Podcast Episode: How can we effectively engage with harder to reach older people?
Category: Adult social care
What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.
VM - Vivien Moffat
SC - Sarah Currie
BM -Betty Milton
AT - Audrey Taylor
GP - Gerry Power
AM - Agnes McGroarty
Plan P: New approaches to prevention with older people is an Iriss project which addresses the issue of social isolation and loneliness amongst older people. Each quarter the advisory group records a group discussion about a related aspect of prevention. This is the fourth discussion - How can we effectively engage with hard to reach older people? It was recorded on the 7th of October 2014.
VM I am Vivien Moffat, I run the Evidence Informed Programme at Iriss.
SC I am Sarah Currie, Programme Manager at SCVO, leading the Building Healthier and Happier Communities programme
BM - I am Betty Milton, I am from a City For All Ages
AT I am Audrey Taylor, and I am from NHS Education for Scotland
GP I am Gerry Power, I am with the Joint Improvement Team
AM I am Agnes McGroarty, I am with Scottish Seniors Alliance
VM Today we are going to think about how we can include the hardest to reach within our community intervention to prevent social isolation and loneliness for older people. We know that social groups and activities provide opportunities for people to get together and enjoy social interaction, but we also know that some immediate barriers are around people knowing what's available, having confidence about attending something and particularly around transport. There's lots of reasons why people may be particularly hard to reach, maybe around physical health, language barriers, being a carer, and so I just wanted to think today if people had thoughts about what kind of activities might help us to reach those harder to reach groups.
BM I certainly would like to see a One Stop Shop in defined areas, and I feel that way people would have a telephone number, but they would also have a place that they can, when they are passing by, they will see it and be inclined to go in and find out what it's about, or they can be referred there and if they are phoning they can be referred to other places, they could be given advice of where they might get help or whatever, and that way it's anonymous, but if they want to go in and look around then they could, and in the same way get help that way.
AT Something has happened in East Dunbartonshire with the older peoples access lines, OPAL, and that has certainly worked quite well, either individuals or friends or family members can call up and say they would quite like them to get involved in a lunch club or a knitting club, or whatever their particular hobby or interest might be, and that's working well in terms of connecting people. I think, for me, there's an aspect about this, I suppose it's about behaviours and behaviour change, so people might not want to change their behaviour and I think we do have to acknowledge that some people just, they might not want to engage in particular things, but there is a huge majority that do want to engage or get to know what's happening, and to me the biggest barrier is definitely information, there is not knowing what's happening out there, from the work we have been doing in East Dunbartonshire, a theme that's emerged and I know it won't be just for that particular area, is people not knowing whether it's different sectors, different populations, people saying I didn't realise this existed, or this is just down the road from me ... but it's using, having a sort of a ... I suppose a lever, something that attracts peoples attention, so what is it that gets them interested. You were saying that, Betty, about people ... the older ladies that you were talking to that dancing was something that appealed to them, so it's about the appeal, it's not trying to just blanket this, so it's probably back to the universal and targeted approach of what works for people.
AM I feel that, what you said, knocking doors ... I think that's the only way you are going to have to find these people who don't go out, who maybe just get everything brought to them by phone or whatever, and it's those people that we worry about, what's happening to them behind these closed doors, how lonely ... and the more they stay on their own, the worse they become fanatically ... and then they decide they don't want to go out, so you just don't know what's going on in these poor peoples minds until you talk to them face to face, and that's the problem.
AT I think that's a really key point, there is something about that conversation about asking people about their personal experience or their subjective sense of isolation, because it's really hard to define one persons loneliness would be another persons, I am absolutely happy with this, you know, and there is something about either key people that would have routine conversations with folk, not about that, but that could ask one or two light touch questions to start getting a sense of it or to start signposting. I don't have an answer who these people would be, the obvious one is to say GP's, but I don't want to load it all there as well, is there some way within our communities that we can find it a little bit easier to ask about somebody's sense of feeling lonely or just feeling a bit disconnected, and could I help with that in any way. But doing it in quite a respectful, light touch kind of way, so that folk don't feel they are bombarded with ... you have got to join 20 groups, and maybe you have never joined a group in your life and never wanted to.
