A Fairer Scotland for Older People: framework for action

Engaging with, and contributing to, communities

Hearing Older People's Voices

Older people have told us they want action to ensure they have access to:

• opportunities to remain actively engaged with, and involved in, their communities 
• measures to improve community safety and reduce their vulnerability to scam callers and other kinds of elder abuse
• concessionary travel and transport
• activity that brings different generations together
• adequate housing that continues to meet their needs as they age.

Supporting positive engagement – what Government and stakeholders are doing, and will do

Challenging discrimination against all older people

The main aspiration of this framework is to challenge unwelcoming attitudes to, and discrimination towards, older people. 

People’s value, entitlement to be treated with respect, affection and dignity, and their rights as human beings do not change as they get older. Some older people, though, find that others can begin to view them differently as they age, making assumptions about diminishing faculties and abilities and gradually excluding them from normal discourses and activity. This leads to older people being treated ‘differently’ – in other words, to them being discriminated against.

Central to all measures to support older people, therefore, must be challenging stereotyping and discrimination. This is at the core of what older people are asking for – that society values them as positive contributors who have much to offer their families and communities. As a society we need to recognise and value the wisdom, knowledge and experience of older generations.

We must recalibrate perceptions so that ageing is not seen as something that should be feared, and older people are not regarded as a burden. Age discrimination and stereotyping are common; they are not only offensive, but in some cases, illegal. We are proud of our inclusive approach and tolerance, so it is unacceptable to continue to portray older people in a negative light, while ignoring the positive contribution they make.

‘Four in five of those working in advertising media and PR agreed that the advertising industry comes across as ageist.’
Ipsos-MORI/Centre for Ageing Better
The Perenials: the Future of Ageing, page 24

All parts of society – government, health and care services, schools, local authorities, public and voluntary organisations, the media and people going about their everyday business – have an opportunity, and a responsibility, to banish ageism and discriminatory behaviour by addressing their own attitudes and actions. Each of us has a part to play in ensuring older people are valued for who they are, not dismissed for what they are.

We Will Work with members of the Older People’s Strategic Action Forum to further develop our understanding of the ageism and negative attitudes older people face and of where focused action is required to combat negative perceptions about older people. We will use the results of this to develop approaches to changing attitudes, working with others, including the media, to have the maximum impact.

The Equality Act 2010 protects people from being discriminated against by employers, banks and businesses, health and care providers, landlords, education providers and local authorities on a range of grounds, reflected through nine protected characteristics, including age and disability. 

The nine protected characteristics defined in the Equality Act offer protection against discrimination on the characteristics of people’s age, sexual orientation and race. Older people may also be protected by other protected characteristics, not simply age. An older person can be gay and disabled, or heterosexual and from a minority ethnic community – people have many characteristics on the basis of which they may experience discrimination, and the law reflects this.

We need to consider how older people, including those with other protected characteristics, can be better supported and their rights protected. We know, for instance, that the prevalence of disability in the UK increases with age: only 1 in 10 (10%) of 16–17-year-olds reports a disability, but this rises to over 1 in 4 (26%) of 50–64-year-olds^[10]. The issue of how we support people with more than one protected characteristic is therefore important.

The Scottish Government’s Independent Adviser on Race Equality made a series of recommendations to sit alongside the Race Equality Framework for Scotland 2016 to 2030, published in 2016.^[11] The Scottish Government’s response to the recommendations was contained in the Race Equality Action Plan,^[12] many of the actions of which also apply to older members of the minority ethnic community. 

One action in the recently published Scotland’s Open Government Action Plan 2018–2020 ^[13] states: “We will work with a group of civic society representatives, including race equality partner organisations, to engage with minority ethnic communities in the development of the Participation Framework towards completion in summer 2018.” The Participation Framework aims to:

• support the realisation of community empowerment through enabling public services to work differently, and with a collective outcome focus
• increase capacity, confidence and capability of public service colleagues, notably Scottish Government staff, to plan and deliver effective participation opportunities
• develop a method for mapping the participation ecosystem in Scotland, using the Scottish Government as a pilot
• significantly enhance knowledge of what participation activities already exist across Scottish Government, who is using them, and where they overlap or could be improved; it will also identify opportunities and gaps for more effective participation.

