Coping with life and using services: how older people over 75 maintain their dignity and self-esteem when faced with a limiting physical condition

Project lead: Professor John Baldock

Research team

  • Professor John Baldock

  • Ms Jan Hadlow


October 1999 - October 2001


Professor John Baldock
School of Social Policy, Sociology and Research
University of Kent at Canterbury
Darwin College
Canterbury CT2 7NY

Tel: +44 1227 827574


This research aims to link two established streams of research and publication which have remained relatively isolated from one another but which, when brought together, have the potential to explain some of the variety in the life quality of older people. The first of the research traditions is that of policy analysis of the allocation of health and social care services among older people. The second is the substantial literature on what has been called 'ageing from within'and is concerned with how people manage their identities when dealing with age and the limitations it may bring.

The 'fit' between needs and services has been a central focus of much social policy and social care research, particularly in the UK. It is driven by a variety of concerns but the potential 'costs' of an ageing society have been paramount. Research objectives have been to pinpoint innovations and strategies that 'target' public resources where they bring maximum social and political benefit. In the UK and other industrial countries this 'managerialist' focus has led to major policy reforms designed to improve the targeting of public resources. Yet the evidence is that, while some progress has been made, there remain substantial inequalities in the take-up and use of services, large unexplained variations in the costs of similar provision, and evidence that considerable numbers of older people with substantial care needs are getting little or no help. Obtaining a good Îfitâ between services and needs remains an intractable policy problem.

The second research tradition, that is concerned with biography, life review and the management of identity, is immensely rich and varied, but it has rarely focussed on people's accounts of the fit between their needs and the help they can or are willing to use. What studies have revealed is that maintaining one's identity and self-esteem, built up over a whole life-time, may be more valued than adjusting to 'appropriate'or 'convenient' solutions to the needs of later life.

Aims and objectives

The main questions this research is seeking to answer are: in what ways do people who are just entering the 'fourth age' (that is where their activity is restricted by at least one of the infirmities commonly associated with later old age) manage and possibly reconstruct their lives in the context of the new problems they perceive they have encountered? To what extent do their understandings of the difficulties they face and the ways in which they are dealing with them reflect their conceptions of self, their life histories and their main sources of self-esteem? How do their adaptations interact with the form and goals of health and social care services and influence their ability to use 'available' provision? The study will map the interaction of older peopleâs own life-strategies with the provisions of the social welfare system and its implications for life-quality.

Study design

Two qualitative interviews, spaced six months apart, are being conducted with a quota sample of 35 people aged 75 and over, who are living on their own and who have recently developed a physical disability which now means they need help at least once a day. The interviews move from relatively specific questions about needs assistance to much more open life-review questions. The research uses the Southampton Self-Esteem and Sources of Self-Esteem Scale (SSESS) developed by Professor Peter Coleman and colleagues. The data will be analysed using qualitative techniques. The central goal is to differentiate the sample in terms of their needs, their coping strategies, their use of services and to relate these systematically to the accounts they have offered of their lives and 'life-themes'. Some of our conclusions will be reported to the respondents in the second interview in order to listen to their judgements of them.

Policy implications

It is hoped that the research, by providing a better understanding of the consumer or user perspective, will be able to widen and influence current policy debates about developing a 'mixed-economy of care' for older people. Subject to the results the research actually produces, we hope to develop an empirically grounded description and explanation of how and why some older people prefer not to use, or are unable to use, health and care services which they 'need'. One of our hypotheses is that there are limits to the degree to which local authorities and others in the primary care system can be expected to ration resources precisely in proportion to need. We are also seeking to influence practice by involving local GPs, community nurses and care managers in the research process itself.