La palma de aceite y el desarrollo regional

Perhaps the most visible, and to some extent predictable, transition that pensioners will confront is in terms of changes in health; that is, that their health will become less robust, and that acute and long- term ill-health and disability may set in or intensify. In part, this is linked to the ageing process, although deteriorations in health rarely correspond neatly with pensionable age. A sizeable proportion of those interviewed had some sort of long-term health problem, although not all of these were entitled to disability benefits.6 _{These were broad-ranging, but included: conditions typically} associated with old age, such as diabetes, heart disease, cataracts and arthritis; longer-term conditions and disabilities, such as deafness, epilepsy and learning difficulties; mental illness, such as hypertension and depression; and acute conditions and degenerative disorders, including cancer, strokes, osteoporosis and diseases of the central nervous system.

Health transitions can be experienced in terms of an extended and gradual process, or at the opposite extreme, as an unexpected and acute decline in health, and medical conditions may occur singly or in combination with others. These changes are characterised by a range of trajectories, frequently interlinked with partners’ experiences and health, and which may incorporate improvements and recovery as well as decline and restriction. Health transitions are likely to involve contact with a range of services, among them doctors, hospitals, social services and private carers, or may be dealt which more individually and informally, or using some combination of these, depending on a variety of factors (see Chapter 5).

Pensioners with more acute medical conditions, characterised by a sudden onset, tended to adopt a narrative which identified a defining moment when they had realised that they could no longer rely on their health, a realisation which could be particularly upsetting or disturbing. For example, Noreen’s cancer diagnosis had initially been devastating to her self-concept, but she had since moved to frame this experience in more progressive terms, and talked about re-evaluating life and developing a heightened appreciation for the here and now:

‘I cried and cried and cried then…I cried when I first found out I’d got cancer, but…I’ve got to thinking to myself, right girl, get on with it, you’ve got to get on with it, you know, this is life and you’ve only got…you might have a short space of time, get on with it. Make life as you can.’ By contrast, Frank was interviewed at a time when he was in the middle of a health crisis. He was as yet undiagnosed, and was suffering from episodes when his thinking became severely compromised, an experience he self-evidently found extremely frightening. The unpredictability of his situation was reflected in his narrative, which veered from lucid to confused, and it was clear that his formerly relatively stable status of living at home by himself, was under threat. He had recently gone to stay in a care home for a week after one attack, and it seemed unclear whether this would need to happen again in the future:

‘Up to then I was quite with myself, you know. I was in good health. But one day something clicked one night, and I wasn’t ...I couldn’t remember when I woke up. I couldn’t at talk. I don’t know how I’m talking I couldn’t understand meself, I couldn’t understand what I were talking about. And my daughter, my daughter took over and she, she does the thingy now. I don’t know…’

6 _{This was partly an issue of the eligibility criteria associated with disability benefits, in particular qualifying}

These kind of acute health crises often required hospitalisation, and consequently prompted or overlapped with a more specialised transition, that of leaving hospital to return to the home (sometimes interspersed with residence in some form of respite care or supported accommodation), which is explored in more detail in Section 4.6.3.

A particularly common response to a health crisis was to talk in terms of a ‘loss of confidence’, and the discussion of these trajectories often formed a sensitive moment in the interview, when it was clear that people had lacked (or might still lack) emotional or practical support. Fergus, a divorced man in his late 60s, elaborated on this experience, in terms of the discovery that he had cancer:

‘It was really bad because I have been fine before and for the first time I started to feel very ill and like an invalid. I felt very lonely and isolated. I think for the first time I felt that I was alone and sick. It’s a horrible feeling to have something like that and then not know if you are going to live or die.’

A critical factor in pensioners’ responses to health crises was the time that had elapsed since the events which marked out the start of their health transitions (although these could also be more gradual and less easy to delineate). Pensioners adopted a range of techniques to ‘cope’ with declining health, to some extent informed by their medical conditions. For example, Joy, a woman in her 80s who had suffered from arthritis and a crumbling spine for over 30 years, appeared to normalise her almost constant pain as something which was to be expected at her age. She painted a relatively positive picture of her health that was in tension with the objective reality of her situation. For a significant group of pensioners, relatively early health crises had prompted their retirement, occasionally some years before they had intended leaving work, illustrating one way in which transitions commonly coincide. Interestingly, discussion of health matters tended to be a less emotionally sensitive topic for these people, presumably because they had had longer to come to terms with limiting health conditions, and longer to develop adaptive strategies.

Changes in partners’ health usually heralded something of a transition for both members of a couple, although this varied in intensity. These ranged from a demand to provide care and the accompanying change in personal priorities which this necessitated, to restrictions upon the kind of lifestyle that couples had previously enjoyed. For example, Eliza explained how over the course of two decades her husband’s Parkinson’s disease had an increasingly limiting effect on the couple:

‘We used to go away a lot and it first showed up when we were in Greece. He fell backwards for no reason whatsoever in the bedroom and knocked himself out, and from there he just seemed to go downhill, and of course with Parkinson’s it takes a lot of diagnosis, so I packed in work to keep us until, and I never went back.’

For pensioners who relied heavily upon their partners for their care, even small changes in their spouses’ health could have significant and sometimes dramatic impacts upon their own circumstances, possibly propelling them into supported forms of accommodation.

Notably, most of the pensioners who described health transitions were those already claiming disability benefits (exceptions to this are explored in Chapter 6). While some of the others had experienced health crises, these were more treatable in the short-term, or else they were at the start of health transitions. One common response to anticipated or actual health transitions was to rethink housing arrangements to meet changing physical needs.