Normal service resumes

Judi Dench and The QueenNormal service is about to resume – with apologies to anyone who noticed that Christmas has been quiet. In the meantime, here are some links:

First, a piece I wrote for the Daily Telegraph, pegged to the news that nearly a fifth of people in the UK will live to be 100.

Second, a New York Times op-ed article by Susan Jacoby, which touches on the longevity/morbidity debate: will longer lives be lived in good health, or will they mean longer periods of illness? Truth is, we don’t know. The latter is an alarming prospect, yet, especially since Shipman, very few doctors appear willing to debate publicly the limits to their obligations to keep people alive.

Third, an article from The Economist suggesting that happiness begins at the age of 46 – though if you’re Ukrainian, it appears you’ll have to wait until your mid-60s. A look at the burgeoning field of happiness indices, with a bit of speculation as to why happiness seems to grow, or at least return, as people age.

And last but not least, a report card on his generation by the Australian philosopher Peter Singer as the first baby boomers reach 65. This is a much broader take on the effects of the boomers than the usual economic analyses, taking in war, the environment and poverty. Personal, beautifully written, and optimistic.

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The past is not another country

Sarah ReedMaking conversation in a care home is hard work. The commonest opening gambit is probably, ‘What did you have for lunch?’ which is not a question to which the answer is going to be a) very interesting, unless Heston Blumenthal has popped in, or b) readily available to anyone with a cloudy memory, let alone dementia.

Sarah Reed spent 10 years visiting her mother in a care home, hearing visitors making similar, hopeless inquiries. She realized family members and residents needed help relating to each other in a disconcerting new setting and came up with Many Happy Returns, a series of A5 picture cards designed to inspire reminiscence.

The cards feature objects and events related to what Professor David Rubin has called the ‘reminiscence bump’ – a period in life, between the ages of five and around 25, when the most vivid images and persistent memories are laid down.

The first beautifully-produced set of 26 cards shows artefacts and activities from the 1940s – a sewing kit, a ration book, cleaning the front step, evacuation. On the back is a few lines of background, designed to give younger people a way into the subject, and  some conversational prompts: ‘Who cut and styled your hair? Whose hair did you admire?’

A set from the 1950s has followed, which seem richer, perhaps because life had got richer, perhaps because the pointers to discussion are a bit more tangential – so, for example, a box of Television Selection biscuits might prompt a conversation about how early TV sets were often covered with lace cloths, or about favourite programmes.

Long-term memory is more persistent than short-term; older people have been described as entering the vale of anecdote. The cards leave plenty of room for that but also offer the possibility of triggering different stories, of refreshing conversations and drawing families closer. There are benefits for younger people too, in hearing about social history from those who were there.

Sarah Reed is persuasive about the importance of reminiscence in maintaining identity in care homes, where it can so easily be eroded. She is adamant that no one should go into a care home without an autobiographical album of their life story, complete with first-person captions, to enable staff to link the individual back to the person they were before, to approach them as a whole person, not simply a ‘resident’. She runs workshops for care home staff in engaging with older people in ways that maintain their dignity and create real relationships – and also writes a very good blog here.

Older people want to shop shock

shopping trolleyIt is a paradox that older people make up a large and growing number of consumers – presenting a tremendous opportunity – yet they are almost entirely ignored by marketing executives. Over-50s need and want to buy stuff like anyone else, but some 90% of marketing spend is directed at younger people.

A report out today from the International Longevity Centre (ILC), published by Age UK, attempts to tease out some of the reasons behind this. These turn out to be a complex nexus of ignorance, prejudice, myopia (metaphorical as well as literal) and ineptitude. What’s more, according to the report’s author David Sinclair, many of the market barriers he has identified are exactly the same as those that were first noted 50 years ago. We may be a maturing population but our marketing techniques are going nowhere.

The Golden Economy is compiled from existing literature and new research and is full of ideas. The causes of market failure being so complex, unfortunately the report can offer no single explanation of what’s gone wrong or how to put it right. One of its clearest messages is that significant numbers of older people are spending less than their incomes would appear to allow: it’s not simply lack of money holding back spending.

The true barriers are best understood from anecdotal evidence: the housebound man who would like to buy by mail order but can’t get to the Post Office to return goods; the blind woman who would like to buy stylish clothes, but has no one to tell her how they look when she tries them on. In many European cities, over-50s are one of the main groups eating out, yet restaurant menus are printed in such a way that it is virtually impossible for anyone over 50 to read them without glasses.

Often these obstacles are the result of a simple lack of thought, of designers and marketers failing to put themselves in the shoes of their consumers. At the root of that lies ageism – a reluctance to think about getting older, presumably in the hope that, if ignored, it might simply go away. A vicious circle sets in: advertisers don’t pay attention to the older market, so the media don’t see any need to cover or address older people, so older people feel they don’t matter and have no right to assert themselves. Too often, they blame their own shortcomings for the lack of services (‘What else can I expect at my age?’)

