytomentalhealthproblemsis
predictivenotjustofmentalhealthproblemsinlaterlifebutalsoofpoor
socialisation,criminality,lackofparticipationandrelationshipdifficulties.On
theotherhand,advantageinchildhoodorearlyadultlifemayresultinbetter
physicalandmentalhealthinlaterlife.’(Lee2006:14)
TheGovernmenthasactedonthisevidenceandinvestedsignificantlyintryingtoreducethenumber
ofchildrenlivinginpovertyandin2006/7therewere600,000fewerchildreninrelativepovertythan
10yearspreviously.Theinvestmentsmadeinearlyyearsandchildhoodhaveachievedagreatdeal
andiftheimprovementsaresustainedthroughadulthoodtherearelikelytobefewerolderpeople
withemotionalandmentalhealthproblemsasaresult.
Theimperativetoinvestearlytoachievelifelongbenefitshasdominatedthepolicyagendaforthelast
tenyears,andhaspartlybeenaresponsetothedemandsforclearcost-efficacybytheTreasury.The
Treasuryhasacceptedthatearly(inageterms)interventionhaslong-termgains.However,tosome
extentthisapproachhasworkedagainstolderpeople,whohavenotreceivedanythinglikethe
resource,attentionandfocusastheyoung.Thisshouldberectified:asoldagebecomesincreasingly
longaspeopleliveforlonger,thereisevidencethatinvestmentinearlyoldagewillpayoffinolder
oldage.Moreover,therearecompellingethical,moralandsocialjusticereasonsforfurthersupport
andinvestmentinolderage.
Inequalitieswithintheover-65group
Highlevelsofinequalityareincreasinglybeingrecognisedasdetrimentaltoemotionalwellbeingand
mentalhealth–resultinginenvywhichcausesstress,andthefeelingofrelativefailure.Withinthe
over-65agegroupitself,thegainsinincomeandwealthhavenotbeenspreadequally:
• Single pensionershavelessthanhalftheearningsofmarriedpensioners.
• Olderpensionershavesignificantlylowerincomesthanyoungerpensioners(seeFigure2.4).
• Female pensionershave,onaverage,lowerincomesthanmen.Forexample,singleretiredmen
hadanaveragenetincomeof£220perweekin2004/5comparedwith£186forsinglefemale
pensioners(ONS(2006).
Figure2.4.
Sourcesof 450 Other income
pensioners’ Earnings
income,byage
group 400 Investment income
Source:ONS2006 Personal pensions
Occupational pensions
350
Benefit income
300
250
200
150
100
50
0
Recently retired Under 75 Over 75
• Therearegeographicalinequalities:pensionersintheSouthEastofEnglandandLondonhave
onaveragehigherincomesthanpensionersinotherpartsoftheUK.Averageincomefromstate
benefitsvariesmuchlessbetweenregionsthanothertypesofincome(ONS2006).
• Minorityethnicgroups accountfor3.5percentofallpensionersinGreatBritainandthat
proportionisgrowing.Someethnicminoritypensionershaveloweroverallincomethantheir
whitecounterparts.Alargepartofthisdifferenceisduetoethnicminoritypensionersbeingless
likelytoreceiveoccupationalorprivatepensions.Theyarealsolesslikelytoreceivestate
retirementpension(ONS2006).
Incomeinequalitiesamongolderpeoplecompoundexistingdeprivationandphysicalandmental
healthinequalitiestoproducesignificantlyhigherlikelihoodofpooremotionalwellbeingforthose
groups.
TheOfficeforNationalStatisticsstatesthat:‘Commonmentaldisordersaremoreprevalentinmanual
socio-economicgroupsthaninnon-manualsocio-economicgroups.Theprevalencewashighestin
SocialClassV(18percent)andlowestinSocialClassesIorIIcombined(6percent)’(ONS2003:xii).
SuicideratesinthemostdeprivedareasinEnglandandWalesfrom1999to2003weremorethan
doublethoseintheleastdeprivedareas(Dunnell2008).
Thestrongassociationbetweenlevelsofdeprivationandpooremotionalwellbeingispartlyexplained
bystressesassociatedwithpoverty–strugglingtomakeendsmeet,poorhousingconditionsand
widerphysicalenvironment,fearofcrime,andrelativelypoorphysicalhealthareallexperiencedmore
themoredeprivedyouare.Thestressassociatedwithlivinginanunequalsocietyisincreasinglyseen
asvitalinunderstandingtheriseofpoormentalhealthandwellbeingin‘rich’societies(Pickettand
Wilkinson2007).
Figure2.5.
GeneralHealth
25 Men
Questionnaire12
score(observed Women
andage- 20
standardised),by
equivalised 15
householdincome %
andsex(menand 10
womenaged16or
over) 5
Source:Donovan
andHalpern2002 0
Lowest Second Middle Fourth Highest
Equivalised household income quintile
Figure2.5showshowstress,asmeasuredbytheGeneralHealthQuestionnaire12score,relatesto
incomelevelandgender.
Physicalhealth
Thereisawealthofevidenceshowingthatphysicalhealthiscloselyassociatedwithemotional
wellbeing.Thisisparticularlyrelevantforolderpeople,whosuffermuchhigherlevelsofchronicill
healththantherestofthepopulation.Healthisoverwhelminglyfelttobethemostimportant
determinantofhappinessamongtheover-55s.Ithasbeenestimatedthatupto70percentofallnew
casesofdepressionarisinginolderpeoplemaybecausedbydisabilityassociatedwithillhealth(Surr
etal 2005,ONS2003).Moststudieshavefoundthatprevalenceratesofdepressionare
approximatelydoubleforolderpeoplesufferingillhealthanddisabilitycomparedwiththosewhoare
healthy.IntheEUalmostoneinthreepeopleaged85oroversaytheyareseverelylimitedbyphysical
ormentalhealthconditionsintheactivitiestheynormallydo(Eurobarometer2007).
Princeetal (1998)suggestedthatimmobilityassociatedwithphysicalillnessbringsaboutisolation
andlimitedcontactwithfriendsandneighboursinthelocalarea,leadingtolossofintimacyand
reducedsenseofcommunity,furtherexacerbatingisolation,lonelinessanddepression.Verhaaketal
(2005)(citedinSurretal 2005)providefurtherevidenceofthis:fromanationalpanelofGPs’
patientsfollowedovermorethan15years,themostimportanteffectfrommentaldistressamong
chronicallyillpeoplewasthesocialimpactofillhealth,ratherthantheillnessitself.However,the
relationshipwecurrentlyseeintheUKbetweenage,poorphysicalhealthandpooremotional
wellbeingisnotinevitable:servicesandcommunityinterventionsaimedatreducingsocialisolation
andimprovingcommunitysupportcanreducetheseimpacts.
