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Journal article

Deciding to move into extra care housing: residents’ views

Authors:
BÄUMKER Theresia, et al
Journal article citation:
Ageing and Society, 32(7), October 2012, pp.1215-1245.
Publisher:
Cambridge University Press

In England in 2003, the Department of Health announced funding to support the development of extra care housing, and made the receipt of funding conditional on participating in an evaluative study. Drawing on data from residents in 19 schemes, this paper presents findings on the factors motivating older people to move to extra care housing, their expectations of living in this new environment, and whether these differ for residents moving to the smaller schemes or larger retirement villages. In total, 949 people responded, 456 who had moved into the smaller schemes and 493 into the villages. Of the residents who moved into the villages, 75% had not received a care assessment prior to moving in, and had no identified care need. There was evidence that residents with care needs were influenced as much by some of the attractions of their new living environment as those without care needs who moved to the retirement villages. The most important attractions of extra care housing for the vast majority of residents were: tenancy rights; flexible onsite care and support; security offered by the scheme; and accessible living arrangements. The results suggest that, overall, residents with care needs seem to move proactively when independent living was proving difficult rather than when staying put was no longer an option.

Journal article

“It keeps me going” – older people's perception of well-being and use of complementary and alternative medicine (CAM)

Authors:
LORENC Ava, et al
Journal article citation:
Quality in Ageing and Older Adults, 13(2), 2012, pp.135-144.
Publisher:
Emerald

Significant proportions of older people appear to use complementary and alternative medicine (CAM). Common CAM treatments used by older adults include nutritional supplements, herbal medicine, spiritual healing, and chiropractic. The aim of this paper was to explore older peoples' decision making regarding CAM use and their perceptions and experiences of well-being. Qualitative focus groups were held at a community centre in southwest London with 37 volunteers aged over 61 years. Transcripts of the discussions were content analysed. Five themes emerged from the participants’ discussions of well-being: physical well-being; impact on activity; emotional issues; community and health services; and keeping positive. A range of CAM was used, most commonly mind/body or physical therapies. The main reason for CAM use was to ‘keep going’ and maintain well-being. ‘Keeping going’ is often promoted by CAM, including manipulative and exercise therapies. Conventional medicine was perceived as central to well-being, with CAM used to address its limitations. Decision making was rarely systematic; anecdotal information dominated, and disclosure to conventional practitioners was uncommon. Healthcare providers should consider exploring CAM use with older people and facilitating access to CAM information.

Journal article

Voluntary and involuntary driving cessation in later life

Authors:
CHOI Moon, MEZUK Briana, REBOK George W.
Journal article citation:
Journal of Gerontological Social Work, 55(4), May 2012, pp.367-376.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

There is limited quantitative information about the differences between voluntary and involuntary driving cessation or the factors associated with these transitions. This study explored the decision-making process of driving cessation in later life, with a focus on voluntary decisions. The sample included 83 former drivers from the Baltimore Epidemiologic Catchment Area Study (mean age 75.3 years and 73.5% females). A majority of participants (83%) reported stopping driving of their own volition. However, many voluntary driving retirees reported external factors such as financial difficulty, anxiety about driving, or lack of access to a car as main reasons for driving cessation. The authors conclude that the distinction between voluntary and involuntary driving cessation is in practice ambiguous and that factors beyond health status, including financial strain, play a role in the transition to non-driving.

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Making a strategic shift towards prevention and early intervention: key messages for decision makers

Author:
GREAT BRITAIN. Department of Health
Publisher:
Great Britain. Department of Health
Publication year:
2008
Pagination:
18p.
Place of publication:
London

This document is designed to provide practical guidance to local authorities and health communities on how to make a strategic shift to prevention and early intervention In doing this it draws on the experiences and evidence emerging from the first two years of the Partnerships for Older People Projects (POPP) programme and other related initiatives such as the Department for Work and Pensions’ Linkage Plus programme. The guide focuses on promoting the independence and wellbeing of older people and is intended to develop over time to include transferable learning for other client groups.

Journal article

The needs and experiences related to driving cessation for older people

Authors:
LIDDLE Jackie, et al
Journal article citation:
British Journal of Occupational Therapy, 71(9), September 2008, pp.379-388.
Publisher:
College of Occupational Therapists

Older people may cease driving owing to health concerns, discomfort while driving, cancellation of their licence or financial reasons. Because driving is fundamental to the freedom and independence of older people, driving cessation can lead to depression, loss of roles and unsafe use of alternative transport. Little consideration has been given to the development of approaches to improve outcomes for retiring drivers. This study aimed to understand the experiences of driving cessation for older people to inform the design of interventions for retiring drivers. Qualitative methodology was used to explore the experiences of driving cessation from the perspective of nine retired drivers, three family members and six service providers. The retired drivers experienced challenges during three phases of driving cessation, in addition to discussing their driving history. The challenges were (1) a predecision phase - a balancing act and achieving awareness; (2) a decision phase - making the decision and owning the decision; and (3) a post-cessation phase - finding new ways and coming to terms. Interventions to facilitate the process of driving cessation may need to be designed according to the phase of driving cessation and the challenges that the person is experiencing and to be underpinned by behaviour change and life transition theories.