GP Yes, I agree with that. I agree with what Betty is saying, there are some people who just aren't on anybody's radar, even GP's, and certainly if you look at some of the data that comes through from looking at acute hospital admissions, what's known as SPARA data, which is about looking at people who are at danger of admission or re-admission into hospital, you will see that that's how some people ... their long term conditions are managed, they don't go near their GP and the first time that they get on the radar of health is when they are admitted into hospital, and then they go out of hospital and then they recover, but then the next time they are on anybody's radar is when they are re-admitted, so there are those individuals. And also, I mean it's about personality types as well, some people all their lives have been quite independent, quite self contained etc, and maybe over time lose connections with the small group of individuals that they have as friends or family, so they are completely isolated and they are not outgoing individuals and they are not used to actually reaching out for help, so I think what you are saying about knocking on doors, sometimes you need to try and identify those people and try and reach out to them. There are individuals who, no matter what happens, if they are isolated or feel lonely, they will reach out to somebody but there are those that won't, and I think Betty is right, I think you have got to actually try and find those people. And there are various ways of doing that, we can perhaps look at information which gives us indications of people who are isolated, like admissions into hospital etc, it's a question of how you share that information. I think there's also issues there, I was thinking about gender issues, maybe males are more reluctant to actually socialise than females, that's maybe an overestimate, but as the only male member of this group, I think perhaps it shouldn't be underestimated, and as I say, you know, certain personality types are more prone to being more insular and introverted and inward looking and sometimes you need to reach out to them as well.
VM So who should be doing that reaching out, you know knocking on doors, should it be your neighbour, should it be a volunteer, should it be a professional person?
BM Not a professional person, I think it should be age groups, I think it should be people over 60, because they are talking this persons language, it's the older person we are looking at, and I feel that there are so many older people out there that would be willing to do that but nobody approaches them because nobody has thought of this, maybe. Even if they just give them a block and say go in the afternoon, not night time, older people don't like going out at night, especially in the dark, so I feel there is so much potential there and sometimes I feel they are not using the older people like they could.
AM The problem is, I am finding very much among our forums, we are not getting the 60's in, the late 60's or the early 70's, they are not joining forums in the way they were before, and that's where our age group is getting higher and higher, and I doubt we have got very, I don't know, I suppose I should really look at that, but I am aware that we are not getting the younger age group.
SC: We can't say that, not in ACLA, no, we have got all age groups. I think I am the second oldest there, we have got a lady of 90, no we have got quite a lot of ... we have even got some people in their late 50's.
AM No, we haven't got that
SC: Yes, we have
AM The thing is that our forums have sort of dwindled because our money was taken away, our Section 10 was taken away, which meant we lost our staff.
AT What sort of activities are they ...?
AM Well they are all part of ... their forums and they are doing bits and pieces in their churches and things like that, but it's really just the forums when they come together and they discuss what's on the agenda and what's important and where we are going from here.
AT I am interested on your knocking on the door, can you say a bit more about how you imagine that might work, because it sounds ...
BM Well I think it would work quite well, I mean I would advise them maybe to go in 2's, maybe, and knock at the door and if it's an older person, what you could find out is that one block, even though you knocked at all the doors, somebody is bound to say I am not old, but there's an older person there, but we don't know her name, we don't know what she does, because that's what will happen, so that gives you an inkling you have got a foot in the door, and if they are not going to answer, I would write a wee note or something to say, look, we are only here to see if we can help you, I am Betty or whoever and we are older people and we know what's on offer. Maybe the offer would be good, because maybe she would think well maybe I will get this, maybe I will get that.
AT To me that's the key point about knowing what's on offer, so whoever you have interacting with them, because there's no point in asking the question if you can't provide some sort of information or solution, or even a commitment to take away, and say, we don't maybe know about it but we can go and find out what is on offer, or set something up, which we could invite you to. Because to me that's about managing the risk there, because the danger is that you get peoples hopes up or say we will provide something ... but even the interaction itself, and the contact is a very positive thing.
