1. Re-thinking care in later life: the social and the clinical Chris Phillipson Co-Director, MICRA School of Social Sciences The University of Manchester

2. The problem ‘The inter-dependent nature of health and social care means that the structural and budgetary split between them is not sustainable: health and social care must be funded jointly, so that professionals can work together more effectively and resources can be used more efficiently. The Government and all political parties will need to re-think this issue’ Ready for Ageing? Report HoL Select Committee on Public Service and Demographic Change, 2013

3. The history: social & clinical together Linkage between social and clinical key aspect of early history of Geriatric Medicine. - Social Medicine of Old Age (Sheldon) - Survival of the Unfittest (Isaacs) Linkage to work in sociology and social policy (e.g. Townsend, Family Life of Old People, Last Refuge) Rooted in placing older people in family and community context: Wolverhampton, Bethnal Green, Glasgow

4. The History: social & clinical apart Expansion and Professionalisation of Geriatric Medicine – 1950s onwards Organisation of welfare state: definition of older people as health and social problem Rise of social gerontology - 1980s onwards - Critique of biomedical model/ ageing as social construction

5. Contrasting paradigms Emergence of contrasting paradigms: - frailty as biologically-driven (deficit- accumulation through ‘normal ageing’) - frailty as environmentally-driven (cumulative advantage/ disadvantage over the life course)

6. The Social and the Clinical: factors driving them together Hollowing-out of the welfare state – opening up of disciplinary space for debate and research. Crisis construction of ageing populations as a social problem Pressure to work together on areas (e.g. dementia) where urgency of developing a new cultural narrative of ageing goes hand in hand with clinical concerns. Debate around multi-/inter-disciplinarity

7. Bringing the social into the clinical Three arguments from social gerontology: Inter- and intra-cohort variability: cohorts age differently but inequalities within cohorts are also important (people age differently under different social conditions). Social networks are important but increasingly complex and diverse– increasingly kin may behave like friends and friends like kin; new relationships formed through importance of single-person households. Communities and neighbourhoods need to be re- developed as sites for ‘active ageing’ (naturally- occurring retirement communities).

8. Areas for development A new social medicine for the ‘life course’ which: -incorporates insights into cumulative inequalities into clinical assessment -acknowledges ageing as a cultural and medical issue -develops model social science and geriatric medicine projects e.g. around community-based care, stroke. -re-build social and clinical practice around recognition of interdependence between ‘age’ and ‘society’.

9. Further reading Baars, J. (2012) Aging and the Art of Living. Baltimore: John Hopkins Press Bengston, V. (2009) Handbook of Theories of Aging. New York: Springer Dannefer, D (2003) Cumulative advantage/disadvantage and the life course The Journal of Gerontology, 58b 327-337 Dannefer, D. and Phillipson, C (2010) Sage Handbook of Social Gerontology. London: Sage Phillipson, C. (2013) Ageing Polity Press