The Fourth Age: A collection of resources

Today I’m focussing particularly on critiques of Laslett’s Third Age argument. So far, I can see that they cluster into two main camps. Well, three maybe.

The most straightforward, I think, is people saying that the idea of a Third Age is not a new one. This is a totally standard and predictable academic response and while, as an ex-historian, I always like seeing that things have longer roots than I thought, I don’t think it’s important for my uses here. It might not be totally original, but Laslett is undoubtedly the person who popularised the notion in UK gerontology and that’s enough for my purposes.

(cc) AnyaLogic

A more challenging critique is that his characterisation of the Third Age is inappropriately aspirational. This argument is basically that it’s not always within people’s control whether they get to have a Third Age at all, and that class, birth cohort and generation might all make big differences. (This all overlaps with the Positive Ageing critiques that I blogged about here and here in 2011, at a similar stage of module production). This is all absolutely fascinating, but I’m a bit worried about whether it will be too difficult for Level 1 students.

The third type of critique is that, crudely put, the notion of the Third Age is horrible to people in the Fourth Age. It positions people who are experiencing frailty and dependence as an Other. It also reifies the stages when, in practice, many people move in and out of frailty (and younger people can be dependent and frail too). This feels more promising to me as a critique that is likely to make sense to Level 1 students.

Here’s I’m collecting together resources that might help me to mediate this argument to students:

New Frontiers in the Future of Aging: From Successful Aging of the Young Old to the Dilemmas of the Fourth Age
Baltes P.B. · Smith J. Gerontology 2003;49:123–135 (DOI: 10.1159/000067946)

Abstract: We review research findings on the oldest old that demonstrate that the fourth age entails a level of biocultural incompleteness, vulnerability and unpredictability that is distinct from the positive views of the third age (young old). The oldest old are at the limits of their functional capacity and science and social policy are constrained in terms of intervention. New theoretical and practical endeavors are required to deal with the challenges of increased numbers of the oldest old and the associated prevalence of frailty and forms of psychological mortality (e.g., loss of identity, psychological autonomy and a sense of control). Investigation of the fourth age is a new and challenging interdisciplinary research territory. Future study and discussion should focus on the critical question of whether the continuing major investments into extending the life span into the fourth age actually reduce the opportunities of an increasing number of people to live and die in dignity.

• Michael Young and Tom Schuller, Life after Work: the Arrival of the Ageless Society, Harper Collins, London, 1991. esp p. 181 where Laslett himself says they critique on these grounds.
• Gilleard, C., & Higgs, P. (2011). Ageing abjection and embodiment in the fourth age. Journal of Aging Studies, 25(2), 135-142. (Too hard for students, excellent stuff though).
• Katz, J., Holland, C., & Peace, S. (2013). Hearing the voices of people with high support needs. Journal of Aging Studies, 27(1), 52-60.
• Gilleard, C., & Higgs, P. (2011). Frailty, disability and old age: A re-appraisal. Health:, 15(5), 475-490.
• Jones, I. R., & Higgs, P. F. (2010). The natural, the normal and the normative: Contested terrains in ageing and old age. Social Science & Medicine, 71(8), 1513-1519. Too hard but really interesting.

Third Age / Fourth Age: A collection of resources

In the Ageing block of K118 (Perspectives on Health and Social Care) one of the overarching concepts we want students to understand is the notion of the Third Age and the Fourth Age, first popularised by Peter Laslett in his book ‘A Fresh Map of Life: The Emergence of the Third Age’. We’ll then go on to critique it, but before we can do that, they need to understand what it means. Since I’m writing the first week’s work of this block, it falls to me to do that explaining. I’m collecting here some possible resources to help me do that, in case they are also of interest to other people.

Peter Laslett’s book is available on google books, which is better than nothing, although the page you really want is always the one that’s cut out. Luckily for me it’s also in the OU library, so I’m off to pick that up later today. Either the first chapter or one of the later ones looks possible for my use, probably edited down a little.

