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The health needs of elderswithin an intentional communityCornelia Featherstone & Peter Michael ForsterPublished online: 01 Jul 2010.

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Community, Work & Family, Vol. 3, No. 1, 2000

SHORT REPORT

The health needs of elders within an intentionalcommunity

CORNELIA FEATHERSTONE1 & PETER MICHAEL FORSTER2

1Findhorn Bay Community, Scotland & 2University of the South Paci® c, Suva, Fiji

ABSTRACT A small-scale survey was carried out on the health needs of those members of theFindhorn Bay Community, in northeast Scotland, who were over the age of 60. The surveyasked questions about their health, quality of life, support received and perceived needs in theseareas. The responses of the elders are summarised and discussed. Most of the elders had healthconditions which affected their quality of life, yet almost all were satis® ed with the support theyreceived and over half with their quality of life. Implications for the links between community,family, work and perceived health were identi® ed.

KEY WORDS Elders; intentional community; quality of life

RE SUME Une recherche a e te faite sur les besoins en sante des personnes age s de plus de 60ans qui vivent dans la communaute de Findhorn Bay dans le nord est d’Ecosse. Il y avait unquestionnaire qui leur demandait des informations sur leur sante , et qualite de vie; il leur e taitaussi demande si ils se sentaient suf® samment soutenus et comment ils percevaient les differentsbesoins de leur vie. Les re sponses de les personnes sont brieÁ vement evoque es et discute es. Lesimplications concernant les rapports entre communaute , famille, travail et sante furentidenti® e es. La plupart d’ entre eux avait des probleÁ mes de sante qui affectaient leur qualite devie, cependant la majorite e tait satisfaite du soutien recË u, et plus de la moitie avec leur qualiteÂde vie.

MOTS CLEFS Personnes age s; communaute intentionnel; qualite de vie

RESUMEN Se llevo a cabo una encuesta sobre las necesidades relativas a la salud de losmiembros mayores de 60 anÄ os en la comunidad de Findhorn Bay, en el noroeste de Escocia.La encuesta contenõ a preguntas relacionadas con su salud, calidad de vida, apoyo que recibõ anasõ como sobre las necesidades que tenõ an en todos estos aspectos.. Se resumieron y discutieronlas respuestas de los encuestados. La mayoria de los encuestados tenian estados de salud queafectaban la calidad de sus vidas aunque casi todos ellos expresaban estar satisfechos con elapoyo que recibõ an. Ma s de la mitad de ellos expresaban estar contentos con su calidad de vida.Fueron identi® cados diversos aspectos que se veõ an afectados como consecuencia de lasconexiones entre la comunidad, la familia, el trabajo y el estado de salud.

PALABRAS CLAVES Ancianos; comunidad intencional; calidad de vida

ISSN 1366-8809 (print) ISSN 1469-3615 (online)/00/010103-07 Ó 2000 Taylor & Francis Ltd

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104 Cornelia Featherstone & Peter Michael Forster

On 17th November 1999, the Findhorn Bay Community, an intentional com-munity of about 450 people in northeast Scotland, celebrated its 37th birthday.The community, like many others which have existed for a relatively short time,compared to established villages or townships, is now having to deal with issuesthat were thought about little, if at all, in the early years after the ® rst familymoved onto the site which is its current, main locationÐ the Findhorn BayCaravan Park.

In the early years, it was an international, spiritual, working communitywith mainly single individuals staying for a short time. It was common forsomeone to leave if they fell ill and could not consistently work every day.

In recent years the culture shifted from that strong work focus to providefor a more diverse and complete lifestyle which includes all age groups. Someof the bene® ts of the extended families of the past are now being found in thebonded relationships within the intentional community, which themselves im-pact upon people’ s perceived quality of life. Provision for changing needs insituations such as bringing up of children, illness, handicap or old age are nowbeing addressed as these issues arise among community members. This paperdescribes the assessment of needs and the present situation of elders (herede® ned as the older community members aged 60 and over) in the FindhornBay Community.