Moreover,whilephysicaldisabilityisariskfactorfortheonsetofdepression,depressivesymptoms
caninturnleadtoincreaseddisability.AFinnishlongitudinalstudyexaminingtherelationship
betweendepressionandphysicaldisabilityreportedthatdepressedolderpeoplewereathighriskfor
physicaldisabilities(KivelaandPahkala2001,referredtoinSurretal 2005).
Theneedtoencourageandsupporthealthylivingforover-65sisimportant,bothtoimprovephysical
healthandtosustainemotionalwellbeingforolderpeople.However,healthimprovementcampaigns
andpublichealthmeasuresaremostlygearedtowardsyoungeragegroupswitholderpeople’shealth
oftenneglecteduntilpeoplebecomeillandrequiretreatment.Physicalactivity,eatinghealthilyand
drinkingsensiblyareallcloselylinkedtobothgoodphysicalandmentalhealthforolderpeopleaswell
asyoungerpeople.Acrossallagegroupslevelsofphysicalactivity,goodnutritionandsensibledrinking
aredeclining.Levelsofobesitycontinuetoriseinbothchildrenandadultsandtheproportionof
alcohol-relateddeathsintheUKmorethandoubledbetween1991and2006(ONS2008c).
Inthenext10yearsandbeyondtherewillbeevenmoresignificantimpactsastoday’smiddleaged
andyoungerpeopleageandtherisingburdenofobesity,poornutrition,smokingandexcessive
drinkingimpactonolderpeople’sphysicalandmentalhealth.
Alcoholabuseisbothacauseandasymptomofseriousandlow-levelmentalhealthproblems,social
exclusionandisolation.Approximately10to30percentofolderpeoplewhoabusealcoholbecome
depressedandtheyarealsoatgreaterriskofsuicide(Beeston2006).Figuresalsoshowthatolder
menarecurrentlybetweentwoandsixtimesmorelikelythanolderwomentoabusealcohol.
Althoughalcoholabuseisaproblemforpeopleofallages,itismorelikelytogounrecognisedamong
olderpeople.
Theproportionofover-65swhosmokedintheUKwashigherthantheEUaveragein1999,
particularlyforwomen–almostoneinfivewomenagedover65smokedintheUKin1999compared
withjustoneintenonaverageintheEU(SwedishNationalInstituteofPublicHealth2006).Smoking
rateshavefallen,however,intheUKsince1999.Smokingiscloselyassociatedwithdeprivation,with
moredeprivedgroupsmorelikelytosmoke,andisatleastpartlyresponsibleforwideninginequalities
inhealthbetweensocio-economicgroups.
Thereisaclearneedtoinvestinhealthpromotioncampaignsaimedatolderpeopleandtocontinue
todriveinitiativesandinterventionstoimproveolderpeople’shealth.Aswellasreceivingfewer
diagnosesandlesstreatmentformentalhealthproblemsthereisalsosomeevidencethatolderpeople
receivelesspreventativetreatmentsfromhealthservices(Leathermanetal 2007).Forinstance,a
2005analysisoftheprescriptionofpreventativemedicinefollowingheartattackshowedclearage-
baseddifferences(Ramsayetal 2005,citedinLeathermanetal 2007).
Ethnicity
Thereisevidenceindicatingthatsomeblackandminorityethnic(BME)groupsareparticularly
susceptibletocertainmentalhealthproblems,forinstancedepression,andingeneral,ratesofmental
healthproblemsarethoughttobehigherinminorityethnicgroupsthaninthewhitepopulation.
However,thosegroupsarelesslikelytohavetheirmentalhealthproblemsdetectedbyaGP(NIMHE
2003).
Comparedwiththewhitepopulation,therearehigherratesofdepressionamongIndianandPakistani
women,butlowerratesamongBlackCaribbeanandBangladeshiwomen.Maleratesofdepressionare
Figure2.6.
Percentageof 7 Male
peoplewith Female
depression,by
ethnicgroupand 6
gender
Source:McCroneet
al 2008 5
0
White Irish Black Caribbean Bangladeshi Indian Pakistani
moreuniformalthoughwhiteandPakistanimenfareworsethanmenfromotherethnicgroups.There
islikelytobeconsiderableunder-diagnosisandunderreportingofdepression,particularlyformen.
InBritain,researchintothephysicalandmentalhealthofolderpeoplefromBMEgroupsisinits
infancy(Smaje1995).Butpoorerphysicalhealthandhigherlevelsofpovertyhavebeenreported
amongsomeminorityethnicgroups,asdiscussedearlier,andbothareriskfactorsfordepressionin
olderage.
A2005studybyNazrooetal,basedoninterviews,foundthatthereweresixmainfactorsthat
influencedthequalityoflifeofolderpeople:havingarole,supportnetworks,incomeandwealth,
health,havingtime,andindependence.Whilethiswasthecaseforallolderpeople,thewaysthe
factorswereexperiencedwereinfluencedbyaperson’sethnicity.Forexample,theextentoffamily
networks,thelevelofpensionresources,orhealthcanallbeshapedbyethnicity.Theinterviews
identifiedsocial,practicalandemotionalsupportaskeytoagoodqualityoflife.Partner,family,
friendsandreligionemergedasthemainsourcesofsupport.
Intermsoffamilyandfriendshipsupport,olderpeopleintheIndianandPakistanigroupsfaredwell
comparedwiththewhitegroup.Theresearchalsoshowedreligiontobesignificantintermsof
emotionalandpracticalsupport.Theroleofreligioninhelpingprotectolderpeopleagainstdepression
andpooremotionalwellbeingisdiscussedlaterinthischapter.Itisworthnotingherethatforsome
BMEgroups,relativelyhighlevelsofreligiousbeliefandparticipationhelpedprotectagainstpoor
emotionalwellbeing.
Formanyolderpeoplelossofrespectorstatusisoneofthecontributoryfactorsthatleadstopoor
emotionalwellbeing.Theroleofolderpeoplewithincommunitiesandfamiliesvariesaccordingto
ethnicity.ForinstanceolderPakistaniandIndianpeopleinmulti-generationalhomesretaintheir
statusasheadofhousehold,eveniftheyhavedecliningphysicalhealthorneedacarerathome;this
isoftennotthecaseinotherethniccultures(Nazrooetal 2005).