(cc) EU Social

Book reviews from journals (one of my favourite shortcuts to getting a handle on a literature):

• Raymond Illsley (1991). Ageing and Society, 11, pp 85­86 doi:10.1017/ S0144686X00003871
• Jacob S. Siegel Population and Development Review Vol. 16, No. 2 (Jun., 1990), pp. 363-367
• COLEMAN, PG. BRITISH JOURNAL OF PSYCHOLOGY; FEB, 1992; 83; p153-p157 (This one is an Essay Review which also discusses related books).

Useful looking commentary:

Gilleard, C., & Higgs, P. (2002). The third age: class, cohort or generation? Ageing & Society, 22(03), 369-382:

ABSTRACT: In this paper we consider some of the ways that the third age can be thought about and studied. Taking the work of Peter Laslett as our key source, we explore his ‘aspirational’ approach toward redefining post-working life and look at some of its limitations as both definition and explanation. There is a need for a more sociologically informed approach to the third age, and we outline three potentially important structures that might better explain it – class, birth cohort, and generation. Whilst it might seem attractive to see the third age as a class-determined status, based on the material and social advantages accruing to people who have retired from well-paid positions in society, the historical period in which the third age has emerged makes this explanation less than adequate. Equally a cohort-based explanation, locating the third age in the ‘ageing’ of the birth cohort known as the baby boom generation, fails fully to capture the pervasiveness and irreversibility of the cultural change that has shaped not just one but a sequence of cohorts beginning with those born in the years just before World War II. Instead, we argue for a generational framework in understanding the third age, drawing upon Mannheim rather than Marx as the more promising guide in this area.

International Journal of Ageing and Later Life 2007 2(2): 13–30. The Third Age and the Baby Boomers: Two Approaches to the Social Structuring of Later Life BY CHRIS GILLEARD AND PAUL HIGGS

EXTRACT: Laslett confounded individual development, cohort and period, making the third age seem a phenomenon of personal achievement as much as social transformation. Each of these ingredients is problematic. First, as Thane has pointed out, delineating the various stages of life has a long history and the distinction between a “green” old age and a “frail” old age goes back at least to medieval times (Thane 2003). Secondly, Laslett’s emphasis upon demographic indicators leads him to seek to “date” the emergence of the third age at the point when the majority of a particular birth cohort can expect to reach the age of seventy (Laslett 1989). This “fact” defines the historical period that determines the emergence of a third age. Taken together, this amalgam of individual development, history and demography, though superficially seductive, fails to provide a convincing analysis of the cultural and social transformation of later life that situates it more firmly within post-war consumer culture. This failure of social and cultural analysis leads Laslett to become preoccupied with the moral imperative for older people to become “true” third agers (Laslett 1989)

(cc) Jim Linwood

This article by Peter Laslett, which looked very promising as a summary of the book, is not suitable for my purposes, being too much about demography. I note it here so I remember not to think I’ve found it again:

• Peter Laslett (1987). The Emergence of the Third Age. Ageing and Society, 7, pp 133­160 doi:10.1017/S0144686X00012538

ERIC MIDWINTER (2005). How many people are there in the third age?. Ageing
and Society, 25, pp 9­18 doi:10.1017/S0144686X04002922

EXTRACT: There has been controversy over Peter Laslett’s designation of a Fourth Age or dependent older age. The question marks over the Fourth Age were that people tended to move in and out of the category, that is, theywere sometimes temporarily incapacitated, while ‘dependence’ is, sadly, a feature in other stages of life. It was also deemed to throw up just that kind of characterisation of older age that has for so long jaundiced public opinion on the very subject of oldness. It should be properly acknowledged that there is another gerontological dispute as to whether or not the extension of people’s lives has been procured at the expense of longer phases of decrepitude and disability. Obviously enough, the ideal is to have an extremely lengthy Third Age and an extremely short Fourth Age – achieving the aphorism of the former manager of Liverpool FC, Bill Shankly, who wished ‘to die healthy’

Probably too hard for Level 1,  and not for this week’s work anyway, but in case it is useful to a colleague:

CHRIS GILLEARD and PAUL HIGGS (1998). Old people as users and consumers of healthcare: a third age rhetoric for a fourth
age reality?. Ageing and Society, 18, pp 233­248

More to follow, probably.

