SCOPING STUDY OF OLDER PEOPLE IN RURAL SCOTLAND
1 In recent years rural policy issues have been to the fore in Scotland. However, the specific needs and characteristics of rural areas have yet to be raised in all policy areas. Issues concerning older people in rural Scotland are a case in point. There have been very few studies of older people in rural areas and in consequence there is little systematic understanding of their life experiences. This report reviews a wide range of material about older people in rural areas, presenting information around five quality of life themes: income, housing, accessibility, health and social care, and social and community life.
2 Life expectancy has increased significantly in recent decades throughout the UK and other Western countries. Older people comprise a larger proportion of the population than ever before.
3 Older people are normally defined as those of pensionable age, and national statistics are usually published for the 60-64 and 65+ age groups. The elderly (the over 75s) comprise a distinct demographic sub-group, particularly in the medical literature. Those aged 75 and over are sometimes termed the 'old-old'.
4 General Register Office Scotland mid-year 2000 population estimates by local authority area indicate that more predominantly rural local authorities in Scotland have a higher proportion of their population over pensionable age than do the more urban local authorities. Dumfries and Galloway was estimated to have the highest proportion, 22.2%, closely followed by Eilean Siar (Western Isles) (22.0%), the Scottish Borders (21.9%) and Argyll and Bute (21.8%). With the notable exception of Eilean Siar, most rural local authority areas saw an increase in the number of older people living in their area of jurisdiction between 1991 and 2000.
Positive and negative aspects of older people's lives
5 The literature on older people is primarily concerned with the problems of ageing, particularly the problems faced by the elderly (the over 75s). For example, as noted by Age Concern Scotland, older people live on lower incomes than the population as a whole and the gap between the wealthiest and poorest pensioners is growing. Furthermore, older people live in poorer housing than the population as a whole, are more likely to experience poor health and are the greatest consumers of health and community care services. Many policies, initiatives and projects, including some described in this report, are explicitly concerned with these problems.
6 Positive aspects of the lives of older people can also be identified. They include the better health and longer life expectancy enjoyed by many older people as a result of medical advances and better living conditions, the freedom brought by early retirement and the financial security offered by private pensions and other investments, enjoyed by a larger number of older people than ever before, and the growing presence of older people's issues on the political and policy agenda - the rise of the 'grey vote'.
7 At a UK level, average pensioners' incomes are growing faster than average earnings and gender based income differences are narrowing. On average, the net income of pensioner households was 64% higher in real terms in 1996/97 than it was in 1979 (Department of Social Security, 2000). Occupational pensions and investment income account for most of the difference between the poorest and the better off in retirement.
8 Not all pensioners have benefited from the average rise in income. Many pensioner households rely solely upon benefit income, comprising state pension, disability benefits and income-related benefits. Recent figures published by the government show that 770,000 pensioners who are entitled to claim the Minimum Income Guarantee are not doing so, and three years after its launch, 83% of pensioners on low income know nothing about the Minimum Income Guarantee and few know how to claim it. It is known from previous research that people in rural areas are generally reluctant to claim benefits, therefore it is likely that the proportion of pensioners in rural Scotland who have not claimed the Minimum Income Guarantee is high.
9 There are lower levels of disposable income among older people in rural areas than among those living in urban areas, and these low levels of income amongst the rural elderly have been linked to low income in rural areas generally. Older people living in the more remote rural areas have lower incomes than those who live in more accessible parts of rural Scotland.
10 Older people living alone are one of the four groups in Britain identified as being most at risk of living in poverty. Pensioners who are most likely to have a low income are older pensioners (those aged 75+), single female pensioners and ethnic minority pensioners.
11 British Household Panel Survey data indicate that the young-old in accessible rural areas have higher incomes than their urban and remote rural counterparts. However, the over 75s in accessible rural Scotland have the lowest incomes of all over 75s in the UK. Notably, for the 65-74 and 75 and over age groups, the proportion of household income from benefits is greater than that from pensions. Schemes which promote benefit uptake are therefore very important.
12 Low income in retirement is linked to low pay during working life (a feature of rural Scotland) and an inability amongst sections of the population to save for their retirement or to contribute to a private pension. It is difficult for older people to move out of low income, although increasing the number of older people who claim the benefits they are entitled to (or increasing the state pension) would go a long way to improve the financial circumstances of many older people.