TherearelessonstobelearntfromdifferentcommunitieswithintheUKaswellasfromabroad,both
fortheapplicabilityandtransferabilityofapproachestothewidercommunityandtohelpgovernment
andotherstodevelopandtailorappropriateservicesforparticularcommunities.Itisimportantthat
moreresearchevidenceisundertakenandusedtoshapefuturepolicymaking.
Gender
Womenaremorepronetosomementalhealthproblemsthanmenare,particularlydepression,self-
harmandeatingdisorders,with14percentofwomencomparedwith9percentofmenhaving
disordersofthiskind(ONS2003).Numerousresearchreportsandalargebodyofevidenceindicates
thatwomenreportmoredepressivesymptomsthanmen,bothatyoungeragesandlaterinlife(Surr
etal 2005).Thesituationdeterioratesformen,too,astheyage,andtheybecomeincreasingly
susceptibletodepression.
Lackofdiagnosisofmentalhealthconditions
Acrosstheagespectrummanymentalhealthconditionsarenotdiagnosedortreated.Forexample,
theKing’sFundfoundin2008that51percentofpeoplewithanxietydisordersarenotincontact
withservicesandofthosewhoare,46percentdonotreceivemedicationorpsychologicaltherapy
(McCroneetal 2008).
Lackofdiagnosisisparticularlyacuteinolderpeopleandtherearealmostcertainlyhigherlevelsof
depressionandpooremotionalwellbeingforthisgroupthaniscapturedinstatistics.Ofthoseolder
peoplewhododiscusstheirdepressionwiththeirGP,onlyhalfreceivetherapyortreatment.Fewer
thanonein10arereferredtospecialistmentalhealthservices,andingeneraltheyarenotofferedthe
rangeoftreatments,suchastalkingtherapies,thatareavailabletoyoungerclients(Godfreyetal
2004).
TheNationalServicesFrameworkforolderpeoplesuggeststhatunder-detectionofmentalillnessin
olderpeopleiswidespread,duetothenatureofthesymptomsandthefactthatmanyolderpeople
livealone(DepartmentofHealth2004).Thelackofdiagnosisandreportingofmentalhealth
problemsinolderpeopleiscompounded,andpartlycausedby,awidespreadlackoffocusonolder
peoplewithinmentalhealthpolicy.Mentalhealthinitiativeshavetendedtotargetadultsofworking
ageandchildrenandyoungpeople(Lee2006).
Relationshipsandsociallife
Contactwithfriendsandfamily
Themostimportantfactorsunderlyingolderpeople’smentalhealthandwellbeingaresocialand
communityparticipation.Thereisasizeablebodyofresearchevidencelinkingthestrengthandquality
ofsocialrelationshipsandcommunityengagementtohealth,wellbeingandqualityoflifeforolder
people(BerkmanandSyme1979,Beekman2000,Gottlieb1987,Smithetal 2002,reviewedbySurr
etal 2005).Higherlevelsofsocialsupport,specificallyfrequencyofcontactwithfriends,reducethe
risksfordepressionevenforthosewithpoorphysicalhealth(Princeetal 1998).Conversely,lackof
socialsupportisassociatedwithincreasedmortalityandpoorhealth.
Havingaclose,confidingrelationshiplessenstheimpactofdepression.Italsohelpsindealingwith
majorlifeeventsandstressincludingchronicillness(Surretal 2005).Thisisrecognisedandvoicedby
olderpeoplethemselves.AstheUKInquiryintoMentalHealthandWellbeinginLaterLife states:
‘[o]lderpeoplesaythatvisitstoorfromfriendsandfamilymotivatethemtogetoutofbedinthe
morning.Havingsomeonetotalkthingsoverwithhelpsthemtocopewithworries.Manysaythatthe
mostimportantthingistofeelwantedandneededbyothers’(Lee2006:42).However,thereare
largenumbersofolderpeoplewhoexperienceisolationandloneliness.Estimatessuggestthat1
millionolderpeopleintheUKaresociallyisolatedandthisnumberisprojectedtoriseto2.2million
overthenext15yearsiftheissueisnotaddressed(ibid).
Asurveyin1992showedthatcomparedwithothercountriesinwhatwasthentheEC,peopleinthe
UKhadlessdailycontactwithotherpeoplethanthoseinothercountriesexceptforDenmarkandan
aboveaveragenumberofpeople–40percent–whoneverhadcontactwithfamilyorfriends
(Eurobarometer1993).
Increasesinthenumberofpeoplewithnochildrenorwithonechildarelikelytoimpactonwellbeing
inlaterageascontactwithfamilyisconsideredbymanyolderpeopletobeveryimportantand
havingfew,orno,childrenclearlymeanslesscontact.
Figure2.7.
Proximityto
grandchildren 90
<30 minutes
Source:Presentation
atipprseminaron 80 30 minutes - 2 hours
grandparenting,
> 2 hours
2008
70
60
Percent
50
40
30
20
10
0
< 60 60 - 69 70+ Manual Non-manual
Figure2.7showsdifferencesinphysicalproximitytograndchildren,byageandsocialclass.Itshows
thatproximitytendstoreducewithincreasingage,justwhensupportintheformofcontactismost
neededbyolderpeople.Italsoshowsthatnon-manualgroupstendtolivefurtherawayfrom
grandchildrenthanmanualgroups.
In2005theBritishSocialAttitudesSurveyaskedrespondentshowmuchtimetheyspentwithfriends
andfamily.Womentendedtospendmoretimewithbothfamilyandfriendsthanmen:65percent
statedthattheysawmembersoftheirfamilyorotherrelativesweeklyornearlyeveryweekand63
percentsawfriendsweekly,comparedwith57percentand58percentrespectivelyformen(ONS
2008c).Formanyolderpeoplecontactdeclinesforreasonssuchasbeinginpoorphysicalhealth,
movinghouseorintoacarehome,orbecomingacarer.Astudyexploringtrendsinlonelinessamong
olderpeoplefoundthatnearlyafifthfeltlonelyandisolated(Actoretal 2002).
Researchintowhatolderpeoplevalueaboutcloserelationshipsshowsthatfeelingusefulandgiving
supportandhelptoothersisparticularlyimportanttothem.Thereisagrowingliteratureonthe
benefitsandvaluetoolderpeopleofvolunteering,whichisexploredmoreattheendofthischapter.