BM And then you know right away that's an older person and they are on their own ... we could make sure that even somebody just wanting once a week ... through my community council, I mean they are determined to try and do something about the older people in my district, so I would do it, I mean I am sure my other friend would do it too, she's a lot older.
SC: There is even the telephone set up, you know, the morning calls or the calls for just to have a chat, see if everything is okay, but I don't know how you would ... how feasible that would be, actually
AT Befriending, even as a very simple concept, I suppose you could break that into 2 aspects, because you could ...
BM But there again you are going to have somebody talking on the phone that's not old, they haven't a clue really what this persons wanting.
SC: But you could have older people doing that because we did that years ago, a few years ago, when the government were providing free central heating, and the council, and the social work department and the council hired us to do it and our members all did that and they had to telephone from their home, and they had each a day, afternoon or morning, and the telephone line would be for people to phone and get the information about having their central heating installed. That was hugely successful, hugely successful, and we had it for about 3 years ...
AT So there were older people in your community who were willing to sort of take that on ...?
SC: Yes, yes ... they did it from their own house, they did it from their own home.
AM That's what Esther Rantzen set up, didn't she ... Esther Rantzen has got this number that anybody ...
SC: No, no, it was before Esther Rantzen, it was when ... you will remember when the free central heating was offered, all the buses had it on as well, well we were the ones who did the phoning and taking the information from the people who phoned in to find out about it, and then referred it onto the Scottish ...
BM There is definitely something about older people being able to connect with other people ...
AT Yes, and there is something about the point of focus around that was around heating ...
SC: Yes, absolutely
VM ... you know, so there's some meaning in that, that isn't about going in and asking somebody, do you feel lonely, it's quite a different thing to say I will come and ... you know, so there's something about how can you kind of learn from that, is there a point of contact that isn't necessarily about being lonely or about feeling isolated? Because I am also thinking one of the kind of, if you were going around and speaking to people, one of the questions might be, well what can you do for us ...?
SC: At the time, it wasn't just about heating, you know ... we had a list of referral agencies and it was hugely successful.
VM What about some of those really harder to reach groups with particular barriers around language or disability or ...?
BM We are finding there's quite a lot of divides now, we are finding, I mean I am not being nasty here, but the Polish people are definitely getting their own little group together, and the Asians do that too. I think I told you the last time that our community council are wanting to now, maybe once a month, have the meeting near the Asian group so they can come, the rest of it ... you see, we try and have it always in a centralised spot, but no Asians come, so we have been speaking to this lovely lady and we have got something set up, one of my community councillors go to their meetings now and meets the Asian people, and they are very private people, but we want them to know what's going on in their district, so we are doing this now, one lady is in charge of doing this because they don't want to come up to the meeting place we have. So we are going to try and hold a meeting, I will be going because I am Chair, and maybe 3 of us with them to see if we can help in any ... because they are having an awful lot of problems with racial abuse and we can't have that, so it's difficult, very difficult, very, very difficult. I just wish I could get somebody on my committee and that would help so much. I don't know if you have found that, but I have.
BM I have found it's more difficult now, but then because there's a lot of very well organised things for groups in their own ... you know, Pollockshields, for instance, has got everything going for it, and they have got Govanhill now, but then that was because of the problems, they have now got so many Romanians in there, they have actually got their own social work department ... they have got their own social work groups that are looking after them, because that's been horrendous, there are about 30,000 of them in Govanhill.
GP I suppose it's an issue about whether specific communities have their own infrastructure and in fact whether that's better with some communities than others, and it may well be within those communities themselves they are better placed than maybe traditional communities are. So for example, I think there's a generational issue in terms of families maybe living further apart in different parts of the country or even different countries, where maybe that infrastructure isn't there in some communities, maybe that's less so, so I think it's a question of are communities that appear hard to reach actually quite strong in terms of their infrastructure, we don't know that, and it may well be that further investigation will show that those communities are strong at the moment, now, who knows what will happen in terms of future years, you know, things change, but I think it's a question of trying to understand where, you know, just because we are not aware of what's going on, I say WE, you know, public service is not aware of what's going on in certain communities, it may actually be quite robust.
