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In this article, we analyse experiences of loneliness among older people living alone. Current knowledge suggests that loneliness is a significant social issue that can compromise health and wellbeing, and that seniors living alone are at a higher risk of loneliness. Based on a qualitative methodological approach and semi-structured interviews conducted with 43 people aged 65 or over living alone in Montreal (Quebec, Canada), this study sought to understand how they perceive, reflect on and react to loneliness. The results show that these seniors perceive loneliness as a dynamic, and rarely static, experience, which has a very different significance, depending on whether it is chosen or circumstantially imposed. The experience of loneliness recounted by the seniors we met is characterised by its heterogeneity, and involves, to varying degrees, their relationship to themselves (solitude), to others (family (and friends) loneliness and loneliness in love) and/or to the world (existential loneliness and aloneness). Lastly, our analyses highlight how social factors, such as age, gender, marital status, social network and socio-economic conditions, shape the experience of loneliness among seniors. These factors also influence the strategies that seniors develop to prevent or alleviate loneliness, strategies that yield very mixed results.
The number of relatives and geographical proximity between them affects informal support provided to older persons. In this study, we investigate whether (a) childless persons and parents living remotely from their adult children experience similar shortages in informal support, and (b) whether neighbours, friends and other non-family helpers compensate for these shortages. On the basis of Survey on Health, Ageing and Retirement in Europe (SHARE) data for 12 European countries, we estimate the probability and amount of informal non-financial support received by persons aged 65 and over who remain childless or live at different distances to their children. The contribution of non-family individuals is rather complementary to the help from family. Parents residing in the proximity of their children rely almost exclusively on family; as the geographical distance between adult children and older parents increases, the probability and amount of non-family support increase as well. But childless individuals differ from parents of remotely living children: the former rely on smaller support networks and resort more often to other relatives than the latter. Non-family individuals compensate for the scarcity of informal support only in the case of parents of distant children, but not in the case of childless individuals.
Focusing on Swedish home care for older people, this article explores the discursive (re)production of home care as an institution. Equality and universal service provision have been described as defining features of the Nordic care regime. At the same time, Nordic research has highlighted a shift in social care policy, from a focus on universalism and egalitarian ideals towards a focus on freedom of choice, diversity and individualised services. This article takes as a starting point that home care for older people is formed by different and potentially conflicting ideas. We understand home care as a contested formation and define institutional change in terms of ongoing discursive struggles. The analysis draws on qualitative semi-structured interviews with key informants, including politicians, local authority officials and representatives of interest organisations. Informants were engaged in policy making, implementation or advocacy related to care for older people. We examine the meanings attached to home care for older people and the analysis reveals three different discourses – on choice, needs and equality. By comparing and contrasting discourses, we reveal silences, conflicts and tensions, and highlight the politics involved in (re)creating home care as an institution.
The older population is particularly susceptible to malnutrition, which currently affects 1.3 million people aged 65+ in the United Kingdom. Malnutrition is an outcome of food insecurity and despite demographic changes that have led to a rise in numbers of older people, we know very little about how older people become vulnerable to food insecurity. The aim of this study was therefore to explore older people's everyday food practices in order to expose the strengths and challenges within local and national food systems, and better understand how food insecurity might arise in later life. This empirical study operationalised practice theory using a multi-method ethnographic approach with 25 households aged 60–94 years, comprising interviews, observation, visual methods and food logs. A model of vulnerability developed by Schröder-Butterfill and Marianti framed data collection and analysis. Analysis revealed the assets and adaptations older households used to protect themselves from threats to food security. Factors ranging from changes to physical and mental health, and structural factors such as supermarket design, moved households towards food insecurity. Smaller everyday ‘trivia’, e.g. lack of seating and accessible toilets in supermarkets, accumulated to shift people towards vulnerability. Vulnerability is structured by the habitus but is a fluid, relational, temporal and socially constructed state, and people moved towards and away from vulnerability. We have developed a model that accommodates this fluidity, incorporates the concept of ‘cumulative trivia’ and suggests how the ‘aggregation of marginal gains’ could counter-balance and address trivial threats. This model demonstrates to policy makers and those working in public health how vulnerability to food insecurity operates and where interventions could be applied to support households to achieve food security and avoid becoming malnourished.