Maritalstatus
Nevermarryingisassociatedwithalowprevalenceofmentalhealthproblems,withjust8percentof
menand4percentwomenwhodonotmarryexperiencingsuchproblems.Divorceandseparation
resultinahighprevalenceoflow-levelmentalhealthproblems(experiencedby19percentof
divorcedorseparatedwomenand17percentofmen).Marriageisassociatedwithalowprevalence
ofmentalhealthproblemsinmen(7percent)but,significantly,marriedwomenhadahigher
prevalence(12percent).ThisappearsalsotobethecaseacrossEuropewithevidencefrom13outof
14Europeancountriesshowingthatmarriagewasaprotectivefactorformenbutariskfactoramong
womenwhenitcametolow-levelmentalhealthproblems(ONS2003).Thereforetrendsinmarriage
anddivorceareimportantinunderstandingtrendsandpatternsofmentalhealthproblemsand
emotionalwellbeing.
Livingalone
Unsurprisingly,reportedlevelsoflonelinessarehigheramongthosewholivealonecomparedwith
thosewholivewithothers.Amongthoselivingalone,17percentratedthemselvesas‘often/always
lonely’comparedwith2percentlivingwithothers,and80percentofthe‘oftenlonely’livedalone
(Actoretal 2002).
Table2.2.Proportionofmenandwomenlivingalone,byage,GreatBritain,1986and
2006(%)
1986 2006
Womenaged25-44 4 8
Womenaged75+ 61 61
Menaged25-44 7 14
Menaged75+ 24 32
Source:Dunnell2008
Therehavebeensignificantchangesinlivingarrangementsoverthepast40years,withmorepeople
livingalone,increasingthelikelihoodoflonelinessandisolationforolderpeople.
WhiletheproportionofolderwomenlivingaloneinGreatBritainhasremainedstableoverthelast20
years,theproportionofoldermenlivingalonehasincreased,reflectingincreasinglifeexpectancyfor
menover65andchanginglivingarrangements.Evenso,womenaged75oroverwerealmosttwiceas
likelytobelivingaloneasmenaged75oroverin2006.
Thereislikelytobeasustainedandsignificantincreaseinnumbersofpeoplelivingalone.Figuresfor
Englandsuggestthat70percentofprojectedgrowthinthenumberofhouseholdsupuntil2026will
Figure2.8.
40 Under 65
Proportionof
Over 65
single-person
households,1971- 35
2021
Source:PMSU2008
30
25
Percent
20
15
10
0
1971 1981 1991 2001 2011 2021
bebecauseofanincreaseinsingle-personhouseholds.Manyofthesearehometopeopleaged65
andover.Theproportionofmenandwomenbetween25and44livingalonehasdoubledandas
thosepeoplegetolderthiswilllikelyincreasetheproportionofolderpeoplelivingalone,making
policyinterventionandsupportforsocialengagementforolderpeoplelivingaloneevenmore
important.
Agediscrimination
Discriminationagainstpeoplebasedontheirageiswidespreadandcomparedwithotherformsof
discriminationisoftenseenas‘acceptable’.Thiskindofdiscriminationunnecessarilyexcludesolder
peoplefrommanyservices,publicplaces,communitylife,leisureactivities,employment,mainstream
culture,mediaandpublicdebate.Suchneglectfostersaculturethattendstooverlookorignorethe
viewsofolderpeopleandmakethemfeel‘castaside’.AsurveyoftheEUcountriesin2007indicated
thatintheUKahigherthanaverageproportionofpeoplethinkthatagediscriminationiswidespread
(51percentcomparedwiththeEUaverageof46percent),ranking18thoutof25countries
(Eurobarometer2007).
In2005theDepartmentforWorkandPensions,whichhasresponsibilityforolderpeople,setouta
promisingandambitiousstrategyforimprovingolderpeople’swellbeing.Whilemanyoftheproposals
haveyettobeactedon,thedocumentacknowledgestheperniciouseffectsofageismand
discrimination(DWP2005).Followingthis,theGovernment’sreportASureStarttoLaterLife setout
thateveryone,includingolderpeople,hastherighttoparticipateandcontinuethroughouttheirlives
inhavingmeaningfulrelationshipsandroles(ODPM2006b).However,therehasnotbeensufficiently
sustainedorambitiousactiontocounterwidespreaddiscrimination,althoughitistooearlytojudge
thesuccessofrecentdiscriminationlegislation.
Discriminationalsohappenswithinfamilies,witholderpeople’sneedsmarginalisedorignored.The
extenttowhichthishappenscanreflectdifferencesinethnicgroups.ForinstanceinBengaliand
someotherAsiancultures,ageisreveredandpeoplegainfamilyandcommunityrespectastheyage.
Olderpeoplewithmentalhealthproblemsfaceadditionaldiscrimination.Prejudiceagainstpeople
withmentalhealthproblemsiswidespreadandcontributestounder-diagnosisoftheseproblems
acrosstheagespectrumandareluctanceforpeopletoadmittothemselves,theirfamilyorhealth
servicesthattheyhaveaproblemofthisnature.Forolderpeoplethiskindofdiscrimination
exacerbatessomeofthemostchallengingproblemsassociatedwithageing,includinglossofsocial
life,respectandfeelingisolatedandexcluded.
Eventsandtransitionsinlifethatcantriggerpoormentalwellbeing
Thereisevidencethatparticularlifeeventsarepowerfulriskfactorsintheonsetofdepressionamong
olderpeople(Surretal 2005).Theseincludeonsetofpoorphysicalhealth,bereavement,retirement,
divorce,illnessofaclosepartnerandtakingoncaringroles.Thesefactorsareparticularlyprevalentfor
olderpeoplebecausethelikelihoodofadestabilisingandnegativelifeeventishigherinolderage.
Inacommunity-basedstudy,BrilmanandOrmel(2001)foundthateventsthatcausedseverestress
(particularlydeath,physicaldisabilitiesandhospitalisationofsomeoneclose)wereassociatedwith
onsetofthefirstepisodeofdepressionamongolderpeople(citedinSurretal 2005).Theincidence
anddurationofdepression,stressandanxietyfollowinganegativelifeeventarepartlydependenton
previouslifeeventsandpersonalresourcesandcapacitytocope,andpartlyonsupportavailableboth
fromfamilyandfriendsandfromservicesandcommunity-basedinterventions.
Retirement
Forsomeolderpeopleretirementofferstheopportunitytoparticipatemorefullyinotheractivities
andspendmoretimewithfamilyandfriends.However,forothersitisachallengingeventthatleads
tolongperiodsspentaloneorinactive,feeling‘worthless’andhavingnopurpose.Onlyhalfofall
retiredpeoplesaytheywantedtostopworkingandoverathirdsaytheyfeltforcedtostop(Lee
2006)and‘castaside’,whichclearlyundermineswellbeing.Retirementisoftenaccompaniedbya
significantdropinincome,havingtoadjustexpenditure,movehomesordisposeofotherassets,also
adverselyaffectingwellbeing.
