‘Health has an intrinsic value. It allows us to do the things that really matter in life: participate in our community and society, maintain flourishing relationships, find meaningful work and hobbies, and attain wellbeing. It is the first wealth.’
‘Health and Prosperity’, Institute of Public Policy Research, 2022, page 14
Often health professionals use lots of facts and figures to describe health and wellness, and disease and illness in different populations. There are some examples in this report! Too much of this type of information can make it harder to relate to the part health plays in our everyday lives and in the lives of our communities.
The quotation above is a reminder that health and wellbeing allow us, ‘to do the things that really matter in life’ and are precious to everybody.
But how we feel in ourselves, day to day can be affected a lot by circumstances, e.g., having the right opportunities to do things that matter, and having access to support from family, friends and others who care and enrich our lives.
A 74-year-old woman who has had a stroke and mini-strokes commented:
“Your health, your brain stops working as well. Mental health. Isolation is a part of it. Sometimes I can’t think straight, and my mind’s gone… half the time I don’t know because I can’t think of what’s coming next. So yeah, people think of me as just that old one. I’ve lost a lot of confidence in doing anything.”
The Living well part of the report hears from older residents about what really matters to them and how they stay connected and involved. There are inspiring case studies about how the places where we live, whether a house, care home, or the wider neighbourhood can boost wellbeing.
How are you? Wellbeing in later life
The graph below shows how people rate their level of anxiety, happiness, life satisfaction and feeling that life is worthwhile at different ages in England. On average people in their 40s, 50s and early 60s are most likely to say they feel anxious, unhappy, not satisfied with life or that life does not feel worthwhile.
This is an important point to consider. Middle age is a time when risk factors like high blood pressure, obesity and smoking might start to show up as longer-term problems like diabetes or chronic lung conditions. For most people, establishing small healthy changes in the 40s and 50s is effective at preventing a lot of health complications, but stress and poor mental wellbeing can make this more of a challenge.
In the 70+ age group there is a noticeable improvement in wellbeing. Adults aged 70 and over are least likely to report feeling unhappy (1 in 12), and least likely to say they feel very anxious (1 in 4). This is good news, but it still means that thousands of older adults in Sefton are living with feelings of anxiety and unhappiness.
Image: A bar chart showing the percentage of different age groups in England who reported low life satisfaction, feeling life is not worthwhile, low happiness and high anxiety at the end of 2022
Source: Sefton Council Business Intelligence team
Mental health and older people
The Royal College of Psychiatrists published a report in 2018 called ‘Suffering in silence: age inequality in older people’s mental health care’. Some important points from the report are:
- A quarter of 18- to 34-year-olds questioned in a large survey believed that ‘it is normal to be unhappy and depressed when you are old’
- Nearly half of older people thought that adults over the age of 65 are less likely to recover from a mental health condition than people aged 18–64
- In fact, it is estimated that depression affects about a quarter of men and women aged 65 or over – similar to other age groups. Older adults also get similar benefits from treatment compared to younger people.
- Mental health difficulties can sometimes appear differently in older people, for example having more issues with anxiety, memory, feeling agitated and physical symptoms. Ongoing depression makes it harder to carry on daily life as usual and increases the chances of needing long-term care
- Some older adults may see depression and anxiety as ‘weaknesses’ to be concealed rather than problems to be treated. More action is needed to tackle the stigma of mental illness.
- Research suggests that older adults with depression are less likely to be receiving treatment, especially talking therapies. The report says,
- ‘Labels such as ‘elderly’ and ‘vulnerable’ are not a substitute for diagnosing and treating genuine mental health problems.’
- Other risk factors for depression and mental illness in older people, such as loneliness, alcohol and substance misuse, fuel poverty and risk of abuse are important to identify early and address.
- Alcohol and drug misuse are growing, but often hidden problems for older adults, which can seriously affect mental as well as physical health
- In 2019/20 in Sefton, more admissions to hospital for alcohol-related conditions took place amongst over 65s compared to under 40s, although the highest rate and biggest number was in 40-64 year-olds
- Older people are at highest risk of misusing prescription drugs, such as benzodiazepines
Feel good, feel better - activities and support
There is lots besides medical support that can boost wellbeing and help keep low moods away. The diagram in this chapter is from The Community Mental Health Framework for Adults and Older Adults, developed by the NHS.
Image: The Community Mental Health Framework for Adults and Older Adults
Source: The Community Mental Health Framework for Adults and Older Adults. NHS, 2019, page 12
The model shows all the different places and activities where older adults can get support for their mental wellbeing, whether they are experiencing a complex, long-term illness or just want to add more feel-good activities to daily life. Surrounding the individual at the centre are personal community and wider community support. Formal services based in the community and hospitals make up the two outer layers of support.
