The Knowledge Exchange Blog

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Better housing for older people means better lives for all

“Sheltered Housing – MVRDV” by KJBO is licensed under CC BY-ND 2.0

Housing is at the heart of a good quality of life. This is especially true as we get older, when health and wellbeing, independence and end-of-life care can all be greatly enhanced by decent housing.

Four recent reports have underlined the importance of good housing for older people, and the wider benefits for society.

Housing with care: progress and problems

The Commission on the Role of Housing in the Future of Care and Support  (CRHFCS) was established last October by the Social Care Institute for Excellence (SCIE). The new commission aims to produce a blueprint to enable greater choice and availability of housing and support for people aged 65 and older who may find it difficult to live independently at home, or who choose to live somewhere which provides more support options. The Commission will focus on five key areas: care homes; retirement communities; retirement housing; supported living; and the Shared Lives schemes.

The first report of the CRHFCS highlights progress made since the Commission on Residential Care 2014 (CORC) reported its findings in 2014. There have been some positive developments concerning the take-up of more new technologies in care settings, such as telehealth, telecare and smart home devices to help people maintain their independence.

Progress has also been made on age- and dementia-friendly housing design. And the report commends the Housing our Ageing Population Panel for Innovation (HAPPI) reports for raising awareness of housing specifically designed for older people.

However, little progress has been made on CORC’s recommended expansion of the market to give greater choice of housing with access to care. Options remain limited, especially for those struggling to pay for accommodation.

The CRHFCS sets out some initial policy proposals. These include planning reforms to make it easier to build retirement community housing, and improved information and advice to support informed decision-making for older people seeking housing with care and support facilities.

The Commission’s final report will appear in the summer, when it will make recommendations about the future shape of housing that facilitates care and support.

Needed: a clear vision about housing for older people

The findings from the CRHFCS report are echoed in another report, published in April by the Cambridge Centre for Housing and Planning Research. The Cambridge report identifies numerous constraints to supply, investment and demand in the market for specialised housing for older people. 

One of the study’s key findings  is that retirement community development is unviable in many areas outside of London and the South East of England.

“Coupled with the fact that the majority of house moves made by older people are relatively local, this constraint to supply reduces housing options for those living elsewhere in the country, particularly home owners who do not qualify for assistance with housing costs. Unless the viability of retirement community development can be improved and the supply of mid-range retirement properties be raised, these households will have very little choice around moving in later life.”

Among the recommendations in the Cambridge report are calls for national government to provide a clear vision about housing for people as they age:

“For example, greater clarity is required around the joint priorities of ‘downsizing’ and ‘ageing in place’, and how these priorities can be best implemented at the local level.”

The report also recommends that local authorities should give priority to housing for older people, through the creation of clear strategic and local plans and guidelines for developers:

“Collaboration between local authority planning, social care, health and housing teams could allow for better planning around retirement housing. For example, retirement housing may make savings possible within health and social care budgets.”

The Cambridge report encourages housing providers to diversify the retirement housing offer, and to gain a better understanding of preferences of different older people:

“Rather than drawing on stereotypes of old age, providers face the challenge of recognising older people as a complex and heterogeneous group of consumers with diverse aspirations.”

Closing the generational divide

According to a report by the Intergenerational Foundation (IF), England now has two housing nations: the first is older, well-housed, often well-off, with space to work and self-isolate; the second nation is younger living in cramped flats or shared homes with little or no access to outside space.

The IF says that the pandemic has exacerbated housing inequalities between the young and the old, and observes that “…while younger generations have lost their jobs, their homes and even their mental health during COVID-19, older generations have stockpiled space.”

The report also highlights a rise in the number of second homes as a consequence of the pandemic.  There are now 5.5 million second homes in England – a 50% increase between 2011 and 2020 – most of them owned by older people.

Space inequality has also increased. Owner-occupied homes have a third more space on average than privately rented homes, and almost double the space as social housing.

Like the previously mentioned reports, the IF calls for market failures on retirement housing to be addressed. It recommends reform of stamp duty to encourage downsizing, and reforms to the planning system both to give a greater voice to the homeless and badly housed and to encourage developers to build more retirement homes.

Making a house a home: impacts of poor-quality housing

While some older people enjoy the benefits of good housing,  there are substantial numbers of people aged 50 and older living in poor-quality accommodation.

A report by the Centre for Ageing Better (CfAB) has found that living in cold, damp housing, or homes in a state of disrepair can increase the risk of illness and accidents. Poor housing also has wider impacts: first-year NHS treatment costs for over-55s living in the poorest quality housing are estimated at £513m.

But there are barriers preventing older people from making the improvements that would help them live healthier, more independent lives. These include a lack of finance and uncertainty about where to find trustworthy information about home improvements.

The CfAB report calls for a  wider range of financing options, including government grants and loans, to help older people adapt their homes. It also recommends clear signposting and advice to support informed decisions about home improvements, as well as initiatives to raise awareness about the impact of poor quality homes on health and wellbeing.

Final thoughts

The number of people aged 65 and over is set to rise from 12 million to more than 20 million by 2030. While poor quality housing presents risks for older people, age-appropriate housing can keep them healthy, help them to live independently and reduce the need for social care.

These reports highlight important issues that must be addressed not only to support older people, but to advance the radical changes needed to fix Britain’s broken housing market. Better housing for older people is better for us all.


