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CHAPTER 8: HEALTH AND WELL-BEING
Introduction
Health and well-being are important at every age and, rightly or wrongly, declining mental or physical health are problems which are commonly associated with ageing. The consultation document posed 4 questions on health issues in later life:
- "What do you think are the most important things for good physical health in later life?"
- "What are the things that contribute most to good mental health and well-being in later life?"
- "What can be done to support those things?"
- "What else could be done?"
In analysing responses it was found that many consultees made a link between physical and mental health and very similar comments were made to the first two questions. Therefore responses to these have been analysed together. Similarly, comments on what can be done and what else could be done covered the same topics; these questions have been also been analysed together.
8.1 GOOD PHYSICAL AND MENTAL HEALTH
Respondents were asked for their views on the sorts of things that can contribute to staying healthy in later life. Responses came from 82% of consultees and 8 main areas were identified as important for good physical or mental health. Chart 8.1 shows a summary of the 5 factors cited by highest proportions of consultees in contributing to good physical and/ or good mental health in later life.
Chart 8.1
Summary of important factors contributing to good health / well-being in later life
8.1.1 Physical Exercise
The main way to stay healthy is to take regular exercise according to 53% of consultees, with 43% mentioning physical exercise in general and 13% commenting on the need to stay active. More specific activities mentioned by consultees included:
- Walking (5%);
- Group activities such as dancing (5%);
- Swimming (2%).
One education organisation commented on the benefits of walking,
"Walking is by far the most common and effective method for people to obtain physical exercise. There is increasing evidence that access to outdoor environments is associated with greater levels of walking in all age groups, so good access to attractive, "walkable" outdoor places is vital for good physical health in later life."
8.1.2 Diet
Forty-one percent of consultees identified a healthy diet as an important part of a healthy lifestyle, with 2% commenting on the need to ensure that healthy food is affordable. In line with this, stopping, or cutting down on, smoking or drinking were identified by 6% and 5% respectively.
8.1.3 Support of Family and Friends
Family and social life were also identified by 37% of consultees as key areas that can help to keep older people both physically and mentally healthy. A voluntary organisation highlighted the issue of,
"smaller family units and increases in people living alone which will have an impact on insecurity, and increased feelings of loneliness which many older people already suffer from."
The need for regular social contact with friends or neighbours was highlighted by 34% of consultees. Eight percent commented on the need for a good family life while 1% felt it better for older people to have family close at hand, rather than dispersed as is becoming more common nowadays.
There were differences across ages, gender and ethnic groups in the number of those commenting on the need for support from family and friends. Only 16% of those aged under 50 commented as opposed to 41% of the 50-64 range and 37% of the over 65 age group. While 38% of women commented; only 26% of men did so. The highest proportion of comments came from members of the Asian community (48%).
8.1.4 Mental Stimulation
Twenty-seven percent of consultees commented on the need for ongoing mental stimulation after retirement and 16% made general comments on exercising the mind. Interests and hobbies were seen as a good way to ensure our minds are kept busy and 8% saw these as important to mental or to physical health. Three percent cited puzzles, 3% reading and 1% creative pursuit activities as providing good mental stimulation. Three percent saw the need to keep learning at every age, while 1% highlighted the need to retain an interest in society. One public body identified the importance of,
"The provision of facilities and events, which allow older people, especially those who live alone, to mix with and meet new people within the community to maintain a network of friends and encourage mental stimulation."
8.1.5 Feeling Secure
Various forms of security were identified by 19% as contributing to our health, although the largest number of comments was on ensuring older people are free from money worries (9%). Eight percent saw the need to reduce any forms of stress in the lives of older people, while 5% commented specifically on physical security and the need for older people not to have a fear of crime. Comments on security included the following from a local authority,
"Feeling secure in terms of financial, emotional, personal safety is also important along with leading a healthy and active life, with access to care and support when required."
8.1.6 Other
Seven percent of consultees saw staying happy and having fun as contributing to good health and this included the need for a positive outlook on life. Allied to this, a feeling of self-worth; of being listened to and feeling useful, was cited by 7% of consultees in ensuring that older people stay happy.
Living conditions and the world around us can contribute to good health; 2% mentioned the need for fresh air and a healthy, pleasant environment while 3% pinpointed good living conditions as key to good health.
Five percent commented on spiritual considerations; 2% mentioned traditional aspects such as faith. Newer or alternative aspects such as yoga or meditation, were mentioned by 3%. A local authority felt that it was important to ensure older people "maintain links with their religious and spiritual communities."
Other factors which were seen as contributing to good health included:
- Good work with reasonable hours and pay (4%);
- Early detection and treatment of illness (3%);
- All-round healthy lifestyle (3%);
- Maintaining independence (2%).