The immediate purpose of this study was to assess the needs of an ageingpopulation, and to feed the results back into their community, so as to furtherintegrate the elders and make sustainable provision for their needs. However, itmay also serve to raise questions about wider society.

It is worth noting that, in 1997, the British Medical Journal joined some 100other medical journals in over 30 countries in publishing an issue devoted toageing. The lead editorial by Greengross et al. (1997: 1029) stated:

Our aims are to alert readers, the public, and governments to theradical changes being created across the world by the aging of popula-tions and to contribute a substantial body of research and informationon all aspects of aging. Aging emerged as the favoured subject for theglobal theme issue after a two stage voting process among editors ofmedical journals. Research has shown that readers also rank it as thetop issue.

Although many books and papers have been written about the Findhorn BayCommunity, the authors are not aware of any which address people’ s healthneeds, nor the needs of community elders. Metcalf (1993), however, doesprovide an overview of many aspects of the community, including an account ofrelationships and belief systems.

The increase in the mean age of community members was mentionedbrie¯ y in a previous paper on the community (Forster, 1998). A survey carriedout in 1974 in the Findhorn Foundation (the largest of the organisationscomprising the community and, at that time, the only one) found that theaverage length of stay of a community member was 10 months and the average

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Health needs of elders 105

age was 26. In 1984 the average length of stay was 2.5 years and the average agewas 33. In an unpublished survey carried out in 1994 by one of the authors(Forster) for the Foundation’ s Human Resource Department, the averagelength of stay for members of staff was 4 years and their average age was 40.

This issue was addressed directly in the Elder Survey, carried out by theHolistic Health Centre at the Findhorn Bay Community. It addressed speci® cquestions about the health needs of older people in the community and is alsoan example of the kind of questions that the more developed, diverse intentionalcommunities want to ask. The average age of community members has in-creased by about 20 years, since it was ® rst measured in the early 1970s. Whilstthe proportion of members over 60 is still small (about 7%), it is growing, andthe community is trying to understand and adapt to the implications of itsageing population.

One of the authors (Featherstone) was head of the Holistic Health Centreand of a complementary health practice in the town of Forres. She devised aquestionnaire to investigate the resources needed to care for the elderly mem-bers of the community and to ® nd out about their quality of life. In September1997, the questionnaire was distributed to the 30 community members aged 60and over (age range: 60± 83 years). There was a 57% (N 5 17) response rate.The respondents had lived in the community for periods ranging from 1 to 35years.

The questionnaire asked a mixture of open-ended and forced-choice ques-tions about current state of health, medical conditions, quality of life generally,support received and its adequacy, and awareness of the relevant services thatthe Holistic Health Centre, and others, offered [1].

Overview of questionnaire responses

A summary of answers to the main questions is given in Table 1.

TABLE 1. A summary of the main questions and replies to the Elder Survey (N 5 17)

Question Yes No No reply

2. Do you have symptoms that impair your quality of life? 10 7 03. Do you require medical care? 8 8 14. Do you use complementary therapies? 15 2 05. Do you feel you have optimal support for your health? 16 1 07. Do you experience as much quality of life as you would like? 10 7 08. Do you have suf® cient support in your daily life? 15 1 1

11. Do you know about the community health scheme? 11 3 312. Would you like to know more about it? 8 3 615.1. Do you know about the elders fund? 8 7 215.2. Would you like more information? 8 1 816. Would you like to ® ll in a personal information form? 13 2 217. Would you like a talk with the Holistic Health Centre? 2 10 5

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106 Cornelia Featherstone & Peter Michael Forster

TABLE 2. Signs and symptomsreported by community elders

AnginaArthritis (3)Breathlessness (2)Catarrh (from allergic rhinitis)Constipation (2)DepressionFamilial spastic paralysisGlaucomaHearing lossHeart condition (2)HypertensionIncontinenceMacular degenerationParkinson’ s DiseaseRespiratory problems