The reports highlighted in this blog post have recently been added to The Knowledge Exchange (TKE) database. Subscribers to TKE information service have direct access to all of the abstracts on our database, with most also providing the full text of journal articles and reports. To find out more about our services, please visit our website: https://www.theknowledgeexchange.co.uk/

Further reading: more on housing for older people on The Knowledge Exchange blog

Healthy ageing: how health inequality can be tackled at the local level

Image: Peter Kindersley via Centre for Ageing Better

Older people make up a significant portion of our population, and projections show the proportion of people over the age of 60 within the global population is set to rise even further over the coming years. ONS data shows by 2066 there will be a further 8.6 million projected UK residents aged 65 years and over, taking the total number in this group to 20.4 million and making up 26% of the total population.

Supporting people to age well, and age healthily is something which both local and national policymakers will have to take account of in order to not only ensure good quality of life for their ageing populations but also ensure that services are not overwhelmed.

Studies show the higher levels of deprivation people face in their earlier years, the more likely they are to enter older age in poor health and die younger compared with people who experience lower levels of deprivation. This highlights the need to tackle inequality across the life course, with the preventative action having a positive knock on impact on health inequalities in later life.

Some of the main drivers of inequalities include: social exclusion and isolation; access to and awareness of health and other community services; financial difficulties including fuel poverty and housing issues; insecure or low paid employment, with reduced opportunity to save or enrol in a formal pension to prepare for retirement; a lack of transport and distance from services; low levels of physical activity; and mobility or existing poor health, often characterised by long term chronic health issues.

These inequalities often combine and overlap to create even more challenging situations as people move into older life. More recent research has shown that the Covid-19 pandemic has only exacerbated these inequalities further.

Tackling inequalities at the local level

Alongside the national discussions around ageing, local demographic change has received comparatively less attention, despite place-based policies and concepts like “ageing well in place” being used in public health conversations for a number of years.

Research from the Resolution Foundation explores the intersection between demography and place, and its implications for politics and policy while further research is looking increasingly at local level case studies to highlight pockets of best practice which could help to inform the national approach.

A review from Public Health England looked at the specific experiences of older people in coastal and rural areas and the specific challenges they face in comparison to people living urban areas, exploring local level interventions and interventions which adopt a place- based approach, responding to the specific needs of people living in the area.

Other research in this area stresses that councils have a clear leadership role in supporting an ageing society and that they are uniquely placed to create strategies which reflect the needs of their populations. Through local engagement of older people systematically and regularly, and through co-production and co-design in the production of local policies and services, councils are in a position to underpin a more positive outlook on ageing, ensuring that older people are regarded as full citizens, rather than objects of charity or pity.

Approaches to poverty reduction in Greater Manchester

In Greater Manchester, healthy ageing and age inequalities have been made mayoral priorities and the Greater Manchester Combined Authority set up the Greater Manchester Ageing Hub to respond to what policymakers there see as the opportunities and challenges of an ageing population.

In 2018 the city published an “Age Friendly Strategy” to promote increased social inclusion within the city by trying to tackle the barriers to inclusion created by poverty and inequality, including creating age friendly places which allow older people to participate within their local communities, and promoting healthy ageing through strategies like GM Active Ageing, a partnership with Sport England.

Image: Peter Kindersley via Centre for Ageing Better

Creating a consensus on healthy ageing

The Centre for Ageing Better and Public Health England established 5 principles for healthy ageing which they are urging government and other policy actors to adopt to support future healthy ageing the five principles are:

  1. Prevention
  2. Opportunities
  3. Good homes and neighbourhoods
  4. Narrowing inequalities
  5. Tackling ageism

These principles can be used as building blocks to help organisations create strategies and policies which accurately reflect the core needs of people as they age. One thing which continues to be a challenge, however, is integrating intersectionality into both research and strategies or frameworks on ageing.

Not treating “older people” as one homogenous group, but taking account of the individual experiences of specific groups and how this may impact on their experience of inequalities: this is something researchers are making efforts to resolve in their work, and while there are limited studies which look specifically at BAME or LGBT groups, in the future taking account of intersectionality in ageing and inequalities will become more commonplace.

The future of ageing

We are living longer than ever before. Taking steps to reduce inequalities and support healthy ageing will ensure that those extra years are fulfilling, both for the individual and for society.

Helping people to continue to contribute to society, to really live into old age, embrace and enjoy it and not just exist in old age should be a priority for everyone, Reducing inequalities to support people to age well will be a major contributor to ensuring this happens.


If you enjoyed this article you might like to read:

A home for life? Developing lifetime neighbourhoods to support ageing well in place

“Same storm, different boats”: addressing covid-19 inequalities and the ‘long term challenge’

Inclusive streets: from low expectations to big dreams

Follow us on Twitter to see which topic areas are interesting our research team.

Inclusive streets: from low expectations to big dreams

We’ve written before about the health, environmental and economic benefits of walking, and the importance of making our cities and towns more accessible for pedestrians and cyclists. This was the theme of two recent webinars presented by Living Streets, an organisation that has been campaigning for better walking and cycling environments for almost a century.

The first webinar was presented by Stuart Hay, Penny Morriss and Robert Weetman from Living Streets, who explained that inclusive streets are defined spaces where all members of the community can walk or cycle.

But inclusive streets are about more than accessibility. Many streets and public spaces that might be accessible are not necessarily navigable. They can present social and physical barriers that mean the streets are not delivering equal access for everyone.

Walking Connects

In this context, Penny Morriss highlighted the work which she’s been doing with older people in a project called Walking Connects. A rising proportion of the UK population is over 65, and while many older people remain active, a lack of facilities – seating, shelter, hand rails, public toilets,  pedestrian crossings and well-maintained streets – can hinder to their ability to access services and meet other people.