Ageing is associated with reduced muscle mass, strength, flexibility and balance, resulting in a poor quality of life (QOL). Past studies have occurred in highly controlled laboratory settings which provide strong support to determine whether similar gains can be made in community programmes. Twenty participants were enrolled in an eight-week community-based resistance training programme (mean age = 61.3 (standard error (SE) = 0.9) years); Body Mass Index = 32.0 (SE = 1.3) kg/m2). All participants completed surveys to assess outcomes associated with QOL. Given the relationship between muscle function and nerve health, nerve conduction studies (NCS) were also conducted in a separate group of participants (mean age = 64.9 (SE = 2.0) years; Body Mass Index = 32.6 (SE = 1.9) kg/m2). This community-based training programme significantly improved QOL measures in older adults (p < 0.001). Although weight loss was not the primary outcome of the study, participants reduced their body weights (p < 0.001), by primarily reducing fat mass (p = 0.007) while maintaining muscle mass. Significant improvements were observed in muscle strength (2.2%), flexibility and balance (3.2–464.2%, p ⩽ 0.05 for all). Improvements were also observed in plasma glucose (p = 0.05), haemoglobin A1C (p = 0.06) and aldolase enzyme levels (p < 0.001). Scores for surveys on memory and sleep improved (p < 0.05). Improved QOL was associated with increased lean mass (r = −0.714, p = 0.002), decreased fat mass (r = −0.702, p = 0.003) and improved flexibility and balance (r = −0.627, p = 0.008). An eight-week, community-based resistance training programme significantly improved QOL in older adults. Influence on the lipid profile and NCS still needs further investigation.
To estimate the prevalence of frequent milk consumption (≥five times/week), the consumption of low-fat/skimmed milk and associated factors in adults and older people, evaluating adherence to current Brazilian guideline.
Population-based cross-sectional study involving the analysis of data from the 2015 Campinas Food Intake and Nutritional Status and 2015 Campinas Health Survey. The prevalence of milk consumption was analysed according to socio-economic characteristics, morbidities and health-related behaviours.
City of Campinas, state of São Paulo, Brazil.
A sample of 1710 participants of the 2015 Campinas Nutritional and Health Surveys.
A total of 73·8 % of the population consumed milk, but the prevalence of frequent consumption was only 44·0 %. Frequent milk consumption was higher among women, older people and individuals with better diet quality. A total of 18·4 % of the individuals who consumed milk reported consuming low-fat/skimmed milk; this prevalence was higher among women, individuals with a higher socio-economic status, those with better diet quality and those with chronic diseases.
Despite the high nutritional quality of milk and the different types available on the market, adults and older people do not follow current recommendations regarding its consumption. Information on the nutritional quality of milk and current recommendations should be disseminated more at healthcare services.
Balancing risk and safety in long-term care settings can be challenging while providing and respecting patients’/residents’ needs and rights in terms of sexual expression. We look at factors affecting the expression of sexuality, including staff attitudes and reactions, and the lack of policies governing sexuality. We review the various statute and case law, other legislative and quasi-legal provisions governing sexuality and sexual expression. Finally, we consider the need for clear policies and training for both staff and family members.
Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand.
interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales.
A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36–181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51–5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26–4.03), at-risk alcohol use (2.38, 1.30–4.35), and bipolar disorder (2.18, 1.25–3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36–0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35–0.89).
Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.
