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What do older people mean by "independence"? What helps promote independence, and how far do services help older people remain independent? These questions are at the heart of a new study by the Audit Commission in partnership with the Better Government for Older People network.

The study found that for some older people independence did not mean doing everything yourself; indeed, many received substantial amounts of help from friends, relatives or services. Rather, independence was defined in terms of choice and control. One respondent summed up the views of many when she said: "The important thing is to feel in control of organising your support." Another said: "Being able to make choices about what I do in my life and when I do it", and "having control over your life, making the decisions you want to make".

Independence also meant avoiding feeling a burden, particularly to children busy with jobs and families of their own. Moving into sheltered housing could feel at first like losing independence. However, the security actually enhanced the feeling of being in control, particularly for older people who had previously lived in areas with high levels of crime that had made them feel vulnerable. Moreover in sheltered housing, help was readily available rather than having to be specially requested - "You can feel safe and you only have to ask for something and it will be done...", was one comment from an older person.

Threats to independence included bereavement; deteriorating health; giving up a car (particularly for men); and poverty. Some people were financially dependent on their children, with one saying: "No matter how independent a person is, they always have to fall back on their children when they are getting a pension because the pension is not enough for two people to live comfortably."

Age often incurred new costs, as many people had to pay for small maintenance jobs around the home and garden. "I used to be able to put my hand to anything," one respondent said, "but past a certain age you can't". Even in sheltered housing, residents needed to pay for small tasks like putting up a curtain rail. Again, this could mean feeling vulnerable; older people wanted a list of reputable workmen who wouldn't "rip them off". "In a village you know people but in the cityÉ people just come up the drive and say you need things done."

Staying independent also incurred extra spending. Several focus group members could not afford a call alarm: "I fell in my garden and I called and called but got no answerÉ we have to buy our own pendants and I couldn't afford one." There was widespread agreement that potentially life-saving services like these should be free of charge.

Older people felt ill-informed about welfare benefits and the services available from their local authority. Although some people felt there had been improvements, information about services was still not getting through to others. Knowing where or who to ask was a major hurdle, with people commenting: "Social services will do things but you don't know what..."; "Sometimes we hang on the phone for half an hour; you don't know who to speak to". One participant pointed out that house-bound people could not access information services, for example at the local library. Others suggested that the charges paid in sheltered housing should include information and advice services.

The way information was provided was important. Older people emphasised the importance of personal contacts in encouraging them to use new services such as attending a day centre for the first time, or suggesting how the attendance allowance could be spent. Help filling in benefit applications was essential. "It's such a rigmarole to make a claim, it puts you off". Some Gujerati-speaking older people described how specialist advice workers had attended their day centre and explained about the potential benefits of services. Personal support of this kind in accessing services did not seem to be available to most people.

The environment inside and outside the home dramatically reduced many people's independence. For instance, inside the home small pieces of equipment (gadgets for jar lids, accessible kitchen cupboards), walk-in showers (with space for a care assistant), and doorways wide enough for a walking frame were important. Lack of these small design features meant having to rely on other people.


Outside the home, transport and access to shops and health services was a widespread problem. Bus routes were inconvenient, stops too far away and buses difficult to access, particularly in rural areas where there are no pavements. Taxis were expensive, rarely available for early morning appointments and some older people felt vulnerable if taxi drivers did not escort them all the way to the door. Even accessing health care was difficult: "You have to get two buses... you don't get hospital transport if you're capable of walking."

Out-of-town shopping centres meant having to use a car or taxi, especially when carrying heavy bags. For those still driving their own cars, parking places (even when reserved for disabled badge holders) were inadequate: "I have to have the door wide open to get in and out; cars are getting wider and the spaces are small." The loss of a car was a major threat to independence: "When they took my wheels away I was desolate".

Although some older people knew of services that delivered shopping to the home, these ignored the social aspects of shopping, and rarely included items such as wallpaper or clothing.

There were major gaps between the help that older people needed to stay independent and what they knew was actually available. Two particular priorities were identified: first was maintaining social contacts, within and outside the home: "If I were ill and someone came in to give me my breakfast and went away and someone came in to do my lunch and I didn't see anyone else until they came to do my tea, I'd be extremely lonely."

Secondly, there was agreement that little help was available for people whose problems were not yet severe. They were "between the set-upsÉ they can't class themselves as young any more but don't want to be dependentÉ" Similar concerns were expressed about the financial vulnerability of those just above the limit for means-tested benefits.

The priorities expressed above do not really tie in with current policies which focus on personal care rather than social contact or domestic help, and speedy hospital discharge rather than long-term support. However, part of the National Service Framework for Older People focuses on promoting physical and mental health. The Audit Commission is currently investigating local initiatives aimed at sustaining independence, as defined by older people themselves - services that sustain and enhance choice and control, whatever the restrictions of frailty or infirmity.

- The commission is keen to hear about interesting or innovative work to help older people to live independent lives. Please contact the project manager Jane Carrier by e-mail: j-carrier@audit-commission.gov.uk    

Caroline Glendinning is professor of social policy at the University of Manchester and is working with the Audit Commission/BGOP study. Contact her at caroline.glendinning@man.ac.uk

The research

To ensure the study was shaped by the views of older people themselves, focus groups were organised by Age Concern in eight urban and rural areas across England. Participants were aged 59 to 96. Some were from ethnic minority communities, others lived in sheltered housing and many had long-term health problems.