One-thirdofadultlivesarelivedinretirementandaslifeexpectancyincreasesandworkpatterns
change,thisproportionwillincrease.Theaveragenumberofyearsweliveinretirementhasalready
nearlydoubledoverthepasthalf-century,from11toalmost20years(Lee2006).
Bereavement
Mostpeoplefacebereavementandgriefastheyage.Womenareatgreaterriskbecausetheyare
morelikelytolivelongerthanmen.Cross-sectionalsurveys(forexample,theGeneralHousehold
Survey)showthataround50percentofolderwomenarewidowedcomparedwith20percentof
oldermen,andtheproportionsincreasewithage.Whereasjustunderathirdofwomen(28percent)
and9percentofmenuptoage74arewidowed,thecorrespondingrateforthoseaged75andover
is62percentand28percentrespectively.
Whilebereavementistraumaticandstressfulforeveryone,mostolderpeopleeventuallymanagethe
distressandadjust.Forsome,levelsofwellbeingrecovertothesamelevelsorhigherasbeforethe
bereavement(Oswald2007).However,someresearchdescribeshowbetween10and20percentof
olderpeoplesufferseveregriefwhichcan,ifunsupported,leadtoseriousdepression,chronicill
health,anddisability(seeSurretal 2005).Bereavedmenareatgreaterriskofdeaththanwomen,
particularlyduringthefirst12monthsfollowingbereavement.Suicideratesanddepressionarealso
significantlyhigherinbereavedmen.
Thereissomeevidencethatsocio-economicfactorsimpactonthewaybereavementisexperienced.
Forexample,highereducationalstatusandincomelevelsmayplayaprotectiverole,again
highlightingthelikelihoodoffurtherinequalitiesinwellbeingandtheneedforcarefullytargeted
interventions.Bereavementmayinvolvesignificantchangesandfurtherlosses,forexamplelossof
income,relocationandlossofcontactwithfamilyandfriends.Targetedandeffectivesupportto
bereavedolderpeoplecouldhelpthemthroughtheimmediateshort-termperiodandhelpimprove
theirlong-termwellbeing.
Care:receivingandgiving
Asurveysuggestedthatdepressionaffectedoneinfiveolderpeoplelivinginthecommunity,risingto
twoinfiveforthoseincarehomes(Godfreyetal 2004),withmuchgoingundiagnosedand
untreated.Mentalhealthproblems,includingdepression,arealsoamajorreasonforadmissionto
nursingandresidentialcare.
Thereisalackofresearchintowhysomanycarehomeresidentsaredepressedandwhetherthey
werealreadydepressedwhentheyenteredortheybecomedepressedasaresultofdoingso.Care
homesvaryinthewaythatdepressedolderpeoplearetreatedandhowattemptsaremadetoprevent
depression.Again,thereisalackofresearchinthisareaintheUK.
ipprhasfoundthatpeoplereceivingandgivingcarearenotreceivingthesupporttheyneed.And
whilemostanalysesconcentrateonthecostsofcareandtheneedforincreasingsupplyofcarersand
carehomes,itisimportanttofocusalsoonthequalityofcaregivenincarehomesandbycarers.
Moreresearchwouldatleastallowidentificationofbestpracticeandpromotionofwellbeingasagoal
initself(Moullin2007).
AstudybytheDepartmentofHealthandAgeinginAustralia,whichinvolved1,758olderpeoplein
168carehomes,foundthattheywereaffectedbybeingunabletotakepartinactivities,poor
relationshipswithstaffandotherresidents,andnotbeingvisitedenough(referredtoinO’Hanlonet
al 2007).Therearealsolikelytobesignificantvariationsinthedetectionandtreatmentofdepression,
justasthereareinthewidercommunity.Insomecases,depressionamongolderpeopleincarehomes
hasbecomenormalisedandstafffailtoseethatdepressiondoesnothavetobeanormalpartof
ageingoranecessaryconsequenceoflivinginacarehome.
Manyolderpeoplecareforanotherfamilymember.InfacttheEnglishsocialcaresystemisrelianton
havingenoughunpaidcarerstolookafterpeoplewhoneedit.Currentlythreemillionolderpeople
providecarethatisworth£15.2billionayear(Moullin2007).Peopleaged50andover,particularly
thoseaged50-59,aremorelikelytobeprovidinginformalcarethananyotheragegroup.IntheUK,
14percentofpeoplecarefororlookafteradependentpersonof65yearsorolder,justabovethe
EUaverageof12percent(Eurobarometer2004).
Formanypeople,givingcareisrewardinganddoneoutofchoice(Moullin2007,2008).However,for
toomanypeoplegivingcareisnotjustachoicebutanecessityandtheamountofcaretheyhaveto
give,unsupportedbyservices,hasadamagingimpactontheirphysicalandmentalhealth,canharm
theirlifechances,andunderminetheirsenseofwellbeing.Inonestudy,thosewhowerebeginningto
givecareatanintensiverate(over20hoursperweek)hadincreasingsymptomsofdepressionthe
moreintensecaregivingtheygave,poorerself-reportedhealthandhealthbehavioursandoutcomes
thatbecameprogressivelyworseovertimethanthoseoftheirpeergroup(Surretal 2005).
Evidencelinkingmentalhealthproblemswithcare-givingtopeoplewithdementiaisseenasrobust.
Fromtheirreviewofstudiespublishedduringtheperiod1989to1995,Schulzetal (1995)foundthat
virtuallyallstudiesreportedhighlevelsofdepressivesymptomsamongcare-givers(28to55percent)
(citedinSurretal 2005).Giventhatthenumbersofolderpeoplewithdementiaaresettorise,the
impactoncarers’wellbeingneedstobeconsideredurgently.
Thereisclearlyfarmoretobedonetosupportcarersandpreventthemfromexperiencingdepression
andworseningphysicalhealth.ipprinitsargumentformore,bettertargetedsupporttobeofferedto
carershassaid:‘ajustsocietycanbejudgedonhowitsupportspeoplewhoneedcaretolive
independentlives.Butcareforadultshasrarelyreceivedtheattentionitdeserves’(Moullin2008:4).
Lookingatattitudestowardscaringforolderfamilymemberswhoneedregularhelp,intheUKa
substantiallylowerpercentageofpeoplethantheEUaveragesaytheyshouldlivewiththeirchildren
(20percentcomparedwith30percent).AhigherthanaverageproportionofpeopleintheUKsay
publicorprivateserviceprovidersshouldvisittheirhomeandprovidethemwithappropriatehelpand
careinstead.Two-thirdsofBritishpeoplethinkdependentpeoplehavetorelytoomuchontheir
relatives–lowerthaninmanycountriesbutsignificantlyhigherthanFinlandandDenmark,for
example(Eurobarometer2007).