AT Yes, certainly around ... you know it's responding to what people need and want and how they feel and everyone has their own ...
SC: It's turning the notion of hard to reach on its head, isn't it? Because it's not that people are hard to reach, it's that they might not be the right people to reach.
BM There's a thingmy known as Nan McKay House in Pollockshields, are you aware of that?
BM And it has, we had a meeting there, and it was all groups and it was very successful, that was one of the meeting areas in the group that we had, Age Scotland and myself, ourselves, and one of the housing development ...
AM In our big group, AGFA, we have a lesbian lady, we have a gay gentleman, we have got an Asian doctor, so we have tried so hard, but you have no idea how difficult it is, even with a group like ours, because you come against things that we have never even thought about ... I mean I am being perfectly honest, inside my heart, you are opposite me, you are a man or a woman, I couldn't care less about anything else and if you go into the hospital you should be treated like everybody else and I don't think of anything else and that's the gospel truth. I think with my Dad being in the regular army I was dragged around so much that people are just people as far as I am concerned, and it's unfortunate that this cannot be brought into everything, but we find we have lots of problems, even just in our group, with different ...
GP Betty, you mentioned about maybe older people approaching other older people. People identify with certain individuals moreso than others, so that could be anything from someone who shares, whether it's gender or whether it's nationality or whether it's ... you talked about people with disability etc, so in essence, if people are able to connect and recognise something in others, they are maybe better able to communicate, because what I think what you were saying, and correct me if I am wrong, is that if you are an older person, you maybe have more understanding of what other older people may or may not want, and therefore that communication might be easier because you are talking, not completely at a similar level, but you may have certain shared understandings, and that maybe is true in terms of other aspects in other communities as well, so perhaps whether a community is hard to reach or not, it might be about ensuring that those who are seeking to offer support have an understanding of what that community is about and the best person to understand that is somebody from within that community, I don't mean just geographical community, in communities of interest, so I think that would be important to ensure that if anything is being developed, that you understand what community you are trying to reach. And it may be it surprises you, it may be that there is significant activity going on which is involving people, but in an attempt to actually ensure that people are being connected, you maybe need to ensure that you play in the right type of individual or individuals to make that connection.
GP Well if you had a 20 year old coming along to ...
BM Oh no, sorry, I thought you were still talking about the older person
GP Well I am, I am just saying that in the sense that what you were saying is that with older people knocking on the door, that perhaps they will have more in common with another older person rather than a 20 year old knocking on the door saying, is there something we can do, and similarly in terms of other groups, of other communities, it might be, if you were talking about Polish folk, for example, it might be if you had other Polish folk who were knocking on the door introducing themselves, that's just one example, it's just, you know, have you something in common with the interests of that individual, and you might ... so, you know, people can get suspicious if a 20 year old knocks on the door, you might get suspicious, but I think it's about being thoughtful and sensitive to ... if you are trying to reach out to people who you feel are socially isolated that you are making that in the most sensitive and responsive way.
AM I mean I guess the most isolated older people possibly would not answer their door, whoever knocked, so something about that ...
BM Yes, there are people like that too, that's very true. So that's why I thought if we could have a wee written something, just pop it through ...
GP Yes, that might be less threatening to folk, it puts the onus on them
BM Something not serious, but not cheeky, just something ...
AT Or it could say we will call back tomorrow at such and such a time, so that when the doorbell goes again ...
GP You will know what it's about.
AT I suppose just one final thing, sorry, can I just say ... it is that thing though, for me, about how often we go out and say what can we do for you, rather than what can you do to help us or help ... you know there is something about, we keep doing it and we make people feel so passive in that, we accentuate that sense, oh I have no control over my community, no power or no place, and there is still something, I keep coming back to this, is there something we can engage people with, say we need your help, we need your stories, we need your experience, we need your life to sort of help us or work with us on that ... just ...
SC: ... idea of when you are speaking to someone, think about something they might like to do and people might not want to ask for help but they might like to get involved in doing something for someone else.
BM I think if you could get out to some of the community councils, even, I think you would be very pleasantly surprised.
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