Older people minority groups

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					           SAFE AND HEALTHY PEOPLE SELECT COMMITTEE
        SCRUTINY REVIEW: AGE-PROOFING MAINSTREAM PUBLIC
                            SERVICES


Briefing Paper: Older people: minority groups

   1.   Older people in prison
   2.   Lesbian, gay, bisexual and transgender older people
   3.   Older refugees and asylum seekers
   4.   Black and minority ethnic (BME) older people



1. Older people in prison

       The number of older people in prison is growing. Around 3% of the prison
        population in England and Wales is over 60 years old. This equates to 2,480
        people. The over 60s have shown the largest percentage increase of all age
        groups in prison, rising by 149% in a decade

       One reason for this is that prisoners are serving longer sentences, and some
        therefore are growing older in prison

       In addition, the conviction against sex offenders, included those who have
        offended in the past, has led to an increase of older prisoners in this category.
        About half of all older male prisoners under sentence are sex offenders

       A review of prisons in 2004 found that prisons were often unsuitable for older
        prisoners because many were less mobile than the younger age groups. Some
        were excluded from daily activities because they were physically unable to get
        there. There was also no overall strategy throughout the prison estate for
        assessing or providing for the needs of older prisoners. A study by the Howard
        League for Penal Reform in 2006 referred to showers not being wheelchair
        friendly. Another study of older men and women in prison referred to the
        inflexibility of prison practices and routines, such as making no allowance for
        a slower paced prisoner to reach the exercise yard in time allotted

       Older people are not entitled to receive their pension when in prison and often
        lack the cash to buy necessary toiletries

       The National Service Framework for Older People (2001) set standards for the
        delivery of health services to older people; it specifically referred to the needs
        of older people while in prison and on release. A Report produced by the HM
        Inspectorate of Prisons in 2004 concluded that this is not yet happening.
        ‘…there is no overall strategy throughout the prison estate for assessing or
        providing for the needs of older prisoners, whose number trebled between
        1992 and 2002’. The report also commented on:




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          -   in general, local authority social services departments were extremely
              reluctant to carry out assessments of older prisoners, still less to offer
              support during or after imprisonment
          -   amongst the growing number of women prisoners in their middle
              years, serving long sentences, feelings of isolation and depression were
              strong, and their particular healthcare needs were not always met

      Studies have shown that prisoners tend to age up to ten years more than their
       biological age. The health problems and care needs of older prisoners
       therefore exceed those of the general population

      Most prisons lack trained staff to meet the medical and physical needs of older
       prisoners

   Sources:
   a) ‘Old and Inside: older people in prison’. Lorraine Atkinson. Working with
      Older People. Sep.2008
   b) ‘No problems – old and quiet’: Older prisoners in England and Wales. Her
      Majesty’s Inspectorate of Prisons. 2004


2. Lesbian, gay, bisexual and transgender (LGBTG) older people

      Older lesbian, gay and bisexual people comprise approximately 5-7 % of the
       population of older people in the UK

      The position of same sex couples improved under the Civil Partnerships Act,
       including giving them the right to be recognised legally as partners, extending
       state pension rights to civil partners, entitling a partner to a survivor pension
       from their partner’s occupational pension, having the same inheritance rights
       as married couples etc

      Older gay and bisexual people may have had early experiences of living
       outside the law, which might understandably colour their views of criminal
       justice agencies. They may have also experienced former healthcare attitudes
       of labelling them as mentally ill, and needing to be ‘cured’; these may affect
       their views of health services

      People in same sex relationships can also be the victims of domestic violence
       within their relationships. And may be more reluctant to report this because of
       uncertainty about how it will be dealt with

      Since the implementation of the Equality Act (Sexual Orientation) Regulations
       2007, no service provider can discriminate against anyone because they are
       lesbian, gay, bisexual or transgender. However, some LGBTG older people
       might be put off asking for personal care help for fear of the reactions of
       others and possible homophobia

      Some older LGB people may find that direct payments offer them more
       freedom to organise their own care and use carers they feel comfortable with.


