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How do people with dementia make sense of their medications? An interpretative phenomenological analysis study
- Authors:
- LIM Rosemary H. M., SHARMEEN Taniya, DONYAI Parastou
- Journal article citation:
- International Journal of Geriatric Psychiatry, 37(2), 2022,
- Publisher:
- Wiley
Background: Managing medication is complex and multifaceted for people with dementia and their family carers. Despite efforts to support medication management, medication errors and medication-related hospital admissions still occur. This study investigated how people with dementia viewed and talked about their different medications and their medication taking. Methods: An interpretative phenomenological analysis (IPA) qualitative research design combining photo elicitation and in-depth interviews was used. People with a diagnosis of mild or moderate dementia took photographs of anything they viewed to be related to medication, with or without the help of family carers, over any two-day period. The photographs were then used as cues for subsequent in-depth interviews, which were analysed using IPA. Results: Twelve people with dementia were interviewed. Four themes encapsulated the experiences: (1) Medication as a lifeline, (2) Managing medications dominates daily lives and plans, (3) Struggling with uncertainty about the effectiveness of dementia medication and (4) Sense of ‘being’ and being in control. People with dementia viewed medication as a lifeline, especially donepezil, giving it preference over other daily medication they were using. Managing medications dominated the daily lives and plans of people with dementia and changed the way they viewed themselves and their life. People with dementia continually struggled with the imperceptible benefits of donepezil on their dementia, but despite such uncertainties, continued to take donepezil. Conclusions: This study provided unique insights into how people with dementia made sense of their medication. Healthcare professionals can use these insights to shape their practice around medication prescribing and advice in dementia. The findings are also useful to researchers looking to develop interventions to support medication management within the home setting. (Edited publisher abstract)
Perceptions and experiences of residents and relatives of emergencies in care homes: a systematic review and metasynthesis of qualitative research
- Authors:
- CURTIS Ffion, et al
- Journal article citation:
- Age and Ageing, 50(6), 2021, pp.1925-1934.
- Publisher:
- Oxford University Press
Background: the perceptions and experiences of care home residents and their families are important for understanding and improving the quality of emergency care. Methods: we conducted a systematic review and metasynthesis to understand the perceptions and experiences of care home residents and their family members who experienced medical emergencies in a care home setting. The review protocol was registered in PROSPERO (CRD42020167018). We searched five electronic databases, MEDLINE, CINAHL, PubMed, Cochrane Library and PsycINFO, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of studies included in this review. Results: of the 6,140 references retrieved, 10 studies from four countries (Australia, Canada, UK and USA) were included in the review and metasynthesis. All the included studies were assessed as being of good quality. Through an iterative approach, we developed six analytical themes: (i) infrastructure and process requirements in care homes to prevent and address emergencies; (ii) the decision to transfer to hospital; (iii) experiences of transfer and hospitalisation for older patients; (iv) good communication is vital for desirable outcomes; (v) legal, regulatory and ethical concerns and (vi) trusting relationships enabled residents to feel safe. Conclusions: the emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care and trusting relationships between staff, patients and relatives, underpinned by good communication and attention to ethical practice. (Edited publisher abstract)
Managing loneliness: a qualitative study of older people’s views
- Authors:
- KHARICHA K., et al
- Journal article citation:
- Aging and Mental Health, 25(7), 2021, pp.1206-1213.
- Publisher:
- Taylor and Francis
Engaging with older people who self-identify as lonely may help professionals in mental health and other services understand how they deal with loneliness. The evidence-base for effective interventions to address loneliness is inconclusive. This study aimed to explore how community-dwelling lonely older people in England manage their experiences of loneliness. Twenty eight community-dwelling older people identifying as lonely, based on responses to two loneliness measures (self-report and a standardised instrument), participated in in-depth interviews between 2013 and 2014. Fifteen lived alone. Thematic analysis of transcribed interviews was conducted by a multidisciplinary team including older people. Participants drew on a range of strategies to ameliorate their distress which had been developed over their lives and shaped according to individual coping styles and contexts. Strategies included physical engagement with the world beyond their home, using technologies, planning, and engagement with purpose in an ‘outside world’, and acceptance, endurance, revealing and hiding, positive attitude and motivation, and distraction within an ‘inside world’. Strategies of interests and hobbies, comparative thinking, religion and spirituality and use of alcohol straddled both the inside and outside worlds. Participants conveyed a personal responsibility for managing feelings of loneliness rather than relying on others. This study includes the experiences of those living with loneliness whilst also living with other people. When developing policy and practice responses to loneliness it is important to listen attentively to the views of those who may not be engaging with services designed for ‘the lonely’ and to consider their own strategies for managing it. (Edited publisher abstract)
Older lesbian, gay, bisexual, transgender, queer and intersex peoples’ experiences and perceptions of receiving home care services in the community: a systematic review
- Authors:
- SMITH Raymond, WRIGHT Toni
- Journal article citation:
- International Journal of Nursing Studies, 118, 2021,
- Publisher:
- Elsevier
Background: Numbers of older lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) people are increasing worldwide in line with the ageing populations of many countries. Most LGBTQI+ people want to remain in their own homes as they age, making it important to understand their experiences and perceptions of receiving home care. This systematic review aimed to examine older (over 60 years) LGBTQI+ people's perceptions and experiences of using formal home care services in the community. Methods: The following six electronic databases were searched from the date of their first records until the first week of March 2020: MEDLINE; PsycINFO; Social Policy and Practice; CINAHL; SSCI; and ASSIA. Hand searches of the reference lists of the included studies and relevant reviews were also conducted. Only peer reviewed research published in English was included. There were no restrictions on study design. Findings were analysed using narrative synthesis. The PROSPERO protocol registration identification number is: CRD42020168443. Results: Seven studies involving 169 participants were included in the synthesis. All were qualitative. Most participants were either lesbian women or gay men, with no studies investigating home care for transgender, queer, intersex or other sexual minorities. Fear of accessing home care services due to the perceived threat of homophobia and past negative experiences of discrimination were common. Some concealed any LGBTQI+ materials in their homes to try and hide their sexuality from home care workers. Despite fear of discrimination, lesbian women and gay men reported wanting and expecting the same level of care, dignity and respect as their heterosexual counterparts. Mandatory LGBTQI+ sensitivity training for home care workers was identified for reducing homophobia and increasing the inclusivity of service providers. Conclusion: Older lesbian women and gay men fear or experience discrimination from home care workers, with some choosing to hide their sexuality causing stress and anxiety. Sensitivity training in the needs of older LGBTQI+ people should be considered by home care service providers as a way of reducing homophobic attitudes which may exist among some home care workers. Due to the paucity of studies and their focus on older lesbian women and gay men, more research is needed to explore the experiences of other sexual minorities receiving home care services who are represented by the LGBTQI+ umbrella term. (Edited publisher abstract)
What keeps them going, and what gets them back? Older adults’ beliefs about physical activity maintenance
- Authors:
- HUFFMAN Mary Katherine, AMIREAULT Steve
- Journal article citation:
- Gerontologist, 61(3), 2021, pp.392-402.