Self-ageism has a significant negative impact on older people's ageing experiences and health outcomes. Despite ample evidence on cross-cultural ageism, studies have rarely looked into the way cultural contexts affect self-ageism. In this article, we compare expressions of self-ageism and its possible predictors across four European countries based on two questionnaires in a study sample of 2,494 individuals aged 55 and older. We explore how predictors of self-ageism are moderated by cultural values in a comparative fixed-effects regression model. We empirically show that similarly to ageism, self-ageism is not present in the same way and to the same extent in every country. Moreover, the level to which cultures value hierarchy and intellectual autonomy significantly moderates the association between self-ageism and individual predictors of self-ageism. Our study adds to the small existing body of work on self-ageism by confirming empirically that certain expressions of self-ageism and individual predictors are susceptible to change in different cultural contexts. Our research results suggest that self-ageism interventions may benefit from a culturally sensitive approach and imply that more culturally diverse comparisons of self-ageism are necessary to figure out fitting ways to reduce self-ageism.
Care in Chile, as in most Latin American countries, remains largely the responsibility of female family members in informal arrangements with little government support. The analysis of caring for a dependent older person has commonly been approached from the burden of care perspective, focusing on the tasks carried out, the time spent providing care and the negative (burdensome) consequences for the care-giver. This study reveals the daily experiences of family care-givers of older people through a thematic data analysis of 42 interviews with main family carers of an older person as experienced by the carers themselves. Findings highlight the complex nature of care work. Tasks carried out do not necessarily relate to the intensity of the care experience or a negative experience. Care-givers can work long hours providing care and still feel comfortable and find the experience emotionally rewarding. Care-givers might also carry out only a few tasks and experience pressure. The broader social and economic context can generate constraints that make a specific set of tasks easier or harder on the carer, but these contextual factors do not fully explain the experience of care. Relations, and particularly those that carry an emotional component such as the carer-older person, carer-siblings and carer-spouse, must be considered alongside the tasks and the difficulties or potential constraints of the context to understand the care experience.
Participatory action research (PAR) advocates end-user involvement in various societal domains. This paper aims to identify and analyse impacts of PAR involving older persons as co-researchers, and how these impacts spread and are enhanced throughout the research process and after its completion. By impact we mean transformational change throughout and after a PAR study. We present a qualitative community-based research project involving older people who live in sparsely populated areas in the Netherlands, and explore three types of PAR impact: personal, interpersonal and community impacts. We demonstrate how these impacts unfold through expanding circles, from a personal to a community level, and how these circles enhance each other. The project was conducted by a PAR team consisting of one researcher and seven co-researchers. The data were collected from observations, interviews and minutes of meetings, which the team subsequently analysed. The results are presented as a narrative account, whereby four project stages are followed by reflection on the impact it made. The discussion addresses the circles of impact, and whether and how they can strengthen each other in community-based projects involving older people. The concluding remarks address the influence of group dynamics on PAR, whether frail older adults can be expected to take an active part in PAR projects and the extent to which the results from such community-based PAR projects can be generalised.
There is a long-established link between care policies and gender equality outcomes, and much modelling of welfare state typologies look at care provision as a distinguishing feature. However, to date, little research has been done which has systematically and critically examined those links by examining the policies and the way they operate, how and why they affect gender equality, and the governance of care policies in a comparative way. This paper draws on evidence from a recently completed comparative study looking at long-term care and gender equality. A CQA (Comparative Qualitative Analysis) approach was used to identify case studies, and further analysis carried out which focussed on: overall, how the policies and the way they operated to achieve gender equality; the governance and design of policies that led to good gender equality outcomes; the level of policy making; the role of the state, the family, the community and the nonstatutory civic sector in designing and delivering effective policies; and how context specific the ideas, actors and institutions supporting the policies were. Instead of using existing welfare typologies that were not driven by gender equality as the defining outcome variable, the author takes an inductive approach to policy analysis to compare policy outcomes according to gender equity outcomes. She devises two new models of long-term care policy: the Universal Model and the Partnership Model, both of which lead to improved gender equality in different ways. This paper concludes by noting the need to move beyond existing welfare state typologies in examining gender equality outcomes, which will result in new models as depicted here.
Medical practitioners are confronted on a daily basis with decisions about patients’ capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end -of-life decision-making capacity in a 72-year old lady with treatment resistant schizophrenia and terminal cancer will be discussed.