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   LGB older carers may feel different to other carers, and cautious about sharing
    their feelings in carer support groups

   Very little is known about what life and health will be like for older
    transgender people. It is only now that we are seeing the first generation of
    transgender people who have taken hormone therapy for 30 years of more, and
    who are living with gender reassignment surgeries performed during the 1960s
    and 70s

   The Gender Recognition Act 2004 affords full legal recognition of a
    transsexual person’s acquired gender

   Almost half of all participants in a study of the housing and support needs of
    LGBT older people in Scotland felt that most services should be delivered
    through accessible mainstream services, rather than specialist provision. The
    one exception was residential care and sheltered accommodation.
    In service delivery, people believed that sexual orientation and gender identity
    issues were often ignored in policies and in equalities training, which led to
    lack of consistency.
    While the majority were content with their housing circumstances, a clear
    minority had experienced serious problems with harassment
    Included in the recommendations is the suggestion that housing and support
    providers should self assess themselves with regard to their sensitivity to
    LGBTG issues, and regularly measure their progress against improvement
    goals

   A recent study has warned about the potential for social isolation among older
    single LGBTG men and lesbians, because they are more likely to be single
    that heterosexuals and less likely to have informal carers such as children

Sources:
a) ‘Health Issues Affecting Older Gay, Lesbian and Bisexual People in the UK’.
   Primrose Musingarimi. ILC – UK. 2008
b) ‘Housing and support needs of older lesbian, gay, bisexual and transgender
   (LGBTG) people in Scotland’. Communities Scotland. 2005
c) ‘Later life As an older lesbian, gay or bisexual person’. Age Concern England.
   2008



3. Older refugees and asylum seekers

   There are few statistics kept on the overall refugee and asylum seeker
    population

   The percentage of older asylum seekers is small. In 2004, 3% of all asylum
    applicants were aged 50+. However, these statistics do not show how many
    older people join the principal asylum seeker as dependents. Nor do they
    reflect the demographic profile of people who remain in the UK once the
    asylum process has ended. More were women than men. (680 : 445) Older


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    people also submit applications as dependents; around 2% of these were aged
    50+

   Refugees have been defined as those who have fled persecution in their
    country of origin, regardless of whether they have been granted refugee status.
    Older ‘refugees’ therefore include a wider group than just current asylum
    seekers

   Experiences are bound to be different for recently arrived older refugees
    and/or their dependents, compared to refugees who have grown old in the UK.
    For example, as they age, refugees may re-experience the traumas of their
    earlier experiences

   It has been suggested that older refugees may be experiencing ageing faster,
    associated with past experiences, such as malnutrition, untreated conditions
    and torture, as well as specific difficulties faced in the UK such as language
    barriers and racism. There appears to be a consensus that refugees are
    adversely affected by the problem of isolation, which is linked to health
    problems

   The Dept. of Health and the Refugee Council produced guidance to health
    services applicable to all asylum seekers in 2003, although more recently
    restrictions have been introduced on health provision to asylum seekers.
    Department of Health guidance (2005) on delivering race equality in mental
    healthcare mentioned the needs of refugees

   Much of the literature on health services for older refugees and asylum seekers
    relates to problems of access, particularly regarding language barriers, having
    relevant information about services, and cultural attitudes affecting
    expectations. Some cultures eg. Somali, are more oral than written based,
    others rely on traditional healers, Trained advocates can assist with these
    difficulties

   Housing plays a critical role for refugee integration. The literature indicates
    that refugees and BME groups share many housing problems, including
    discrimination, segregation, overcrowding, and poor housing maintenance.

   While there appears to be no specific literature on education provision and
    older refugees, literature on older refugees on lack of English language as a
    barrier to information, services, and ultimately integration. There is anecdotal
    evidence that older refugees meet special barriers to accessing education: these
    range from general assumptions about older people difficulties in learning a
    new language and skills, to a lack of availability of classes if priority is given
    to working age people

   Family and community networks are a central aspect of older refugee’s lives,
    but the scope and role of these networks cannot be generalised, and there are
    pressures on the networks associated with changing family structures.
    Intergenerational conflicts can arise due to different norms.



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   Source:
   a) ‘Older refugees in the UK’. Age Concern England and the Refugee Council.
      2008
   b) ‘The Social Care Needs of Refugees and Asylum Seekers’. Bharty Patel and
      Nancy Kelley. SCIE. 2006



   4. Black and Minority Ethnic (BME) older people

   Drawing on the 2001 Census data:

      England’s population aged 65 and over is predominantly White British
       (93.37%)

Hants: 97.03%

      There are wide variations in the population aged 65 and over within BME
       groups in England. For example, Irish and Other White was the largest group
       (56%), followed by Asian or Asian British (23%), and Black or Black British
       (14%). Chinese (4%) and Mixed (3%) were the smallest

Hants: Irish and Other White was the largest group (79%), followed by Asian or
Asian British (8%), and Mixed (4.9%), Chinese or other (4.1%) and Black or Black
British (3.5%) were the smallest