In one Airdrie community studied by the Walking Connects team, residents found the lack of pedestrian access at the end of their housing complex a significant barrier to accessing the shops, community centre and church.

Robert Weetman of Living Streets noted that this community’s experience was by no means uncommon, and is not confined to older generations.

“We’re not talking about a small number of people not being able to get along a particular street; what we’re talking about actually moves into a large number of people not even being able to get to the end of their own local streets, or even outside of their gate.”

The reasons for this largely rest on the longstanding assumption that everyone in towns and cities wants to get around by car. Today, the need to tackle climate change and the recent improvements to air quality due to the pandemic restrictions, is driving a reappraisal of our car-centric cities. At the same time, local authorities, who are mostly responsible for the design and maintenance of streets, are under greater financial pressure than ever.

Challenging the authorities

The webinar stressed that citizens are not powerless when it comes to challenging councils to improve their streets. Penny highlighted another Walking Connects project in Edinburgh, where a number of tenants in a retirement development had experienced falls because of poor paving. The problem had been reported to the council many times, but residents were repeatedly told that the faults were not bad enough to warrant resurfacing. However, after working with Living Streets to document the number of falls, they persuaded the council to resurface the pavements.

Penny explained that this pro-active approach was vital, but that marginalised groups in the community often felt that their voice didn’t count:

“One of the first things that we need to do is to make sure that they understand it’s okay to ask for an issue that they encounter on a day-to-day basis to be resolved.”

A common message throughout the webinar was the need to bring local people, councillors and road technicians together. As Robert Weetman observed, once that happens communities can drop their low expectations and start to dream big:

“I think that our biggest and in some ways our most difficult priority is to create and communicate a vision of how different our streets could be, and why that would be so much better for everybody.”

People with disabilities: overcoming the barriers

The second webinar included contributions from  Keith Robertson, an advisor to the Scottish Government through the Mobility and Access Committee Scotland, and  Catriona Burness from the Royal National Institute of Blind People (RNIB), who spoke about the particular barriers faced by people with disabilities when navigating urban streets.

These include temporary road signs, advertising boards, bins and seating. For wheelchair users, blind or partially-sighted pedestrians, this ‘street furniture’ can make a simple journey more like an obstacle course, and can also have serious consequences. Barriers can cause accidents, and if people are deterred from getting out and about, they may experience mental ill health.

Both Keith and Catriona stressed the importance of local authorities engaging with disabled people and disability organisations, not as a tick-box exercise, but to really take their needs into consideration. The results of such consultations can be dramatic.

In Perth, for example, a pedestrianisation project did away with grilles where trees were planted, removing a hazard for wheelchair users and people using canes. At the same time, all of the signs, seats, bins and other items of street furniture were aligned, giving pedestrians unimpeded access along the street. Restaurants, cafes and shops placing advertising boards outside their establishments have to follow these regulations, or face a fine from the local authority.

People with sight loss: the challenges of social distancing

Catriona highlighted the numbers of people in Scotland who are blind or partially-sighted, amounting to over 200,000 people. This figure is likely to rise further over the next decade due to an ageing population and greater prevalence of diseases such as diabetes.

Pedestrians who are blind or partially sighted have found the context of coronavirus especially challenging. Social distancing, which is such a crucial part of preventing the spread of the virus, is very hard for people with sight loss to deal with.

One particular challenge has been the increasing use of ‘floating bus stops’. Councils have been responding to the need for greater social distancing on pavements by creating more pop-up cycle lanes, which in turn has led to bus stops being repositioned from the kerbside to ‘floating’ in-between bike lanes and the road.

For blind and partially-sighted pedestrians, such arrangements make boarding a bus more inaccessible and potentially hazardous. As Keith pointed out, accidents are usually a signal to local authorities that a design isn’t right, but if people with sight loss don’t feel safe going out, there will be no accidents to report, and the situation will be unchanged.

Final thoughts

If there was an underlying message emerging from the two webinars, it was that when it comes to accessible streets, design matters to ensure fair access for all. Badly designed streets can be frustrating, and dangerous, leaving some groups of people feeling excluded. On the other hand, well designed streets can help all of us feel good about getting around, and can especially help people with disabilities feel more independent. The key is to enable engagement between the people who design our streets and those who use them.

There was so much more useful content in both of these sessions, including a discussion on how to raise issues on street accessibility with the authorities who have the powers to make changes.

Living Streets have provided recordings of both webinars, along with transcripts of the proceedings.

Living Streets Webinar One: Video Recording; Transcript

Living Streets Webinar Two: Video Recording ; Transcript


Further reading: more from our blog on accessible streets

Virtual knowledge: recent webinars on public and social policy

Earlier in the summer, we shared some of the information our Research Officers had picked up while joining webinars on public and social policy.

Since then, we’ve taken part in more of these virtual seminars, and in today’s blog we’re providing an overview of the wide range of topics covered.

Low traffic neighbourhoods

Earlier this month, Project Centre, which specialises in public realm regeneration and sustainability, organised a webinar on the challenges of implementing Low Traffic Neighbourhoods.

Low Traffic Neighbourhoods (LTNs) are a group of residential streets where through traffic is removed or discouraged, and any remaining traffic must operate at a pedestrian pace. The focus is not only to reduce congestion and improve safety by getting traffic back onto main arterial road networks, but also to provide environmental benefits, improve public health, community cohesion and encourage people to spend more, quality time in the areas where they live by making places “liveable”.

