Tuesday, 14 May 2013

Ageing Gracefully

They will still bear fruit in old age,
they will stay fresh and green.
Ps 92.14

One of the often-told stories in my family is of how my grandmother got on a train and travelled from Colwyn Bay to Liverpool at the height of the bombing during World War II. She rescued her elderly mother and brought her to live with the family in Old Colwyn, where my great-grandmother, 'Nain', ended her days in the bosom of her family. I think she was only with them for a few months before she died peacefully in her sleep. In the next generation, my grandfather enjoyed about ten years' retirement, had a stroke and was nursed in the local community hospital, with friends and neighbours popping in, for about 6 weeks until he died.

The pattern of the end of life is changing. It's much more common, now, for people to have long years of retirement. I was talking to a friend the other day who said he was just about to tip over into the situation where he had been retired for longer than he had worked. Often people get to the stage where they need increasing amounts of support and nursing over many years and there is, at some point, a decision to be made about whether this can go on happening at home. Many spend more years in a nursing home than my Nain spent months with her family in Old Colwyn.

Our social care system is based on out-dated assumptions about the shape of society. In the 1940's when the Welfare state was born, most people died in their 60's, 70's or early 80's after a relatively short retirement and so those who contributed to the State far out numbered those who relied on its provisions. This is increasingly not the case. Some studies show that between 2010 and 2030 there will be an estimated 50% growth in the population of over 65's and a doubling of the number of over 85's. (See Social Care Funding; A Bleak Outlook is Getting Bleaker published by the Association of Directors of Adult Social Services on 6th May 2013.) This has been described as a 'demographic tsunami.' A study undertaken by Dan Blazer in 2005 shows that depression among the elderly is a dramatically growing phenomenon in the West - The Age of Melancholy; Major Depression and its Social Origins, Routledge 2005.

What good to us is long life if it is so difficult and barren of joys,
if it is so full of misery
that we can only welcome death as a deliverer?
Sigmund Freud

We appear to be walking unprepared into a wholly untenable situation and the answer does not seem to be to fling more money at the NHS. The NHS has long been focused on acute health care and is, I think, getting better at preventive health care. It has increasingly handed social care over to other providers and divorced medicine and nursing from basic care such as cleanliness, nutrition and emotional support. I can't see that changing anytime soon even with large injections of cash.

Don't we need a major re-think about what makes life whole and valuable and even possible for older people and their families? The answer probably does lie partly in more social care available in the home. It probably lies with the generation of strong community services such as day centres, education centres for older people, activity groups, places to eat and dedicated transport networks; much of this can be done by volunteers. But doesn't it also lie with giving far more of a voice to the elderly who have a lifetime of experience on which to draw and who, with support, can often find their own solutions to living with the limitations that old age brings? I know a group of five friends who eat their main meal together every weekday. This means each one has to cook only once a week and the local 'you shop, we drop' lorry does the carrying.

How welcome is old age,
the aged are beloved of God.
Midrash Rabbah

We need to think differently about the shape of the end of life. We tend to  assume that people have their family networks and that families will take on the care of their 'own' older people. This can be a source of pride - 'we looked after Gran well.' But this does not take seriously the geographically scattered and fragmented nature of society and it leaves those with no family to turn to for whatever reason singularly isolated and vulnerable.  It also fails to recognise that, much as many of us love our families, we need the understanding, friendship and support of our contemporaries to live well. And that is perhaps especially true as we begin to experience the bereavements that inevitably come in later life.

Suggestions might be
  • Fund more work to link the elderly with each other and initiate and support self-help groupings.
  • Re-educate for a culture that encourages people to seek out their friends as they age and see what they can do to give mutual support beyond just the immediate family.
  • Use volunteer groups and faith communities to generate inter-generational interaction and discussion.
  • Promotion of strong, positive elderly role models by the media and on the internet. 
  • Provide retirement courses or interviews with GPs where people are encouraged to make plans for their old age and to have goals. (A bit like a birth plan - it seldom goes entirely smoothly, but it helps to have one!)
  • A review of the safeguarding systems so that they allow us to vet who is looking after our elderly without excluding common sense sharing of knowledge and care across the professional and voluntary sectors and with family.
None of these things would be very expensive. But they require us to question some of the assumptions that underlie belief in the value of the nuclear family and some of the values embedded in our current approach to health-care. They require us to talk openly about the things we look forward to and the things we fear in old age.

In their book A Vision for the Ageing Church James M. Houston and Michael Parker tell the story of Mor, a Norwegian grandmother. 'Mor's daily disciplines were consistently loving and honouring of those around her. For example, each day, coffee was served at 4pm for anyone choosing to visit. Mor provided her total attention to the needs of the guests.' Having nursed the elderly when I was younger, done upwards of 1,000 funerals as priest, and tried to look after my own ageing relatives, the thing which I think most besets old age is isolation and aloneness. Or the fear of it. There is a real sense of being alone, even while living in the middle of people, if they, in fact, present as strangers or as non-empathetic in their various roles. The greatest need for most old people is someone they can really talk to regularly. In the Christian and Jewish scriptures, hearing what the old have to say is connected with the learning that, in turn, leads to long life and wisdom.

He who learns from the old
 is like one who eats ripe grapes and drinks old wine.
Abot 4.20

J.M. Houston and Michael Parker A Vision for the Ageing Church; IVP Academic, Illinois, 2011
The Joseph Rowntree Foundation Bog We need A Plan to Care for An Ageing Society John Kennedy 8th May 2013
The Association of Directors of Adult Social Services website  Social Care Funding; A Bleak Outlook is Getting Bleaker 6th May 2013
Dan G. Blazer The Age of Melancholy; Major Depression and its Social Origins, Routledge, New York 2005

Bringing together Age Concern and Help the Aged.

No comments:

Post a Comment