Showing my workings: Early and late drafts of teaching materials

Alongside my reflections on what I had learned working on K101, I also found my first and late drafts of some of the material. I’ve stitched them together here with a little commentary on why the later version is (IMNSHO) better.

It was a section on the place of protocols and guidelines in health and social care practice. Initially I wrote:

In the previous section we looked at what is meant by the phrase ‘evidence-based practice’.  We also considered how evidence is created and what sorts of evidence are valued by different people. We saw that there are several reasons why evidence-based practice is important in current health and social care services.  One of these reasons is that many people trust care workers less than they used to partly because of some of the difficulties and scandals discussed in Block 5.  In this section we look at one of the main ways evidence can be put into practice – protocol and guideline-based care.

As you saw in the previous section, finding and evaluating the research on a particular topic is time-consuming and complex.  Individual care workers rarely have the time or the resources to find out what the evidence says about an issue they are facing in their job.  Protocols and guidelines are designed to help with this by collecting together the evidence on a particular topic and then turning it into a way of working.

1. What are Protocols and Guidelines?

Protocols and guidelines are authoritative statements about what should happen in health and social care settings. They are usually written down and staff are expected to be aware of them in their everyday practice. Guidelines are usually general statements of principles whereas protocols are usually more specific and particular to a place of work.  However, sometimes the terms ‘protocol’ and ‘guideline’ are used interchangeably and sometimes they are used differently in different workplaces.  Just to further complicate the issue, sometimes people also use terms like ‘integrated care pathway’ to describe something that looks very similar to a protocol.  But don’t worry about this because the underlying principles are very similar and the underlying principles are what we are focusing.

Many guidelines and some protocols are developed as a national level by organisations such as the National Institue for Health and Clinical Excellence, the Royal College of Nursing and the General Social Care Council.  Protocols are more likely to be developed specifically for a workplace or a group of workplaces, like all the GP practices within a group or a multi-agency team.  They are more commonly found in health care than in social care settings.  Social care settings are more likely to use more general guidelines.  A typical health care protocol might cover, for example, which medication should be prescribed, what treatment should happen when, and which staff will be involved in providing care.

In the next activity, you are going to use a very simple protocol to help you decide what treatment to offer to a patient, Iain.  Don’t worry if you don’t understand all the technical terms in the protocol – we’ve put explanations at the bottom and you don’t need to understand them all.

Activity:

Iain Ferguson is 13 and has felt ill and had a sore throat for about a fortnight.  His stepmother has brought him into the GP practice because she is worried.  In this practice, patients arriving with symptoms of common ailments like colds, sore throats and ear infections see a nurse first and are only referred on to the GP if necessary.  Iain has a fever and his tonsils are inflamed.  He does not have a runny nose or cold symptoms, nor does he have any signs of meningitis.  Use this protocol to work out what treatment he should be offered and whether he should see the GP

[Here there was a diagram, which showed the protocol]

Explanations of medical terms:

Rhinorhoea – runny nose!  (usually spelled rhinorrhoea)

Afebrile – no fever

Meningism – symptoms of menigitis

Paracet – paracetamol

Lymphadenopathy

Circumoral Pallor –

Streptococcal

Erythromycin – an antibiotic

Paul Bunnel for Glandular Fever – a test for Glandular Fever

Commentary

Unlike many of the activities you have done on the course, there is a ‘right’ answer to this activity.  According to this protocol, the correct response to Iain’s symptoms is to recommend that he be given penicillin, or erythromycin if he’s allergic to that, and if that doesn’t clear it up, to check for glandular fever.  At this stage, he doesn’t need to see the GP. Here’s how you get to this answer [add no.s to decision points on diagram and then talk through].

We will look at the advantages and disadvantages of this sort of approach in more detail in the next sections but for now make some notes on what you thought and felt while you were doing this activity.

