The Capabilities Approach and the Concepts of Self-Determination, Legal Competence and Human Dignity in Social Services for Older People

In this chapter, the tension between self-determination and human dignity in the Swedish legal system of social care for older people is analysed with help of the capabilities approach. The core focus of this approach is the individual person’s capability to make decisions. Also important is a supportive societal system that enables the realisation of self-determination, specifically for individuals who are not fully capable of making arrangements for themselves. The capabilities approach emphasises the responsibility of the State and can be used to analyse the impact of legal and political obligations for nation-states, and to balance the increased focus on self-determination and the quest for increased capabilities among older people. In the context of a dismantled welfare state, a one-sided focus on individual autonomy might turn out to be a double-edged sword, leaving the individual with self-determination but no (or insufficient) available care to decide about. In this chapter, the underlying principles of practical decisions are theoretically explored and reflected upon. Of specific relevance is human dignity (in addition to enhancing individual freedom), normativity (a set of fundamental capabilities is identified) and the central role of the nation-state (as the responsible political subject for the achievement of minimum thresholds for all capabilities).

eHealth Literacy and Capability in the Context of the Pandemic Crisis

The rapidly increasing size of the ageing population, and in particular older adults living alone, requires the incorporation of eHealth into social and healthcare services, in order to choose the best way to manage their needs and demands for health and medical care. The purpose of this brief scoping study is to describe and identify an important dimension in this context, namely eHealth literacy (eHL) and its relation to health-promoting behaviours among older adults within the capability theoretical framework. The chapter examines some aspects of eHL and recent research highlighting the importance of eHL and the direct correlation between eHL and quality of life for older adults within the capability context. To make this more specific and explicit, this study takes into consideration outstanding circumstances, such as those caused by a pandemic crisis, namely the coronavirus disease 2019 (COVID-19). Since the COVID-19 pandemic has required urgent action and rapid containment, it offers a unique opportunity to test and evaluate the readiness of healthcare systems and to rapidly develop, scale up and enhance eHealth for the benefit of older people. However, this comes with a price, which is the necessity to quickly and effectively navigate complex information environments and manage behavioural changes and health.

The ICECAP-O Measure

This chapter presents the ICECAP-O, a measure of capability tailored for older people. It briefly presents the original version of the ICECAP-O. In addition, it describes the work that has been done concerning the translation and cross-cultural adaptation of the ICECAP-O to the Swedish context. Finally, the chapter contains arguments for the use of the Swedish version of the ICECAP-O in health and social care, and in the evaluation of interventions and longitudinal research studies where older people’s capabilities are a focus.

Capability in Research on Cognition and Well-being in Ageing and Retirement

In this chapter, we outline our thoughts on capability in relation to previous and ongoing research projects conducted by the Adult Development and Ageing (ADA-Gero) Research Group located at the Department of Psychology, University of Gothenburg, Sweden. More specifically, we relate our research on cognitive ageing and subjective well-being to the overarching capability framework implemented as a theoretical platform in the AgeCap research consortium.

A Historical Perspective on Ageing and Capability

This chapter discusses the value of a capability approach in historical research on older people. Historians are generally focused on studying continuity and change over time. Their research often aims at explaining how and why certain phenomena appear and take different shapes. Capability is a way of capturing an individual’s ability to live a meaningful life, or a life that they perceive as good. A modern analytical tool such as the capability approach can be used for visualising historical patterns, even though individuals’ values of well-being change over time. In that sense, historical studies of individuals’ capabilities, or functions, can add another perspective to this theoretical framework.Old newspapers, biographies, diaries, letters, novels and government reports make it possible to understand which capabilities individuals and societies have valued for older citizens at different times. The meaning of functions differs over time and is dependent on several factors, such as gender and economic conditions, as well as social and civil status. This also means that conditions for a phenomenon such as retirement change over time, but they also differ depending on people’s previous life conditions. In this article, we explore these things using two different examples. Firstly, we discuss how Selma Lagerlöf, a woman with high social status, arranged for her retirement. The second example shows how women with low economic status struggled to retire at the time when universal pension reform was being implemented in Sweden.

