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Technology and trust: older people's perspectives of a home monitoring system
- Authors:
- LIE Mabel L.S., LINDSAY Stephen, BRITTAIN Katie
- Journal article citation:
- Ageing and Society, 36(7), 2016, pp.1501-1525.
- Publisher:
- Cambridge University Press
With demographic changes and the growing numbers of older people living alone, concerns have been raised about the care of the ageing population. Increasingly, developments in technology are being seen as the solution to these concerns. For those who do not see themselves as old or frail enough to require personal care provision, and who prefer to maintain their identity as autonomous and independent individuals, the development of assistive technologies such as ambient home monitoring systems is one answer. However, this involves careful negotiations with older people's understandings of safety and privacy, and their experiences and relationships with technology, their carers and relevant service-providers. In two trials of a home monitoring system funded by the United Kingdom Technology Strategy Board, older people were interviewed pre-trial and post-trial about their perspectives on these issues. This paper presents a conceptual analysis of the qualitative data using a sociological framework of trust that considers habitual action, and relationships with kin and with wider institutions. The research found that older people's habits and norms do not need to be disrupted by the ambient system. What was of more importance was relationships between the older person and her or his ‘monitor’ based on trust, as well as institutional providers who need to instil or earn trust.
Constructions of frailty in the English language, care practice and the lived experience
- Author:
- GRENIER Amanda
- Journal article citation:
- Ageing and Society, 27(3), May 2007, pp.425-445.
- Publisher:
- Cambridge University Press
The way frailty is conceptualised and interpreted has profound implications for social responses, care practice and the personal experience of care. This paper begins with an exegesis of the concept of frailty, and then examines the dominant notions of frailty, including how ‘frailty’ operates as a ‘dividing-practice’ through the classification of those eligible for care. The definitions and uses of ‘frailty’ in three discursive locations are explored in: (a) the Oxford English Dictionary, (b) the international research literature, and (c) older women's accounts of their lived experience. Three distinctive discourses are found, and applying a Foucauldian analysis, it is shown that the differences reflect overlaps and tensions between biomedical concepts and lived experiences, as well as negative underlying assumptions and ‘subjugated knowledge’. The concept of frailty represents and orders the context, organisational practices, social representations and lived experiences of care for older people. The evidence suggests that if, as the older women's accounts recommended, socially- and emotionally-located expressions of frailty were recognised in addition to the existing conceptions of risk of the body, frailty might no longer be thought of primarily as a negative experience of rupture and decline. To encourage this change, it is suggested that practice focuses on the prevention of frailty and associated feelings of loss, rather than reinforcing the feelings and experiences which render a person ‘frail’.
Attitudes of homebound older adults and their caregivers toward research and participation as research advisors
- Authors:
- ENGLAND Ashley L Eaton, et al
- Journal article citation:
- Gerontologist, 61(8), 2021, pp.1202-1210.
- Publisher:
- Oxford University Press
Background and Objectives: Homebound older adults and their caregivers have not historically been engaged as advisors in patient-centred outcomes research. This study aimed to understand the attitudes of homebound older adults and their caregivers toward research and participation as research advisors. Research Design and Methods: Descriptive thematic analysis of semistructured interviews conducted with 30 homebound older adults and caregivers recruited from home-based medical care practices. Interview questions addressed opinions on research and preferences for engaging as research advisors. Results: Of 30 participants, 22 were female, 17 were people of color, and 11 had Medicaid. Two themes emerged related to perceptions of research overall: (a) utility of research and (b) relevance of research. Overall, participants reported positive attitudes toward research and felt that research could affect people like them. Three themes emerged related to participating as research advisors: (a) motivators, (b) barriers, and (c) preferences. Participants were open to engaging in a variety of activities as research advisors. Most participants were motivated by helping others. Common barriers included time constraints and caregiving responsibilities, and physical barriers for homebound individuals. Participants also reported fears such as lacking the skills or expertise to contribute as advisors. Many were willing to participate if these barriers were accommodated and shared their communication preferences. Discussion and Implications: Diverse homebound older adults and caregivers are willing to be engaged as research advisors and provided information to inform future engagement strategies. Findings can inform efforts to meet new age-inclusive requirements of the National Institutes of Health. (Edited publisher abstract)
"The poor carer": ambivalent social construction of the home care worker in elder care services
- Authors:
- TIMONEN Virpi, LOLICH Luciana
- Journal article citation:
- Journal of Gerontological Social Work, 62(7), 2019, pp.728-748.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article examines the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. The authors connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector. (Edited publisher abstract)
What constitutes ‘good care’ and ‘good carers’? The normative implications of introducing reablement in Danish home care
- Authors:
- BODKER Malene Norskov, LANGSTRUP Henriette, CHRISTENSEN Ulla
- Journal article citation:
- Health and Social Care in the Community, 27(5), 2019, pp.e871-e878.