I’ m not ashamed to have written this, but it’s not very good. It’s very wordy and not very attention-grabbing to start with. It starts with general principles, rather than the case study which I think is part of what makes it seem waffly and dull. There’s too much ‘we’ voicing. Who is this we?! The discussion of terminology is deeply offputting! The idea of using a real-life protocol for the Activity is a good one but the protocol chosen doesn’t seem very suitable if all those terms need explaining. The instruction to ‘make some notes on what you thought and felt’ is vague and not very helpful.

Here’s a much later version:

2      Working with protocols and guidelines

One of the ways in which Marie and Isabel are made accountable for their practice is that they have to follow guidelines which tell them what to do in particular situations –  for example, if a resident has a fit or if there are serious worries about someone’s safety. In this section you will look in more detail at protocols and guidelines like these and you will consider whether they do help make care better and safer – whether they contribute to getting care right.

2.1    Introducing protocols and guidelines

Here is part of the guidelines about child protection from Isabel’s organisation:

Child protection guidelines at Women’s Aid

8     If a child discloses abuse to a member of staff or a volunteer

8.1  Women’s Aid staff or volunteers will:

• Stay calm and listen carefully.
• Reassure the child that s/he was right to disclose what happened and that the abuse is not her/his fault.
• Explain to the child that in these circumstances confidentiality cannot be maintained.
• Assure the child that the issue will be taken seriously.
• Fill out an incident form immediately stating what was said by both the child and the member of staff, and recording facts rather than opinions.
• Discuss this with the member(s) of staff responsible for dealing with child protection issues, decide on the appropriate course of action and record this decision.

8.2  If the abuse is recent or continuing, staff or volunteers will also

• Tell the child what action is likely to be taken, who will be informed and what the consequences may be.
• If the child has sufficient understanding, discuss options realistically, including talking with the mother/carer with a staff member present (if the mother/carer is not the abuser).
• Keep the child informed throughout the entire process.

8.3  The staff member will then discuss the allegations with the designated person or child protection team, who will decide on a course of action depending on the nature and seriousness of the abuse and consult with Children’s Services at the earliest opportunity regarding whether a referral to Children’s Service is needed.

This is one section from a larger set of guidelines which tell Isabel how to proceed if she has worries about the safety of a child. As you have seen, this particular section tells her what to do if a child lets her know that they are being abused. The guidelines contain general advice on how to behave (e.g. ‘stay calm and listen carefully’, ‘reassure’, ‘[record] facts rather than opinions’) as well as specific steps to take (e.g. ‘fill out an incident form’ and ‘discuss this with the member(s) of staff responsible for dealing with child protection issues, decide on the appropriate course of action and record this decision’). Isabel can refer to these guidelines to check that she has done everything necessary. Written instructions like these can be particularly useful when dealing with an upsetting issue like possible child abuse. The guidelines also are one of the ways in which Isabel is made accountable for her actions. If, for example, it later came to light that she had not filled in an incident form or she had not discussed it with her colleague, she could be disciplined.

A protocol is another term for this sort of guidance. It is more often found in health care settings than in social care organisations. It is sometimes used to describe quite detailed step-by-step instructions or rules by which organisations agreeto be bound. However, one study, which examined how people used the different terms for this sort of guidance, found that the terms ‘protocol’, ‘guideline’, ‘guidance’ and ‘pathway’ were all used interchangeably in different contexts (Ilottet al., 2006). For the purposes of this unit the distinction between protocols and guidelines does not matter.

Guidelines and protocols tell you what to do in a particular set of circumstances. They are designed to standardise some aspects of care in order to improve care outcomes and make care safer (NHS Modernisation Agency / National Institute for Health and Clinical Excellence, 2002). They formalise the ways in which health and social care workers are supposed to carry out their jobs. Of course, there have always been procedures and instructions within workplaces. But in recent years there has been an increased emphasis on formalising everyday work into guidelines and protocols. There has also been more emphasis on making care workers accountable for whether they have followed their guidance.

Protocols and guidelines make it possible for staff to undertake more complex tasks. So, for example, many home carers nowadays change catheter bags. Traditionally, this was a task for nurses but protocols have been written which detail the process to be followed and the problems to look out for. This makes it possible for home carers to change catheter bags safely without having specialist nursing knowledge. And this in turn gives district nurses more time to work with service users who need more complex care, enabling people to stay at home rather than going into hospital or into residential care.