      There are further differences in the relative size of the population aged 65 and
       over within individual ethnic groups eg. in the Asian group, the Indian group
       had the largest proportion of over 65s followed by Pakistani, Other Asian and
       Bangladeshis

Hants: in the Asian group, the Indian group had the largest proportion of over 65s
followed by Other Asian, Pakistani and Bangladeshis

      Women generally outnumber men in the White, Mixed and Chinese groups.
       This is reversed in the Asian and Black groups. The Indian group was unique
       in that there was an even distribution of men and women

      Population pyramids display the spread of population across all age ranges (0
       – 90+). The population pyramids for BME show a relatively youthful
       population compared to the White group, with the population of school-age
       children and young adults outnumbering the population of adults. This is most
       apparent in the Asian British and Mixed groups.

Hants: the population pyramids for BME show a relatively youthful population
compared to the White group. This is most apparent in the Mixed groups

       However, the shape of pyramids for sub groups in the Asian group showed
       differences: the Indian, and Black or Black British groups had a higher



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       proportion of middle-aged people who will reach old age in the next 20 years
       compared to Pakistani or Bangladeshi groups.
       Overall, there were relatively small differences in the age structure of males
       and females in all BME groups, with the exception of the Bangladeshi group
       where there was an older age structure among men than women

Hants: overall, there were relatively small differences in the age structure of males
and females in the main ethnic groups


      There are many parallels with elders from the majority population group in
       general, but there exists specific areas of differences and/or concern arising
       from culture, language, faith, and the consequences of the experiences of
       racism

      While the experience of BME older people in the UK is diverse, particular
       patterns have been observed :
           - in some BME groups the % of the population experiencing long term
               illness were higher than that for the over 65s as a whole: 50% for all
               over 65s, compared to 60% for Asians and 54% for Black people.

Hants: in some BME groups the % of the population experiencing long term illness
were higher than for the over 65s as a whole: 45% for all over 65s, compared to 49%
for Asians and 50% for Black people

               (After standardising for age, Bangladeshi, Pakistani, Indian and Black
               Caribbean groups are at increased risk of diabetes, coronary arteries
               disease, arthritis, stroke, and respiratory disorders – predisposing them
               to the high levels of limiting long term illnesses)
           -   consequences for BME elders with chronic conditions is an increased
               likelihood for experiencing higher levels of disability in old age, and
               being at an increased risk of becoming dependent on others at an
               earlier age than their contemporaries in the general older population
           -   in spite of the use of GP and hospital services, take-up of some health
               care, such as the district nurse and health visitor, and social care
               services tends to be lower
           -   the main information and advice needs of BME elders have been
               identified as benefit entitlements and help in the home, and advocacy
               in health matters. Access to interpretation facilities is crucial for many
               groups, and face to face advice is often the best approach
           -   there were noticeably fewer single-pensioner households, (with
               exceptions eg. Irish and Caribbean elders), and couple-pensioner
               households than in the general older population

Hants: there were noticeably fewer single-pensioner households (with exceptions eg.
Irish) than in the general older population

           -   although with some exceptions, lower incomes than white elders
               (highest among Bangladeshi and Pakistani group), and less likely to be
               receiving an occupational pension


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       -   higher rates of blood pressure and diabetes among African, Caribbean
           and Asian people increase the risk of vascular dementia
       -   some ethnic groups appear particularly prone to depression in older
           years; one study estimated levels of depression ranging from 19% in
           black African elders (above the rate for the general population) to 13%
           in Chinese elders (below the average).
           Access to appropriate treatment may be impeded by factors such as the
           use of culturally inappropriate diagnostic tools and interventions, the
           older person’s lack of knowledge about available health and social care
           services

   Figures for limiting long-term illness in people aged 50-64 years in England
    by ethnic group show that the health of people in this age group follow an
    identical pattern to that of older people 65 +. This has implications for the
    planning and delivery of health and social care services

Souces:
a) ‘Information and advice needs of black and minority ethnic older people in
   England’. Report to Age Concern England, Kamila Zahno and Clare Rhule.
   2008
b) ‘Under the radar: BME mental health’. Kaye McIntosh. Health Services
   Journal. 4 August 2008
c) ‘The extent and impact of depression on BME older people and the
   acceptability, accessibility and effectiveness of social care provision’. SCIE.
   2008
d) ‘Ageing and Ethnicity in England’. Dr. Savita Katbamna and Mrs. Ruth
   Matthews. Age Concern England. 2006




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