This webinar looked at the design and implementation of Low Traffic Neighbourhoods, with guest speakers from two local authority areas (Waltham Forest and the Liverpool City Region), as well as designers from Project Centre who support the implementation of Low Traffic Neighbourhood Schemes. The speakers discussed their own experiences designing and implementing low traffic neighbourhoods and shared potential lessons for those looking to implement their own scheme.

The speakers all emphasised some key elements to effective design and implementation of LTNs they included:

  • LTNs are not just about transport, they can have health and wellbeing, community cohesion and crime reduction and economic impacts for local businesses as people are encouraged and enabled to shop more safely in their local areas.
  • schemes should be done with communities, not to them
  • LTNs should be designed with everyone in mind to bring pedestrians and cyclists “on par” with cars in terms of the use of street space
  • effective data and evaluation can help build a case for wider roll outs.

The new long life: a framework for flourishing in a changing world

This webinar was delivered by the International Longevity Centre (ILC) and included a number of speakers from a range of backgrounds who came together to discuss the impact of longevity and ageing on our engagement with work and the labour market, particularly in relation to digital technology and the changing nature of work post COVID-19. Speakers included Prof. Andrew Scott, Caroline Waters, Jodi Starkman, Stefan Stern, Lily Parsey and George MacGinnis.

Many of the speakers highlighted the difference between the ageing agenda and the longevity agenda, explaining that while many of us will live and work for longer than ever before, the nature of work and the stages of life are changing in a way that for many will be unrecognisable as the “traditional life journey”.

They stressed the need to move away from “traditional linear thinking” about how we age, with education at the start, mid-life being punctuated by work and potentially parenthood, then retirement, and that ageing in the future will be full of more “life stages” and more mini cycles where career breaks, learning and other life “punctuations” will take place at different times of life. It was suggested that the nature of work will change so much that re-learning and at times re-training will be a necessity at multiple points in life, and not just by those who change career deliberately.

Ageing well must, according to speakers, remain high on the policy agenda of future governments to ensure that the growing population of older people can live lives that are enjoyable, purposeful and productive and can contribute to wider society well into what would currently be considered “old age”.

Clearing the air

This has been a year like no other. But while attention has rightly focused on the number of Covid-19 fatalities – more than 800,000 worldwide – there is another hidden killer which has been responsible for more deaths than coronavirus, HIV and malaria combined. Research has found that air pollution caused an extra 8.8 million deaths around the world in 2015.

We’ve written before about efforts to improve air quality, and in July a webinar organised by Catapult Connected Places looked at further innovative ways to understand and tackle air pollution across the globe.

Eloise Marais,  an Associate Professor in Physical Geography at UCL talked about TRACE – the Tool for Recording and Assessing the City Environment – that she is developing using satellite observations of atmospheric composition. Satellites offer more complete and consistent coverage than surface monitors, and satellites can also monitor many air pollutants, such as sulphur dioxide, ozone, nitrogen oxides and fine particulate matter.

But while satellites have a long and well sustained record of recording data – some have been in space for more than a decade – their measurements have limitations in terms of spatial resolution. At the moment, these can only cover city-wide air quality, rather than providing postal code measurements. Eloise explained that, while satellite data has been used to show that air quality improvement policies have been effective in London as a whole, they cannot yet confirm that in some parts of the city pollution levels are not falling. Even so, Eloise noted that spatial resolution is improving.

Later in the webinar, Bob Burgoyne, Market Intelligence Team Lead at Connected Places Catapult talked about the Innovating for Clean Air India Programme. India is home to 14 of the world’s most polluted cities. One of these, the city of Bangalore is especially badly affected, and Bob described a project which aims to improve the city’s air quality and enable a transition to electric vehicles. The Catapult network has been working with academic and professional bodies, and with small and medium sized enterprises in India to measure and demonstrate the impact of pedestrianizing a major street in Bangalore on Sundays. The long term goal is to permanently pedestrianise the street, and to demonstrate active and electric mobility solutions.

Back on track: London’s transport recovery

This webinar, organised by the Centre for London, discussed the impact of the Coronavirus pandemic on London’s transport systems and explored the impact of changes to Londoners’ travel habits on the actions required for recovery.

The event included contributions from Rob Whitehead, Director of Strategic Projects at Centre for London, Cllr Sophie McGeevor, Cabinet Member for Environment and Transport at London Borough of Lewisham, and Shashi Verma, Chief Technology Officer and Director of Strategy at Transport for London.

A major concern raised by speakers was that current trends indicate that car usage is returning to normal levels faster than any other form of transport. Public transport, such as bus and tube, is slowly recovering but its usage is often linked to changes to lockdown restrictions, with surges in use as restrictions are lifted that very quickly level off. Additionally, although it appears that active transport use has increased, this increase tends to be at weekends and is more apparent in outer London.

As a result of these trends, there is a serious concern that levels of traffic in London may exceed the levels experienced prior to the lockdown. Currently, road traffic is at roughly 90% of normal levels, if this rises to 110%, the resulting congestion will result in gridlock and could have major implications for London’s economy.

How should we use grey literature?

This webinar was organised by the CILIP Health Libraries Group, for CILIP members to learn about and discuss how grey literature is used by libraries, and the benefits and challenges of making use of such content.

The main talk was delivered by two members of the library team from the King’s Fund – Deena Maggs and Kathy Johnson – who emphasised the importance of grey literature as a means of delivering timely and up to date information to users, particularly in the context of health and social care policy, where information needs tend to be very immediate.