The seniors we spoke to also felt that their health was rooted in the physical and social world around them - where you live and how you live determines how well you can feel in yourself.
“Keeping on the go helps keep me healthy. Support groups have helped to come to. If we didn’t have places to go, we would all be alone and I don’t think some of us would still be here...I keep myself going by cleaning, going the bingo, coming here, going for a meal, meeting with friends for a little walk round the shops. Getting a bit of breathing space, ‘some me time’, I call it...I have a dog and he keeps me active. I walk the dog three times a day. A little colly cross, short coat.” [female, age 76]
“It's about finding out what things stimulate your brain because we are all different. It’s not your activities, it’s the mental side of things. My big thing is the poetry group...We have a gardening group too, that’s not for me but some of the others I believe really enjoy that. [male, age 77]
The case studies in this chapter show how some older adults in Sefton are benefiting from this type of holistic mental health and wellbeing support and making connections in their communities.
The impact of the pandemic on older adults
The sudden arrival of the new Coronavirus in everyone’s lives at the start of 2020 caused shock and worry. In 2020, 567 deaths in Sefton involved COVID-19. As in other parts of the country, three quarters of these were in people aged over 75. Countless families, friends and loved ones experienced loss and grief under circumstances few of us could have imagined. Before, the roll-out of the vaccine programme in early 2021 whole communities found themselves cut off from one another.
Age UK described how the day-to-day lives of millions of older people had become ‘crushingly hard’. Their research highlighted long-lasting fear of leaving the house and more problems with thinking and planning associated with spending so much time alone or with much less social contact.
Independent Age, an organisation which campaigns on issues that matter to older people, surveyed thousands of older adults during the first year of the pandemic.
- 66% reported feeling worried or anxious about COVID-19
- 45% said they had seen an increase in negative language used about older people in relation to COVID-19
- Financial and food shopping worries were commonly reported. Over half of respondents continued to feel anxious about shopping in supermarkets
- 42% reported their mental health had got worse
- 21% reported routine medical appointments were postponed or cancelled during the pandemic
- 43% reported their physical health had got worse during the pandemic – loss of mobility, strength and balance was a common concern
This is how one 74-year-old Sefton resident summed up her experience:
I mean during COVID I have never felt so old. I have never felt frightened, but during that COVID I can understand how people, when you’re isolated, how you can just go in on yourself. Because I think I cried right through COVID. And I have never done that in my life. I have never done that in my life because we are always out … doing this and doing that, but then you couldn’t do anything and I was like, “I can’t cope with this”. I had never been told in my life what I had to do apart from when I was a kid, and I hated every single part of it. I can understand now how people feel who are stuck in a house and can’t get out [female, age 74]
It is easy to see how the loss of social connection and community support really added to health problems caused by Coronavirus itself. A key lesson from the pandemic is not to overlook the importance of being connected and involved with people and places for a healthy mind and body.
Case study: At the Library
At The Library is a great example of… doing something different with a familiar community space and supporting community members of all ages to make it even more their own. Activities that use the senses and creativity have led to new friendships, new confidence and for some new work or volunteer roles.
At the Library is an award-winning programme of activities developed as a collaboration between artists, librarians, volunteers, and the local community. Some examples include Chopping Club, where participants gather to prepare and share food; the Kitchen Table Collective which is gradually producing a community dinner service; Stitch – a sustainable making and mending club; and Colour of Pomegranates, which is a group facilitated by the Red Cross and Venus for women who are newly arrived in the UK and want to learn English, develop friendships, and feel supported.
At the Library is based in Bootle and Crosby libraries and aims to deepen the relationship between libraries and the wider community, act as a truly inclusive space, and help people to grow new skills, confidence, and connections.
The core group of participants includes people from ‘all walks of life; the retired, elderly, those who can’t work for health reason, parents home schooling their children and some members who are long term unemployed or who have never worked….’ Participants commented,
‘The project got me back from COVID....encouraging my individuality – social support.’
‘Being retired and living alone, At The Library has been valuable to me from the point of view of combatting loneliness, enjoying company and people to meet and talk to.’
‘There is shame in feeling lonely, but, human beings, we need two things: we need connection, and it needs to feel real. That's kind of what's embodied by these projects because it does feel very real.’
Healthy places to live well
Sefton’s health and wellbeing strategy 2020-25 spells out three ambitions under the Age Well heading and one that applies to all ages equally.
