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A year ago, in the midst of the festivities, I couldn’t help but notice the role of the older person on some of the TV programmes. In recent years, two comedy programmes, Little Britain and The Catherine Tate Show reached cult status and were duly awarded with prime time Christmas slots. In both programmes the older person featured prominently in various sketches.

Little Britain
A scene in a nursing home shows an elderly man sitting at a table struggling to eat his meal. A male carer notices the man struggling and helpfully leans over, offering assistance by cutting up the food. Whilst leaning over the man, the carer then feeds himself, the food passing agonisingly past the old man’s gaping mouth! The same carer is seen in an earlier episode offering an old lady a cup of tea. She motions to stand up and he carefully helps her, only to sit in her chair, put his feet up and drink the tea, leaving the lady standing stranded!
A subsequent series portrayed a new character – a lady who is (blissfully unaware) copiously incontinent whilst chatting to acquaintances. In the Christmas show she finally arrives to see her GP, the audience being seduced into the idea it will be for her embarrassing problem. But of course, no – she asks about a knee problem! Whilst using a rather unorthodox technique to examine her, the GP himself on his knees is duly greeted by her predictably releasing copious amounts of urine! Interestingly the embarrassment often associated with the problem (often inhibiting people from seeking help) was not seen in the patient but was evident in the hapless GP who made weak protestations about the incident – the patient suggested she had had problems with water retention but it wasn’t too bad at the moment!

In the live stage show, an elderly zimmerframed man is seen walking painfully slowly across the stage to ask the rude and unhelpful ‘the computer says no’ travel agent character about a round-the-world trip. The tension whilst the man agonisingly makes his way across the stage, with the crowd of several thousands sensing the man’s inevitable rebuttal, was eventually lifted with perfect timing by the travel agent shouting unsympathetically, ‘for ***** sake get a move on!’

The taboo theme of sex/sexuality and the elderly person was explored in Little Britain. One teenage character called Jason has a fetishistic crush on his friend’s grandmother. As the series progresses he is seen in a couple of shocking scenarios indulging in sexual acts with the grandmother. Another sketch involves ‘the only gay in the village’ Dafydd setting up a stall at a summer fete. The sketch uses a lady, clearly in her 70’s, enquiring about whether a particularly large sex toy came with batteries or not. The issue of sexuality in the elderly was however, beautifully explored in the hit movie, ‘Meet The Fockers’ where Barbara Streisand is a sex therapist and runs regular classes for the elderly, using an ergonomically (and hopefully OT and physiotherapy accredited) designed pieces of soft furniture to safely aid various sexual positions!

The Catherine Tate Show
The start of one sketch showed a hospital nurse pushing an old lady to an en suite toilet. The nurse becomes distracted and ends up projecting the chair and helpless brakeless patient into the toilet and shutting the door.

One of the favourite characters is an old Londoner lady who has a propensity to swear colourfully and has the unerring knack of commenting on obvious disabilities/weaknesses in others, producing various social faux pas. In the Christmas show the old lady is seen attending a Christmas lunch for the elderly at the local church hall with her teenage grandson. She enters, moving between tables, warmly greeting others. On sitting down at her table she comments ‘don’t they ******* stink!’. She was patronisingly offered a meal based on a recipe by the eminent TV chef Gordon Ramsay – this prompted her, in a delightfully insightless manner, to refuse the meal offered, as she couldn’t abide the man due to his excessive and wanton use of profanities!

Whilst this may be some frontal cortical loosening as part of an emerging dementia, or the beloved and tolerated eccentric grandmother/granddad, it reflected a phenomena I regularly see when trying to sell the idea of day care to an older person who complains bitterly about being lonely – they decline to go as they don’t see themselves as being ‘old’ and sitting in a big room with lots of older people! A 94 year old patient of mine recently declined our offer with such an argument, yet I suspect this view is as much about ‘the thin end of the wedge’ - a precursor to being ‘put away’ and their perceived fears of residential care.

These programmes bed their humour in challenging political correctness and push boundaries using ‘shocking’ stereotypes (even the BBC’s own website advertises one Little Britain episode as ‘more grotesque comedy’). However disturbing or shocking, these stereotyped elderly characters demonstrate commonly encountered issues such as nutrition, mobility, incontinence and sexuality, some of which have been aired via the media over the past couple of years.

Nutrition
The issue of (under) nutrition in the elderly received media attention when figures from the annual returns of the Commission for Social Care Inspection for 2004-05, uncovered by the Liberal Democrats, suggested that more than 2,500 care homes for the elderly were failing to meet minimum standards on meals. The Liberal Democrat MP Paul Burstow called on a celebrity chef to step forward and campaign for better food for the elderly in the same way Jamie Oliver did in his campaign for improved school meals. It is interesting to note, over a year after this call, nobody has taken up the challenge.