- Publisher:
- Wiley
This paper explores how transitioning from compensatory care to reablement care is not merely a practical process, but also a deeply normative one. Drawing on Annemarie Mol's concept of ‘ontonorms’ the article analyses the normative dynamics involved in transitioning from one form of care to another as reflected in reablement professionals' practices and discourses. The paper draws on 10 months of multisited ethnographic fieldwork carried out from April 2015 to February 2016 in a Danish municipality, including participant observations of reablement practices as well as qualitative interviews with 13 professionals working with reablement. The authors demonstrate that professionals generally consider reablement to represent a desirable shift in home care from ‘bad care’ practices of making people passive through compensatory care, towards ‘good care’ practices of ‘keeping people going’ despite their limitations. Moreover, the article demonstrates that while therapists are valued as ‘good carers’ due to their ability to focus on development and training, nurses and in particular home helpers are devalued as ‘bad carers’ due to their ‘caring genes’ and lack of technical and theoretical skills necessary for documentation work. Finally, the authors discuss the implications of these normative dynamics, which may risk stigmatising compensating care practices, although this form of care to a large extent continues to coexist with reablement practices. They argue for a more nuanced approach to care, recognising compensatory care and reablement as complementary forms of care, each doing good under different circumstances. (Edited publisher abstract)
Squalor, chaos and feelings of disgust: care workers talk about older people with alcohol problems
- Authors:
- KARLSSON Lis Bodil, GUNNARSSON Evy
- Journal article citation:
- Ageing and Society, 38(8), 2018, pp.1624-1644.
- Publisher:
- Cambridge University Press
Older persons with alcohol problems have today become an all too common part of everyday elder care, but research in this area is still scarce. This article has a Swedish context with the aim of describing and analysing home care workers’ narratives about older people who can be characterised as heavy drinkers, i.e. people with severe alcohol problems who need considerable care for extended periods. Limited knowledge is available concerning this age group. This article therefore fills a knowledge gap about home care workers’ perspective about body work and the abject, and breaches the myth that older individuals should be able to drink as they prefer and/or notions of drinking alcohol as a last enjoyment in life. The care workers talked about how they got drawn into the daily lives of the care recipients and how they ended up in situations where they, on the one hand, removed the consequences of drinking, and on the other, felt that they sustained the drinking by cleaning out dirt and washing the care recipients’ bodies. (Edited publisher abstract)
Satisfaction and difficulties of French professional home caregivers in supporting older people with Alzheimer's disease or alcohol misuse
- Authors:
- MOSCATO Alba, VARESCON Isabelle
- Journal article citation:
- Health and Social Care in the Community, 26(1), 2018, pp.27-34.