- Older people will stay active, connected, and involved
- As people grow older they will be provided with support tailored to their needs
- Our communities and the built environment will meet the needs of people as they get older
- The places where we live will make it easy to be healthy and happy, with opportunities for better health and wellbeing on our doorstep
Together, these mirror many of the things people told us were important when it comes to keeping healthy, staying independent and expressing their individuality.
You can find links to the different plans and strategies that support and underpin these ambitions in the final section of this report, called ‘Information used in this report’.
Sefton is one of 58 Age Friendly Communities across the UK. In turn, this network belongs to a global network of Age Friendly Cities and Communities, where work is being led by older people to drive improvements in eight areas of life, which the World Health Organisation recognises as being important for healthy and active ageing. The Sefton Partnership for Older Citizens supports the work of Age Friendly Sefton and is guided by The Sefton Older People’s Strategy. Age Friendly changes that relate to the themes discussed in this chapter include:
- Tackling Loneliness
- Transport that meets older people’s needs
- Improving housing for older people
- Improving communication and information
- Improving safety and security
Case study: Hillside station
Hillside station is a great example of… community driven change, led by senior residents working in partnership with delivery organisations and funders. Merseytravel and Senior residents both benefited by bringing together their different skills and knowledge.
Hillside railway station, near Birkdale is now a fully accessible station with two lifts to ensure everyone can easily reach the platform. In fact, the Merseyrail Northern Line is now the most accessible stretch of railway in England.
In 2018, catching a train meant walking up 32 steps. For many senior residents and others with mobility needs train travel to and from Hillside station was not an easy option. Sefton Partnership for Older Citizens (SPOC) had previously advocated for the needs of older residents in connection to bus services and designs for modernised trains; now, SPOC played a crucial role in helping Merseytravel develop a funding bid to resolve the access problems at Hillside. Members organised and completed an extensive consultation involving other community groups and networks of senior residents. SPOC’s evidence contributed to the successful bid at Hillside and further improvements on the line.
Since then, SPOC has taken up a seat at with the Age Friendly Liverpool City Region Steering Group, meaning the experiences and needs of Sefton’s older residents can influence changes across Age Friendly domains regionally as well as locally, for example housing and spatial planning, jobs and skills, digital connectivity, and culture and the environment.
Case study: Care home improvements
The Care Home Improvement Capital Grants Programme is a great example of… how knowledge about healthy, age-friendly places can be applied at any scale.
In 2020, Sefton Council Adult Social Care introduced and funded a grants programme that care homes could apply for to make certain improvements,
- Designing better outdoor spaces and communal areas, with more scope for socialising and doing different activities
- Creating more dementia friendly areas inside care homes that can help lower feelings of distress and anxiety
- Offering residents more opportunities for fun and interest using new technology like interactive tables
- Introducing further COVID Safe improvements
In 2022, improvements from the first round of 43 grants were in place, and residents, staff and carers were keen to explain the benefits they had seen. Several care homes had improved their garden areas. This included additions to stimulate the senses such as water features, scented planting schemes and music. New covered areas with protection from heat and cold were now allowing residents to get involved in growing and crafts out in the fresh air.
‘We love our garden and I love to do my morning exercise in the garden while listening to the birds sing.’
‘Some of our Service Users took a great interest in the project, choosing the furniture and décor. They are really pleased with the finished project, and we use this space [conservatory] for daytime activities, birthdays, visitors, and we have had our first residents’ Christmas dinner in the conservatory.’
One care home had installed an outside lift to ensure all residents had good access to the garden.
Indoor improvements included the construction of a hair salon for residents; swapping out patterned carpet for plain to create a simpler space for those with dementia to find their way around; installation of cold-touch radiators; purchase of dementia friendly dining room furniture and, interactive tables and robotic pets.
Everyone involved felt happy and proud about the changes in their home, and managers commented on improvements in mental wellbeing, confidence, social interaction and eating and drinking.
- Feeling depressed, confused, or anxious is not an inevitable part of getting older and should not be overlooked or dismissed. A range of medical, social, and practical support can be effective, especially when concerns are identified early.
- Accessible, well-connected neighbourhoods with places that everyone can meet, connect, and participate are good for everyone’s health and wellbeing
- Senior adults have an indispensable role in shaping strategic changes that meet their varied needs and benefit the wider community
- Organisations should work together to further embed age-friendly cities design and sustainability principles, and promote overlaps with the needs of other more vulnerable groups, for example, children, and those with a physical or learning disability
- Health, care, and other support providers should know how to identify and act on risks to wellbeing and mental health needs in seniors