Over half of the group (10/17) experienced medical conditions that theysaid diminished their quality of life (see Table 2). However, the same number(10/17) reported experiencing as much positive quality of life as they would like.Almost all (15/16) felt that the support they received was adequate. We wonderif the same would be true for a similar, low-income group outside the setting ofa relatively close community. Finding a comparable group may be dif® cult,however, because, in the Findhorn Bay Community, the average salary of £185sterling (about US$314) per month is well below the national average. While thecommunity is working towards greater economic sustainability, currently thereis a predominantly low-cash economy with payment in kind’ , neighbourhoodsupport, informal bartering and other means of resource management.

Most (11/14) were aware of the resources available to them and used morethan one. Most (8/11) wanted to know more about the Community HealthScheme and were prepared to provide information about themselves, but didnot want to meet with a doctor.

Discussion

This paper was written at a time when the provision of health care in thecommunity was in a major transition. Despite the outcome of this and an earliersurvey (Ponka, 1996), which showed wide appreciation of the support providedby the Holistic Health Centre, the ® nancial and staf® ng resources were in-suf® cient for it to continue. It was closed in April 1998. Informal enquiries bythe authors indicated that community members appreciated having a doctor inthe community to help with medical emergencies, but for most medical con-cerns they preferred to travel to the free National Health Service Health Centrein the nearby town. The most likely explanation is that the National Health

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Health needs of elders 107

Service provides free or low cost health care for most people, while the HolisticHealth Centre charged fees to meet its costs. In a community with a low-casheconomy, more people are likely to choose the former option. Another possiblefactor is the doctor± patient relationship. The head of the Holistic Health Centreis a community member and as such knows most other members very well.Could it be that people prefer a more distant relationship with their doctor?

This would need to be clari® ed in further studies and raises some interest-ing questions to be asked about the nature of work within particular types ofcommunity. For example, are some forms of work facilitated by insider’ statusto a community (whether it is an intentional community or not), whereas othersare disabled by insider status?

Further research could also help to identify the different elements whichcontribute to the sense of well-being in the research population and how this islinked to both family and wider social support. It may be that there is a linkbetween perceived needs and the length of time the participants have lived in thecommunity. For example, it may be that the longer people live in the com-munity, the more likely they are to scale down their expressed needs, in orderto match the resources they see as being available to them. While this may beparticularly relevant to people living in intentional communities, it may alsoapply to those living in stable neighbourhoods elsewhere. More detailed work isneeded to answer this point.

Most (15/17) participants used some form of complementary therapy intheir health care. This use of complementary therapies is signi® cantly aboveaverage for the local population (Emslie et al., 1996). The effect of complemen-tary therapies on quality of life in the elderly requires further research, includingthe possible self-empowering effect of choosing such a therapy. The linkbetween community cohesion, identity, quality of life and proactive decisionsabout different forms of health provision has not been studied to date. Woulda nation’s health bill come down if more people lived in closer-knit communi-ties? Would quality of life improve, or would closer communities be experiencedas overly intrusive?

Conclusion

In the early years after its formation, the Findhorn Bay Community, in commonwith most other intentional communities, had a collective focus on such issuesas generating enough income to support members, retaining members andgetting necessary work done. The health needs of their ageing membership onlybecame apparent after the community had existed for some years.

The current survey found that, despite being adversely affected by ill health,more than half of these older people were satis® ed with their quality of life andalmost all reported receiving all the support that they needed for their health. Itwill be left to a future study to investigate how it may be possible to improve thequality of life for those members of the community who are experiencing lessthan they would like. An approach which extends to using occupational therapy

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108 Cornelia Featherstone & Peter Michael Forster

has shown promise, in a study by Clark et al. (1997) of a low-income,multi-ethnic group of older people in the USA.