Publicopinionofwhetherpeoplewouldbeprovidedwithappropriatehelpandlong-termcareinthe
futureshouldtheyneeditalsovariesgreatlyamongthecountriesoftheEU,withGreecehavingthe
highestproportionofpeoplebelievingthis,at89percent,followedbyBelgiumat88percent.The
UKislowestamongEUmemberswithonly61percentbelievingtheywillreceiveappropriatecare
whentheyneedit(Eurobarometer2007).
England’ssocialcaresystemforolderpeopleneedstobereappraised,bothforthoseincarehomes
andforthosegivingandreceivingcareathome,withagreateremphasisonemotionalhealth.
Currentlymostofthepolicydebatesandresearcharebasedonfundingandsupplyconcerns.While
theseareimportant,thereisaneedtoensurethatthedebatesdonotlosesightoftheoverall
ambitionofthesocialcaresystem:toprotectandsupportpeoplewhoneedcaretolivehappyand
independentlives.
Communityparticipation
Inouranalysiswehavehighlightedtheimportanceforolderpeopleofhavinganactivesociallife.
However,manyfactorsmitigateagainstolderpeople’sactiveparticipationintheirlocalcommunity.
Physicalaccesscanbeasignificantbarriertoparticipation,forexamplebusyroadscanbevery
difficulttonegotiateforpeoplewithlimitedmobility.Andfearofcrimeorfearofyoungpeoplein
publicspacesmayalsopreventolderpeoplefromaccessingandusingpublicspaces.Inthissectionwe
describesomeofthemainbarrierstocommunityparticipationandaccessforolderpeople.
Crimeandfearofcrime
Oneofthemostfrequentlysuggestedexplanationsforolderpeople’ssenseofisolationandsocial
exclusionwithintheircommunityiscrime.Becomingavictimofcrimehasasignificantandlong-
lastingimpactonolderpeople’swellbeing,leadinginsomecasestoseriousdepressionandwithdrawal
fromsocialengagement.Thereisevidencetosuggestthattheincreasedriskofdepressionasaresult
ofcrimecanpersistoveralongperiodoftimeforolderpeople(ONS2008c).
AccordingtotheBritishCrimeSurveyover-60saretheagegrouptheleastlikelytobeavictimof
crime.Overalllevelsofcrimearefalling,whichshouldfurtherreducetheimpactofcrimeonolder
people.However,theincreaseinnumbersofolderpeoplewillinalllikelihoodresultinincreasesin
numbersofoldervictims.
Fearofcrimeisalsooftenreportedtocontributetoolderpeople’sisolationandexclusionfrom
participationincommunitylife.TherehasbeenafallinfearofcrimeinEnglandandWalesinallage
groups.
In2003intheUK,theover-65shadslightlyhigherlevelsoftrustinpeoplethanyoungeragegroups.
ThiswasnotthecaseinotherEuropeancountriesexceptforPortugalandFinland(SwedishNational
InstituteofPublicHealth2006).
Localenvironment
Thereareage-relateddifferencesaboutwhatpeoplefindmostproblematicintheirlocalarea.People
over65aresomewhatlesslikelythansomeotheragegroupstoviewlitter,teenagershangingaround,
vandalism,crime,drugs,graffiti,anddrunkanddisruptivepeopleasseriousproblems(ONS2008c).
Table2.3.Aspectsoftheirneighbourhoodhouseholdersviewedasaseriousproblem,England:byage,
2006/07(%)
16–24 25–34 35–44 45–64 65andover Allaged16
orover
Traffic 12 17 19 21 19 19
Litterandrubbishinthestreets 14 13 13 15 11 13
Teenagershangingaroundonthestreet 15 18 16 13 8 13
Vandalismandhooliganism 11 11 10 10 8 10
Crime 14 13 12 11 7 10
Peopleusingordealingdrugs 9 10 10 10 5 9
Noise(excludingnoisyneighbours) 8 7 6 7 6 7
Dogs 8 8 8 6 5 7
Graffiti 5 5 5 5 4 5
Peoplebeingdrunkordisruptive 8 8 6 5 2 5
Neighbours(includingnoisyneighbours) 7 6 5 5 2 4
Peopleover65findtrafficthemostproblematicofallthepotentialissuesinaneighbourhoodand
fromthisONSsurveyappearsurprisinglyunworriedaboutteenagers,crimeanddrugs.Forolder
peopletrafficpresentsasignificantobstacletoleavingthehouse,socialisingandparticipatingin
communitylife.Inadifferentstudyof600olderpeoplebyScharfetal (2002)carriedoutinthe
mostdeprivedwardsofthreelocalauthoritiesinEngland,particularfeaturesofthephysical
environmentweresourcesofstressandanxiety:deteriorationinthephysicalfabric–lackof
maintenanceofbuildingsandpublicspaces–andenvironmentalproblemssuchastrafficnoise
andpollution.
UsingdatafromalongitudinalstudyofageinginAmsterdam,Knipscheeretal (2000)explored
therelationshipbetweenthephysicalenvironmentanddepressioninolderpeople(citedinSurret
al 2005).Theyfoundthatlivinginahighlyurbanenvironmentincreasedpooremotionalwellbeing
andlow-leveldepressionamongolderpeople.Highlyurbanenvironmentswereassociatedwith
worsehousing,ahigherriskofbeingavictimofcrime,worsetrafficandhavingfewersocial
contactswithintheneighbourhood.Allofthese,aswehavedescribedabove,arerisksforpoor
emotionalwellbeinginolderpeople.Ontheotherhand,feelingabletoinfluencetheenvironment
andhavingacommunityrole,decreaseddepressivesymptomsinolderpeople.
Housingquality
Housingqualityishighlysignificantforolderpeople’semotionalwellbeing.Poorhousingcontributes
todepression,anxietyandstressandolderpeoplearemostsusceptibleastheyaremorelikelythan
otheragegroupstospendlongperiodsoftimeathome.
Therehavebeensomeimprovementsinhousingqualityinthelasttenyearsandin2005therewere
sixmillionhousescategorisedas‘non-decent’,downfrom9.1millionin1996,theproportionofnon-
decenthomesfallingfrom45percentto27percent(Lee2006).However,sixmillionisstillalarge
number.Theproportionofolderpeoplelivinginnon-decenthomesis34percent,justoverathird.
