The changing demographics over the past century which have seen an increase in life expectancy, massive advancements in medical technology, and subsequent escalating costs for health and social care have led to a greater awareness of the importance of a successful ‘old age’. Demographically, economically and culturally, old age is experienced differently by different people. In Western developed countries, old age is chronologically determined at the onset of retirement, usually because physical and psychological changes begin to manifest themselves around this time. However this is unsatifactory in some circumstances as age doesn't always correlate with physical changes.And using the biomedical approach to ageing leads to a focus on the absence of chronic disease and risk factors. Research by Bowling & Dieppe (2005) revealed that whereas ‘usual ageing’ involved physical, mental and cognitive decline, ‘successful ageing’ involved a more psychosocial approach. This included for example life satisfaction, social participation, a sense of purpose and personal growth (Bowling & Dieppe 2005).
A prominent dimension of the promotion of quality of life in old age revolves around ideas of social inclusion and engagement. Although current UK policy aims to promote themes such as social capital and participation, the agenda of social exclusion (the antithesis of inclusion) focuses more on the needs of the labour market, which is clearly a problem when the issue of social exclusion is examined from an older people perspective (Victor & Scharf 2005). Social exclusion is a multi-faceted phenomenon that can affect different sections of the population and at any age and as such is difficult to measure. It is often described within a variety of concepts, usually in discussions on social participation and the impact of poverty on health and social inequalities. Indeed, the term 'social exclusion' encompasses a wide variety of societal problems that are a result of poverty and deprivation (Whitehead 2001). An increasing body of evidence suggests that those who are socially isolated or excluded are at greater risk of ill-health (Tones & Green 2004).
The Government Task Force on social exclusion defines it as:
‘a complex and multi-dimensional process. It involves the lack or denial of resources‚ rights‚ goods and services‚ and the inability to participate in the normal relationships and activities available to the majority of people in society‚ whether in economic‚ social‚ cultural or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole.’ (idea 2009).
According to Age Concern (2009), although acknowledging the importance of a good income, there are a number of factors in relation to the elderly and their inclusion into society, including access to services‚ good social networks‚ decent housing‚ adequate information and support‚ and the ability to exercise basic rights (Age Concern 2009). A report on behalf of Help the Aged (2007) that included a series of workshops with elderly people as part of a Europe-wide study into the barriers to inclusion, found that the impact of a poor quality environment, and in particular the fear of crime, prevented a lot of older people from making the most out of local services and community resources (Sinclair 2007).
An overriding theme in the exclusion of older adults is isolation and loneliness, perhaps an over emphasis, as Victor & Scharf (2005) argue, because of the stereotypes and prejudice afforded the elderly. But as Owen (2006) states, becoming older does increase the risk of becoming lonely and socially isolated, due mainly to retirement, the consequences of both physical and mental illness and disability, bereavement and poverty (Owen 2006). Additionally, the individualistic attitude prevalent in modern British society has meant the breakdown of traditional family and social networks and a greater emphasis on autonomy. A study by Perrig-Chiello et al (2006) cited a number of literature that identified factors such as physical activity, social interaction and control over one’s life as vital to functional autonomy in old age (Perrig-Chiello et al 2006). Indeed, autonomy is regarded as a vital component in effective health promotion.
The concept of social exclusion encompasses deprivation and poverty, resulting in some members of society being marginalised from social and community life. It is not however,limited to economic factors, with cultural and social discrimination also having an impact. According to Bowling et al (2006)there is a wealth of literature on the beneficial health benefits of social interaction and support, believed to act as buffers to the detrimental effects of deprivation and stress. This belief coincides with an increasing interest in the health effects of social capital, a term used to describe the various resources available to people by the participation and cohesiveness of communities, creating mutual trust and reciprocity (Bowling et al 2006). As a social system, a community is especially important within the ideology of health promotion and empowerment. Indeed, one of the key phrases of health promotion is empowerment, implied as crucial in public health policies and initiatives if the community is to be actively engaged (MacDonald 1998).An empowered community enables people to take an active part in policy making and decisions. And whereas community is generally regarded as a group of people in a small geographical area, a community can also be 'virtual' i.e. shared ideals and identity, and by using advancing technology such as the Internet, an increasingly powerful one (Tones & Green 2004).
Yet Baum(1999)believes trust and co operation are too subjective to be measured, and the concept of the healthy community is not only romantic but also not necessarily healthy and adds that there is no consistent evidence for causal associations between social capital and health (Baum 1999). Whilst Bowling et al (2006) tentatively agree with this and state that there is little research into the associations between social capital and health, they argue that the concept of social capital needs to be understood in a wider social and political context.
However, what does need to be acknowledged is if social capital is linked to health outcomes then access to it needs to also be taken into account.As stated by Baum & Ziersch (2003)differences in access to social capital can potentially reinforce established health inequalities.
Lynn Mythen