8.2 WHAT CAN BE DONE IN SUPPORT OF GOOD HEALTH?
Having identified factors that contribute to good health, respondents were then asked, "What can be done to support these things?" and "What else could be done?" Only 22% of respondents did not comment at this question. Not surprisingly, many of the responses to these two questions echoed points made in relation to the important things for good physical or mental health. One public body suggested that,
"If older people had ready, affordable (ideally free) access to learning opportunities, leisure opportunities, sports facilities, etc., and were enabled and encouraged to use them (through advertising campaigns, buddy systems, GP prescriptions, etc), they would remain much fitter in body and mind, and would make significantly less demands on health and care services."
8.2.1 Groups and Activities
Requests for more clubs, groups or activities for older people featured in 28% of responses but fewer of those in the under 50 group mentioned this (10%). A further 21% of consultees wanted to see more support and funding for older people's activities. Six percent mentioned the need for involvement with other age groups or cultures and 3% mentioned the need for more activities.
8.2.2 Health Services
Twenty-six percent of consultees commented on the importance of good health care in helping older people stay healthier for longer. Again, there were a smaller number of comments from the under 50 age group (14%). Regular health checks were seen by 8% of consultees as a necessary part of staying healthy, and 4% commented on prevention, rather than cure. A charity noted,
"Much of the focus of future work of services such as the health service will be on preventing problems occurring in the first place, which will be a far more cost effective and efficient way of caring for older people. A preventative approach, which encourages good health throughout an individual's life, will also help ensure older people remain healthy and are able to contribute fully to society and the economy, thus benefiting themselves and the rest of Scotland."
Good access to medical services, including short waiting times, attracted comments from 17%, and 1% highlighted the need for hospital staff to be trained in dealing with the needs of older people specifically. One voluntary organisation commenting on reports from its members noted,
"Many had experienced rushed GP appointments, dismissive attitudes, poor explanations and fears over repeat prescriptions of multiple drugs not being clearly monitored in their local practice."
8.2.3 Advice and Information
The linkage between good services for older people and communication about these services cannot be understated and an organisation from the health sector recommended, "A health improvement agenda which promotes people taking responsibility for their health based on access to good information and advice." In line with this, offering advice on what people can do to help themselves to remain healthy, and publicising services which can offer support, was suggested by 18% of those responding and included:
- Advice, publicity or education on services available to support a healthy lifestyle (12%);
- Advice, publicity or education on diet (9%);
- Advice, publicity or education on exercise (7%);
- Advice, publicity or education on mental health issues (2%).
8.2.4 Encourage Participation
Overall, 14% of consultees, including 24% of organisations, expressed the opinion that more encouragement should be given to older people to participate in a variety of activities. Offering more courses or education choices was seen by 6% as a way of encouraging life-long learning and 2% felt that older people should be encouraged to learn more about IT and other new technology. Voluntary work was seen as a good way to stay active after retirement and 4% felt this should be encouraged.
General comments on the need to encourage older people to stay active were made by 3% while comments on encouraging participation in activities or hobbies were mentioned by 2%. Some of the substantive comments included suggestions that GPs could write prescriptions for activities. One local authority, however, made this proviso,
"Older people should be encouraged to participate in new pursuits made easily available for them to access in their local area(s). Older people should decide what these activities are to be, when they should take place and where etc., and the provision and choice should not be prescribed by younger people who think they 'know best'."
8.2.5 Good, Accessible Amenities
Various suggestions were made, by 12% of consultees, (and 20% of organisations), relating to the need for appropriate and safe houses and localities to allow older people to remain independent and active. These included:
- Good, appropriate housing (5%);
- Good footpath network (1%);
- Good parks (1%);
- Good places to exercise (1%);
- Easy access to community facilities (4%);
- Improved access to libraries (1%);
- Better town planning (1%).
8.2.6 Sports and Leisure Facilities
Ways to improve sports and leisure facilities with the needs of older people in mind were suggested by 12% of consultees, and the affordability of these was the key comment. Eight percent of respondents wanted to see free or discounted access to leisure centres and this included transport to these facilities. Exercise classes specifically for older age groups were requested by 3% while 1% wanted to see set times for older people in sports centres and swimming pools. One percent specified support for walking groups.
8.2.7 Support in the Community
As people grow older there can be a danger that they experience social isolation and 11% of consultees wanted to see more support within communities to relieve this problem. Specific suggestions included 2% who cited befriending schemes, support networks to replace dispersed families (1%), community visitors with 'time to chat' (2%) and friendly neighbourhood support schemes (2%). Five percent of consultees wanted to see more opportunities for interaction with groups from other ages or cultures. The following suggestions and examples came from a local authority,
"Other measures include enabling older people to maintain links with their religious and spiritual communities, and by ensuring that the mental health needs of older people are considered within the Choose Life Suicide Reduction Action Plan. Support has been provided in this area in the respondent's region through a voluntary sector befriending scheme for isolated older people. This complements well-established voluntary projects aimed at increasing and maintaining social contacts such as lunch clubs, phone befriending schemes and walking groups etc."