[Insert Picture AX1T2B here: close-up of someone connecting two tubes]

Picture caption: Home carers can safely change over catheter bags because they have access to written protocols which tell them exactly what to do

Of course this is far from perfect  (and it’s much wordier than we would write nowadays for online working) but it’s much better. It starts with a concrete example involving people they have already met (Isabel and Marie). The protocol chosen is much more comprehensible to a general audience. It makes much more explicit links to why they are learning about this stuff (links back to the Block themes of making care safer and the previous section on Accountability). The discussion of variant terminology is handled much more elegantly and the assertion that the terminology doesn’t really matter is backed up with an (at the time of writing) up-t0-date citation to the literature. The voice is more direct and clear (and without all those ‘we’s)

What I learned from working on K101: Old reflections

Just after I had finished working in production on K101, I wrote these reflections on what I had learned about writing distance teaching materials. I had a vague idea of working them up into an article, but that never happened. At the time, I didn’t keep a blog so they just sat forgotten in a folder. Now, as I’m chairing K118 (hot news! New (provisional) title: Perspectives in Health and Social Care), I’m collecting together my various musings on module production in case they are useful to the K118 team. It occurred to me that this too might be of interest. It should be read with the proviso that I wrote this in ?2007 and some terminology and practices have changed since then. But not, I think, the general principles.

(cc) ecotist

What I learned about writing distance learning material while working on K101

It’s really important to have a compelling logical arc for the academic content of a Unit. You can try to retrofit one onto a miscellaneous hodge-podge of topics which you’ve got to cover because they have to be in course and you got the short straw, but it’ll never really be satisfactory. At best, you might end up with an effect like the silver line through a banknote – “oh yes, there’s a theme, no, it’s gone again, oh no, here it is, I can see that’s a development of the other thing, oh but then again that doesn’t really seem related although maybe I can see a sort of tenuous link”. If you do manage to create such an arc, it becomes a thing of beauty and a joy to behold (well, if you have a taste for that sort of thing).

The best teaching material combines a compelling logical arc for the things you are trying to teach with a compelling narrative arc about the characters or issues you are using as the vehicle for your teaching. The Unit of mine that caused by far the least trouble and underwent the least revision was the one where I managed to hit on a way of combining those early on and it just always worked. But this is hard to get right. You can easily end up with a forced and unnatural narrative arc that just isn’t convincing.

For this level (1st year undergrad, lots of students with very little experience of formal education), really strong case material is crucial. It’s concrete and real and meaningful to students in a way that theoretical principles seldom are. Once you’ve seduced them with the case study, then you can reel them in on to the theory. They remember the case studies and, you hope, some of the theory because it’s attached to something concrete.

Show, then tell (I don’t think I agree with ‘show don’t tell’ because I think some telling is helpful, but certainly ‘telling without showing’ is all wrong). I struggled with this one because, as someone who is used to thinking abstractly, my own preference is to have a general statement first which gives me an idea of what we’re talking about, then an example which elaborates and makes it crystal clear, and then some more abstract discussion of how the example relates to others and the general principle. But the consensus seems to be that the students on this course skip or are turned off by abstract statements at the beginning of a section. Instead, it works much better to start with the example, then use that to introduce the general principle.

Real life case studies almost always work better than things you make up. You may know the area really well and think that if you write it yourself you can make it say exactly the things you want to cover, but it never reads as authentically. Yes real life material is often more complicated that what you had thought of writing yourself, but that complexity often helps you to get into really useful areas and makes you realise that you were oversimplifying the issue.

It is (almost) impossible to have too much signposting in your text. And I say this as someone who is already prone to lots of signposting.

(cc) Andrea_44

If you are aiming to have Units 15,000 words long, make your first drafts 10 – 12k. By the time 8 people have commented on 3 drafts and 30 people have commented on the middle draft you are bound to have a lot of suggestions for things you have left out and really must cover. Most people don’t suggest cuts.