The session involved discussions about the usefulness of grey literature in terms of Covid-19 recovery planning, as well as the challenge of determining the credibility of content which is not peer reviewed or commercially published.

The speakers gave practical advice around selecting and evaluating such sources, and highlighted the broadening range of ‘grey’ content that libraries can make use of, such as audio recordings, blog posts, and Tweets.


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A home for life? Developing lifetime neighbourhoods to support ageing well in place

aerial view architecture autumn cars

Photo by Pixabay on Pexels.com

The UK population is ageing. A 2019 report from AgeUK using data from the ONS highlighted that there are nearly 12 million (11,989,322) people aged 65 and above in the UK of which: 5.4 million people are aged 75+, 1.6 million are aged 85+, over 500,000 people are 90+ (579,776) and 14,430 are centenarians. By 2030, one in five people in the UK (21.8%) will be aged 65 or over, 6.8% will be aged 75+ and 3.2% will be aged 85+.

Allowing people to live well in old age in their own homes is something which housebuilders and planners are giving increasing thought to, both from a wellbeing perspective for residents, and a financial perspective for services, including the NHS and social care. The creation of “lifetime neighbourhoods” – spaces where people can live well from birth to retirement – brings together a number of elements: providing easy access to services; creating physical spaces which are suitable for people with disabilities and mobility issues to navigate; and allowing people to maintain those social and community ties which are associated with wellbeing, which can sometimes be lost with forced moves to residential care or a prolonged stay in hospital.

Homes for life

Building homes that are suitable for an ageing population is an important first step in creating lifetime neighbourhoods. However, planners and developers are starting to realise that one size doesn’t necessarily fit all when it comes to housing for older people. As with the general population, older people are not a homogenous group, and while some may need the support provided by extra care or sheltered housing projects, or may need single-storey open plan living to accommodate mobility aids or telecare packages, others simply want to live in a space which enables them to live comfortably in a community which suits their needs in terms of location and availability of services.

Designing and building a range of different housing types, which includes single-storey homes, extra care and sheltered housing, as well as stock which is suitable for people looking to downsize, is a key part of the development of effective lifetime neighbourhoods. This can free up larger family homes for people with children to move into and ensure that people are not kept unnecessarily in hospital because housing cannot be adapted to meet changing needs. A 2014 Age UK report showed that the scarcity of suitable and affordable retirement housing is a barrier to downsizing, highlighting that retirement housing makes up just 5-6% of all older people’s housing. Now groups like the Housing Made for Everyone coalition (HoME) are calling on the government to make all new homes accessible and adaptable as standard to help meet growing need in the future.

Social infrastructure such as libraries, community centres, local shops and good transport links are also a key aspect to planning effective lifetime neighbourhoods, as is ensuring accessibility of services such as GP appointments. Effective infrastructure planning can help enable the whole community, not just older people to feel connected to their local area, both physically and socially which can really help to support the idea of lifetime neighbourhoods and enable people to live well regardless of age.

Preventing loneliness and isolation in older age

Preventing loneliness and isolation in old age by creating spaces which facilitate engagement and encourage people to have positive social interactions is important to ensure that everyone within the community feels respected, involved and appreciated. However, the challenges are different depending on the nature of the community in question. In rural areas, social isolation can be compounded by a lack of appropriate transport infrastructure or the removal of key services at a local level in favour of “hubs” which are often located in towns and cities; in urban areas, loneliness can be exacerbated by the chaotic, hostile or intimidating environment that living in a densely populated area can have, a flip side to the benefits of density.

Ambition for ageing is a programme which aims to discover what works in reducing social isolation by taking an asset based approach to creating age friendly communities. Asset based approaches seek to identify the strengths and the abilities of people and communities, rather than their deficits. The asset based approach to creating age friendly neighbourhoods also seeks to use the experiences and  attributes that all members of the community have to help make the community better. To create effective age friendly neighbourhoods older people need to have opportunities to participate and feel that they are making a positive contribution.

A space for all ages

While much of the research and literature on lifetime neighbourhoods focuses on older people, it is also important to ensure that spaces meet the needs of all groups in the community, including children and young people and people with disabilities. Creating places which balance the needs of all groups within the community is an important consideration for planners.

The physical environment can be as important as the built environment and infrastructure development when it comes to developing lifetime neighbourhoods. Spaces which make use of natural and green infrastructure with lots of green and open public spaces have been shown to help improve mental health and wellbeing, as well as encouraging people of all ages to be more active. A number of design factors such as good paving, effective street lighting and easy access to seating and public toilets make neighbourhoods accessible to older people and people with impairments. Poor design can ‘disable’ people in their immediate environment and act as a barrier to participation in local activities.

adult affection baby child

Photo by Pixabay on Pexels.com

Final thoughts

For lifetime neighbourhoods to be successful, it is necessary that there is access to a range of appropriate housing options. In addition, the planning of public, open and green spaces, availability of transport links and local community infrastructure like libraries, police stations and local shops are all vitally important to ensure communities can thrive.

It is clear that while there is demand for more suitable housing for people in older age, the location and type of housing being built must also meet the needs and expectations of older residents, including good connections to local infrastructure, and safe accommodation. Projects which bring a range of ages together can be effective in strengthening community cohesion, can help challenge stereotypes and can reduce feelings of loneliness and isolation. Collectively these different elements feed into the creation of lifetime neighbourhoods which can support people to live well into retirement and beyond.


Further reading: more articles from our blog

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‘Digital prescribing’ – could tech provide the solution to loneliness in older people?