8.2.8 Finance
Freedom from money worries had been identified as a key contributor to remaining healthy and 11% of consultees felt that financial assistance or advice would help to achieve this. Increased income was identified by 7% of consultees, while 1% felt there should be more help to ensure older people were claiming all appropriate benefits. The need for increased funding for the services themselves was mentioned by 4% of consultees.
8.2.9 Healthy Lifestyle
The need for all ages to lead a healthy lifestyle was commented on by 11% of consultees who felt that this would have a positive effect on health in later life. The members of one charity recognised, " that healthy habits need to be instilled from an early age and it is often too late to give up bad habits when you are older."
8.2.10 Care
Ten percent of consultees commented overall on care issues; 6% saw the need for an increase in those in the caring professions, including social workers, or in the availability of care places. Increased support for families caring for elderly relatives was mentioned by 2%, and 2% felt home-carers should receive funding specifically to enable them to take elderly people out on trips and visits. One percent of consultees felt care homes needed to be better equipped to deal with minority groups. One individual made a specific comment on the subject of finance for care,
" Entry to care homes should not be means-tested as they are now. It is not right that some who have very little in total assets should pay little or nothing, while others who have been prudent and careful all their lives should have to sell their homes to pay for entry to a care home."
Only 3% of the under 50 age group commented on care. Only 5% of men compared to 14% of women commented.
8.2.11 Attitudes Towards Older People
Again, attitudes to older people were identified as one of the factors contributing to physical or mental well-being in later life and attitudes were seen as a factor in health issues by 6% of consultees. Two percent stressed the importance of medical practitioners who care about and listen to older people. General comments on changing negative attitudes towards older people were mentioned by 3%, while 1% stressed that older people should be treated as individuals and not statistics. One percent reiterated that older people should not be made to feel a burden.
8.2.12 Diet
The availability and affordability of healthy food was identified as key to good health by 6% of consultees. The need for low priced health food, including fruit and vegetables was stressed by 5% of consultees, while 1% felt it should be more readily available. One percent called for a ban on unhealthy food. A voluntary organisation commented,
"Nutrition was viewed as being particularly important by the group of people with dementia who informed this response. They said that if people are reliant on home deliveries or someone to cook for them, then good, healthy food is important, as in their experience such meals were viewed as having 'little nutrition currently' and being of 'very poor quality'."
8.2.13 Support for Minority Groups
Overall, 5% of consultees mentioned the need for support for minority groups in relation to supporting healthy living. Specific comments included a need for a higher level of awareness of the needs of older people from ethnic minorities (cited by 3%), while 1% wanted to see language classes or interpreter services more widely available. Comments on the need for more health care information to be available in minority languages were made by 1%. One percent wanted to see specific, perhaps single-sex, groups or activities for ethnic minorities.
8.2.14 Transport
Transportation to allow older people to access services and activities was a feature of 4% of responses on health issues. One public body commented on the need for, "Affordable, accessible transport to make it possible for older people to get out to doctor, shops, etc., but also to a wide range of social events with clubs, or just to visit friends." Two percent wanted to see more frequent, easily accessible buses, while 1% made the same comments about train services. Two percent suggested less expensive transport.
8.2.15 Other
Various other comments and suggestions were made by smaller numbers of consultees and these included:
- No set retirement age (1%);
- The need to ensure older people in need are identified and supported (1%);
- Improved community policing (1%);
- Specialist services deigned for older people and delivered in-home (1%);
- Bereavement counselling (1%);
- Access to short holidays or trips for all older people (1%);
- Comments against a 'nanny state' (1%).
There were also suggestions from some substantive responses that a concerted information campaign in conjunction with other forms of communication are needed to help redress the often negative perceptions held about older people. One consultee noted that campaigns such as the recent advertising campaign for individuals with mental health or the Scotland wide campaign against racism need to be extended to incorporate all individuals, including older people.
In summary,
- The key ingredients for good mental and physical health in later life were seen as physical exercise, diet, support from family and friends, mental stimulation and security. For many, the two elements of good health are interlinked.
- A wide range of services and support were identified as being needed to ensure good health (physical and mental). A key element for any service is the degree to which they help to reduce social isolation and encourage ongoing social interaction.
- Some consultees also noted that a holistic approach to life is needed, with healthy diet and physical exercise from an early age and not just for older people. Additionally, a preventative approach, encouraging good health throughout an individual's life, is important.
- Good health and care services were high on the list of priorities as was the need for advice and information.
- Encouragement for older people to participate in, or make use of, available opportunities was seen as important, with good, accessible amenities to allow them to do so. Sports and leisure facilities should be available and accessible to older people.
- The importance of support from and in the community was stressed and the need for relief from financial stress and the affordability of healthy activities and options.
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