Promotion

life events (Andersson 1992). According to Coleman and O’Hanlon (2004: 115) ‘Primary
control involves the use of proactive strategies directed towards overcoming obstacles
and attaining the individual’s chosen goals’, while ‘Secondary control refers to strategies
directed towards managing and influencing emotions and perceptions’. For older
people having a sense of control is linked to feeling valued and having a purpose in life.
Several studies of older people moving into residential care have shown that the perception
of control and self-esteem are critical components in adjusting mentally and physically
to institutional living (Yoon 1996; Antonelli et al. 2000; Shyam and Yadav 2002).
The link between the impact of falling and depression is well recorded. Research
has shown that older people who have experienced a falls-related injury are more at risk
of depression if improvement in physical function slows down (Scaf-Klomp et al. 2003).
A study in Australia found that older women (aged 75 years and over) considered
falls and consequential injury as great risks to their independence and quality of
life. The majority declared that they ‘would rather be dead than experience the loss of
independence and quality of life that results from a bad hip fracture and subsequent
admission to a nursing home’ (Salkeld et al. 2000: 344).
Community living older people often describe a range of different coping strategies
to deal with changes in life, which may be influenced by social and cultural factors. The
strategies they use can provide useful clues as to where interventions are needed. In order
to develop successful mental health promotion programmes we need to consider what
influences individuals’ ability to adapt and cope with loss and other changes in later life,
and why some older people are better at finding new sources of self-esteem than others.
Economic determinants
Not having enough income or social protection in the form of old age pension can
seriously affect older people’s vulnerability and consequently their mental health.
Older women living alone and those who live in rural areas are particularly at risk of
social exclusion, poverty and ill health. The Social Exclusion Unit (2006) highlights
that many of the most excluded people are among the very old. According to the report
many older people face multiple exclusions because of overlapping problems of poor
housing, low income and limiting illness. The mental health risk factors linked to the
economic determinants are therefore multi-faceted; loss of job and drop in income may
be linked to a change of role, decreased independence and sense of self-worth.
Box 7.4 Special issue in later life: retirement
OLDER PEOPLE: THE RETIREMENT YEARS 185
Retirement affects people’s health both positively and negatively. With retirement no
longer being determined by old age, research has increasingly started defining retirement
as a period of transition, rather than as entry into old age. As Johnson (2004: 40–1) puts it:
Indeed, when the population of seventy-year-olds includes both the physically fit and
active and the bedridden, the very wealthy and the abjectly poor, the socially connected
and the socially excluded, the family figurehead and the isolated singleton,
then it is no longer evident that age should be regarded as a meaningful social or
economic category.