THE title of this article rather gives away one of its chief conclusions: Henry V (1413–22) made a mess of relations with Scotland. Some of the blame for this failure can certainly be laid at the feet of the king himself. His preconceptions and personality traits did not equip him well to deal with what might fairly be called an English governmental problem with the Scots throughout the later middle ages. But the reasons for Henry's difficulties are far more than just personal. He is not, after all, generally thought to have been a stupid man. He might be expected to have found a way of coming to grips with the challenges posed by the Scots. That he did not sheds interesting light not just on the king himself, but on the constraints under which his foreign policy, if such a term is appropriate for medieval rulers, had to be conducted. It is fitting that an article in tribute to Sandy Grant explores such themes. The honourand has already shown, in his discussion of Richard III (1483–85) and Scotland, the multiplicity of insights that can arise from examining English rulers in the light of their Scottish policies. Dealing with a king who has received much scholarly (and even more popular) attention, Sandy showed that the Scottish angle could provide abundant illumination on the workings of Anglo-Scottish relations, naturally; on Richard III himself, both the king and the person; and on broader contexts in which we can seek to understand interactions between states in the later middle ages. I hope that the current article makes its own contribution to these themes.

Little scholarly attention has been paid to Henry V's relations with Scotland. On one level this is quite understandable. Given that Henry, and most other English kings, attached scant weight to the Scots, it is not surprising that his-torians primarily interested in English government and politics should do like-wise. So we find, for instance, that the collection of essays on Henry's kingship edited by Gerald Harriss gives little place to Scotland, which does not merit a mention in Maurice Keen's chapter on diplomacy. The Scottish angle also impinges tellingly little in Keith Dockray's volume on the king, an overtly his-toriographical work. The Scots do, of course, feature more than this in many other approaches to Henry's reign.

Introduction

According to Age UK, over 3 million people across the UK are either malnourished or at risk of malnourishment, of which over 1 million are over the age of 65 (Age UK, 2017). Over 30 per cent of adults are malnourished on admission to hospital, increasing hospital stay, risk of complications and likelihood of being discharged into care (BAPEN, 2003; Stratton et al, 2004; Age Concern, 2006; Brotherton et al, 2010; Elia, 2015). Malnutrition in people aged 65 and older costs healthcare in England almost ￡10 billion per year (Elia, 2015). Age UK highlighted the problem of impractical eating environments for many older patients, and made seven recommendations to tackle malnutrition in older hospital patients, which focus on assistance at mealtimes and identification of patients at nutritional risk.

The Better Hospital Food programme launched in 2001 was successful in improving the quality of hospital food, although it did not specifically address older patients’ needs, for example, reduced sensory perception, smaller appetites and in some instances, eating difficulties. Approximately 12 per cent of older hospital patients have intermittent swallowing difficulty, which is of concern as the sensorial quality of foods for such patients is poor and does little to stimulate the appetite of those at particular nutrition risk.

The Department of Health (DH) and National Health Service (NHS) devised a Joint Action Plan for improving nutritional care in hospitals with five priorities for action: raising awareness of the link between good nutrition and health; ensuring accessible guidance; encouraging nutritional screening; nutrition training; and improving standards of inspection (DH, 2007). The DH Dignity in Care campaign (DH, 2006) recognised that delivering adequate food is ‘a fundamental human right’ and stressed the need for maintaining dignity and providing older people with the assistance they require at mealtimes. The Care Quality Commission's Dignity and Nutrition Inspection Programme highlighted concerns over nutritional care, including patients not being given the help they needed to eat, meaning that they struggled to eat or were physically unable to eat meals; patients being interrupted during meals, meaning they could not finish their meal; accurate records of food and drink not being kept so progress was not monitored; and many patients were not able to clean their hands before meals.

Introduction

The ‘Envision’ research described in this chapter was conducted between late 2007 and early 2009, the first of the New Dynamics of Ageing (NDA) projects to complete. The findings from the project provided the platform for further Research Councils UK funding to continue our research in this area, and so although our account is now somewhat historical, and some of the statements arising from our findings at the time relate to either the limitations of the technologies that were available to us or practices current at that point, this chapter allows us to usefully contextualise the value of this NDA Envision work with reference to what was to follow and to refer to more recently published articles where some of the themes outlined in this chapter have been discussed in more detail.