13 Most older people live at home, around 95% of the over 65s, and most older people in rural Scotland are owner occupiers (70%). The over 75s are the most likely to live in rented accommodation (31.3%). Given the tenure pattern of younger pensioners it is likely that the proportion of owner occupiers amongst the over 75s in rural Scotland will increase in the future. 14 In light of recent demographic trends it is likely that the proportion of single pensioner households will continue to increase across rural Scotland. Single pensioners in need of some support to remain independent require that assistance from outwith the home.
15 Urban to rural migration upon retirement, particularly to scenic rural areas, is fairly common across the UK. Early retirement opportunities have increased the potential pool of young-old retired households moving into rural areas. Retiral-age incomers can bring 'new' money to rural communities and they may bring with them a range of business/committee/political skills that can be used to the benefit of their new locality. However, they may also further reinforce a top-heavy age structure, they sometimes object to proposed developments that may alter the character of the area they have moved to and they may push up house prices.
16 Care of the elderly in the UK has become increasingly de-institutionalised in recent decades, a trend not limited to the UK. A central tenet of Care in the Community is to enable people to live in their own home for as long as possible. Housing issues, including design, adaptations and maintenance are important to older people, as is the availability of formal and informal home care services.
17 The housing needs of older people are highly variable and are closely associated with health status and age. Most older people do not require assistance from family, friends or the statutory/voluntary sectors to maintain an active, independent life. The need for assistance becomes more likely with age, with the over 80s being those most likely to require support to live at home or require a move into supported accommodation.
18 Intensive home care is particularly valuable in rural communities as it allows older people to remain living in their community: a move into supported accommodation often requires a move of some distance and a loss of community ties.
19 Accessibility incorporates personal mobility and the ability to access a variety of goods and services. It is an important cross-cutting issue for all those who live in rural Scotland, but many problems associated with accessibility are particularly acute for older people. Transportation and access to medical facilities, shops and social activities are of particular importance.
20 An ability to get 'out and about' is as important to older members of the community as it is to younger people. Personal mobility allows day-to-day living activities, such as food shopping, to be undertaken, and allows the activities that contribute to quality of life, such as maintaining social contacts, to be sustained.
21 Personal mobility enables older people to remain independent, allowing many to remain in their own homes, living within their community. Rural Scotland is characterised by a dependency upon private cars. Although pensioner households are significantly less likely than other households in rural Scotland to run a car, approximately 64% of over 65s do so. Car ownership does, however, drop notably between the 65-74 and 75+ age groups. Not owning a car is closely related to financial status in rural areas, thus older people most likely to rely upon public transport and/or voluntary and community transport schemes are those aged 75+ and those on low incomes.
22 There are many policies, projects and initiatives operating across Scotland that aim to improve the personal mobility of older people. The further development of community transport initiatives, particularly in remote rural areas, is being encouraged by the Scottish Executive. The introduction of community transport services should take full cognisance of existing voluntary transport schemes and work with them to develop an enhanced, rather than competing, service.
23 A shop, primary school, GP and community hall have been identified as the core services needed to sustain a vibrant rural community. There has been a steady decline in the number of private services, such as shops, banks and pharmacies, in rural Britain over the past three decades. Services has become more centralised, and although their quality is high, some members of rural society, notably the elderly, can find them difficult to access. Those most vulnerable to the loss of local services in rural Scotland are likely to be those on low incomes who do not have ready access to transport, and the elderly.
24 Findings from the Scottish Household Survey indicate that a smaller proportion of people in rural areas find it very or fairly convenient to make use of services than those in urban areas. Almost 20% of rural over 75s did not find the Post Office convenient to make use of, 23% did not find grocery shopping convenient and 28% did not find the doctor's surgery convenient. Fewer rural over 75s found the bank, attending hospital or going to the chemist convenient when compared to their non-rural counterparts.
25 Notwithstanding the fact that there will always be a need for face-to-face services, there is considerable scope to exploit developments in information technology to improve access to services and information. Home computer ownership in rural Scotland is higher than it is in non-rural areas. Although the ownership rate amongst the over 65s in rural Scotland is currently 13%, this proportion is likely to increase significantly in coming years. Those over 65 at present may not be confident using IT but it is likely that over the coming decade the proportion of the older population able and willing to make use of IT will grow, opening up new opportunities for service provision to older people in rural areas.
Health and social care
26 Most older people are healthy and can enjoy active lives well into their 70s. In rural Scotland, almost 80% of over 75s and 84% of those aged 65-74 considered their health over the past 12 months to have been good or fairly good.
27 The elderly are one of the largest consumers of NHS services, and as the absolute numbers within this age group increase there will be increased pressure placed on health services.