There are dismayingly few examples of good practice, although David Sinclair cited an interesting case at the launch event for the report. Some time ago, Google doubled the size of its entry box without explanation. The only clue to what was going on came from a small blog by a designer, who revealed the move was meant to make the search engine more accessible. Good inclusive design, as has been noted again and again, is almost unnoticeable because it benefits everyone.

Girls shopping

This is how you have to look when you go shopping

There is a real problem in marketing to older consumers, in that no one wants to think of themselves as old, or even ‘older’. So you have to take age out of the equation while thinking of what works for people who for any number of reasons are not standard, or fully fit. But in a profoundly ageist society, that’s a big ask. Think of shopping, and what do you visualise? I’d be surprised if it’s not twentysomething girls with carrier bags: shopping is presented as an exclusively youthful pleasure.

Yet older people need to eat and care for their homes and wear clothes and have a good time as much as anyone else. This report is a useful reminder of that, while also painting a rather daunting picture of how far we have to go to give everyone fair and easy access to the goods they need.

ILC report

Of carers and careers

elephant in the room‘The most serious social policy issue in decades,’ is how the Centre for Social Justice (CSJ) describes the ageing population and, in particular, its need for social care. Yet there’s quite astonishing apathy when it comes to planning for what’s about to hit us – the 1.7 million more people who will need social care over the next 20 years and projected doubling of those with dementia in the next 30 years.

The CSJ, a think tank founded by Iain Duncan Smith, highlights this paradox in its Interim Review of Older Age, a 250-page assessment of the state we’re in. Recommendations will follow in a final report due out next year.

Why aren’t we better prepared? Is it that nobody wants to think about ageing? That we can’t imagine it will happen to us? Is it the fault of the financial services industry, for not coming up with insurance products? Should governments have worked harder to resolve the tangled relationship between healthcare (free) and social care (means tested)?

The fact is that the soaring demand will come at a time of spending cuts and falling numbers of unpaid carers. The Centre for Social Justice attributes the latter largely to family breakdown, which is certainly a factor although there is also a more general atomisation, a feeling that individuals’ duties are first to themselves and their careers. Old people and our kind of capitalism don’t go very well together, unless the old people happen to have done extremely well financially earlier in life.

In a recent poll for ippr, the Institute of Public Policy Research, 45% of those asked said they would prefer professionals to provide care while a majority felt they should not be compelled to pay for care of their relatives. Many people believe social care is, or should be, the responsibility of the state. Unfortunately for them, the state is much less convinced. (The government’s recent Vision For Social Care talks a great deal about individuals, community groups and the Big Society.)

The scale of the problem is terrifying, the lack of preparedness more terrifying still. And every single discussion about it concerns money. We might find it easier to think about the issues if we looked down the other end of the telescope, if we started by asking: What would good social care look like? How might it genuinely involve both the social, and caring? Then maybe people would find care less horrible and overwhelming to think about, and we could begin to have a sensible debate.

Worth remembering

Nora Ephron

Nora Ephron

If you’ve ever rummaged frantically through the accumulated rubbish in your brain for someone’s name at a party, you will relish Nora Ephron’s latest book, I Remember Nothing. Ephron, who wrote When Harry Met Sally, Sleepless in Seattle, Heartburn and, most recently, Julie and Julia (which she also directed) has published a new collection of blogs, columns and jottings, in several of which she addresses the depradations of age with her characteristic wit and verve.

The articles are of variable length and some seem rather more tossed off than others, but Ephron is incapable of being boring. The opening piece, which gives the book its title, is stylishly constructed and full of good jokes about the awfulness of losing your memory: ‘I used to think my problem was that my disk was full; now I’m forced to conclude that the opposite is true: it’s becoming empty.’ Ephron goes into a store to buy a book about Alzheimer’s Disease and forgets its name; she spots a woman in a Las Vegas Mall and wonders why she recognises her, only to recollect that she’s her sister, the person she is there to meet.

In one of the best passages, she describes attending an anti-Vietnam march in her youth – or rather, not attending it because she spent most of the day in a hotel room having sex with the lawyer she was dating at the time.

Norman Mailer wrote an entire book about this march, called The Armies of the Night. It was 288 pages long. It won the Pulitzer Prize. And I can barely write two paragraphs about it. If you knew Norman Mailer and me and were asked to guess which of us cared more about sex, you would, of course, pick Norman Mailer. How wrong you would be.

