Ageing unequally

In the UK the population is ageing and inequalities in both health and wealth are growing. Those living in the most affluent areas live disability-free for 15 years longer than their poorest counterparts, thus health disparities are expressed most profoundly in later life . Numerous studies demonstrate the association between social disadvantage and ill health. The contemporary political climate of economic austerity impacts health both through the rationalisation of health resources and cuts to public services, which worsen the socioeconomic determinants of health . These structural inequalities are modifiable at a policy level. However governmental and media discourse frequently overlooks both these political dynamics, and the benefits of living longer, and instead construct the older population as a threat to the economic sustainability of health services .

Health inequalities in later life can be understood to reflect social advantage and disadvantage accumulated over the life course. Consequently, when looking to address health inequalities in older populations, practitioners often justifiably feel overwhelmed. This chapter considers the issue of unequal ageing and aims to challenge this by suggesting strategies health care professionals might employ when looking to close the gap in health inequalities. First an overview of unequal ageing is provided; here attention is drawn to the domains across which social disadvantage operates. Next, the dominant geriatric concept of frailty is described. It is demonstrated that the burden of frailty is distributed unevenly amongst the population, with poorer groups becoming frailer at younger ages and experiencing a faster decline once frail. Finally, practical suggestions are made for practitioners looking to address unequal ageing within an often-restrictive political climate. Rather than proffering a one-size-fits-all approach, this chapter argues for a focus on patient-centred care for older people, which actively considers the cumulative and intersecting disadvantages experienced over the life course. Importantly, it is suggested that in order to close the gap in health in later life, health care professionals must be advocates beyond the clinic.