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Discretion and service use among older adults: the behavioral model revisited
- Authors:
- MITCHELL Jim, KROUT John A.
- Journal article citation:
- Gerontologist, 38(2), April 1998, pp.159-168.
- Publisher:
- Oxford University Press
Argues that research applying the behavioural model to the use of services among older adults could be enriched by the classification of services along a discretionary dimension uses. Survey responses from community-dwelling older adults in the USA to test the hypothesis that predisposing, enabling and need characteristics are better predictors of discretionary than nondiscretionary service use.
Effects of age expectations on oncology social workers’ clinical judgment
- Authors:
- CONLON Annemarie, CHOI Namkee G.
- Journal article citation:
- Research on Social Work Practice, 24(4), 2014, pp.477-490.
- Publisher:
- Sage
Objective: This study examined the influence of oncology social workers’ expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers (N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the patent’s age and gender. Structural equation modeling served as the primary tool for testing the study hypotheses. Results: Significant differences were found in clinical judgment based on patient’s age, and social workers’ ERA and ERAC which affected diagnostic and treatment judgment for all patients. Lack of congruence was also found between the diagnosis and treatment phases of care for older patients. Emotional reaction was more often reported for the younger patient. Conclusion: Results suggest a barrier to “whole patient” care for all cancer patients and a need for student and practitioner training to place greater emphasis on the treatment phase of patient care. (Publisher abstract)
Self-determination among frail older persons: a desirable goal older persons’ conceptions of self-determination
- Authors:
- MARTENSSON Lena, EKLUND Kajsa
- Journal article citation:
- Quality in Ageing and Older Adults, 15(2), 2014, pp.90-101.
- Publisher:
- Emerald
Purpose: Self-determination is governed by ethical and legal rights in western society. In spite of that, older people are still restricted by others in their decision-making processes. The purpose of this paper is to explore older persons’ different conceptions of self-determination. Design/methodology/approach: A qualitative phenomenographic interview study on frail older persons (n=15). Findings: Three categories emerged, showing the variations of conception of self-determination as experienced by frail older people: first, self-determination changes throughout life; second, self-determination is being an agent in one's own life; and third, self-determination is conditional. In summary, while self-determination is changeable throughout life, and older persons want to be their own agents, and struggle to be that, certain conditions must be met to make it possible for them to be able to exercise self-determination. Practical implications: Suggestions for supporting and strengthening frail older persons’ self-determination, and indirectly their well-being and health: to have a person-centered approach, treat them with dignity and respect and give them opportunities to influence and to feel involved; to improve their health literacy by, for example, supporting them with enough knowledge to be able to exercise self-determination; to make them feel safe and secure in relationships, such as with family and caregivers. Originality/value: This study explores frail older persons’ own conceptions of self-determination to be able to gain knowledge of how professionals can support them so that they may experience self-determination in life
HIV diagnosis disclosure: stigma management and stigma resistance
- Authors:
- POINDEXTER Cynthia Cannon, SHIPPY R. Andrew
- Journal article citation:
- Journal of Gerontological Social Work, 53(4), May 2010, pp.366-381.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
HIV stigma is the context within which HIV persons experience their daily lives. This stigma affects personal relationships, social and medical services, and physical and mental well-being. In this article that authors report on diagnosis disclosure decision comments arising serendipitously in five focus group discussions with 34 HIV-infected people over the age of 50, from New York, United States. Three main disclosure themes were identified, demonstrate the complexity of diagnosis disclosure decision-making: hiding or selectively disclosing, or stigma management; partial disclosure because of the perception of partial control of the information; and widespread or complete voluntary diagnosis disclosure, representing stigma resistance. In conclusion, the authors suggest that social workers and other human services practitioners should remember the diversity within the HIV population, the ageing population, and the HIV-positive aging population. Experiences of HIV stigma, and choices about diagnosis disclosure and stigma management or resistance, are individual, reciprocal, and dynamic.