Journal article

Actuation of mobility intentions among the young-old: an event-history analysis

Authors:
BRADLEY Don E., et al
Journal article citation:
Gerontologist, 48(2), April 2008, pp.190-202.
Publisher:
Gerontological Society of America

Although migration decision making is central to understanding later-life migration, the critical step between migration intentions and mobility outcomes has received only limited empirical attention. The authors discuss two questions: How often are intended moves actuated? What factors condition the likelihood that mobility intentions will be actuated? Data were employed from the 1994-2002 Health and Retirement Study in the US, which is a nationally representative panel targeting households containing persons aged 53 to 63 years at baseline. Event-history techniques are used to examine the link between reported mobility intentions at baseline and mobility outcomes across the study period, net of relevant controls. Separate household-level analyses were conducted for couple and noncouple households and recognize three types of moves: local, family oriented, and nonlocal. Findings confirm the utility of mobility expectations as a predictor of future mobility. More importantly, results highlight the complex nature of later-life mobility. The actuation of mobility intentions appears to operate differently in couple than in noncouple households. Moreover, the findings suggest that the role of several key variables depends on the type of move under consideration. The ability to identify potential "retirement migrants" may be of practical importance for state and local government officials as well as developers interested in recruiting or retaining young-old residents. The study offers insight on the interpretation of stated mobility intentions. Moreover, consistent with early theoretical work in the field, our analysis suggests that empirical studies must account for heterogeneity among older movers in order to avoid misleading results.

Journal article

A choice too far

Author:
CRESSWELL Rick
Journal article citation:
Professional Social Work, March 2008, pp.10-11.
Publisher:
British Association of Social Workers

A social worker involved in assessing the capacity of patients to understand and make decisions, uses the example of an elderly women confronted with the prospect of losing her leg, and possibly her life, to highlight why, sometimes, there are no right and wrong answers to professional decision making.

Journal article

Clinical evidence in guardianship of older adults is inadequate: findings from a Tri-State study

Authors:
MOYE Jennifer, et al
Journal article citation:
Gerontologist, 47(5), October 2007, pp.604-612.
Publisher:
Gerontological Society of America

This preliminary study compared clinical evaluations for guardianship in three states with varying levels of statutory reform. Case files for 298 cases of adult guardianship were reviewed in Massachusetts, Pennsylvania, and Colorado, three states with varying degrees of statutory reform. The quality and content of the written clinical evidence for guardianship and the hearing outcome were recorded. The quality of the written clinical evidence for guardianship was best in Colorado, the state with the most progressive statutory reform, earning a grade of B in the ratings, and worst in Massachusetts, a state with minimal reform, earning a grade of D – with nearly two thirds of the written evidence illegible. Information on specific functional deficits was frequently missing and conclusory statements were common. Information about the individual's key values and preferences was almost never provided, and individuals were rarely present at the hearing. Limited orders were used for 34% of the cases in Colorado, associated with more complete clinical testimony, but such orders were used in only 1 case in either Massachusetts or Pennsylvania. Implications: In this study, states with progressive statutes that promote functional assessment are associated with increased quality of clinical testimony and use of limited orders. A continuing dialogue between clinical and legal professionals is needed to advance reform in guardianship, and thereby provide for the needs and protect the rights of adults who face guardianship proceedings.

Journal article

Dementia advocacy

Author:
WELLS Sally
Journal article citation:
Working with Older People, 11(1), March 2007, pp.25-27.
Publisher:
Emerald

Advocating for someone with dementia is a difficult task. How can the advocate be confident that they are making the right decisions on behalf of their client? The author explores the underlying issues and describes the necessary skills to practise this form of advocacy.

Journal article

The discretion and power of street-level bureaucrats: an example from Swedish municipal eldercare

Authors:
DUNER Anna, NORDSTROM Monica
Journal article citation:
European Journal of Social Work, 9(4), December 2006, pp.425-444.
Publisher:
Taylor and Francis

This paper focuses on discretion in the frontline practice of social work with elderly people in Sweden. The aim is to describe and analyse how care managers in municipal eldercare use discretion and power in needs assessment and decision-making. Emanating from Lipsky's concept of discretion, we identify the conditions of decision-making, which along with the concepts of structural power and intentional power constitute the theoretical framework of this analysis. Eight care managers from four Swedish municipalities were observed and interviewed. The researchers carried out 38 observations and nine in-depth interviews. The analysis led to the identification of four techniques in the decision-making process of care managers: reject, execute, transform needs and control. The consequences of these practices are discussed at the end of the paper.

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