We need more language translations available for ethnic minorities

We recognise that the barriers to ageing people face might differ, depending on the community they come from. Older Gypsy Traveller women, for instance, will benefit from funding of £100,000 from 2018 to 2020 to ensure that their voices are heard and they are involved in the decisions that affect their lives. This is part of the new Gypsy Traveller Women’s Voices Project we launched in January 2019.

Promoting lesbian, gay, bisexual and transgender (LGBT) equality

Scotland is considered one of the most progressive countries in Europe in terms of lesbian, gay, bisexual and transgender (LGBT) equality, and we aim to preserve and advance this reputation. Older LGBT people, however, have lived through much less tolerant times. Having felt the need to hide their sexual orientation or gender identity, they have on the whole been less visible within society.

They have experienced considerable disadvantage, including the criminalisation of homosexuality, widespread lack of legal protection and absence of recognition and affirmation of their identities and relationships. Today they have to cope not just with the legacy of prolonged exposure to stigma and discrimination, but also continue to experience a relatively high level of prejudice from their peers. 

Older LGBT people face many issues in relation to ageing that are common to the general older population, but they are also likely to face other issues and inequalities related to their LGBT identity. These include diminished support networks, high levels of isolation, the long-term health and financial impact of lack of legal protection, invisibility, and the double discrimination of ageism and homo/bi/transphobia. 

While this all points to a greater need for professional services and formal support in older age, older LGBT people often fear they will encounter discrimination, lesser treatment and ignorance from services. The Scottish Government will continue to take forward a range of measures to tackle prejudice and discrimination against LGBT people, including older LGBT people.

We Will
Continue to support the LGBT Age project, which provides LGBT people over 50 (including those ‘coming out’ later in life) with support, social groups and activities, raising awareness of the needs of older LGBT people and promoting greater inclusion both within the LGBT community and more widely.

Tackling social isolation and loneliness

Remaining active and engaged in communities is a clear priority for older people, and there is much the Government and partners can do to make this possible. Issues as diverse as making public spaces safe and welcoming, ensuring availability of transport at affordable prices, delivering adequate housing, fostering communities, encouraging intergenerational activity and ensuring people feel safe in their homes and communities are key to delivering this. 

Stakeholders and their networks have told us that tackling social isolation and loneliness is fundamental to a thriving older age. Yet there continues to be a stigma that prevents people from admitting that they may be isolated or lonely^[14]; we want to champion projects or initiatives that have proven successful in tackling social isolation and loneliness.

Of course I’ve got views on how football and other sports should be developed for the future. I’ve been involved in this for over 70 years and plan to keep being involved for a good while yet.

At all ages, people’s attitudes and self-esteem are significantly affected by feeling needed and appreciated. Social isolation and loneliness can occur at any age, but common trigger points (bereavement, retirement, children leaving home, relationship breakdown) tend to congregate in later years. Chronic loneliness harms mental and physical health and can cause destructive behavioural changes.^[15]

There are well-documented mental health impacts for older people who are lonely, including becoming more susceptible to depression and a greater likelihood of developing clinical dementia. The physical health impacts are comparable to obesity or smoking – chronic social isolation and loneliness can increase the risk of death, comparable to a 15-a-day smoking habit.^[16]

People want actions that enable them to be and stay part of their communities, rather than having a sole focus on reacting to social isolation. People discuss the challenges of making new connections and friendships, and describe the many ways in which they are gradually distanced from their local communities and other networks to which they belong – issues such as the impacts of changes to shopping patterns, fewer post offices, libraries and similar places, reduced public transport, unmaintained pavements and poor street lighting that pose risks to safety, and problems with availability of public toilets, for instance. They want to be part of finding new ways of doing things that build inclusive communities. 

Our strategy in this area, A Connected Scotland^[17], was published in December 2018 to tackle social isolation and loneliness and build social connections. It recognises that people of all ages can be at risk for different reasons, and that long-term physical and/or mental health conditions can also play a significant part. Evidence suggests that over a third of people in Scotland live alone, and 40% of adults who were living alone in 2017 were of pensionable age.^[18] Older people are proactively seeking support; in the first half of 2016, 31% of the 16,000 calls received to Silver Line Scotland included loneliness as a key theme.