This survey also found that, despite having a health centre available to themwithin the community, most preferred to travel to the free, state-provided healthcentre in a nearby town for their medical care. It must be left to future researchto ® nd out whether this is due to the cost, the relative closeness of therelationship between doctor and patient, or some other factor(s).

The authors see this study as one of a series that looks at the changingneeds of a community over an extended period of time, both for the bene® t ofthe community itself and for those with an interest in community development.Other long term studies have demonstrated the health bene® ts of living in aclose-knit community. The study by Wolf (1992) of the Roseto community overa period of 30 years illustrates the bene® ts of longitudinal research, as well as thehealth bene® ts of some forms of community. To quote Wolf:

Those with the conventional risk factors are more likely to developmyocardial infarction than those without the risk factors, but an evenlarger proportion of the population may have the risk factors and notsuccumb to myocardial infarction over a period of nearly threedecades, if they are protected by a strong sense of connection andcommunity.

Finally, this study may be looked at as an example of the kind of researchthat communities want to carry out for themselves and for which they may needaccess to the kind of resources usually only found in universities. To meet suchneeds, the idea of the Science Shop as a community resource, provided byuniversities to the communities where they are located, was developed inHolland. The idea was later taken up elsewhere in Europe, for example, inBelfast by Queens University (Martin, 1992). The authors suggest that, bydeveloping such ideas in cooperation with their local communities, universitiescould provide a needed service by helping communities to answer some of theirmore dif® cult questions and in return gain wider community support.

Note

[1] Copies of the questionnaire are available from the authors.

REFERENCES

CLARK, F., AZEN, P.A., ZEMKE, R., JACKSON, J., CARLSON, M., MANDEL, D., HAY, J., JOSEPHSON,K., CHERRY, B., HESSEL, C., PALMER, J. & LIPSON, L. (1997). Occupational therapy forindependent-living older adults: A randomized controlled trial. Journal of the American

Medical Association, 278(16), 1321± 1326.EMSLIE, M., CAMPBELL, M. & WALKER, K. (1996). Complementary therapies in a local health care

setting. Complementary Therapies in Medicine, 4, 39± 42.FORSTER, P.M. (1998). Communities and academics: A developing dialogue. Community, Work &

Family, 1(1), 39± 49.GREENGROSS, S., MURPHY, E., QUAM, L., ROCHON, P. & SMITH, R. (1997). Aging: A subject that

must be at the top of world agendas. British Medical Journal, 315(7115), 1029± 1030.

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Health needs of elders 109

MARTIN, E. (1992). An introduction to the work of the Northern Ireland Science Shop.In E. MARTIN & M. TOMLINSON (Eds.), The Northern Ireland Science Shop: Report of a seminar

8th November 1991. Belfast: Northern Ireland Science Shop.METCALF, W.J. (1993). Findhorn: The routinization of charisma. Communal Societies, 13, 1± 21.PONKA, D. (1996). A survey of attitudes towards health and the Community Health Scheme within the

Findhorn Foundation. Findhorn Bay, Canada: Findhorn Bay Holistic Health Centre andFaculty of Medicine, McGill University.

WOLF, S. (1992). Predictors of myocardial infarction over a span of 30 years in Roseto,Pennsylvania. Integrative Physiological & Behavioral Science, 27(3), 246± 257.

Biographical notes

Cornelia Featherstone is a general practitioner and the resident doctor at theFindhorn Bay Community. Her main areas of interest are community-basedhealth care and the integration of orthodox and complementary medicine. Sheis co-author of Medical MarriageÐ The New Partnership between Orthodox andComplementary Medicine (Findhorn Press, 1997).

Peter Michael Forster is a chartered psychologist and Senior Lecturer inPsychology at the University of the South Paci® c, in Suva, Fiji. He is a memberof the board of the International Communal Studies Association and has aparticular interest in the factors that promote the health and well-being ofcommunities. He also has an active interest in marine conservation.

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