The same old process?: older people, participation and deliberation
- Author:
- BARNES Marian
- Journal article citation:
- Ageing and Society, 25(2), March 2005, pp.245-259.
- Publisher:
- Cambridge University Press
Opportunities for older people to take part in decision making about public policies and services are expanding in the United Kingdom and elsewhere. This paper considers the potential of older people's participation in policy processes for both transforming the policy process and for achieving socially just outcomes. It argues that the way in which such participation takes place, in particular the nature of the deliberative processes, affects both who will feel able to take part and the capacity to develop new policy discourses which can challenge official perspectives and assumptions. It draws from critical perspectives on deliberative democracy to provide a theoretical framework. This work emphasises the importance of story telling and forms of exchange designed to offer recognition to others, as well as the rational argument more usually associated with deliberation on matters of public policy. The argument is illustrated with examples of participation initiatives that have involved ‘active’ older people and those who are users of social care services. Different styles and processes of exchange are distinguished in the three case studies. In one, active facilitation enables individual stories of ageing and of service use to be woven into collective narratives that offer an alternative vision of care services. In another, a strong emphasis on ‘greeting’ enables conflicting views to be expressed without participants falling out. In the third, styles of exchange familiar in formal debate limit the development of an alternative discourse. The conclusion suggests that attention needs to be given to the process of participation as well as to outcomes.
Can we talk about it? A qualitative study exploring occupational therapists' decision making in judging when to ask an older person about drinking alcohol
- Authors:
- MacLEAN Fiona, et al
- Journal article citation:
- Ageing and Society, 42(3), 2022, pp.521-538.
- Publisher:
- Cambridge University Press
Older people now currently drink alcohol more frequently than previous generations, indicating a need to understand how this influences health and wellbeing in older adults. However, knowledge and awareness of the changing role alcohol plays in the lives of older people is not necessarily widely understood by allied health professionals in acute hospital contexts. In turn, conversations about drinking alcohol in later life may not be routinely addressed as part of practice, limiting an older person's choice to make informed decisions about their drinking. This paper qualitatively examines when occupational therapists (N = 17) in an acute hospital setting will initiate a conversation with older people (65+ years) about their drinking, guided by a theoretical lens that encompasses both person-centredness and collective occupation. Adopting a qualitative methodology, this study illustrates a typology of reasoning describing how, and in what circumstances, therapists ask older people about their alcohol use. Three themes were generated that provide further insight into the typology, these being 'hesitancy in practice', 'failure to link life transitions to alcohol use' and 'challenges of focusing on healthfulness'. These findings provide a potentially useful tool for therapists, services and organisations to self-assess their approach to asking older people about alcohol use; a necessary element of professional health-care practice as social trends in alcohol use continue to increase. (Edited publisher abstract)
"You're at their mercy": older peoples' experiences of moving from home to a care home: a grounded theory study
- Authors:
- O'NEILL Marie, et al
- Journal article citation:
- International Journal of Older People Nursing, 15(2), 2020, p.e12305.
- Publisher:
- John Wiley & Sons, Ltd
- Place of publication:
- West Sussex
Background: Internationally, it is recognised that the transition to a care home environment can be an emotional and stressful occasion for older people and their families. Aim: This study explores individuals' experiences of moving into a care home. The paper has a specific focus on the preplacement (7 days) and immediate postplacement (within 3 days) period of the move to the care home. Design: A grounded theory method was used to conduct semi‐structured interviews with 23 participants. Results: Data analysis revealed five distinct categories that captured the experience of the preplacement and immediate postplacement period. These were as follows: (a) inevitability of the move: “I had to come here,” (b) making the move: “Abrupt Departures,” (c) decision‐making and exercising choice: “What can I do, I have no choice,” (d) maintaining identity: “Holding on to self” and (e) maintaining connections: “I like my family to be near.” Together, these five categories formed the basis of the concept “You're at their Mercy” which encapsulates the perceived transition experience of the older people within the study. Participants felt that the move was out of their control and that they were “at the mercy” of others who made decisions about their long‐term care. Conclusions: Moving to a care home represents a uniquely significant relocation experience for the individual. Key factors influencing the move were the individuals' perceived lack of autonomy in the pre‐ and postrelocating period of moving to a care home. Nurses have a key role to play in working with older people to influence policy and practice around decision‐making, planning and moving to a care home with greater emphasis on autonomy and choice so that older people do not feel “at the mercy” of others as they navigate such a major transition. Implications for practice: There is a need to standardise approaches and develop person‐centred interventions to support older people considering relocation to a care home and nurses have a key role to play in making this happen. (Edited publisher abstract)
Care arrangements of older adults: what they prefer, what they have, and implications for quality of life
- Authors:
- KASPER Judith D., WOLFF Jennifer L., SKEHAN Maureen
- Journal article citation:
- Gerontologist, 59(5), 2019, pp.845-855.
