Introduction
Across the development divide, countries such as the UK confront the challenges of populations increasingly skewed toward the elderly (and rapidly so) while some developing countries still cope with the strain of predominantly young populations. Economic historian Emma Joseph of the London School of Economics and Prof. Johnson of the University of Pennsylvania ascribe the phenomenon of “greying” populations to long-term declines in both fertility and mortality, notably in Europe as a whole, the United States and Japan (BBC, 2004).
Main Text
There are three grounds for universal concern, a United Nations briefing for the World Assembly on Ageing and its follow-up warns (Population Division, 2002):
- The phenomenon is entirely new to human experience and will continue become even more pronounced in the twenty-first century;
- Accelerating ageing has the potential to affect everyone in the nation, if only because of the competition between the elderly and the very young for support from wage earners and the self-employed.
- There is no reversing the trend. Progress in the life sciences will see to that.
By 2050, the UN Population Division estimates, the large cohort of Britons in their 30s and 40s will be at the threshold of retiring or have done so (see Figure 1). Fully a third of the nation’s population will be 60 years of age or older (see also Appendix 1 for other details), over one-fourth will be at least 65 and one in nine 80+ years in age. In total, there will be only a 2:1 ratio between the working population 15 to 64 years old and the elderly.
In just 17 years or by 2025, there will be 13.4 million Britons 65 years of age or older. This is a very substantial increase of 42.6 percent over the 2000 population of 9.35 million in the time it takes to raise an infant to mature and enter university. In the present situation where the NHS is hard pressed to even man all its services and commitments, forward planning is plainly needed to make provisions for care, to grapple with the scale of economic impact, and to accelerate the initiative of government for soliciting advice and assistance from all stakeholders.
Current State of Affairs
The more forward-looking of academic and health authorities empathize with the desire of the elderly to live out the third epoch of life in dignity, to receive the care they require, and in all other ways, to enjoy reasonably excellent quality of life. At the university level, preparing for the next decade and a half or the rest of the century must start with a sober assessment of where matters stand.
The following examples suffice at this point to suggest that viewpoints remain myopic and that concern for the elderly remains inextricably linked with gerontology. One needs to get away from a narrow-minded focus on degenerative diseases and dementia.
While the concern with dementia is valid enough –the University of Bradford estimates there are three-quarters of a million afflicted in the UK (2008) – the fact is the school offers no less than three ways to specialise in treating the degenerative condition: a Professional Development Programme in Dementia Care, DipHE in Dementia Studies, and BSc (Hons) in Dementia Studies. These have the unfortunate consequence of revealing narrowed perspectives on the clearly varied needs of the elderly.
Representative of the other extreme is the somewhat lackadaisical attitude where degrees and clinical practices subsume concern for the elderly under more general areas. For example, the University of Reading offers a 3 year full-time Degree in ‘Psychology, Childhood and Ageing’. At the Cheltenham General Hospital and Gloucestershire Hospitals NHS Trust, elderly care is entrusted to Registrars and Residents specialising in either ‘General and Old Age Medicine’ or ‘Adult Medicine/Elderly Care’. True, the department of General and Old Age Medicine admits to dealing primarily with the diagnosis, treatment and rehabilitation of older people. During confinement, patients are seen by a multidisciplinary team usually including doctors, nurses, physiotherapists, occupational therapists, speech therapists, dieticians, social workers, pharmacists and psychologists since the avowed aim is to restore the elderly not only to health but also independence and a sustained quality of life. In turn, the Delancey Hospital, RW1 and RW2 units of the Trust provide ongoing care of older people with more complex needs, and those requiring a re-organisation of their care at home before leaving hospital. There are also specialist clinics, usually led by Consultants, that specialise in stroke, falls and movement disorders like Parkinson’s disease. Once older patients regain optimal health and can be discharged to community living, the Trust has ongoing links with community hospitals and a variety of Intermediate care services in Gloucestershire so primary care can subsequently be administered as needed.