Introduction

In 2020, for the first time in history, there were more people in the world aged 60 years and over than there were children below the age of 5 years. The population aged over 65 years is projected to increase from one billion in 2019 to more than two billion in 2050, and those aged over 80 years are projected to increase from 143 to 426 million, with the largest increase occurring in the developing world (UN World Population Prospects, 2019). This demographic trend constitutes the largest global health challenge, according to the World Health Organisation (WHO). The European Union has set it as one of the major challenges in Horizon 2020 and it has important societal implications (European Commission, 2020). The proportion of retired individuals will increase, leading to an increased ratio between those who have exited the workforce and those still active in the labour market. Thus, ageing represents a global societal and scientific challenge requiring integrated efforts, multidisciplinary translational research approaches and social innovations that build on ideas of potentials and capabilities, emphasising the value of old age.

Increasing People’s Capabilities by Using Design Thinking in the Decision-Making Process

A growing older population is placing new demands on the welfare system. Elder care has been criticised for its lack of resources, competence, or respect for older people. Caregiving needs to be transformed and based on older people’s real needs and what they perceive as important. However, both older people and service organisations have to be capable of participating in new development processes. Design thinking (DT) has emerged as a field of research that provides tools and processes that are helpful for supporting innovations and new ways of thinking about problems. The concept of capability (Nussbaum M. Creating capabilities: the human development approach. The Belknap Press of Harvard University Press, Cambridge, MA, 2011), and how design researchers have embraced it, is discussed. The results from two case studies show that DT can support increasing capabilities among both service recipients and service providers when developing new services and digital solutions. The DT process can generate valuable knowledge about users’ needs in a resource-efficient way, as well as balancing the economic and human perspectives when developing new services. By directing more time and attention towards relevant problems, the solution might end up as something other than initially contemplated, which can increase the capability of being innovative when developing new services.

The Capability Approach in Research on Ageing Well at Home for Frail Older People

This chapter describes the work of the Frail Elderly Support Research Group (FRESH) in relation to the capability approach as a theoretical framework. The FRESH research group works with people who are at risk of developing frailty, as well as those who are already frail or very frail. In this chapter, FRESH aims to utilise the capability approach as a theoretical framework for research with and for frail older people, and to focus on the older people’s opportunities to realise their goals in relation to contextual factors that may influence them. A broad understanding of the concept of frailty in general is also presented. The capability approach makes a fundamental contribution to the understanding of the process of becoming frail, and how it may influence people as they age, because it focuses on people’s real opportunities, what it is possible to achieve and what people have reason to value, in relation to the resources that they have at hand. This chapter will hopefully encourage future researchers to consider evaluating the capability approach and implementing it in their own research.

Capability and Political Participation Among Ageing Populations

In this chapter, we study reasons for, and conceptions of, non-voting among Swedish seniors. We present a tentative framework for studying capability and political participation among older people in which we combine insights from previous research on age, health and political participation from the perspective of capability; that is, what a person is effectively able to be and do. The empirical illustration is based on extended interviews with eight individuals, both voters and non-voters, aged 80 years or older. The results show that the concepts of internal and combined capabilities are fruitful when understanding conceptions of and reasons for non-voting. For some individuals, voting is simply too much of an effort, and they need to direct their capabilities towards other, more desirable, functionings. For other individuals, health and mobility issues would have hindered their ability to vote if it were not for the practical and social support of close relatives. The chapter ends with a discussion on the importance of continuing to integrate explanations at different levels in order to understand political (in)activity among older individuals.

Invisible or Powerful? Ageing in a Mediatised Society

In order to live your rights and achieve your goals, you need to be informed, have a voice and be listened to, and have the opportunity to engage in society, regardless of age. Freedom of expression and freedom of information are core human rights values that connect the concept of capability with the role of the media in society. The media can be a tool for enhancing a person’s capabilities, but it can also be seen as hindering a good life if technology and its applications are perceived as awkward and/or difficult to access.At a structural level, a wider discussion of media responsibility has the potential to contribute to enhancing people’s capabilities in later life. One critical issue is who should be held accountable and responsible for media content that lacks diverse stories about older people and their voices, possibly reinforcing ageism. Furthermore, where the responsibility lies for ensuring that older people have the technological means to act as digital citizens is somewhat unclear. In an increasingly mediatised environment, we might see a stronger relationship between media literacy, health and ageing, which in turn could emphasise the importance of the role of the media in enhancing capabilities.