Date Published: May 05, 2018
Publisher: Oxford University Press
Author(s): Krysia Canvin, Catherine A MacLeod, Gill Windle, Amanda Sacker.
legislation places an onus on local authorities to be aware of care needs in their locality and to prevent and reduce care and support needs. The existing literature overlooks ostensibly ‘healthy’ and/or non-users of specific services, non-health services and informal assistance and therefore inadequately explains what happens before or instead of individuals seeking services. We sought to address these gaps by exploring older adults’ accounts of seeking assistance in later life.
we conducted semi-structured qualitative interviews with 40 adults aged 68–95. We invited participants to discuss any type of support, intervention, or service provision, whether medical, social, family-provided, paid or unpaid.
this paper reports older people’s accounts of how they evaluated their need for assistance. We found that the people in our sample engaged in a recursive process, evaluating their needs on an issue-by-issue basis. Participants’ progression through this process hinged on four factors: their acknowledgement of decline; the perceived impact of decline on their usual activities and independence; their preparedness to be a recipient of assistance; and, the opportunity to assert their need. In lieu of seeking assistance, participants engaged in self-management, but also received unsolicited or emergency assistance.
older people’s adaptations to change and attempts to meet their needs without assistance mean that they do not present to services, limiting the local authority’s knowledge of their needs and ability to plan appropriate services. Our findings offer four stages for policymakers, service providers and carers to target to address the uptake of assistance.
The World Health Organisation’s concept of an ‘Age Friendly World’  that helps people stay connected and healthy and provides support to those in need is being adopted across the UK. Legislation places an onus on UK local authorities to be aware of care needs and to prevent and reduce care needs in their locality (i.e. the Care Act 2014 in England, Social Services and Well-being Act 2014 in Wales). Challenges to achieving these aims include identifying people needing assistance before they require extensive care packages, and reaching non-users of specific services. Although considered heavy users of services older adults often do not take-up available health and social care due to barriers to access, denial of need or lack of information [2–5]. The extensive literature details these and other reasons (e.g. see Dixon-Woods et al.’s synthesis ). The usefulness of these studies in understanding how older people recognise and respond to emerging needs is limited, however, because they sample individuals with chronic health problems and/or existing service users, thus excluding ostensibly ‘healthy’ and/or non-users of specific services, non-health services and informal assistance. Similarly, the extensive health behaviour literature  informs our understanding of individuals’ uptake of services and treatments, but excludes non-health aspects of individuals’ lives and broader types of assistance [cf. 8, 9]. Consequently, the literature inadequately explains what happens prior to individuals’ contact with services or what they do instead of seeking assistance. In this qualitative study, we sought to address these gaps by exploring older adults’ experiences and views of assistance with health, social and other issues from services or other sources. Unlike other studies, we did not recruit participants based on their health status or service use. Given the policy emphasis on prevention, this paper focuses mainly on participants’ reasons for not seeking assistance from outside the household, what they did instead and the consequences.
We interviewed 40 participants: 20 in North Wales (CFAS Wales) and 20 (UKHLS) in North west England, including four couples (Table 1). Participants’ ages ranged from 68 to 95 (mean age = 79). Participants’ unique identifiers indicate site (U = UKHLS, C = CFAS Wales), gender, age and living alone (A) or with a partner (P).
Table 1.Sample characteristicsCharacteristicsEngland (UKHLS)Wales (CFAS)TOTALParticipants (n = 20)Participants (n = 20)(n = 40)Living alone (n = 10)Living with someone else (n = 10)Living alone (n = 9)Living with someone else (n = 11)Living alone (n = 19)Living with someone else (n = 21)Gender Male46 (3)46 (1)812 (4) Female64 (3)55 (1)119 (4)Age 60s00 (0)02 (0)02 (0) 70s34 (2)44 (0)78 (2) 80s54 (3)33 (0)87 (3) 90s12 (1)22 (2)34 (3) Not known10 (0)00 (0)10 (0)Marital status Married28 (4)010 (2)218 (6) Widowed81 (1)100 (0)181 (1) Divorced01 (1)00 (0)01 (1)Household Living alone100 (0)90 (0)190 (0) Living with spouse or partner010 (6)010 (2)020 (8) Living with spouse and children00 (0)01 (0)01 (0)Numbers given in brackets show how many participants took part in a couple interview.
We found that our sample of older adults evaluated their need for assistance on an issue-by-issue basis, engaging in a four-stage recursive process. This process was not influenced by the type of issue arising, e.g. ill-health versus housework. Instead, participants’ progression through the process hinged on their acknowledgement of decline and its perceived impact on their usual activities and independence, their preparedness to be a recipient of assistance, and opportunities to assert their need. Participants told us that, in lieu of assistance, they employed a plethora of self-management techniques. They also revealed how, despite not seeking assistance, they received unsolicited and emergency assistance nevertheless.