Critical reader and developmental tester comments are really really useful. Of course it’s hard to have your carefully crafted masterpiece torn to shreds. And yes it’s initially frustrating and annoying when they contradict one another. And if you know some of the readers it’s tempting to dismiss comments you don’t like with ‘they would say that, they’re always going on about x’. But one of the points of having this many people critiquing your work is that you get that diversity of response and a deliberate attempt is made to have readers who are like the students who will be taking the course. If you’ve got a reader saying ‘that’s outrageous, you can’t say that’, the chances are you’ll also get students responding like that, so you need to either explain better what you meant or change what you’re saying.

And many critical readers are astonishingly ready to help you deal with the problems they have identified. I had one who said he ‘hated, hated, hated’ one particular section and I was approaching the issue from entirely the wrong angle. I contacted him to ask for advice on how to improve it (it was clear from his comments that he was a bit of an expert in the area and I certainly wasn’t) and I got a quick tutorial on the topic, a case study from his own experience and some really useful suggestions about literature.

It’s very easy to spend far too long googling for material and case studies. If you haven’t found what you’re looking for in 2 or 3 serious tries, you’re not going to find it like that. Instead try looking in the literature (qualitative studies often contain quotes you can lift and grey literature reports often contain case studies), using your contacts (I spent years looking for some suitable real life guidelines for a particular activity, coming up with various ones that were too technical or too medical or didn’t fit the particular criteria of my use for them, before at the very last minute I realised that my local Women’s Aid, of whom I am a Trustee, has a guideline that would do the job nicely. And because they know and trust me they were quite happy to let me use it) and develop a list of generalist websites that you seem to keep returning to.

When working with a producer and/or director on audio visual material, recognise that you inevitably have somewhat different agendas. Their highest priority is making something which has artistic integrity and dramatic coherence. Your highest priority is making something which conveys the theoretical points that you want to teach. These are sometimes in conflict, and recognising this difference can really help you to resolve it.

It’s tempting not to think about the pictures and cartoons until the end, because you’re not made to specify them until that point. But actually, it makes much more sense to start looking early because then they can support and even drive your text much more effectively.

(cc) brentdanley

By the time I got to the fourth and final handover draft, many of the sections which had always been problematic could simply be cut out and that improved the whole thing. I don’t think I could have cut them out earlier, partly because I wouldn’t have had the deadline-inspired courage and partly because I didn’t have such a clear sense of what I was trying to say.

It really pays to be a bit of a generalist, or at least to be prepared to turn your hand to anything. Approximately 1/8th of what I wrote was in an area where I have done any research (and that only 6 months work leading to one rejected journal article and a failed funding bid). The rest was topics about which I had a general clue, because they’re major themes in my discipline, but no research record at all. But if you enjoy literature searching (I do) and can get a handle on things fast, it can be lots of fun. I’ve got so many interesting ideas about some of these topics now. Who knows, that might turn into future research directions.

But also, don’t forget your non-academic knowledges. My material ended up having quite a lot of case material about domestic violence and new parenthood (both in combination and separately) because I have non-academic knowledge of those (although not in combination) so it was easy to use those in interesting ways.

It’s a completely different voice from research writing. You have to be much more direct, use much more everyday language and generally think (broadsheet) journalism rather than academic voice. It’s okay to lay down the law and be directive and prescriptive about what students should do pedagogically as in ‘do this Activity’, ‘think about this’, ‘turn to the Reader’. But it’s really tempting to overextend that authoritative voice into making unjustified assertions about the subject matter. This can be tricky, especially in my field where it’s easy to get into a moralistic voice. And some of the things you want to say are really difficult to do academically. One of my co-authors had written that ‘punishment is ethically unacceptable in health and social care’. I wanted to at least support this claim with some research or policy statements. But it turns out to be so widely accepted that nobody’s writing about it. I found material on the corporal punishment of children and in relation to prisoners, which are still somewhat debated, but nothing as generalised as this statement. I hadn’t got space to go into ethics and punishment properly, so I ended up rewriting it out, which was not entirely satisfactory.

ETA 2013: At that point, you will be relieved to read, I ran out of steam.