Forward-looking releases from government notwithstanding, it would seem that educating for elderly care under the aegis of a great drive for training in the healthcare sector are limited to upgrading staff to NVQ level 2 (Train to Gain). At that, institutions that respond are left on their own to find sources for mandatory and bespoke short courses.
Aims of Plan
In general terms, this government-funded study will aim to:
- Test target public awareness, interest in, and conviction about taking action to prepare better for an ever-expanding population of elderly.
- Gauge public attitudes to care, health, accommodation, quality of life gaps, professional preparedness, and many other issues associated with ageing.
- Test the consensus for the extent to which gaps in service delivery to the elderly can be remedied with new areas of academic and professional training.
- Gather expert opinion on occupational effects of expected advances in life sciences and technology that might apply to various aspects elderly lifestyles.
- Investigate what other opportunities exist in respect of care for the elderly in the coming decades.
What is the Research Question?
Accordingly, the central question of this research plan pertains to ‘what is the broader scope of academic curricula’ that will better inform public policy and provide the full range of specialised occupational skills the elderly will need in future?’
Proposed Methodology and Rationale
The study hypothesis going forward is that enriching academic curricula must take into account the concerns of all stakeholders. As well, a combination of primary data-gathering methods will be required to optimise the rigour, reliability and validity of the plan.
The Key Resources to be Surveyed
Over a time scale of 30 months, this study will pool a variety of resources:
- An extensive review of the literature in order to arrive at a comprehensive inventory of the needs of the elderly and the specialist occupations required to satisfy those needs.
- The elderly themselves, including those nearing retirement, to update our understanding of a cohort that had, in the course of their working and business lives, known war, liberalism, wrenching economic change and the flowering of the information age.
- The families and community-based carers expected to lend an objective view of assistance needed from known and absent specialist occupations.
- The front liners in primary health care.
- Pulling together interdisciplinary teams of social and medical scientists to consult with academic leaders on occupational manning needs in the long term.
- All other organisations that presently play a role in catering to elderly wants and needs (see below for a partial listing).
As to the stakeholders:
Data Collection and Analysis
Research Strategy and Process
In broad terms, we plan for a three stage process combining:
The first stage of qualitative methods is required by the presumption that one needs to know the full range of quality-of-life goals and care that needs to be delivered to a sophisticated population of elderly Britons. The open-ended mindset of focus group discussions, depth interviews and (for those nearing or already in retirement) a one-month electronic or traditional diary will be required to canvass all critical issues and:
- Complete the questionnaire content for the second-stage quantitative studies.
- Refine the working hypotheses and independent variables that will be examined in randomised controlled trials.
At the third stage, findings will be discussed in professional, government and academic symposia in order to draw up the recommendations for academic curricula.
Study Instrument
Even at the exploratory stage, it is already possible to foresee study instruments that address a comprehensive range of issues relating to care or quality of life for the elderly. These issues include:
- General primary, acute and critical care
- Disability care
- General health and fitness
- Mental health
- Day centres, residential and nursing care homes
- Second careers and personal learning
- Counselling
- Entrepreneurship, home business
- Care payments, personal financial management and pensions
- Volunteerism
- Travel, leisure, driving and mobility
- Social activity, belonging to organisations such as political parties or trade unions, charities or sports clubs
- Extended and nuclear family networks
- End-of-life issues: wills and benefits
Area Coverage
Nationwide, in both urban and rural settings across both England and Ireland.
Data Analysis
This will consist of content analysis in the first stage, cross-tabulation and statistical significance in the second, and consultations or peer review in the third stage.
Bibliography
BBC (2004) Are we the wrong age?, Open2Net, The Open University. 2008. Web.
United Nations Population Division (2002) World population ageing: 1950-2050, Dept. of Economics and Social Affairs, Population Division. Web.
University of Bradford (2002) Dementia studies, Undergraduate Courses 2008. Web.