Ephron blogs for The Huffington Post and the pieces in the book reflect a wide range of interests – her love of journalism; the alcoholism of her parents; her online Scrabble addiction; and a moving piece about her identity having been defined for most of her adult life by the fact of being divorced. But it’s the pieces about ageing (Ephron is 69) that bookend the selection and give it resonance. ‘You lose close friends,’ she writes, ‘and discover one of the worst truths of old age: they’re irreplaceable.’ This is a particular, spiky, charming take on ageing, fiercely individual but very recognisable.Book jacket

Purpose Prize winners 2010

Allan Barsema

Allan Barsema

A former homeless alcoholic and a housekeeper are among this year’s winners of The Purpose Prize, a $100,000 award for entrepreneurs over the age of 60.

The five winners, announced today, were selected by a panel of judges chaired by Sherry Lansing, former CEO of Paramount Pictures and the first woman to head a Hollywood studio.

Sherry Lansing

Sherry Lansing

Among them is Allan Barsema, whose alcoholism cost him his marriage, his home and his job, and who lived for a period from a trailer pulled behind his car. With help from his parents, he managed to stop drinking and to re-establish himself in work; and when, 10 years later, a homeless man barged into his construction company, he decided to set up a room for homeless people in his offices. At the end of that year, 2000, his work with the homeless had become so consuming that he devoted himself full-time to his centre, Carpenter’s Place. He settles 300 long-term homeless people in accommodation each year and has set up an innovative online system to coordinate services for the homeless, Community Collaboration, which has been adopted by 140 agencies in five states.

Margaret Gordon

Margaret Gordon

Margaret Gordon started reading environmental magazines in the house she cleaned and began to link pollution from the nearby container port to the one in five children aged between one and five in her home town of West Oakland who were being rushed to the emergency room  with asthma. Her analysis and campaigning has reduced diesel fumes and pollution from West Oakland’s port and she has been appointed by the Mayor to monitor toxic emissions.

Barry Childs

Barry Childs

Barry Childs is a former corporate executive who has set up a project to provide care and schooling for children, mainly orphaned by AIDS, in Tanzania, which has ended up helping whole communities.

Inez Killingsworth

Inez Killingsworth

Inez Killingsworth worked for the Cleveland Board of Education before she started fighting banks that had mis-sold mortgages and were turfing people out of their homes, demonstrating to them that they were wrecking whole neighbourhoods as well as individual lives. By fighting foreclosures, she has helped more than 10,000 families keep their homes. She has appeared in front of Congress and become a national spokesperson against shady mortgage practices, and a campaigner against the hefty penalties imposed by banks for missed mortgage payments.

Judith B Van Ginkel is a professor of paediatrics who, at the age of 60, created a home visits programme for first-time mothers at risk, half of whom were clinically depressed, and two-thirds of whom had witnessed violence or been victims of violence. Mothers in the programme are visited from the time when they first discover they are pregnant to when their children are aged three and can access help with health concerns, literacy, parenting and education.

Judith B Van Ginkel

Judith B Van Ginkel

So, five people with very different backgrounds, but a common desire to achieve something for others in the later part of their lives. You can see short films about all the $100,000 winners here; and there is more information, including about the five more $50,000 winners here. Oh, and please, Europe needs a Purpose Prize, too.

Design for living

lightPeople of 80 or 90 plus who are eking out their lives in nursing homes with very poor quality of life are, according to New York geriatrician Mark Lachs, an indictment of society’s priorities. ‘I would argue,’ he writes, ‘that the “life extension” these people have experienced – a good deal of it the result of technology – is as big a failure of medicine as any 40 year-old dying of breast cancer or 50 year-old perishing of a heart attack.’

Dr Lachs is the author of Treat Me Not My Age which, despite its title, isn’t mainly a book about ageism in medicine, but about how to avoid becoming one of those people with half-lives, detached from the world, fading away even while being kept alive by the ‘miracle’ of modern science. Some of Lachs’ prescriptions are familiar – he emphasizes the crucial role exercise plays in delaying immobility – but he also draws on fascinating work being done at Cornell University’s Weill Medical College, where he is professor of medicine, on the ways in which design can allow people to remain at home and connected to the world.

Architects typically base their designs on the body measurements and movements of people aged between 20 and 50 with no visual impairments. In an ageing population, this is a serious problem for housing, not to say discriminatory. Sometimes the modifications that would, for example, prevent falls – using contrasting colours for seating and carpets, or ensuring that there is good lighting in hallways, especially between bedroom and bathroom – are inexpensive and, once you have been alerted to them, glaringly simple.

Mark Lachs’ book led me to the Environmental Geriatrics website of his department at Cornell and to its offshoot This Caring Home, both of which are full of tips for intelligent design for homes. It’s worth looking at the multimedia course, which is aimed at medical students but is fascinating for anyone, to see what it’s like to go downstairs with perfect vision, then again with glaucoma or macular degeneration.