Potential value in the use of biomechanical analysis

Over four decades of research, the field of biomechanics (the study of the mechanical laws relating to the movement or structure of living organisms) has contributed knowledge about the musculoskeletal system and the way it operates dynamically in relation to muscle force and the effects of gravity. Biomechanical analysis can be used to scientifically assess the causes of the movement problems of individuals. In the healthcare context, biomechanics can be used to assess patients and to measure, for example, their progress and outcomes following treatment. In relation to the design of, for example, the built environment, furniture and transport, biomechanical analysis can be used to help provide an evaluation of the impact of design details and features on individuals’ capabilities in performing a range of daily living activities, such as the impact of the variation in the height of seating or the inclusion of armrests in furniture, or the impact of the variation of worktop and stair heights in homes and buildings.

Barriers to widespread adoption

To date, biomechanical data measurement and analysis have only been used in a small number of clinical scenarios, largely in clinical gait analysis (the systematic study of locomotion in a clinical setting). These specialist sessions are expensive both in terms of the types of equipment used to collect motion data and the specialist staff required to collect and interpret the results.

Introduction

Knowledge transfer is the starting point for this chapter, which has been crafted by members of six collaborative research teams who have been involved in unique projects concerning aspects of everyday living for older people, addressing issues of technology and design from a human perspective. A real dichotomy underpins this work, because while the focus has been on working with and learning from people in later life, all address issues that may affect people of all ages. So there is a real sense that while we may continue to highlight the underpinning ageism of designers, retailers and the youth-obsessed market, what we are really demonstrating is the importance of inclusive or universal design (Coleman, 1994) throughout the life course, or what has been called ‘transgenerational design’ (Pirkl, 1994). In recognising this we can see that this body of work from the New Dynamics of Ageing (NDA) Programme builds on the seminal research carried out for the i-design consortium funded by the Engineering and Physical Sciences Research Council (EPSRC) (2002–07) that brought together researchers in engineering and design (see Clarkson et al, 2003; Royal College of Art, 2012). It also recognises the dynamism of design outlined here by Fuad-Luke (2009, p xix):

The NDA researchers also include a wide range of disciplines, bringing together social and medical scientists and the humanities alongside engineering and design colleagues.

Introduction

As explained in Chapter One, a major focus of the New Dynamics of Ageing (NDA) Programme was nutrition, and the two connected critical issues concerning older people: malnutrition and obesity. Malnutrition is defined as a state in which there is a deficiency, excess or imbalance of energy and nutrients which leads to adverse effects on body tissues, function and/or clinical outcomes (MAG, 2011). In the UK, it is estimated that at any one time under-nutrition affects over three million older people (The Advisory Group on Malnutrition, 2009). Approximately 10–14 per cent of people living in sheltered housing have been found to be at risk of under-nutrition, as well as 30–42 per cent of residents recently admitted to care homes (BAPEN Quality Group, 2010, p 4). Even older adults living at home are at risk – data from the 2012 Health Survey for England (HSCIC, 2013) indicate that 0.5 per cent of those aged 65–74 and 1.3 per cent of those aged 75 or older are underweight (defined as a body mass index <18.5kg/m2). Concurrently, overweight and obesity are a growing concern in older adults as they increase the risks for, and complications of, chronic diseases such as cardiovascular disease, type 2 diabetes, hypertension and some cancers. The prevalence of obesity in the UK is 34.1 per cent in men and 35.9 per cent in women aged 65–74, and 29.8 per cent in men and 28.7 per cent of women 75 years or older, respectively (HSCIC, 2013).

Various important contributors to under-nutrition, overweight and obesity in older adults have been identified. These include medication use, age-related physiological and psychological changes such as reduced mobility or problems with chewing and swallowing, depression or social isolation, cognitive factors such as dementia or other neurological illnesses, financial limitations, low levels of physical activity and function, limited access to affordable and appetising healthier foods, and difficulties in acquiring, preparing and consuming healthier meals (Brownie, 2006). These factors can result in an inadequate nutritional intake or an imbalance between energy intake and expenditure, both of which increase the risks for malnutrition and related acute and chronic illnesses.

Maintaining independence and autonomy are critical features of healthy and successful ageing. This includes being able to look after oneself, including shopping and preparing meals (McKie, 1999; Rioux, 2005).