We will continue to work with and support key stakeholders through A Connected Scotland and take forward cross-government work to identify where we can deliver better outcomes for people as they age to ensure they do not become socially isolated. Significant events such as ill health, retirement or a bereavement can have a big impact, and we will work to ensure that barriers are identified and targeted. 

We have established a National Implementation Group to embed a cross-sectoral approach through the development and implementation of a shared delivery plan for the strategy, along with a shared performance framework to help us understand the difference we are making. The Group will consider how best to reach and take account of a range of views and voices in shaping plans for implementation, including engagement with initiatives like the Action Group on Isolation and Loneliness, which comprises a range of third sector organisations. Membership of the Implementation Group was announced in January 2019 and includes representatives of Age Scotland and the Campaign to End Loneliness, which has a particular focus on older people in relation to social isolation and loneliness.

We Will
Deliver A Connected Scotland in partnership with the National Implementation Group to help tackle social isolation and loneliness as they affect Scotland’s older people.

Supporting volunteering

Volunteering brings enormous benefits and enjoyment, not only to beneficiaries, but also to communities and to volunteers themselves. We know that among other things, volunteering increases social and civil participation, empowers communities, and reduces loneliness and isolation. It can improve mental and physical health, support the development of job and life skills, and foster a greater sense of belonging.

Volunteering also makes a huge contribution to the Scottish economy – the annual value of volunteering in Scotland is estimated to be £2.26 billion.^[19]

Older adults make up a significant proportion of Scotland’s volunteers, but the 75+ age group has the lowest participation rate of any demographic. Inequalities of volunteering for all disadvantaged groups run across all ages.

Action to increase volunteering participation for all and to address inequalities is vital to the continued expansion of opportunities for more people to volunteer and participate in society. We want to build on the positive contribution older people are already making to society and the economy through volunteering by reducing barriers to participation. We want everyone who wants to participate to be able to do so, and to be able to experience the positive benefits of volunteering. 

We are working in partnership with the sector to develop a National Volunteering Outcomes Framework that will set out a coherent and compelling vision for volunteering and identify the key evidence and data that will be used to drive an increase in participation for all.  

We Will
Engage with the Older People’s Strategic Action Forum, using data and evidence compiled in the development of the Volunteering Outcomes Framework, to discuss the key drivers and barriers to volunteering for older people and ensure the Forum is engaged in the development of the associated Delivery Plan.

Supporting the veterans community

In the UK, a veteran is anyone who has served for at least one day in Her Majesty’s Armed Forces (Regular or Reserve), or merchant mariners who have seen duty on legally defined military operations. Approximately 220,000 people in Scotland^[20] have served in the Armed Forces in one manner or another, of whom over 80% are estimated to be over the age of 50. The experiences of veterans today range from serving in the Second World War, through National Service, to more recent operations in the Balkans and Middle East. 

The vast majority of older veterans lead a long and fulfilling life, and overall, there are no differences between the percentage of veterans and non-veterans who report that their health problems limit their activity. We will continue to ensure they are not disadvantaged due to their service when compared to the civilian population.

We Will
Work alongside the UK Government and others to take forward the Strategy for Our Veterans20 to help ensure that we respond to the changing needs of Armed Forces veterans over the next decade. The strategy addresses the immediate needs of older veterans, and defines the right conditions for society to empower and support them.

In taking this work forward, we will engage with a range of veterans and veterans’ organisations, both large and small, and the Scottish Veterans Commissioner to better identify how we can support the Armed Forces community.

Tackling and preventing malnutrition

Preventing malnutrition, and effective identification and treatment, can significantly improve the quality of people’s lives and reduce demand on health and social care services. Older people are particularly at risk of becoming malnourished, which can seriously affect their health and wellbeing.  

Long-term health conditions can have an impact on people’s ability to eat well and maintain adequate nutrition levels. We also know that low incomes, loneliness and social isolation are strongly associated with malnutrition.  

We remain committed to Scotland becoming a Good Food Nation in which the people of Scotland – including older people – have improved access to, and understanding of, the benefits of healthy local foods. Our Good Food Nation consultation will inform the further development of our plans for policy action and legislation. 

We Will
Work with health and social care partnerships and other stakeholders on practical actions to ensure malnutrition is identified and managed quickly and effectively, learning from experience in Scotland and further afield.