Notruf und Hilfe für Rentner und Kranke

The number of over-50s experiencing loneliness could reach two million by 2026. This compares to around 1.4 million in 2016/7 – a 49% increase in 10 years.

It has also been estimated that around 1.5 million people aged 50 and over are ‘chronically lonely.’

With an ageing population and increasing life expectancy, it would seem likely that loneliness among older people is set to continue; unless something significant is done. According to Age UK, tackling loneliness requires more than social activities. A new report from Vodafone suggests technology could be the answer.

Impact

The impact of loneliness in older people can be immense, not only for the older people themselves but for those around them. It can also put strain on the NHS, employers and organisations providing support to people who are lonely; and have a negative impact on growth and living standards.

Research has suggested that those experiencing social isolation and loneliness are at increased risk of developing health conditions such as dementia and depression, as well as increased risk of mortality. The damaging health effect of loneliness has been shown to be comparable to smoking 15 cigarettes a day. Older people who are lonely are therefore more likely to use health services than those who are never lonely.

The economic impact is also significant. It has been estimated that increases in service usage create a cost to the public sector of an average £12,000 per person over the medium term (15 years). Vodafone’s report suggests that loneliness has a £1 billion a year impact on public services. It has also been found to cost employers £2.5 billion per year.

How tech can ease the burden

According to Vodafone, “new technologies are a key part of the solution” alongside more traditional public and community services. Two key routes through which technology can be used to reduce loneliness are highlighted:

  • by supporting older people to remain independent in their home and community; and
  • maintaining and building networks and contacts.

From wearable devices and touchscreens to personal robots that act as the eyes, ears and voice of people unable to present physically, these are all highlighted as viable and positive uses of tech to ease the burden of loneliness. And there are already a number of examples of innovative use of technology that can benefit older people.

1024px-AV1

No Isolation AV1 robot. Image by Mats Hartvig Abrahamsen, via CC BY-SA 4.0

Good practice examples

One such example is Vodafone’s smart wearable wristband, the V-SOS Band, which supports independent living while also increasing the wearer’s safety. It can directly alert family members via their phone if the wearer needs help. It also uses fall detection technology so that families can be alerted automatically if the wearer falls either in the home or when they are out.

Kraydel is another example. Its smart TV-top hub links elderly people to their carers or family members, through their TV screens, helping people be more independent and remain in their own homes for longer as well as helping them be more socially connected. It provides for user-friendly video calling via the TV and can help people return home from hospital earlier. Via connection to the cloud, the device interprets the data it receives to build up a picture of the user’s daily activities, health and wellbeing. It issues medicine and diary reminders, and alerts caregivers if it sees something amiss, or identifies potential risk.

Although aimed at children, No Isolation’s AV1 – a smart robot designed to reduce the risks of children and young adults with long-term illness becoming socially isolated – demonstrates the positive impact innovative technology can have on social isolation and loneliness. The robot avatar, with its 360 degree camera, acts as the child’s eyes, ears and voice in the classroom or at other events, keeping children closely involved with school and in touch with their friends.

Of course, loneliness is particularly prevalent among people who don’t use smart technology such as smart phones and tablets, one of the reasons cited by Kraydel for using the TV – probably the most familiar and widely used screen globally. This issue also led No Isolation to develop KOMP, a communication device for seniors that requires no prior digital skills. It enables users to receive photos, messages and video calls from their children and grandchildren, operated by one single button.

Another new project recently launched in Sweden – considered one of the world’s loneliest countries – uses a unique conversational artificial intelligence which enables older people to capture life stories for future generations while providing companionship. Memory Lane works with Google Voice Assistant and is able to hold meaningful conversations in as human a way as possible. A pilot test showed that the software “instantly sparked intimate conversations” and led to stories that hadn’t been told before.

Final thoughts

With a significant number of older people lacking confidence in their ability to use technology for essential online activities, support for digital skills is obviously still important. In response to this issue, Vodafone has launched free masterclasses across the UK, as part of a programme called TechConnect.

Many of the above innovative examples bypass the traditional barriers to realising the potential of technology in reducing loneliness as most:

  • don’t rely on older people engaging directly with the technology; and
  • are based on mobile technology that can be constantly connected, whether inside or outside the home.

However, there is still the issue of awareness of such technologies and their accessibility to older people. The Vodafone report suggests that access could be improved through social and digital prescribing and revitalising support for independent living, and calls for a challenge fund to support innovation. It is suggested that these innovative ideas are just the start and that combined action is needed from across all levels of government, business and community groups, amongst others.

Perhaps if such action is taken to address existing barriers, we will see a reverse in the loneliness trend over the next 10 years.


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Is technology really the answer to social isolation and loneliness?

Old man sitting on a benchBy Steven McGinty

As we head towards Christmas, the media is filled with images of families coming together and enjoying the festivities. However, the reality is that many people will not be spending the Christmas period with loved ones, and will be spending the festive season alone.

In April, Future Cities Catapult produced a report into the impact of social isolation and loneliness. They highlight that those experiencing social isolation and loneliness have an increased likelihood of developing health conditions such as dementia (1.9 times more likely) and depression (3.4 times more likely). In addition, there is a 26% increased risk of mortality.

The report also included findings from the Mormont Review, highlighting that in emergency situations social networks have a significant impact on recovery.

Individuals who are socially isolated are between two and five times more likely than those who have strong social ties to die prematurely. Social networks have a larger impact on the risk of mortality than on the risk of developing disease, in the sense it is not so much that social networks stop you from getting ill, but that they help you to recover when you get ill.

