How Older People
their Identities and Preferences in the
Face of a Limiting Physical
Condition and the Need to Accept
Health and Care Services
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This research aims to link two established streams
of research and publication which have remained relatively isolated
from one another but which, when brought together, have the potential
to explain some of the variety in the life quality of older people.
The first of the research traditions is that of policy analysis
of the allocation of health and social care services among older
people. The second is the substantial literature on what has been
called 'ageing from within'and is concerned with how people manage
their identities when dealing with age and the limitations it
The 'fit' between needs and services has been a
central focus of much social policy and social care research,
particularly in the UK. It is driven by a variety of concerns
but the potential 'costs' of an ageing society have been paramount.
Research objectives have been to pinpoint innovations and strategies
that 'target' public resources where they bring maximum social
and political benefit. In the UK and other industrial countries
this 'managerialist' focus has led to major policy reforms designed
to improve the targeting of public resources. Yet the evidence
is that, while some progress has been made, there remain substantial
inequalities in the take-up and use of services, large unexplained
variations in the costs of similar provision, and evidence that
considerable numbers of older people with substantial care needs
are getting little or no help. Obtaining a good Īfitā between
services and needs remains an intractable policy problem.
The second research tradition, that is concerned
with biography, life review and the management of identity, is
immensely rich and varied, but it has rarely focussed on people's
accounts of the fit between their needs and the help they can
or are willing to use. What studies have revealed is that maintaining
one's identity and self-esteem, built up over a whole life-time,
may be more valued than adjusting to 'appropriate'or 'convenient'
solutions to the needs of later life.
Aims and objectives
The main questions this research is seeking to answer
are: in what ways do people who are just entering the 'fourth
age' (that is where their activity is restricted by at least one
of the infirmities commonly associated with later old age) manage
and possibly reconstruct their lives in the context of the new
problems they perceive they have encountered? To what extent do
their understandings of the difficulties they face and the ways
in which they are dealing with them reflect their conceptions
of self, their life histories and their main sources of self-esteem?
How do their adaptations interact with the form and goals of health
and social care services and influence their ability to use 'available'
provision? The study will map the interaction of older peopleās
own life-strategies with the provisions of the social welfare
system and its implications for life-quality.
Two qualitative interviews, spaced six months apart,
are being conducted with a quota sample of 35 people aged 75 and
over, who are living on their own and who have recently developed
a physical disability which now means they need help at least
once a day. The interviews move from relatively specific questions
about needs assistance to much more open life-review questions.
The research uses the Southampton Self-Esteem and Sources of Self-Esteem
Scale (SSESS) developed by Professor Peter Coleman and colleagues.
The data will be analysed using qualitative techniques. The central
goal is to differentiate the sample in terms of their needs, their
coping strategies, their use of services and to relate these systematically
to the accounts they have offered of their lives and 'life-themes'.
Some of our conclusions will be reported to the respondents in
the second interview in order to listen to their judgements of
It is hoped that the research, by providing a better
understanding of the consumer or user perspective, will be able
to widen and influence current policy debates about developing
a 'mixed-economy of care' for older people. Subject to the results
the research actually produces, we hope to develop an empirically
grounded description and explanation of how and why some older
people prefer not to use, or are unable to use, health and care
services which they 'need'. One of our hypotheses is that there
are limits to the degree to which local authorities and others
in the primary care system can be expected to ration resources
precisely in proportion to need. We are also seeking to influence
practice by involving local GPs, community nurses and care managers
in the research process itself.