In the case discussed there were differences in opinion about the patients decision-making capacity. In light of this, the role of the treating clinician and importance of health-related values in capacity assessment are highlighted. It is recommended that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient’s wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient’s capacity will change the treatment approach.
Compared to the general population, people with serious mental illness have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services and are rarely engaged in end-of-life care discussions. Older people with serious mental illness can engage in advance care planning. Conversations about end -of-life care can occur without fear that a person’s psychiatric symptoms or related vulnerabilities will undermine the process. Clinicians are also advised to attend to any possible underlying issues, instead of focusing strictly on capacity. Routine documentation of end-of-life care preferences can support future decision making for family and clinicians at a time when patients are unable to express their decisions.
More research about palliative care and advance care planning for people with serious mental illness is needed. This is even more urgent in light of the COVID-2019 pandemic, as there are potential needs for rationing of health care in the context of scarce resources. Health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with serious mental illness.
In this paper, we explore ageist depictions of both young and older people as they emerge from discourses addressing ‘other people's’ digital media usage practices. We carried out eight focus groups (four with teenagers, four with people aged 65 or older) in two southern European cities (Rome and Barcelona). By negotiating the affordances and constraints of (digital) tools and platforms, people develop their own usage norms and strategies, which might – or might not – be intersubjectively shared. Discourses surrounding usage practices and norms tend to refer to what people understand as an appropriate way of using digital platforms: these discourses proved to be powerful triggers for expressing ageist stereotypes; ‘the others’ were depicted, by both teenage and older participants, as adopting inappropriate usage practices (with regard to content, form, skills and adherence to social norms). These reflections proved to have broader implications on how other age cohorts are perceived: participants tended to take discourses on digital media usage as an opportunity for making generalised judgements about ‘the others’, which address their manners, as well as their attitude towards communication and social life. Inter-group discrimination processes and ageist stereotypes play a major role in shaping the strong moralistic and patronising judgements expressed by older and younger participants towards ‘the other’ age cohort.
The review aimed to identify factors influencing opioid prescribing as regular pain-management medication for older people.
Chronic pain occurs in 45%–85% of older people, but appears to be under-recognised and under-treated. However, strong opiate prescribing is more prevalent in older people, increasing at the fastest rate in this age group.
This review included all study types, published 1990–2017, which focused on opioid prescribing for pain management among older adults. Arksey and O’Malley’s framework was used to scope the literature. PubMed, EBSCO Host, the UK Drug Database, and Google Scholar were searched. Data extraction, carried out by two researchers, included factors explaining opioid prescribing patterns and prescribing trends.
A total of 613 papers were identified and 53 were included in the final review consisting of 35 research papers, 10 opinion pieces and 8 grey literature sources. Factors associated with prescribing patterns were categorised according to whether they were patient-related, prescriber-driven, or system-driven. Patient factors included age, gender, race, and cognition; prescriber factors included attitudes towards opioids and judgements about ‘normal’ pain; and policy/system factors related to the changing policy landscape over the last three decades, particularly in the USA.
A large number of context-dependent factors appeared to influence opioid prescribing for chronic pain management in older adults, but the findings were inconsistent. There is a gap in the literature relating to the UK healthcare system; the prescriber and the patient perspective; and within the context of multi-morbidity and treatment burden.
Research regarding quality of life among older people has predominantly focused on functional elements experienced at individual or dyadic level despite the complex interplay of factors that contribute to quality of life. Perspectives which explore interdependencies within communities and the intersecting environments in which older people exercise agency have seen less study. They do, however, play an important role in influencing quality of life as experienced by older people across community settings. Qualitative data from a co-produced study of dimensions influencing quality of life in older people was subjected to secondary analysis using a critical human ecological approach. Findings demonstrate the importance of community interdependencies in supporting individual quality of life, the expression of active agency to foster quality of life within and across communities, and the importance of state infrastructures and service provision within these interdependencies. This article argues for a movement beyond functional conceptualisations of quality of life towards the inclusion of perspectives regarding communal wellbeing, alongside the role differing types of community play in influencing quality of life. Through developing conceptions of quality of life in social relations and community cohesion, in particular how quality of life is influenced by perceptions of solidarity and social justice including across generations, assessing quality of life at community level will assist in driving cultural change in policy making and practice.
