Look on the bright side of ‘later life’

It’s not what I wanted to hear. I recently came to terms with my middle age, and was feeling positive about the future – but it seems my optimism is misplaced. Two recent reports have painted a rather bleak picture of old age in the UK, portraying it as a time when one is likely to be abused by loved ones and/or to suffer from mental illness. The reports appear to give substance to earlier claims by campaigners and the media that there is an unacknowledged epidemic of ‘elder abuse’ in contemporary British society (1).

A report prepared for the charity Comic Relief and the Department of Health, the UK Study of Abuse and Neglect of Older People, claims that hundreds of thousands of elderly people are being abused in their own homes (2). It estimates that as many as 342,000 older people could be victims of abuse. According to Jean Gould of Help the Aged, such figures ‘paint an alarming picture of the way we treat our nearest and dearest’ (3).

The second report, Improving Services and Support for Older People with Mental Health Problems, produced by the charity Age Concern, claims that a third of older people have symptoms of mental health problems, and ‘one in four older people living in the community have symptoms of depression that are severe enough to warrant intervention’ (4). If we’re to believe the figures in the first report on elder abuse, perhaps such a level of depression is only to be expected.

The ageing process, it seems, is something to be feared. But is such fear the result of a real threat to older people, or the result of societal changes in how we articulate our relationships and view the challenges thrown up by modernity? There is little doubt that growing old presents challenges, and that physical and mental health can deteriorate to such an extent that health and social care are required to maintain a person’s dignity and social functioning, and to alleviate the burden of care that can be placed on relatives. And there are certainly instances where such care is sadly lacking or where those who are supposed to be caring for an older person abuse their position and mistreat their relative or client. In such cases, targeted intervention is desirable and necessary.

What is not helpful, however, is to portray older people as victims-in-waiting and all carers as potential abusers. In fact, growing old is not as bad as these reports and commentators suggest. There are, indeed, many reasons to be cheerful about the ageing process.

First, social and medical advances have dramatically raised not only actual life expectancy but also the length of time when we will be fit and active. As recently as 1910 average life expectancy in the UK was only 50 years. Today, men can expect to live to their mid-to-late seventies, and women into the early eighties. We can also expect to remain free of serious or prolonged disability until we are in our seventies (5).

Second, it may be true that many old people are abused, but there is no epidemic of elder abuse. For example, the UK Study of Abuse and Neglect found that 2.6 per cent of its sample of people aged 66 and over who lived in private households had ‘experienced mistreatment’ from a family member, close friend or care worker. This may include some horrific individual cases, but it does not suggest widespread mistreatment. What is really going on is a blurring of categories. A small number of very bad cases of abuse are being lumped together with a more common form of mistreatment: ‘neglect’. While the consequences of neglect can be serious, it is more often than not an act of omission rather than necessarily a calculated form of abuse. Other forms of abuse, such as psychological, physical and sexual, were so uncommon that the report’s authors combined them under the term ‘interpersonal abuse’. And given the wide range of behaviours included in the definition of psychological abuse – shouting, taunting, neglect, and so on – it is surprising that more elderly people do not claim to be suffering from abuse. For all the scary headlines, it would appear that actually most of us get on very well with our elderly relatives (6).

Third, while it would be understandable if the elderly were anxious and fearful, especially given overblown media reports about abuse, older people are remarkably mentally resilient on the whole. The ominous sounding figures of ‘one in three’ or ‘one in four’ elderly people suffering from depression are achieved by including, not only those who meet the criteria for a clinical diagnosis, but also those who ‘experience symptoms’ of depression. So, experiencing symptoms such as low mood, irritability, sleep or appetite disturbances means you are classed as suffering from ‘sub-threshold depression’, which is said to cause just as much suffering as clinical depression – a claim that anyone who has worked in acute psychiatric services will greet with astonishment. This ‘sub-threshold’ category also allows the conflation of serious disabling conditions such as dementia with those who may suffer mild anxiety or who drink more units of alcohol than current government recommendations. Again, serious cases are lumped together with everyday ups and downs to give an impression of widespread mental illness amongst the elderly population.

It is also worth pointing out that the self-reporting of abuse and psychological problems may not be a result of individual experience, but rather of how such experiences are interpreted today. The discourses of psychology and abuse have entered the mainstream, and there are powerful social influences that encourage us to view our experiences in such terms (7). What may have been described as a ‘bad week’ for elderly people in the past is now likely to be looked upon as a ‘psychological’ or ‘abusive’ episode in their lives.

If there are reasons to be cheerful, there are also reasons to be angry about the way in which elderly people are discussed today. First, the problems of community care used to be seen as emanating from badly thought out government policies and lack of resources due to financial cutbacks. It was pointed out that community care policies led to the burden of care being transferred from the state to families, often without adequate, if any, support. Now, we are expected to believe that the only problem in community care is ‘abusive’ carers. In the past, the family was not seen as inherently malevolent, but rather as a unit which cared for its loved ones often in very difficult circumstances. Today, such informal caring relationships are viewed as suspicious.

Second, there is the tendency of those involved in social care to extrapolate from their caseloads on to wider society. For example, some people working in community care may read this article and exclaim that they have met lots of older people who are being abused, and many who are mentally vulnerable, and accuse me of complacency. This overlooks the fact that it is their job to work with such people. Encountering such instances does not mean that they are widespread. It is reflective of an anti-human tendency within society and social policy when informal human interaction is viewed through the prism of ‘worst-case scenarios’.

Third, treating the elderly as a homogenous group united by vulnerability and ubiquitous danger is not only wrong, it can also distract attention from where intervention really is necessary. This can end up making things even harder for those in genuine need of help.

If we are to confront contemporary social problems we need a social policy that views humans as the solution, not as an abusive and abused mass in need of education and control. An ageing society is a positive development, and the majority of elderly people can cope perfectly well with later life. It’s the anti-human view of certain campaigners that is the real problem today.

Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University, England.

(1) Epidemic of attacks on the elderly, Gaby Hinsliff, Observer, 18 April 2004

(2) UK Study of Abuse and Neglect of Older People: Prevalence survey report, Comic Relief

(3) Elder abuse ‘affecting thousands’, BBC News, 14 June 2007

(4) Improving Services and Support for Older People with Mental Health Problems, Age Concern

(5) See Phil Mullan (2000), The Imaginary Time Bomb: Why an ageing population is not a social problem for a critique of many of the negative assumptions surrounding ageing and society.

(6) UK Study of Abuse and Neglect of Older People: Prevalence survey report, Comic Relief

(7) See Ian Parker (2007), Revolution in Psychology: Alienation to Emancipation for a discussion of problems in contemporary psychology