Health and wellbeing promotion strategies for ‘hard to reach’ older people in England: a mapping exercise.

Abstract

Background: Older people from deprived areas, the oldest old and those from ethnic minorities engage less in health promotion interventions and related research, potentially generating inequities. Aim: To explore and map the extent to which such ‘hard to reach’ groups of older people, are the focus of local health and wellbeing strategies in England. Methods: Document analysis of current health and wellbeing promotion strategies in a purposive sample of 10 localities in England with high proportions of some or all of the three hard-to-reach groups. Documents were analysed using an interpretive approach. Findings: A total of 254 documents were retrieved and reviewed. Much of the content of the documents was descriptive and reported the implications for resources/services of population ageing rather than actual initiatives. All localities had an Older People’s Strategy. Strategies to counter deprivation included redistribution of winter fuel payments, income maximisation, debt reduction and social inclusion initiatives, a focus on older owner occupiers and recruitment of village ‘agents’ to counter rural deprivation. The needs of the oldest old were served by integrated services for older people, a community alarm service with total coverage of the 85+ population, and dietary advice. The needs of Black and Ethnic Minority (BME) older people were discussed in all localities and responses included community work with BME groups, attention to housing needs and monitoring of service use by BME older people. Three other themes that emerged were: use of telecare technologies; a challenge to the idea of ‘hard to reach’ groups; and outreach services to those at most risk. Conclusions: Document analysis revealed a range of policy statements that may indicate tailoring of policy and practice to local conditions, the salience of national priorities, some innovative local responses to policy challenges and even dissenting views that seek to redefine the policy problem.