- Publisher:
- Oxford University Press
Background and Objectives: The overall purpose of this article was to investigate beliefs related to physical activity maintenance among adults aged 60 years or older. Research Design and Methods: Study 1 identified modal, salient behavioral, normative, and control beliefs using a free-response format. Study 2 was designed to gain a deeper understanding about these beliefs through in-depth semistructured interviews. Results: Findings indicate that perceived physical and emotional benefits, scheduling and having a physical activity routine, social support, and features of indoor and outdoor locations are facilitating of maintenance. Some beliefs appear more relevant to sustained engagement in physical activity, while others may be more helpful for reengagement after 1 week of inactivity. Discussion and Implications: This investigation raises new hypotheses for future research and provides insight for the use and adaptation of behavior change strategies that are potentially more acceptable and effective for the promotion of physical activity maintenance for older adults. (Edited publisher abstract)
Older people's perspectives on living in integrated housing and care settings: the case of extra care housing
- Authors:
- CAMERON Ailsa, JOHNSON Eleanor K., EVANS Simon
- Journal article citation:
- Journal of Integrated Care, 28(3), 2020, pp.281-290.
- Publisher:
- Emerald
Purpose: This paper explores residents’ perceptions and experiences of extra care housing as an integrated model of housing with care. Design/methodology/approach: Data were collected in a longitudinal qualitative study based on four extra care housing schemes. Data from interviews with residents, care workers, managers and local commissioners were analysed thematically. Findings: The integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs, including chronic illness, led some residents to question the ability of the model to support residents to live independently. Research limitations/implications: The study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews. Practical implications: The study suggests the need to ensure that residents are fully informed about levels of care and support is available when considering a move into extra care housing. Originality/value: This paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector. (Edited publisher abstract)
Older people’s views on what they need to successfully adjust to life with a hearing aid
- Author:
- KELLY Timothy B.
- Journal article citation:
- Health and Social Care in the Community, 21(3), 2013, pp.293-302.
- Publisher:
- Wiley
This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit. (Publisher abstract)
Perceptions and views of self-neglect: a client-centered perspective
- Authors:
- DAY Mary Rose, LEAHY-WARREN Patricia, MCCARTHY Geraldine
- Journal article citation:
- Journal of Elder Abuse and Neglect, 25(1), 2013, pp.76-94.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
“Not just grapes and flowers”: older people's perspectives on the role and importance of hospital visiting
- Authors:
- GREEN Bert, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 13(2), 2012, pp.82-88.
- Publisher:
- Emerald
This paper presents findings from a service user controlled research project which sought to provide commentary by older people on their experiences as visitors to hospital or as patients receiving visitors. Nine focus groups were held with a total of 43 older people at 8 different locations in North Lancashire and South Cumbria. The participants were asked about their recent experience of hospital visiting and its value to them, given their individual circumstances and those prevailing at the hospitals. Full transcripts of digital recordings from the focus groups were analysed to identify particular concerns or vivid experiences. These were classified into the following common themes: getting there and back; on the ward; and the value of visiting. The findings suggest that visitors’ needs are not always being met. Recommendations are made that could improve hospital visiting for older people, and consequently their wellbeing, including: times and rules for visitors; the response they get from staff; the potential of older visitors to help improve the welfare of the older patient; and locating older people's wards.
Alcohol use in later life - older people's perspectives
- Authors:
- WARD Lizzie, BARNES Marian, GAHAGAN Beatrice
- Journal article citation:
- Quality in Ageing and Older Adults, 12(4), 2011, pp.239-247.
- Publisher:
- Emerald
This paper reports on qualitative research aiming to generate a wider evidence-based by exploring the circumstances in which older people drink, and the meaning that drinking alcohol has for them and its impact. The study developed a participatory methodology in which older people were actively involved in designing and carrying out the research. 21 older people were recruited for interviews, which were carried out by older co-researchers. The article describes the study and its findings. Thematic analysis identified drinking styles (social - regular; social - occasional; heavy lone drinking; and heavy drinking in a drinking network) and themes illustrating what affects drinking styles (social relationships; loss, change and adaptation; cost and availability; health, well-being and growing older; and responsibility, control and independence). The article discusses aspects of older people's drinking habits, including seeking help. It notes that this is a sensitive topic, discusses implications for practice and policy development, and suggests that more research is needed to understand the social, cultural and economic contexts of older people's drinking behaviour.