Keeping physically fit and active

Everyone forgets that us "oldies" still love things like music and sport. I love going to gigs.

Opportunities for engagement in community activities are enhanced if people remain physically fit and active throughout older age. Our Active Scotland Delivery Plan^[22] aims to cut physical inactivity in all people by 15% by 2030, using wide-ranging approaches that include active travel funding, support for formal sports and informal physical activity, and partnership-working across the transport, education, health and planning sectors. 

Specific actions for older people include expanding the Care About Physical Activity Programme (see the ‘Avoiding falls’ section overleaf), programmes to enable older people to enjoy travelling more actively, supporting the Cycling Without Age project to expand across Scotland, and working in partnership with sports bodies to encourage participation in sport for older adults.

We Will
Consider how agencies might improve partnership-working to further address inequalities in access to opportunities to be physically active, including inequalities relating to age, at the next meeting of the Active Scotland Delivery Group in May 2019.

Avoiding falls

The incidence of falls among people living in care homes is three times greater than for those living in their own homes. The impact of falls is stark: 20% of older people who sustain a hip fracture die within six months, and the cost to the NHS of hip fractures alone is around £73 million per year. 

Improving levels of physical activity can drastically reduce the risk of falling in older people. We have provided £1.7 million since 2016 to the Care Inspectorate to deliver the Care About Physical Activity Programme to support older people residing in care homes to become more active. The Programme was designed specifically to support social care professionals to feel skilled and confident in enabling older people experiencing care to move more and live well. 

External evaluation of the Care About Physical Activity Programme has confirmed that it is having a positive impact. Older people experiencing care significantly reduced their likelihood of falls and significantly improved their hand-grip and lower-leg strength. They were able to do more tasks independently, without the use of equipment like hoists. Overall, the proportion of time spent moving increased significantly and individuals reported spending 80 more minutes per day moving. Alongside this, fewer people needed assistance standing, with 82% being able to stand unassisted. Older people who participated in the Programme also reported being significantly happier and more satisfied, and feeling more worthwhile and less anxious.

We currently are preparing a falls and fracture prevention strategy for Scotland which will present a series of ambitions and commitments to help people avoid falling and recover more effectively following a fall. The strategy is not exclusively about falls and fracture prevention in older people, but its commitments and outcomes will have a big effect on older people going forward. 

The falls and fracture prevention strategy will highlight that the risk of harm from falls can be shaped by life circumstances, health, wellbeing and lifestyle choices in early and adult life and into older age. Prevention requires a through-life approach; behaviours such as being physically active, eating well and avoiding smoking should be promoted across the life span. 

Allied health professionals across Scotland are transforming the way they work to bring more of a focus on prevention, early intervention and rehabilitation to help older people in Scotland to live healthy, active and independent lives.

Transforming local democracy

There is a growing recognition that it is often better for decisions about the issues that affect communities in Scotland to be taken with more active involvement of those communities, whether at local, regional or even national level. This enables public services to work in ways that meet local circumstances and reflect the priorities of different communities.

Percentage fairly/very strong feeling of belonging to community
Older people are more likely to have a strong feeling of belonging to their community

In 2018, people came together in their communities to take part in the Democracy Matters conversation^[23]. Over 4,000 people from diverse places and with a range of interests and backgrounds got involved. We heard a very broad range of views, but nearly everyone wanted to change how people are involved in decisions that affect their lives. The Scottish Government, Convention of Scottish Local Authorities and the community sector will now work together to deepen and broaden the conversation.

We Will
Re-engage with the Older People’s Strategic Action Forum to help shape new transformative arrangements for local democracy in Scotland, with equalities and human rights at their core.

Ensuring housing for all

We champion independent living for older and disabled people within their communities. Living in the right home with the right support can be the key to enabling people to live safely and independently at home. 

Wouldn’t it be good if housing designers thought about ageing – you know, houses that can adapt and age with us?

We recognise that older people want to live safely and independently at home for as long as possible. Our strategy for housing for Scotland’s older people for 2012–2021, Age, Home and Community,^[24] presents our vision for housing and housing-related support for older people. We published a mid-point review of the strategy in October 2017^[25], and in August 2018 launched our refreshed Age, Home and Community: next phase strategy.^[26] It takes account of changing needs and demographics and will help address issues of isolation older people can face. It also looks at improving access to suitable housing.

