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While research on the health and wellbeing of older lesbian, gay and bisexual adults is gradually expanding, research on older trans and gender non-conforming (TGNC) adults lags behind. Current scholarship about this group raises important questions about the intersection of ageing and gender identity for enhancing care and support for older TGNC adults and the lack of preparedness of health and social professionals for meeting these needs. In this paper, we examine the accounts of 22 TGNC individuals (50–74 years) on the topic of ageing and unpack their concerns for and expectations of later life. We present qualitative findings from a study of gender identity, ageing and care, based in Wales, United Kingdom. Data were generated from two-part interviews with each participant. Four key themes are identified: (a) facilitative factors for transitioning in mid- to later life; (b) growing older as a new lease of life; (c) growing older: regrets, delays and uncertainties; and (d) ambivalent expectations of social care services. We argue that growing older as TGNC can be experienced across a multitude of standpoints, ranging from a new lease of life to a time of regret and uncertainty. We critically discuss emergent notions of trans time, precarity and uncertainty running across participants’ accounts, and the implications for enhancing recognition of gender non-conformity and gender identity in social gerontology.
This article tests the fit of a social support network typology developed for collectivist cultures to six migrant populations living in England and Wales. We examine the predictive utility of the typology to identify networks most vulnerable to poor quality of life and loneliness. Variables representing network size, and the proportion of the network classified by gender, age, kin and proximity, were used in confirmatory and exploratory latent profile analysis to fit models to the data (N = 815; Black African, Black Caribbean, Indian, Pakistani, Bangladeshi and Chinese). Multinomial logistic regression examined associations between demographic variables and network types. Linear regression examined associations between network types and wellbeing outcomes. A four-profile model was selected. Multigenerational Household: Younger Family networks were most robust with lowest levels of loneliness and greatest quality of life. Restricted Non-kin networks were least robust. Multigenerational Household: Younger Family networks were most prevalent for all but the Black Caribbean migrants. The typology is able to differentiate between networks with multigenerational households and can help identify vulnerable networks. There are implications for forecasting formal services and variation in networks between cultures. The use of a culturally appropriate typology could impact on the credibility of gerontological research.
This paper considers the support networks of older people in populations with a preponderance of multigenerational households and examines the most vulnerable network types in terms of loneliness and isolation. Current common typologies of support networks may not be sensitive to differences within and between different cultures. This paper uses cross-sectional data drawn from 590 elders (Gujaratis, Punjabis and Sylhetis) living in the United Kingdom and South Asia. Six variables were used in K-means cluster analysis to establish a new network typology. Two logistic regression models using loneliness and isolation as dependent variables assessed the contribution of the new network type to wellbeing. Four support networks were identified: ‘Multigenerational Households: Older Integrated Networks’, ‘Multigenerational Households: Younger Family Networks’, ‘Family and Friends Integrated Networks’ and ‘Non-kin Restricted Networks’. Older South Asians with ‘Non-kin Restricted Networks’ were more likely to be lonely and isolated compared to others. Using network typologies developed with individualistically oriented cultures, distributions are skewed towards more robust network types and could underestimate the support needs of older people from familistic cultures, who may be isolated and lonely and with limited informal sources of help. The new typology identifies different network types within multigenerational households, identifies a greater proportion of older people with vulnerable networks and could positively contribute to service planning.
This literature review focuses on patient satisfaction with skill mix in primary care. This is an important, rapidly changing, topic as the range of health professionals working alongside GPs increases and the roles of staff change. The review is intended to assist primary care organizations in developing skill mixes that meet patients' preferences and needs.
A number of characteristics that influence the type of services that patients want were discovered. Older people and those from ethnic minorities want a ‘traditional’, GP-led service. Access is important to younger people and those in full-time work. Those from lower socio-economic groups value nurses, but have found the increasingly complex organization of services a problem. There are different levels of knowledge and expectations about health services and information on the skills and knowledge of professionals, what they do and the links between them, needs to be available.
A number of aspects of care are important to patients. Patients liked nurses as they were good communicators, formed good therapeutic relationships, gave information on illnesses and spent more time. The location of services is important and patients liked services provided in the home or community. Continuity of care is key, but has been presented as old fashioned and reorganizations may have reduced continuity; skill mix could be viewed as forming a barrier between doctor and patient, but personal lists and teams where practices are divided into smaller units with shared support may help. The competence of health professionals is clearly vital and patients considered nurses competent, although they had concerns about nurses and pharmacists taking on some new roles.
The literature focuses on patients' views about doctors and nurses, although they also want a wider range of services and professionals available in primary care: occupational therapy, link workers, CAB advisers, pharmacist advice and mental health workers. Despite being satisfied with nurses, some patients still wanted to see a doctor next time or felt that a doctor should be available. GPs can help build awareness and confidence in patients about the roles and contribution of the team.
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