- Publisher:
- Wiley
In France, few studies have examined home care when it comes to ageing support and even fewer have considered alcohol misuse in this context. The studies also show that being old and having alcohol use disorders are two unfavourable conditions for receiving help, whereas for the Alzheimer's disease, there is a clear need for optimal care. In this article, the authors study professional home caregiver's perceptions of their job along with their difficulties and satisfactions in supporting older people with Alzheimer's disease or alcohol misuse. Out of the 23 professionals approached, 17 took part in a research interview from October 2013 to January 2014. All interviews were recorded, fully transcribed and lexically analysed with Alceste® software. Among the five classes that were identified from 63% of the initial data, the main themes that emerged illustrate the nature of the associated pathologies, the perceptions and satisfactions related to the profession, their adaptive skills, the difficulties related to the life context of the older person, and the wine consumption of the latter. The lexical discourse analysis shows that the professional home caregivers are involved in looking after not only people with Alzheimer's disease but also those with alcohol misuse. However, despite the difficulties and satisfactions encountered, adaptation to the older people seems to be their priority and one of the many skills that they have acquired during their professionalisation. Most of the older people who are helped are women and the difficulties mentioned by their caregivers usually arise at the time of their death. Lastly, when caring for alcohol misusers, they describe negative attitudes in their support. Although research in this area is rare while home care for the older person, whatever the pathology, is increasing, professionals need to be supported by the associations or companies that employ them and should be trained to help them provide the appropriate care. (Edited publisher abstract)
Letters from Sweden: low expectations
- Author:
- LINDELOF Margareta
- Journal article citation:
- Community Care, 20.6.02, 2002, p.43.
- Publisher:
- Reed Business Information
Reports on how users' apparent satisfaction with home care services in Sundsvall, Sweden is not necessarily a reflection of the quality of those services.
Home-care robots - Attitudes and perceptions among older people, carers and care professionals in Ireland: a questionnaire study
- Authors:
- KODATE Naonori, et al
- Journal article citation:
- Health and Social Care in the Community, 30(3), 2022, pp.1086-1096.
- Publisher:
- Wiley
Many countries face major challenges to ensure that their health and social care systems are ready for the growing numbers of older people (OP). As a way of realising ageing in place, assistive technologies such as home-care robots are expected to play a greater role in the future. In Asia and Europe, robots are gradually being adopted as a public policy solution to the workforce shortage. Yet, there is still a strongly held belief that such technologies should not be part of human and personal care services such as OP's care. However, there has been little research into attitudes and perceptions of potential users regarding home-care robots which can provide companionship and support with activities of daily living. To explore these in more detail, a questionnaire study was carried out in Finland, Ireland and Japan. This study reports findings from the Irish cohort (114 older people [OP], 8 family carers and 56 Health and Social Care Professionals [HSCPs]). Seventy per cent of the total respondents (N = 178) reported being open to the use of home-care robots, and only one quarter had a negative image of robots. People with care responsibilities in their private capacity expressed more interest in, and readiness to use, home-care robots, while stressing the importance of 'privacy protection' and 'guaranteed access to human care'. Both OP and HSCPs identified observation and recording of OP's mental and physical condition as desirable functions of such robots, whereas practical functions such as fall prevention and mobility support were also deemed desirable by HSCPs. There is generally positive interest in home-care robots among Irish respondents. Findings strongly suggest that the interest is generated partly by great need among people who deliver care. Should such robots be developed, then careful consideration must be given to user-centred design, ethical aspects and national care policy. (Edited publisher abstract)
Social care managers and care workers’ understandings of personalisation in older people’s services
- Authors:
- STEVENS Martin, et al
- Journal article citation:
- Working with Older People, 23(1), 2019, pp.37-45.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the impact of personalisation policy on the providers of social care services in England, mainly to older people, within the context of austerity and different conceptions of personalisation. Design/methodology/approach: The paper draws on part of a longitudinal study of the care workforce, which involved 188 interviews with managers and staff, undertaken in two rounds. Findings: Four themes were identified: changing understandings and awareness of personalisation; adapting services to fit new requirements; differences in contracting; and the impact on business viability. Research limitations/implications: The paper reflects a second look at the data focussing on a particular theme, which was not the focus of the research study. Furthermore, the data were gathered from self-selecting participants working in services in four contrasting areas, rather than a representative sample. Practical implications: The research raises questions about the impact of a commercial model of “personalised care”, involving personal budgets (PBs) and spot contracts, on the stability of social care markets. Without a pluralistic, well-funded and vibrant social care market, it is hard to increase the consumer choice of services from a range of possible providers and, therefore, fulfil the government’s purposes for personalisation, particularly in a context of falling revenues from local authorities. Originality/value: The research presents an analysis of interviews with care providers and care workers mainly working with older people. Their views on personalisation have not often been considered in contrast to the sizeable literature on PBs recipients and social workers. (Edited publisher abstract)