We Will
Work with stakeholders to deliver actions within the Age, Home and Community strategy to ensure we have a housing system that works for older people.

We have already begun to work on a vision for how our homes and communities should look and feel in 2040 and the options and choices to get there. We want this to be a lasting legacy that is not just about new homes, but also about making best use of our existing buildings. That is why we are proposing to develop a new approach encompassing the whole housing system.

We Will
Continue to engage with a wide range of stakeholders who have an interest in housing to ensure we address the housing needs of a growing ageing population.

Since the integration of health and social care, integration joint boards are responsible for the planning and delivery of housing adaptations (using budgets created by delegation) and for reviewing and developing services to improve outcomes for people who require housing adaptations. We are undertaking a practical review of the existing guidance on adaptations and will issue revised and updated guidance and support to integration joint boards later this year.

We Will
Undertake a practical review of existing guidance on housing adaptations to identify barriers and potential areas for development.

The Housing (Scotland) Act 2014 (which comes into force in May 2019) introduces under-occupying as a new reasonable preference category for social housing tenants in the allocation of social housing. This will enable social housing tenants who have more bedrooms than they need to be prioritised in allocations when they want to downsize to a smaller social housing property. While the legislation does not specify any age group, in practice it is more likely to be older people who are under-occupying and may be seeking to downsize. This will help support older people to move to housing that better meets their needs.

Protecting from scamming and other forms of abuse

Older people have expressed concern about their vulnerability to doorstep crime, scamming and other forms of abuse. Research indicates that more older people feel safe in their communities, but this is certainly not the case for all. And unplanned life events, such as having to move to a new community for housing reasons, can exacerbate anxieties through people losing their neighbours and social circle, and becoming at risk of loneliness and isolation. 

The Independent Review of Hate Crime Legislation in Scotland: final report carried out on behalf of the Scottish Ministers by Lord Bracadale was published in May 2018^[27]. It proposes the creation of a new statutory aggravation whereby an offender who was motivated by hostility based on the victim’s age, or who demonstrates hostility towards the victim based on age during, or immediately before or after, the commission of the offence, would be recorded as having committed an offence aggravated by age hostility. Lord Bracadale recognised, however, that in some cases where a crime is committed against an older person, it may be that the victim is not targeted because of the offender’s hostility against older people, but rather because the offender perceives the victim as being more vulnerable than other people in society.

As part of our consultation on Lord Bracadale’s report on hate crime, the Scottish Government has sought views on whether there should be a new statutory sentencing aggravation that would apply in situations where criminals deliberately target someone whom they perceive to be particularly vulnerable.

Many older people rely on others for maintenance of their homes, which can make them more vulnerable to scammers and rogue traders. Online and cold-calling scams can also be harder for some older people to detect and protect themselves from. Lack of awareness and technical knowledge may be contributing factors. The role of the Telephone Preference Service should be much more prominent, but its effectiveness should be monitored and reported.

The Telephone Preference Service is the only official UK ‘do not call’ register for opting out of live telesales calls. Its register is established and supported by legislation. Organisations that want to make live telesales calls in the UK are legally required to screen their sales lists against the Telephone Preference Service list. Public money is not used to support this service – the direct marketing industry pays for it.^[28]

Promoting intergenerational activity

‘Four in five (83%) want to mix with people of different ages and generations.’
Ipsos-MORI/Centre for Ageing Better
The Perenials: the Future of Ageing, page 75

The opportunity to take part in activity with people of different ages – commonly referred to as intergenerational activity – offers a real positive incentive for older people to remain engaged and contributing to their communities. Intergenerational activities provide a vital role in ensuring that different generations (older and younger) come together to connect and interact, building relationships, respect and understanding. Together they can share experiences, knowledge and skills which are mutually beneficial, tackling shared challenges and preventing exclusion and isolation. 

The children brightened my day!

As part of the legacy of the Year of Young People, we’ll look at what more we can do to develop intergenerational practice and encourage contact between people of all ages. This will help to challenge ageism and discrimination and ensure that people of all ages are more included in their communities.

