The challenge of inclusion for older people with impairments: Insights from a stigma-based analysis

The bidirectional association between the disability in activities of daily living and depression: a longitudinal study in Chinese middle-aged and older adults

AIM

Depression and disability in activities of daily living (ADL) are common in middle-aged and older adults. This study investigated the bidirectional relationship between depression and disability in ADL in Chinese middle-aged and older adults.

METHODS

Data from a baseline study of 17,596 participants from the China Health and Retirement Longitudinal Study (CHARLS) and two follow-up visits at 4 and 7 years were included. We designed Study A and Study B to explore the interaction between depression and disability in ADL in middle-aged and older people.

RESULTS

Individuals with disability in ADL at baseline had adjusted odds ratios (ORs) of 1.331 (1.118, 1.584) and 1.969 (1.585, 2.448) for developing depression compared with those without disability in ADL at the 4- and 7-year follow-ups, respectively. Individuals with depression at baseline had adjusted ORs of 1.353 (1.127, 1.625) and 1.347 (1.130, 1.604), respectively, for developing disability in ADL 4 and 7 years later.

CONCLUSIONS

There was a bidirectional relationship between depression and disability in ADL. Depression increased the risk of disability in ADL, but this risk did not increase with time, whereas the effect of disability in ADL on depression increased with time.

Ageing in Context: An Ecological Model to Understand Social Participation Among Indigenous Adults in Chile

The social participation of older adults occupies a central position in international discourse regarding ageing, the ecological model makes it possible to examine and assess the different factors that influence the understanding of what encourages social participation by older adults. This study used the ecological model to analyse how personal, community and environmental factors are related to satisfaction with social participation among Chilean older adults, a majority of whom are indigenous, living in rural areas (n = 800). The results confirmed that satisfaction with social participation was related to personal factors (feelings of depression, functioning into basic activities of daily living (ADL) and autonomy), community factors (perceived social support from social group) and environmental factors (accessibility of physical setting within the village). Our findings confirmed a high level of social participation among indigenous adults, with rural and indigenous surroundings appearing to be a factor that protects and promotes social integration.

Optimizing older adult co-researchers’ involvement in PAR: proposed evaluation tool

Purpose

This paper aims to share a practical evaluation tool intended to guide and support the participation of older people in PAR projects. Participatory action research (PAR) studies with older adults have been increasing over the past ten years. Scientific evidence provides key principles for PAR projects to achieve meaningful participation by older people; however, respecting the ideals of PAR is not always straightforward.

Design/methodology/approach

This paper presents a case study that evaluated the involvement of nonacademic researchers in a PAR project using an evaluation tool derived from a literature review of PAR undertaken with this population (Corrado et al., 2020). The study goals were first to assess the assets and limits of the older co-researchers’ participation within the PAR project, and second to provide a revised version of the evaluation tool to support future PAR with older people. First, the authors designed an evaluation tool for nonacademic participation in PAR studies by older people that covers three main themes: older people positioned as prominent research partners; symmetrical power relations between academic and nonacademic researchers; and commitment regarding inclusiveness and long-term collaboration. Second, the authors performed an evaluation using this tool within the Active Aging with Dignity PAR Project.

Findings

Third, the authors used the results of this experiment to suggest improvements for an enhanced version of the evaluation tool aiming at supporting fuller involvement of older nonacademic researchers in PAR studies.

Originality/value

To the authors’ knowledge, this evaluative tool is a methodological innovation in gerontology.

Multiple Case Study of Changes in Participation of Adults with Myotonic Dystrophy Type 1: Importance of Redesigning Accomplishment and Resilience

Background: Myotonic dystrophy type 1 (DM1) is the most prevalent adult form of neuromuscular disorders, for which a decrease of participation with age is known. However, little is known about facilitators and barriers to participation, especially from the perspective of both patients and caregivers. Objective: This study explored and explained changes in participation post-diagnosis with myotonic dystrophy type 1 from the perspective of six adults, their relatives and nurse case managers. Methods: A multiple case study was carried out with these triads (n =  6) using semi-structured individual interviews, medical charts, and a participation patient-reported outcome measure. The six cases were built around three women and three men (age: 40–56 years; disease duration: 19–39 years). Their “relatives” were mainly family members. Nurse case managers had done annual follow-ups with all the adults for approximately ten years. Changes in participation were characterized generally by: 1) heterogeneity, 2) insidious increase in restrictions, and more specifically by: 3) redesigning accomplishment, 4) progressive social isolation, 5) restrictions in life-space mobility, and 6) increasingly sedentary activities. Results: Important facilitators of participation were the adult’s resilience, highly meaningful activities, social support, living arrangement, and willingness to use technical aids. Barriers were mostly related to symptoms and a precarious social network, and were affected by misfit and potential syndemic interactions between personal (e.g., comorbidities) and environmental (e.g., stigma) factors. Conclusion: This study identified key facilitators and barriers and their underlying processes, which should be integrated into the evaluation and intervention framework to optimize participation over time.

Equality according to whom? Debating an age-related restriction in the upcoming disability legislation reform in Finland

Within many countries, the policies of disability and old age have been developing on distinct paths. Even though the prevalence of disability is higher in older populations, older persons tend to be excluded from disability discourses. Taking Finland's disability service legislation reform as an example, this article elaborates on the justifications for excluding or including older persons from disability policies. The paper analyses the public statements given in 2017 to a proposal that introduced an age-related restriction to disability services in order to understand how the restriction is argued for and against, and what kind of conceptualisations of old age and disability the statements portray. This study found that although equality is the most important principle underlying the reform, the conceptualisation of equality varies. Depending on who is included in the disability discourse, the idea of what is fair differs. Hence, it is necessary to recognise the differing understandings of equality in the debate regarding the age-related restriction. In addition, I argue that equality research can be helpful in assessing the fairness of public policies at the intersection of ageing and disability.

Participation of People With Impairments in Seniors' Organizations: Conditions and Limitations on Inclusion

BACKGROUND AND OBJECTIVES

While older adults' social participation has attracted sustained attention, the realities faced by seniors with impairments in this area are still understudied. Social representations are formed from socially constructed opinions regarding a given object and have four functions (knowledge, identity, orientation, justification). The purpose of this article is to document the social representations that exist within seniors' organizations regarding participation by older people with impairments.

RESEARCH DESIGN AND METHODS

In this mixed-methods study, an exploratory sequential design was applied. First, a qualitative phase involved meetings with five focus groups to explore how participants would manage difficult situations in which the inclusion of an older person with impairments must be addressed. Second, a quantitative phase consisted of a questionnaire administered to 86 respondents to examine the components of social representations about the participation of older people with impairments.

RESULTS

Results show that, although research participants acknowledge that all seniors have the right to participate, this right confronts a collective identity infused with aging model that demands a youthful, "un-disabled" appearance and activities. In terms of the orientation function, making participation a reality is seen as relying on the efforts of people with impairments, but when there is a failure of inclusiveness, the reasons offered to justify it concern the resources available, rather than possible prejudices.

DISCUSSION AND IMPLICATIONS

Interpretation of the results leads to recommendations for both implementing an inclusion philosophy and practices in seniors' organizations and revisiting the view of impairment in old age as otherness.