Drawing on a 2010 analysis of the reform and costs of adult social care commissioned by Downing Street and the UK Department of Health, this paper sets out projected future costs under different reform scenarios, reviews what happened in practice from 2010-19, explores the impact of the growing gap between need and funding, and explores the relationship between future spending and economic growth. In the process, it identifies a ‘lost decade’ in which policy makers failed to act on the warnings which they received in 2010, draws attention to the disproportionate impact of cuts on older people (compared to services for people of working age) and calls for urgent action before the current system becomes unsustainable.
We studied older people's perceptions of how they organise their out-of-home mobility and independent living when they face mobility restrictions, based on seven focus groups with older people (N = 28) from a suburb in Finland. This article provides an everyday life view of how the ability to move outside the home evolves through interdependencies between older people and their neighbourhoods, social relations and societal arrangements. Our findings show that supportive socio-material surroundings can provide older people with new ways to move outside their home despite mobility restrictions and new ways to organise their daily life with decreased mobility. In contrast, restrictive socio-material surroundings can lead to situations in which older people forgo certain out-of-home journeys and activities. The findings contribute to an understanding that organising one's daily life and out-of-home mobility is an act of interdependence. Policies promoting independent living in old age should recognise these fundamental interdependencies and support versatile ways of living rather than overemphasise activity and self-reliance. Based on older people's everyday life perspectives, both sides of the coin need to be considered: how to enable the out-of-home mobility of older people facing mobility restrictions and how to support them in managing and enjoying daily life with decreased mobility.
A grounded theory approach, consistent with the work of Strauss and Corbin, was used to undertake semi-structured interviews with 17 older people, to explore their experiences of living in a care home, during the four- to six-week period following the move. Purposive sampling was initially adopted, thereafter, theoretical sampling was employed to recruit individuals identified by care managers within older peoples’ community teams and care home managers within a large Health and Social Care Trust in the United Kingdom. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. Constant comparative analysis underpinned data analysis and data management techniques. Data analysis revealed five distinct categories that captured these experiences. These were: (a) wanting to connect – ‘I am so lost here’, (b) wanting to adapt – ‘Well mentally you have to make the best of it’, (c) waiting for assistance – ‘it's a frustration for me’, (d) ‘waiting on the end’ – I am making no plans’ and (e) wanting to re-establish links with family and home – ‘I love getting home and I like getting out to the town’. Together these five categories formed the basis of the core category, ‘Waiting and Wanting’, which encapsulates the initial adaptation experiences of the men and women in the study. Findings indicate that individuals were dependent on others to create a sense of belonging, independence and wellbeing. Moreover, risk aversive practices were perceived as a threat to individuals’ independence and autonomy. Recommendations include the need to amend policy and practice for the development of a bespoke induction programme for each resident facilitated by a senior member of the care home staff working in partnership with individuals and families, in addition to the health and social care team, to support a more positive transition for new residents, relatives and care home staff.
The social needs of frail or isolated older people are sometimes aided by referrals to day centres in the United Kingdom. Since the late 1940s, day centres have had a role to play promoting socialisation in later life. Additionally, attendance at day centres is often open ended, with participants only leaving due to moving to a nursing home or dying. In this study, the views of those attending time-limited day centre programmes in seven day centres in Northern Ireland have been sought in relation to their thoughts about the service as well as how they feel when it ends. Seventeen participants completed diaries for the programme duration and/or engaged in an interview process. Participants reflected on the social and educational benefits of attending but also recognised impositions in the centres that impinged upon individual choices and also the length of time they could remain. This study reveals that, in order to maintain socialisation, time-limited programmes must have clear follow-on strategies for participants. Additionally, respondents’ experiences reflect that a paternalistic model of care delivery remains in place that, whilst restrictive, reveals that access to the service is more specialised and not universal. Nevertheless, should day centres wish to remain relevant, it is important that service users are fully consulted about their desires and choices within the setting.