28 In rural Scotland accessing most health services, particularly specialist services, involves patients travelling considerable distances. An overarching problem is how to deliver quality acute and primary health services to small numbers of people dispersed across large geographical areas. The most difficult rural areas to deliver health and social care services to are remote rural areas.
29 With fewer older people now residing in institutional care than in previous decades there is increased demand for home-based care services. It has been estimated that a half of the 85+ age group need help with an activity of daily living and thus this age group, whose absolute numbers are increasing across rural Scotland, make significant demands upon care in the community resources.
30 Social care services are co-ordinated by Social Work departments and the voluntary sector is often involved in the provision of social care. There is not always a match between the services provided and the services older people themselves would like. There is a need to ensure that services for older people strike a balance between what professionals think older people should receive, and what older people themselves think they need to help them remain independent.
31 An unpaid volunteer army of carers provide help and support to thousands of elderly people across rural Scotland. Approximately 7.5% of the adult population in Scotland are involved in the provision of informal care for the elderly. Unpaid, freely given care of elderly people comes mostly from spouses and adult children, daughters in particular. To pay for their services would involve considerable public expenditure.
32 Demographic trends evident across rural Scotland, where the numbers in the older age bands are expected to increase and numbers in younger age bands decrease, mean that there may not be enough voluntary carers available in rural communities to look after older people in coming decades.
33 Depression and dementia are the most common mental health problems experienced by older people. Mental health service provision across Scotland is uneven, and coupled with a lack of awareness and training about mental health issues amongst professionals in daily contact with older people, many mental health problems pass undiagnosed. Community based psychiatric teams deliver locally based services to rural communities. Mobile clinics and tele-psychiatry both bring mental health services closer to older people, overcoming mobility constraints.
34 The rural dimension to health and social care is expressed primarily in terms of service delivery challenges. The increasing proportion of older people in Scotland will affect rural areas in particular, leading to increased demands upon health and social care services in rural areas. Resource allocation systems will need to plan for the increased demands likely to be placed upon services as a result of demographic trends.
Social and community life
35 Upon retirement people are released from the structure and constraints paid work places upon life. Leisure time is increased, with those who have left the labour market being at liberty to spend their time as they wish. An ability to participate in leisure and social activities is an important contributing factor to overall quality of life.
36 The organisation of and participation in a wide range of social and community activities comprises an area where older people can make a significant contribution to the vitality of their local community. The young-old in particular tend to be able to make full use of their leisure time, but the constraints of money, health and personal mobility in an individual or their spouse can conspire to reduce older people's ability to play a full role in social and leisure activities in later life.
37 Most people, regardless of age, have some form of social interaction on a regular basis. Many meetings, lunch clubs, outings and other social events are organised by national and local groups specifically for older people across the country. Such groups view their ability to promote social interaction and counteract loneliness and isolation as particularly important. Many operate on shoestring budgets but provide a service whose importance belies the financial outlay. Various friendship groups and befriending services, often involving older people helping other older people, also provide social contact.
38 Older people, particularly those who have lived most of their lives in a specific rural area, are an important resource when it comes to ensuring local traditions are upheld. Local History Societies, Family History Societies and Reminiscence Groups may be found across Scotland, and the memories and expertise of older people are often crucial to their activities.
39 Lifelong learning activities are pursued by many older people, and along with a wide range of recreational activities these can promote intergenerational contacts within rural communities.
40 Volunteering is an important aspect of rural society. People of all age groups who live in rural areas are far more likely than their non-rural counterparts to give up their time for charitable or local groups. Although the likelihood of an individual being a volunteer decreases with age, a large number of older people across rural Scotland give freely of their time to a wide range of voluntary groups on a regular basis. Older people who do volunteer tend to give more 'volunteer hours' than do younger age groups.
Quality of life
41 Older people who can enjoy active, independent and healthy lives are likely to have a high quality of life. Quality of life encompasses a wide range of economic, social, environmental and health factors.
42 The various elements of quality of life have strong interrelationships. Financial security, as well as not having to worry about every household bill, means choice, for example in terms of choosing where to live and in what type of accommodation. Good health means that an individual can get out and about, enjoy recreational activities and pursue their social life.
43 Maintaining a social network of friends and family can promote self-esteem and being mobile, whether on foot or by private or public transport, facilitates day-to-day living and allows participation in recreational and social activities. Promoting quality of life therefore requires policies, projects and initiatives that address many areas and issues, as outlined above.
Opportunities for future research
44 This report has demonstrated the paucity of information on the specific topic of older people in rural Scotland. There is therefore considerable scope for further primary and secondary research in all of the thematic areas mentioned in this report to be conducted.