It’s this substantial impact on people lives’ – and the costs to the health service – which has led to many public bodies looking for ways to tackle social isolation and loneliness.

Technology-based interventions, in particular, are some of the most innovative approaches to addressing the issue that affects over half of all people aged 75 and over who live alone, as well as increasing numbers of young people. Below we’ve outlined some of the most interesting examples.

CogniWin

CogniWin provides support and motivation for older people to stay active and in employment by providing smart assistance and well-being guidance. It helps people to adapt cognitively with their work tasks through their interactions with a system (which collects information using an intelligent mouse and eye tracking software). A virtual Adaptive Support and Learning Assistant then provides feedback, which helps the older person adapt their working lifestyle or have the confidence to take up a part-time job or become a volunteer.

Casserole Club

Casserole Club is a social enterprise that brings together people who enjoy cooking and who often share extra portions with those who may not be able to cook for themselves. Founded by FutureGov and designed in partnership with four local authorities, the service uses its website to allow volunteers to sign up and search for diners in their area (most of which, are over 80 years old). Overall, there are 4,000 cooks nationwide, and 80% of diners highlight that they wouldn’t have much social contact without the Casserole Club.

Family in Touch (FIT) Prototype

The Family in Touch (FIT) prototype was developed by a team of Canadian researchers who noticed that elderly people in care homes and retirement communities often touched photographs in an attempt to connect with family members. Based on this, the team created a touch screen photo frame which sent a message to a relative to say that they were thinking of them. The relative was then able to record a video message, which could be viewed by the elderly person in the photo frame. It was found that elderly people appreciated the simple design and tactile user experience.

Final thoughts

These are just some of the innovative tools being used to tackle social isolation and loneliness. And although technology is not the whole solution, it can certainly provide new opportunities for projects seeking to provide friendship and support to those who feel disconnected.

Individually, we can also make a difference. Even just making a phone call to an elderly relative, sending a message to an old friend, or visiting a neighbour, can brighten up someone’s day.


The Knowledge Exchange provides information services to local authorities, public agencies, research consultancies and commercial organisations across the UK. Follow us on Twitter to see what developments in policy and practice are interesting our research team. 

“A new journey”: creating a dementia-friendly public transport system

People diagnosed with dementia can live independently for many years – in fact, 1 in 3 people with dementia are still able to drive safely.  However, as the disease progresses, people with dementia must eventually stop driving.  Public transport can be a good alternative to driving for those in the early stages of dementia, enabling them to stay connected with their families, friends and local communities, and provide access to healthcare.

Indeed, the provision of easily accessible public transport options is a key aspect of dementia-friendly communities.  It is difficult to overstate its importance:

“If I didn’t have coping strategies to remain independent and mobile I’d be very lonely and soon sink into depression. Travel brings normality to an often abnormal life” Wendy Mitchell, recording a Dementia Diary for Upstream

However, the challenges faced by people with dementia mean that travelling by public transport can be daunting.  This is because dementia affects more than just memory.  Environments that are noisy and busy can be extremely disorientating for people with dementia, particularly when there are added time-sensitive elements such as bus or train times.

People with dementia often lose the confidence to travel.  They may experience difficulties purchasing the correct tickets, become confused by different fares or travel options, or feel hurried or pressured.  They may feel anxious or unsafe, for example, when becoming separated from their luggage or they may have a fear of becoming lost, or getting off at the wrong stop/station.

In addition to the cognitive, emotional and sensory challenges faced by people with dementia when travelling, there are a number of additional barriers.  These include:

  • Difficulties with journey planning
  • The use of fast changing technology which can exclude certain groups of people
  • A lack of service integration
  • Staff with limited awareness of the needs of people with dementia
  • Poor, inconsistent or confusing signage – or unclear rules regarding reserved seats/spaces

Policy and practice

The UK has set out the goal of becoming the best country in the world for people with dementia by 2020.  It has made some significant steps forward – currently, there are now over 200 communities working towards becoming ‘dementia friendly’.

In regards to transport improvements specifically, earlier this year, the Bus Services Act gained royal assent in England.  The Act provides powers to ensure that buses make both audible and visual announcements about the route and the next stop.  These reminders can help to reassure people with dementia.  The government has committed to work alongside the bus industry, passengers and disability groups to develop the policy further.

The government is also currently consulting on a draft ‘Accessibility Action Plan’, which addresses the barriers faced by people with disabilities using public transport, including a focus on hidden disabilities, such as dementia.  It also commits to updating existing guidance on ‘inclusive mobility’ to incorporate current knowledge and understanding of the needs of those with hidden disabilities such as dementia.

Involving people with dementia in service design

Involving people with dementia in the design of services can help to ensure that their needs are addressed.  Upstream is a project that does just that.  It helps to give people living with dementia across Scotland a voice in the design of future mobility services.

Projects have involved visiting various groups in the Western Isles to learn about the challenges of island transport, workshops to gather insights about travel with Dementia Friendly East Lothian and the North Berwick Coastal Area Partnership; and developing training programmes in conjunction with transport providers.  They have produced a report of their work so far.

Use of technology

The expansion of real time audio and visual information as set out in the Bus Services Act provides a good example of where technology can be used to make transport more accessible for people with dementia and other disabilities.

Other ways in which technology may help include the expansion of live departure boards at bus stops and increasing the use of journey planners – either online or via the telephone.  Apps may also have the potential to help organise shared modes of transport for groups of people in rural areas, and in the future, driverless cars may offer an additional transport option for people living with dementia.

