Editorial

Citation

Poland, F.M. (2023), "Editorial", Quality in Ageing and Older Adults, Vol. 24 No. 3, pp. 81-82. https://doi.org/10.1108/QAOA-09-2023-095

Pressures can creatively push the boundaries of inclusion in older peoples’ lives and care provision

Older peoples’ lives and services to support them are under pressure to levels of intensity and in areas previously not widely experienced as societies question and debate financial, familial and institutional responsibilities for meeting contemporary demands and expectations. Individuals, institutions and societies can respond to such pressures in unexpected ways that can lead to creative processes for including new groups, partnerships and practices in complex care, to assess and address previously unrecognised needs.

Pressures to respond to the COVID-19 pandemic has highlighted the need for preventive measures to safeguard the health of older people, but also, rather than taking such measures’ positive effects for granted, to review their effects across many societies. Chan, Al-Ghafri et al. have examined changes in life satisfaction, depression and quality of life for a convenience sample of older people in a healthcare centre in Oman, where tailoring preventive interventions to the needs of older people within their community could be seen to positively impact on depression in women and to improve quality of life for men, and to inform community-level intervention planning in such settings.

As Scourfield comments in his opinion piece on the financial crises now being faced by UK hospices, mostly run by the independent sector, despite introducing many innovative measures to reduce costs by moving delivery to community and home-based settings. They have been experiencing rising demand from people approaching end of life, but only a minority can receive such specialist care. Again experiences of the pandemic have highlighted both the value of such end of life care but also the fragility of the sources of charitable funding relied on to support these services, as lockdowns limited engagement, fundraising events had to be cancelled or curtailed and costs of staff and energy have skyrocketed. Scourfield argues for a new case to be made for such highly-valued services to be based on more stable funding that can sustain rising and new demands.

Over recent years the needs of people with dementia have been increasingly recognised as encompassing far more complexity than earlier widespread assumptions of dementia being intrinsic to processes of usual ageing. Very few studies to date have explicitly addressed the consequences of such complexity. The findings of an e-survey questionnaire study sent to people with dementia lead roles in UK dementia experience, care service provision and policymaking, are reported here by Keady, Jones, Cullum and Watson of complexity in inpatient pre- and post-admission assessment to wards. This has aimed to identify a range of ways to engage with and better understand the features such complexity may encompass and how ward practices may or may not recognise such complexity when assessing care needs in mental health and dementia care. This identified three key domains of complexity, encompassing individual factors, degree of intensity and severity of needs and degree of risk and distress. The authors argue that although there appears to be some agreement about reasons for admitting to in-patient dementia care, this does not appear to be reflected in a similar level of agreement about ways to address such reasons in practice. This calls into question the focus of current assessment in the face of complexity of dementia need.

The adequacy of assessment may similarly be called into question for the increasingly recognised LGBTQ+ population. In the policy commentary paper offered here by Sladen and Thomas with reference to the analysis of the process of Joint Strategic Needs Assessment within England’s public health system, as examined by the Opening Doors charity working for LGBTQ+ over 50s in the UK. UK public authorities have a duty to eliminate discrimination of people with protected characteristics including age and sexual orientation. The analysis of answers to a research questionnaire asking 15 questions sent to all 31 London Boards overseeing Joint Strategic Needs Assessment for all London Boroughs demonstrated how many of these contained little or no information on nor any specific consideration of the needs of their local LGBTQ+ population. Yet where specific information was collected a disproportionately high level of health issues could be seen to affect this group, new and specific health issues were identified and other health research questions were indicated. This commentary provides argued recommendations if Joint Strategic Needs Assessments are to be proportionately more inclusive.

It should be noted how, in all of these articles, we can see how pressures imposed by the COVID pandemic shaped the research and discussions supported here, either by limiting or refocusing the range and types of research that could be conducted during the pandemic, or by encouraging further experimentation in ways of building research relationship, encouraged by lessons in overcoming isolation and anxiety stimulated by the pandemic. Learning these lessons are particularly pertinent and valuable for older people, on whose lives the pandemic imposed heightened disruption and paths to isolation. Such pressures have therefore also helped revalue and reframe research attention and methods to ensure inclusion by identifying both unanticipated and also known and planned-for pressures.

Professor Fiona Mary Poland.

School of Health Sciences, University of East Anglia.

Norwich, England, United Kingdom.

Email: f.poland@uea.ac.uk