Table2.3.PoorlivingconditionsinEngland,bytypeofhousehold,2005(%)
Non-decent Poor-quality Energy-inefficient Homesin
homes environments homes seriousdisrepair
One-personhouseholds
Agedunder60 35 20 10 11
Aged60andover 34 14 11 13
One-familyhouseholds
Couple,nodependentchildren
Agedunder60 25 16 11 9
Aged60andover 23 11 13 9
Couplewithdependentchildren 22 16 8 8
Loneparentwithdependentchildren 26 23 7 14
Othermulti-personhouseholds 28 21 9 12
Allhouseholds 27 16 10 10
Source:ONS2008c
TheSocialExclusionUnitestimatedthat2.2millionhouseholdswithapersonover60liveinunfit
housing(ODPM2006a).13percentofolderpeopleliveinhomesthatareinseriousdisrepair,slightly
morethanforpeopleunder60.Cold,damphomesthatarepoorlyheatedhavebeenlinkedtoill
healthandearlydeathsamongolderpeople.
Protectingolderpeople’swellbeing
Insomerespects,whatfostersgoodemotionalwellbeinginolderpeopleistheconverseofsomeof
thefactorsthatundermineit.Certainlyinalltheareaswedescribeabovethereismorethatcarefully
targetedanddesignedpoliciesandservicescoulddotooffersupport.Belowweoutlinesomeother
factorswhich,formanyolderpeople,helpprotecttheiremotionalwellbeing.
Takingonanactivegrandparentingrole
Olderpeopleoftenrefertobeinganactivegrandparenttotheirgrandchildrenasbothasourceof
pleasure,andasgivingthemapurpose(Lee2006).In2007therewere13milliongrandparentsover
theageof50intheUK(PMSU2008)andin2001almost90percentofpeopleaged60andover
weregrandparents(ONS2001c).Inthefuturetherewillbeanincreaseinthenumbersofolder
peoplenothavinggrandchildren,asfewerpeoplehavechildren,butalsointhenumbersof
grandparents,asthepopulationages.
Grandparentsprovide26percentofchildcare,morethananyothersource,eitherformalorinformal:
10percentisprovidedbyfriendsorneighboursand17percentinformaldaycare(PMSU2008).
ThissavesfamiliesintheUK£3.9billioninchildcarecostsannually(Lee2006),andmakesahighly
significantcontributiontothenationaleconomyandtothelivesofchildren.
Thereissomeevidencethattheroleofgrandparentsisbecomingevenmoresignificant.InJune2003
30percentofgrandparentsdescribedthemselvesasafriendorconfidanttotheirgrandchildren,but
thishadrisenbyAugust2006to58percent(PMSU2008).61percentofgrandparentsseetheir
grandchildrenatleastonceaweekandafurther17percentseetheirgrandchildrenmonthly
(informationfromparticipantsinaprivateipprseminar).
Afterhavingamotherstayingathomefulltime,grandparentsarethemostpopularchoiceof
childcare-giversformothers(Leachetal 2008),astheyareconsideredtoprovidethemostintimate
andlovingcare.However,thereissomeevidencethatchildcareisconsideredaburdenoran
obligationbysomegrandparentsandonestudyfoundthat39percentofgrandparentswouldliketo
havealifefreefromtoomanyfamilyduties(informationfromprivateipprseminar).
Thereisstillalackofinformationabouttheimpactonthequalityoflifeandwellbeingoffamiliesof
grandparentsprovidingcarefortheirgrandchildren.Thequalityofcareprovidedbygrandparentsis
highlyvariableandthereislittlesupportforthem,andnoregulation.Researchbycampaigning
organisationshasfoundthatthemajorityofBritishgrandparentsbringinguptheirgrandchildrenhave
experiencedfinancialdifficultiesasaresult,andreceiveverylittleexternalfinancialsupport.
Exercise
Forallagegroupsexerciseprotectsagainstmentalhealthproblemsincludingdepression,aswellas
preventingphysicalhealthproblems:asmallnumberofepidemiologicalstudieshaveexaminedthe
relationshipbetweenphysicalactivityanddepressivesymptomsovertime,findingexercisetogivea
positiveeffectonmentalwellbeing.
Despitethisevidence,thereiscurrentlylittleprovisionorencouragementforolderpeopletoexercise
andwhatthereismostlyfocusesonthephysicalhealthbenefits.Butsomepositivestepsinclude
measuresintheNationalServiceFrameworkforOlderPeople,developedin2001,totestoutwaysof
encouragingolderpeopletotakeexercise,andfrom2008swimmingwillbefreeforpeopleover60.
Educationandlearning
Whilethelevelofeducationachievedasayoungadultisasignificantindicatorofemotionalwellbeing
inlaterlife,continuingeducationandlearningisalsoimportantbothfordevelopinganactivesocial
lifeandasasourceofmentalstimulationandfocus.Morethanathirdofpeopleintheirsixtiesin
EnglandandWalesareinvolvedinadultlearning.OrganisationssuchastheOpenUniversity
encourageolderpeople’sparticipationinlearning.However,fundingforcommunity-basedadult
learningisverylimitedandmanycoursesvaluedbyolderpeoplearebeingcut:thefundingand
nationalpolicypriorityisforcoursesfor16-to19-year-olds(Lee2006).
Volunteering
Volunteeringisconsideredveryimportantforolderpeopleandforallthecharitiesandservices
thatdependonvolunteers.Volunteeringisassociatedwithincreasedlifesatisfaction,withsome
evidencethatolderpeoplederivegreatermentalhealthbenefitsfromvolunteeringthanyounger
agegroups.Itenablesolderpeopletomakeacontributionandisameansbywhichto
participatesociallyandengageincommunitylife,whichreducesthelikelihoodoftheir
experiencingdepressionandincreaseslifesatisfaction,improvesmoraleandselfesteem,creates
largersocialnetworksandincreasesaltruisticbehaviour(Surretal 2005).Interestinvolunteering
peaksintheyearsimmediatelyfollowingretirementandhelpsthetransitionfromworkinglife
intoretirement.Nearlyaquarterofpeopleaged50andoverareengagedinformalvoluntary
activity(Lee2006).
However,therearebarrierstoolderpeople’sparticipationinvolunteering.Nearlyone-fifthof
organisationsplaceupperagelimitsonvolunteeringopportunities,oronspecifictaskssuchas
driving(Lee2006).Otherbarriersincludepoorphysicalhealth,lackofskills,fearofcrimeand
lackoftransportonthepartofthewould-bevolunteerandwhiletheGovernment’scurrent
effortstoboostvolunteeringnumbersfocusonyoungpeople.