- Publisher:
- Oxford University Press
Background and Objectives: Meeting individual preferences for long-term services and supports (LTSS) is a policy priority that has implications for quality of care. Evidence regarding preferences is sparse. In addition, little is known regarding whether preferences and care arrangements match for those receiving care, and implications for quality of life. Research Design and Methods: A random sample (n = 1,783 in 2012) of National Health and Aging Trends Study participants were asked the best care option for someone 80+ who needs help with personal care and mobility. Analyses examine variations in care preferences, the relationship of preferences to care arrangements, and the association of matched preference and care arrangements to quality of life indicators. Results: Care preferences vary by demographics. Equal proportions (3 in 10) of older adults chose assisted living or continuing care retirement communities (CCRC), care in own home with family help, and care in own home with paid help, as the best options. Persons in assisted living/CCRC settings were significantly more likely to choose this option as best. Only 1 in 3 older persons receiving care are in arrangements that match preferences. No association with quality of life indicators was found. Discussion and Implications: Aging in place remains the care preference of a majority, but close to one-third chose assisted living/CCRC, suggesting preferences are evolving. Aligning care preferences and arrangements is a policy goal, but many do not achieve a match and there remain gaps in understanding trajectories in preferences and care arrangements and implications for quality of life. (Edited publisher abstract)
The decision to work after state pension age and how it affects quality of life: evidence from a 6-year English panel study
- Authors:
- DI GESSA Giorgio, et al
- Journal article citation:
- Age and Ageing, 47(3), 2018, p.450–457.
- Publisher:
- Oxford University Press
Background: despite an increasing proportion of older people working beyond State Pension Age (SPA), little is known about neither the motivations for this decision nor whether, and to what extent, working beyond SPA affects quality of life (QoL). Methods: QoL was measured using the CASP-19 scale. Respondents in paid work beyond SPA were distinguished based on whether they reported financial constraints as the main reason for continuing in work. Linear regression models were used to assess the associations between paid work beyond SPA and CASP-19 scores among men aged 65–74 and women aged 60–69 (n = 2,502) cross-sectionally and over time using Wave 4 and Wave 7 of the English Longitudinal Study of Ageing. Results: approximately, one in five respondents were in paid work beyond SPA, one-third of whom reported financial issues as the main reason. These individuals reported significantly lower CASP-19 scores (β = −1.21) compared with those who retired at the expected/usual age. Respondents who declared being in paid work beyond SPA because they enjoyed their work or wanted to remain active, reported significantly higher QoL (β = 1.62). Longitudinal analyses suggest that those who were working post-SPA by choice, but who had stopped working at follow-up, also reported marginally (P < 0.10) higher CASP-19 scores. Conclusions: potential QoL benefits of working beyond SPA need to be considered in light of individual motivations for extending working life. Given the trend towards working longer and the abolishment of mandatory retirement ages, it is important that older people maintain control over their decision to work in later life. (Edited publisher abstract)
Cognitive, social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: a review and new model
- Author:
- SPRENG R. Nathan
- Journal article citation:
- Journal of Elder Abuse and Neglect, 28(4-5), 2016, pp.320-344.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The authors briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological ageing, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. The authors highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk. (Edited publisher abstract)