Improved awareness of dementia among travel staff

Improving awareness of dementia among transport staff, and developing training programmes on how to respond to the needs of passengers with dementia, is another key way in which services can be improved.

For example, East Anglia Trains, has worked with the Dementia Society to deliver a dementia-awareness training pilot for staff at four of its stations, and plans to roll this out to all East Anglia staff. Arriva Rail Northern has also announced funding to develop the Bentham Line from Leeds to Lancaster and Morecambe as a ‘centre of excellence’ for people with dementia.

Transport assistance cards are another example of possible ways to improve transport for people with dementia. These cards record details of an individual’s needs so that the individual can show the card privately to the driver or other travel staff as a means of asking for extra assistance. Many individual transport operators and local authorities across the country already issue such cards.  Standardising these schemes across the UK may be one way to help improve people’s confidence when using public transport.

Future developments

While these initiatives are making a significant impact, there is still much to do.  If the growing number of people living with dementia are to maintain their independence, then it is essential that transport services become more dementia-friendly. Bringing together the shared knowledge and experiences of those living with dementia, and the skills and experience of professionals involved in the design and delivery of transport services will help to create a more inclusive, person-centred public transport system.

Dr Joy Watson, an ambassador for the Alzheimer’s Society who herself has been diagnosed with dementia, sets out an admirable goal:

A diagnosis of dementia is not the end of the road, but the beginning of a new journey.  Some people need a little more help to take the first steps, and if I can contribute to them living well, then my mission is fulfilled.”


If more than one in three homeowners are interested in downsizing, why aren’t they making the move?

 

According to Savills estate agents, about 90,000 people over the age of 65 in the UK downsize to smaller homes each year. On the face of it, that’s a substantial number, but it still leaves more than three million houses under-occupied.

With an ageing population and a serious housing shortage, government at local and national levels is looking for ways to encourage older people to downsize their accommodation so that more family-sized housing is made available.

Benefits of downsizing

Everyone needs good housing, but as people grow older their homes become especially important as places where they can feel safe, independent and comfortable. Downsizing from larger properties can offer significant benefits to older people:

  • Smaller homes can be easier to heat and have lower utility bills.
  • People downsizing to sheltered housing can retain their independence, while having access to support when it’s needed.
  • Smaller homes are easier to manage and cheaper to maintain.
  • People moving into specialised retirement accommodation can experience improvements in their health and wellbeing.

Enabling people to remain in their own homes may also alleviate the pressures on the country’s social care system – pressures that are likely to intensify as the population age rises.

Downsizing barriers

While there are attractions to downsizing, important factors are putting off large numbers of people from moving to a smaller home. Some may feel too confined in a smaller space, experience problems storing their possessions, or miss having a large garden. Others may feel that they’ve taken a long time to climb the property ladder, and want to enjoy the home they have spent a lifetime working to achieve.

But for those who do want to move, downsizing can be expensive.  It may release equity, but some households find the costs of moving – notably stamp duty – may cancel out the financial benefits. And although lower maintenance costs can be a major reason for downsizing, older people moving into apartments may find that costs for maintenance and factoring, may be higher than in a standard family home.

Downsizing: the real story

A 2016 report by the International Longevity Centre (ILC) explored the experiences and expectations of people downsizing from under-occupied housing later in life. The report found that one in three homeowners over 55 are considering or expect to consider downsizing. However, while demand for downsizing is substantial, the reality is a different story:

“In many ways, the older generation is stuck in its current housing, which has resulted in the UK having one of the lowest moving rates amongst its older population compared to other developed countries.”

The study echoed the findings from a 2014 Age UK report which showed that the scarcity of suitable and affordable retirement housing was a barrier to downsizing:

“At the moment, retirement housing makes up just 5-6% of all older people’s housing. Research indicates that many more older people might consider downsizing if alternatives were available, although not just retirement housing schemes.”

The Age UK report noted that, based on demographic trends, specialist retirement housing would need to increase by between 35 and 75% just to keep pace with demand. The report also pointed to poor access standards and cramped accommodation in some sheltered housing schemes as downsizing deterrents.

Alternative approaches

The Scottish Government’s strategy for housing for older people, published in 2011, supports downsizing, and highlights Highland Council’s scheme as an example of good practice. In association with local housing associations, the council has provided financial and practical incentives to support older people wishing to move because their homes are too large for their needs.

Another approach, popular in Scandinavia and the Netherlands, is co-housing, which offers older residents a balance between independence and community life. Co-housing schemes are run totally by the residents, offering support when needed to those who live there, while respecting their dignity and independence.

In the Netherlands, there are now more than 200 co-housing communities. Successive governments there have supported co-housing because it has had such positive impacts on demand for health and social care services.

In April, the UK’s first co-housing project for older women opened in Barnet, north London. One of the scheme’s proponents, Maria Brenton, believes that it will be a model for similar projects:

“One of our purposes is to promote the idea of senior co-housing. Now we have shown the way, we are a living, breathing example, it will encourage people enormously.”

Final thoughts

As the ILC report notes, the policy debate on housing in the UK has focused almost completely on first-time buyers. However, with more than three million homeowners aged 55 or over open to the idea of downsizing, the impact of freeing up large numbers of family homes could be significant. Before that happens, the under-supply of affordable homes meeting the particular needs of older residents needs to be addressed:

“Fundamentally, the notion of downsizing in later life should be about choice rather than obligation. It therefore becomes clear that if we were to develop the right policy environment, we can enhance the choices available to people in later life, encouraging downsizing and creating a more dynamic housing market.”



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Buurtzorg: reinventing district nursing in Scotland

Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

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