The National Centre for Intergenerational Practice in Scotland, Generations Working Together, promotes intergenerational approaches to enhancing and improving the lives of older and younger people. Intergenerational practice contributes to giving people of all ages a more positive attitude to ageing, countering and reducing negative attitudes towards older and younger people, helping older and young workers to support each other and see the shared benefits of a vibrant community, and supporting people’s educational development.^[30] But of course, encouragement must be given to ensuring intergenerational links are forged naturally and are not derived solely from projects. 

Engaging with culture and supporting creativity

We recognise how important culture is to Scotland’s future and want to enable everyone to have an equal opportunity to take part in, or contribute to, cultural life in Scotland. The benefits of taking part in creative activities and coming together to celebrate our diverse heritages as we age are becoming increasingly clear, with positive impacts on health, wellbeing and addressing isolation and loneliness. 

There is also increasing awareness of the many benefits that intergenerational activity or ‘social prescribing’ can bring for young and old, with culture providing a broad platform on which to get involved, from storytelling and reflections of the past, to singing, dancing, drawing and painting, to name but a few. 

That’s why we are developing a culture strategy for Scotland that will show how important culture is to Scotland’s future and will enable everyone to have the opportunity to take part in, or contribute to, cultural life in Scotland, no matter their background. We are reflecting on the rich material that the consultation for the strategy has generated, and will bring forward the final version later in 2019.

[We need] more places like the Craft Café in Govan with an open and relaxed environment and choices of activities – something to suit everyone.

Creative Scotland provides a range of support to organisations that offer opportunities to older people. Luminate, for example, Scotland’s creative ageing organisation celebrating creativity as we age, runs a diverse programme of creative events and activities throughout the year. The Luminate Festival between 1–31 May 2019 is a nationwide event that brings together older people and those from across the generations to celebrate our creativity as we age, share stories of ageing and explore what growing older means to us all. Events take place in care homes, village halls, community centres and arts venues, and creative activities can bring young and old together.

We Will
Ensure that the voices and experiences of older people are reflected through the forthcoming culture strategy for Scotland, which will be published in 2019, and will continue to celebrate the valuable contribution that older people make to cultural life in Scotland.

Hearing the rural voice and promoting inclusive growth

Although the population in mainly rural local authorities of Scotland^[a] has grown in the past 10 years by nearly 4%, the population in the islands and remote rural local authorities^[b] has grown by only 1.8% and has actually declined in some areas, most noticeably in Argyll and Bute and the Western Isles.

The proportion of people over 65 years in 2017 was highest in remote rural Scotland, with 25% of the population in that category compared to 21% in accessible areas and 18% in the rest of Scotland. The share of the working age population (16–64 years) was lowest in remote rural areas (59%) compared to accessible rural (62%) and the rest of Scotland (65%). For this reason, we need to ensure rural needs and opportunities are mainstreamed across all areas.

Access to housing, health care and education has implications for economic growth in rural Scotland, and the distinctive demographics of rural areas have real implications in terms of health and social care. We must look to creative, holistic solutions if we are to future-proof our rural communities and take a cross-government approach to solutions, actions and opportunities.

It is the people who live and work in rural Scotland who are best placed to create and sustain the resilient communities on which the development of Scotland’s rural economy depends.

A new group tasked with bringing the rural economy to the forefront of policy-making, 

the Rural Economy Action Group, will guide how Scottish Ministers drive forward any actions flowing from the recent report by the National Council of Rural Advisers.The recommendations, currently under consideration by Scottish Ministers, include ensuring rural policy is embedded in all decision-making, and national economic plans and industry-led strategies are joined up to promote the rural economy. This work highlighted the need for support for the rural workforce, including those over 50. 

One of the National Council of Rural Advisers’ 10 outcomes relates to the need to have highly valued, flexible, adaptive and skilled people. Two further recommendations specifically reference older people in relation to housing solutions, around the need to:

• address restrictive regulations that affect housing (such as retirement options for tenant famers without capital) and remove regulatory barriers to collaborative planning 
• collaborate with local authorities, residents, their families and key stakeholders to find innovative housing solutions to adapt housing that meets the needs of the ageing, and the young, rural population. 

We Will
Support the mainstreaming of rural policy and learn from examples of successful communityled practice that supports good rural outcomes. Those with the right skills needed to support our rural economy and communities should be encouraged to do so.