Older people's perceptions and experiences of strengths and vulnerabilities across the UK food system

Like the rest of the developing world the UK is experiencing demographic change. There are currently 10.8 million people aged 65 or over in the UK and over 1.4 million are aged 85 or over. The numbers of centenarians has nearly quadrupled since 1981, from 2,600 to over 12,000 in 2010. The number of people aged 60+ is expected to be more than 20 million in the UK by 2031 and the number of individuals aged over 85 years is predicted to double in the next 20 years and nearly treble in the next 30 (Age UK 2013). A significant minority of older people have ongoing health conditions and for those aged over 85 up to two thirds has a disability or limiting long term illness. Two thirds of NHS clients are aged 65 and over (Philip 2007). Such statistics and demographic shifts highlight that addressing when, how and why older people might become vulnerable through the food that they eat should be a research priority in terms of impact on the UK food system, quality of life for individuals, better public health outcomes, reducing the burden of disease and disability not to mention the resultant economic benefits for the UK.
Whilst food security and the UK food system itself are relatively secure, the potential for older people to become vulnerable could be strengthened, weakened or influenced by a number of external factors, though no research has explored such factors broadly in relation to the older population. Older people might disproportionately acquire food from different parts of the food supply chain and civil society compared with other groups of the population as they are perhaps more likely to encounter food delivery services marketed directly at them and the health professionals who care for them and through social enterprises serving food, such as 'meals on wheels' and Age UK lunch clubs.
The ways that vulnerability linked to the food system might operate for different groups of older people is not straightforward but a framework for assessing different domains of vulnerability - exposure, threats, coping capacities and outcomes is proposed. Trust is thought to be an integral part of relationship building between actors in the food system and consumers are increasingly being viewed as having an active role in the trust relationship. It is unclear whether and how civil society actors within the food system undertake to build and market trust or whether the mechanisms by which trust operates or is perceived by consumers is different when the commercial sector is not involved. Assessing older people's own views on trust and their experience of different actors at the point that food is acquired is therefore important.
We have reviewed the datasets available via the UK Data Service and found none matches the study objectives. New data will therefore be collected and a qualitative approach used. In the first phase of the study the research team will use interviews, photography/photo-elicitation, video observation and other techniques designed to engage participants including the use of diaries with 25 households drawing on a broadly ethnographic approach to investigate the food acquisition practices and perceptions of trust of a range of household types incorporating individuals aged 60+ years. These findings will inform 4-6 focus groups with older people (Phase Two). Finally, a consensus event with stakeholders from across the UK food system will be organised to debate and critique the findings from the first two phases (Phase Three). To maximise public engagement, and ability of a lay audience to more fully participate in the study, we will develop an interactive exhibition. Members of the public, through the Public Involvement in Research group, will be a key part of the approach taken throughout the research.

There are a range of non-academic beneficiaries from the proposed research; impact will be created in the short through longer term. At the heart of this proposal is the aim to enhance the food system and quality of life of older people. This has impacts in terms of health, wealth and culture for the food supply chain, civil society, local authorities, central Government departments and the general population. Building an evidence base about vulnerabilities in the food system will provide opportunities to ensure that the UK food system is fit for purpose in terms of providing food that tastes good, is nutritious, safe and that minimises food (and therefore economic) waste through attention to portion size. The proposed study will support the development of food products and services that are safe and nourishing. The findings will support evidence based policy making at local, regional and national level as well as informing studies worldwide about the development of safe services in countries with an ageing population. Benefits for policy include the potential for keeping older people well, preventing malnutrition and helping people to remain in their own homes; this could impact on use of primary care health services and reduce hospitalisation rates. Identifying and mitigating risks to older people from vulnerabilities in the food system will increase effectiveness of public services. There is potential for significant economic development for the private sector in terms of development of food products that appeal to older people as well as with regard to new models for the delivery of food-related services in the community. This may also impact on the civil society/third sector in terms of social enterprise for the delivery of services. Social impact and benefits for the wider population will be created in terms of identifying best practice in the current food system and making recommendations for the enhancement of meals and services; e.g. recommendations about community-based meal services to prevent social isolation could arise from the proposed study.
To summarise, impacts will be created in:
The food supply chain- manufacturers, retailers, delivery companies.
Private sector organisations providing care for older people in their own homes, (who often provide support with food preparation/cooking).
Kitchen companies, product/technology design, housing design - in terms of using findings about how kitchens/technologies/housing/town planning enhance and make safer the food system and older people in their own homes.
Civil society actors - social enterprises and others supplying food for older people e.g. Meals on Wheels, Age UK lunch clubs and other services.
Other 3rd sector/charitable organisations tasked with enhancing the life of communities: e.g. the Food and Health Alliance; Community Food and Health (Scotland), Age UK (national and local), Alzheimers Society, food banks, Carers Organisations, faith organisations as well as direct services such as community food support, (eg Age UK Hertfordshire provides support at potentially vulnerable times such as following discharge from hospital).
Government departments. FSA in England, Scotland, Wales and Northern Ireland; Department of Health; DEFRA, Association of Directors of Social Services.
Local authorities (including social services) and county councils -improve the effectiveness of services, food safety (environmental health).
Health services - Cost saving through reducing potentially avoidable use of GPs/other primary care and hospital services through improved/strengthened food systems.
The research design and methods used will benefit non-academic users of research, particularly those interested in the use of visual methods and the dissemination of visual research. E.g. Jude England and Polly Russell at the British Library and Erik Klein Wolterink, a Dutch photographer interested in kitchen design.