Age Concern’s “Hungry to be heard” campaign was run in January 2007 (with Jackie Morris acting as advisor) and one would hope that the awareness raised by this campaign has started to see positive results, but until the issue re-enters the orbit of media attention, we cannot know for sure.

Sexuality
Age Concern (1999-2004) recognised there are specific issues for older lesbians, gay men and bisexuals. It developed a programme of publications, resources and events that seek to address the needs of this often ‘hidden population’ under the umbrella term “Opening Doors”.

Another charity, The Relatives and Residents Association, suggested that special rooms be set aside in care homes so that elderly residents can have sex in private. The charity produced a guide highlighting the need to be aware of the sexual needs of residents especially as 1 in 10 are still married and homes do not discriminate between the needs of single and married residents. The author suggests there is an ageist assumption that older people are no longer interested in intimacy. A study by Ginsberg et al. concluded most of the elderly in their survey wanted to maintain a sexual relationship which included touching and kissing, and they would like to have more sexual experiences than they have accessible.

Incontinence
A national audit of incontinence care for older people in the UK demonstrated widespread failure to diagnose and manage continence problems. The audit, undertaken by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit and commissioned by the Healthcare Commission, examined the quality of care for older people with urinary and faecal incontinence in primary care, secondary care and care homes in England, Wales and Northern Ireland.

The audit was based on the standards set in the National Service Framework for Older People and the Department of Health guidance Good practice in continence services and recorded the care of over 9,000 patients and 700 care home residents.

No longer the possessors of special wisdom
The world of aging portrayed in the mass media has not traditionally been an enjoyable or positive one. Dail suggests that elderly populations suffer from negative stereotyping more than any other identifiable social group. She argues that preconceived notions about cognition, physical ability, health, sociability, personality, and work capability perpetuate these negative stereotypes. She also suggests that increasing age seems to portend decreasing value as a human being. Meyrowitz offers some insight into this devaluation: ‘Old people today are generally not appreciated as experienced "elders" or possessors of special wisdom.........Old people are respected to the extent that they can behave like young people, that is, to the extent that they remain capable of working, enjoying sex, exercising and taking care of themselves’.

Ian Philp, National Clinical Director for Older People, when commenting on the service development guide, ‘Everybody’s Business’ noted that providing services for people with mental health needs can be complex, cutting across health and social care, physical and mental health and mainstream and specialist services. He emphasised such needs should be met in a co-ordinated way, and that they don’t fall between gaps in the system. It would seem that issues such as nutrition, sexuality and incontinence may in actual fact frequently fall between such gaps.

Whilst they run the risk of promulgating negative stereotypes these programmes may paradoxically be a vehicle to increase awareness of everyday problems and break down some established social taboos - at least Channel 4 (being a tad more PC) would advertise a helpline number at the end of a programme!

Martin Curtice
Queen Elizabeth Psychiatric Hospital
Edited version of an article which appeared in “Old Age Psychiatrist”

BGS Newsletter, December 2007
Issue 14 ISSN 1748-6343 14

References

• Dail PW (1988) Prime-time television portrayals of older adults in the context of family life.
• The Gerontologist, 28, 700 – 706.
• Department of Health (1992).Report on Health and Social Subjects 31 - The Nutrition of Elderly People. Committee on Medical Aspects of Food Policy.
• Department of Health (2000) Good practice in continence services.
• Department of Health (2001) National Service Framework for Older People.
• Department of Health (2005) Everybody’s Business.
• Ginsberg TB, Pomerantz SC & Kramer-Feeley V. (2005) Sexuality in older adults: behaviours and preferences. Age and Ageing 34(5):475-480.
• Health Education Authority (1998) Effectiveness of interventions to promote healthy eating in elderly people living in the community: a review.
• Highlight of the day? – Improving meals for older people in care homes, Commission for Social Care Inspection, Issue 1, March 2006
• Malnutrition within an ageing population: a call for action. Report on the Inaugural Conference of the European Nutrition for Health Alliance. London, 14th September 2005. www.european-nutrition.org.
• Meyrowitz J (1985) No Sense of Place: The impact of electronic media on social behavior. New York; Oxford: Oxford University Press.
• Opening Doors - www.ace.org.uk/AgeConcern/openingdoors.asp
• Relatives and Residents Association (2001) Involving Relatives and Friends. A Good Practice Guide for Homes for Older People - Julia Burton-Jones.
• Royal College of Physicians (2005) Inadequate and incomplete – continence care in the UK.
• WHO (2002) Keep fit for life - Meeting the nutritional needs of older persons.