Mohammed T. Abou-Saleh

THE NORMAL AGED AMONG COMMUNITY-DWELLING ELDERS IN THE UK 81future, it is important to remember the limitations inherent inapplying current health prevalence rates to succeeding generations.POVERTY AND SOCIAL INEQUALITYIn contrast to the traditional views of later life as a time of povertyand deprivation 19 , there has recently emerged the image of the‘‘Well-Off Older Person (WOOPIE)’’. This image has portrayedolder people as a newly affluent group who are benefiting at theexpense of younger people. However, recent studies have illustratedthat, for the majority of older people, poverty remains the norm,especially in advanced old age 19 . In Britain, one in three of thoseliving in poverty are older people and rates of poverty increase withage, are higher amongst women than men and amongst those fromthe manual occupation groups 19 . The explanation of such high ratesof poverty amongst older people is the low level of state pensions,the principal source of older people’s income, and the lack of accessby many older people to additional sources of income, such asoccupational and private pensions 20–22 .PATTERNS OF FORMAL AND INFORMAL CAREOlder people are the main users of the formal health and socialcare services provided in Britain 9 . However, despite this the majorityof older people do not regularly use formal care services. Forexample, 19% of those aged 65+ use hospital inpatient servicesannually, 6% are visited by a district nurse and 4% by a home help 9 .Even for the potentially most vulnerable (those aged 85+ livingalone), the district nurse/health visitor is in contact with less than15% 9 . For most daily tasks that older people (and indeed other agegroups) need help with, the principal source of support comes fromthe informal sector, usually either a spouse or children 23 . Hence thefamily is, as it always has been, the major provider of care to thefrail older person 23 . However, we still know little about the tieswithin families that promote the development of the caringrelationship 24 . There is comprehensive research evidence whichclearly shows that older people are themselves significant providersof care to each other 23 and younger age groups 23 .CONCLUSIONThe research evidence now available illustrates that the commonstereotypes of later life are both inaccurate and out of date. Themajority of older people live in the community, in their own homes,and are integrated within a network of family and social relationships.The health status of older people is considerably better thanthe popular stereotypes, with chronic physical and mental impairmentfar from universal, even in the very oldest age groups.Furthermore, although older people do use the health and socialcare services, the family remains their principal source of care.Indeed, older people are major contributors to the provision of care.Moreover, within this less pessimistic review of later life, it isimportant not to treat older people as a single homogeneoussocial group. The experience of later life is greatly influenced byimportant dimensions of social stratification, such as gender, classand, increasingly in the future, ethnicity. It seems likely that suchsocially differentiating dimensions, especially ethnicity, willbecome increasingly important in determining the experience offuture cohorts of older people.REFERENCES1. Matheson J, Summerfield C (eds). Social Focus on Older People.London: HMSO, 1999.2. Thomas R. The demography of centenarians in England and Wales.Population Trends 1999; 96: 5–12.3. Coleman P, Bond J. Ageing in the twentieth century. In Bond J,Coleman P, eds. Ageing in Society. London: Sage, 1990, 1–12.4. Maclntyre S. Old age as a social problem. In Dingwell R, Heath C,Reid M, Stacey C, eds. Health Care and Health Knowledge. London:Croom Helm, 1977, 42–63.5. Victor CR. Care of the frail elderly: a survey of medical and nursingstaff attitudes. Int J Geriatr Psychiat 1991; 6: 743–7.6. Phillipson C. Reconstructing Old Age. London: Sage.7. Victor CR. Old Age in Modern Society, 2nd edn. London: Chapman& Hall, 1994.8. Bury M, Holme A. Life after Ninety. London: Routledge, 1991.9. Victor CR. Community Care and Older People. Cheltenham: StanleyThornes, 1997.10. Dale A, Evandrou M, Arber S. The household structure of the elderlypopulation in Britain. Ageing Soc 1987; 7: 37–56.11. Wenger CG. TheSupportiveNetwork. London: Allen and Unwin, 1984.12. Jerrome D, Bond J, Coleman P, eds. Intimate Relationships in Ageingin Society. London: Sage, 1991, 181–207.13. Jerrome D. The significance of friendship for women in later life.Ageing Soc 1981; 1: 175–97.14. Jones DA, Victor CR, Vetter NJ. The problem of loneliness in theelderly in the community: characteristics of those who are lonely andthe factors related to loneliness. J R Coll Gen Pract 1985; 35: 136–9.15. Victor CR. Health and Health Care in Later Life. Buckingham: OpenUniversity Press, 1991.16. Victor CR. Inequality in health in later life. Ageing Soc 1991; 11: 23–39.17. Kay DWK. The epidemiology of dementia: a review of recent work.Rev Clin Gerontol 1991; 1: 55–67.18. Joam AF, Korten AE, Henderson AS. The prevalence of dementia; aquantitative integration. Acta Psychiat Scand 1985; 71: 366–79.19. Fries JF. Ageing, natural death and the compression of morbidity. NEngl J Med 1980; 303(3): 130–5.20. Vergrugge LM. Longer life but worsening health. Millbank MemFund Qu 1984; 62(3): 475–519.21. Falkingham J, Victor CR. The myth of the Woopie. Ageing Soc 1991;11: 471–93.22. Vergrugge LM. Longer life but worsening health. Millbank Mem Qu1984; 62(3): 475–519.23. Midwinter E. Pensioned Off. Buckingham: Open University Press, 1997.24. Vincent JA. Inequality and Old Age. London: UCL Press, 1995.