TheDepartmentofHealthiscurrentlydevelopingastrategyonvolunteeringinhealthandcare
whichaimstoraisetheesteemandprofileofvolunteering,developsupportforvolunteers,
evaluatethebenefitsofvolunteeringandallowcoherentinvestmentinvolunteering.Itis
importantthatthefuturestrategyfocusesonhowtomosteffectivelysupportvolunteering
forolderpeople,particularlytheolderoldandhowtoencourageandenableolderpeople
whodonotcurrentlyvolunteertoparticipate.Thestrategypresentlyfocusesonvolunteeringin
careandhealthservices,butitwouldbevaluabletobroadenthisfocusbeyondthoseservices
andrecognisethevaluetohealthandwellbeingforvolunteers,whateverthesectorthey
volunteerfor.
Personalresilience
Mostolderpeoplearenotdepressed,eveniftheyexperiencesignificantdifficultevents.Butfor
others,similareventsdoleadtodepression,forawiderangeofreasons.Supportisveryimportant,
butinternalpersonalfactorsintheformofself-esteemandself-efficacyinmanagingstressand
difficultlifeeventsalsoplayasignificantrole.Lowself-esteemisapowerfulpredictoroflow-level
depression(Surretal 2005).Therearecomplexexplanationsforhowself-esteemandefficacy
develop,muchofwhichrelatetoexperiencesinchildhoodandarebeyondthescopeofthispaper.It
issignificantthathavinggoodsocialsupportandanactivesociallifecanlessentheeffectoflowself-
esteemandself-efficacy(ibid).
Religion
Researchhasshownthatreligionhelpssomepeopletocopewithdifficultlifetransitions,suchas
losingajobordivorce,andcanfostergoodemotionalwellbeingforolderpeople(Donovanand
Halpern2002).Thebenefitsstemfromgivingpeopleasenseofpurposeandcontinuedparticipation
inasocialandsupportivesocialnetwork.Morebenefitsareexperiencedthroughactiveparticipation
inreligiousevents.AccordingtotheBritishSocialAttitudesSurvey54percentofthepopulationin
GreatBritainclaimedtobelongtoareligionin2006,afallof3percentsince1996.
Respect
Feelingvalued,respectedandunderstoodcontributestogoodmentalhealthandwellbeing(Lee
2006).Asdescribedearlier,agediscriminationandfeelingexcludedfrommainstreamsocietycan
contributetopooremotionalwellbeingandlonelinessamongolderpeople.Thereisaclearneedto
fosterandencourageolderpeople’sactiveparticipationandcontributiontocommunitygroups,
schoolsandotherneighbourhoodactivities.Encouragingotheragegroupstorespectolderpeople
andencouragemoresocialinteractionwiththemrequiressomequitefundamentalculturalshifts,yet
therearetraditionsamongsomeethnicgroupsintheUKandabroadthatcouldoffertheUKsome
excellentexamples.
3.Conclusions
WhileGovernmenthasarguedthatmanyexcludedolderpeoplerequireadditionalsupportandhelp,
therequiredcoordinatedaction,prioritisation,resourcesandpoliticalandpublicappetitehavebeen
lacking.Thefocusinthisreportonwellbeinghashighlightedthecomplexityofissuesandfactorsthat
drivewellbeingforeveryone,notjustolderpeopleandthereareinequalitiesinthewaytheyare
experiencedwhicharerelatedtowidersocialandeconomicinequalities.
Driversofwellbeing–summary
Emotionalwellbeingisshapedbymanyfactors,includinggender,ethnicity,socio-economicstatusand
inequalities,andphysicalhealth.Lackofdiagnosisandtreatmentofmentalhealthproblemsis
widespread.Continuedparticipationinneighbourhood,familylifeandsociallifeareseenas
particularlyimportantinprotectingemotionalwellbeinginlaterlife.Infact,theimpactofpoor
physicalhealthisoftenmainlyfeltthroughtheresultingimpactonsocialandcommunity
participation.
Wehavehighlightedcontinuedandoftenworseninginequalitiesinincomeandphysicalhealthwhich
compoundanddeepenexistinginequalitiesinolderpeople’smentalhealthandwellbeing.Thereis
alsoaclearsocio-economicdivideinlaterlife,justasinchildhoodandearlieradulthood–being
relativelypoorisasignificantriskfactorforpooremotionalwellbeinginlaterlife.
Thereisaclearneedtotacklepensionerpovertyandhealthinequalities,andaneedformoretargeted
interventionstosupportthosemostatriskofpooremotionalwellbeing.Therearespecifictrigger
pointsinolderpeople’slives,timeswhenadditionalsupportisneeded,particularlyaroundretirement,
bereavement,movingintoacaringroleandmovingintoacarehome.
Beingabletomaintainarolewithinthefamilyandlocalareaandparticipateinsocialandcommunity
lifeisseenasimportantforgoodemotionalwellbeing,buttherearemanyobstaclesforolderpeople.
Changesinfamilyformationsandagrowingnumberofpeoplelivingalonearelikelytoleadto
increasednumbersofolderpeoplefeelingisolatedanddepressed.Poor-qualityhousingcontributesto
poorphysicalandmentalhealthforolderpeopleandjustoverathirdofolderpeopleliveinpoor-
qualityhousing.
Similarly,poorlymaintainedphysicalenvironmentsandbeingavictimofcrimeunderminewellbeing
andcontributetodepression,isolationandloneliness.Trafficproblemsareafurtherobstacleto
communityparticipationandfeelingsofcontrol,bothofwhicharehighlyvaluedbyolderpeople.
Inthesecondphaseofourwork,ipprwilladvocatemoreeffectivestrategiestosupportolderpeople,
particularlythosemostatrisk,toparticipateincommunityandsociallife.
Futurework:internationalcomparisons
Whileoldageissometimesassumedtobeatimeoflonelinessandisolationthisdoesnothavetobe
thecase:othercountriesandcultureswhoseattitudestoageingaredifferentfromthoseintheUKdo
nothavethesamelevelsofexclusionandunhappiness.Inthesecondphaseofthisworkipprwillbe
exploringageinginothercountriesandculturesinmoredetailandassessingwhetherthemost
successfulpolicies,servicesandapproachescanbeappliedintheUK.Wewillalsobeaskingolder
peoplethemselveswhattheywouldfindmosthelpful,particularlyforthosemostatriskandduring
timesofdifficulty.Wewillbeadvocatinganewapproachtoageinginwhichpromotingwellbeingand
soundmentalhealthofallolderpeopleisapoliticalandpublicpriority.Wewillalsoexamineefficacy
incaresystems,againusinginternationalcomparativeevidence.
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