My home in later life: A phenomenographic study of older adults' experience of home

Conceptualizing the Facilitators and Barriers of Successful Multidisciplinary Teamwork Within the Reablement Process: A Scoping Review

Background

As the global population ages, there is increasing pressure on health systems to provide high-quality and cost-effective care for this growing segment of the population. Reablement, primarily a strategic home-based rehabilitation approach, has been demonstrated to be a cost-effective, multidisciplinary, holistic, and person-centred approach to maintaining functional independence as one ages. Given that care delivery in the home setting for older persons is complex, a key feature of effective implementation of reablement is the integration of a multidisciplinary team.

Objective

The primary objective of this study was to identify the facilitators and barriers that lead to successful teamwork in a multidisciplinary reablement team setting.

Methods

Scoping review approach was used in this study to determine trends, and mapping themes prevalent in the peer-reviewed literature. Eligible articles were sourced from four electronic databases, and data were extracted, coded, analyzed and chartered in February 2024.

Results

Twenty studies were included in this study. Six main themes were identified: (1) multidisciplinary teamwork for quality service development, (2) dynamics of multidisciplinary collaboration, (3) professional autonomy and reflective practice, (4) towards a flat organizational structure and shared goals, (5) openness and flexibility of developing new cultures, and (6) open and frequent communication for success. Each of the themes can exert a facilitating or/and inhibiting effect depending on the context.

Conclusion

The findings indicate that multidisciplinary teamwork in reablement settings is diverse, complex, and situational. In this paper, we propose a conceptual model that integrates each theme as a way to understand the complexity and interconnectedness of the themes along the quest for greater multidisciplinary teamwork in reablement. Given the positive outcomes of both service consumers and providers, amplification of multidisciplinary teamwork within reablement holds the promise of effective care for older persons in a time of growing service demands.

Home-making or home harms: Perceived and experienced tensions between domestic materiality and ageing

Home, as a physical place and psychological construct, is often thought of as being an important locus of ontological security across the life course. However, there is a growing awareness of a darker side to the home (see Gurney, 2021), and home-unmaking practices (see Baxter and Brickell, 2014) that challenge the assumptions of home being purely a place of shelter, comfort, and control and instead foreground the temporal, material, and spatial fluidity of the home, and tensions between privacy and the ability to engage in health-harming behaviours largely unnoticed. Here, a material gerontological approach enables a rethinking of how home, and the household objects contained within, can both promote and undermine well-being as we age. Drawing from two qualitative studies, this paper focuses on the tensions created by the materiality of a home which can both support daily life (see Coleman et al., 2016) and the project of the self (Belk, 1988) and be at the heart of harmful behaviours and more risky living environments. The first study explores the experiences of older women living alone during the Covid-19 pandemic. It explores how, over time, the ontological security of home can be challenged as a result of events such as bereavement, changes to physical capabilities and external influences such as the Covid-19 pandemic. The meaning and materiality of home become reframed, through the lens of gender and age, during the lockdowns associated with the pandemic. The second study, examining a voluntary service supporting older people to declutter, shows how the reduction of possessions can help clear space for adaptations to the home, reduce chances of slips and falls, and create opportunities for therapeutic engagements with the past through reminiscence, but can also threaten the 'affective scaffolding' of the home. These two studies illustrate the ways that materiality is enrolled in perceived and experienced tensions between the 'right' and 'wrong' ways to age at home. The paper argues for greater acknowledgement of the grey area between idealised imaginings of the materiality of home and actual everyday experiences of 'living with things' (Gregson, 2007) in later life.

Middle aged and older adult's perspectives of their own home environment: a review of qualitative studies and meta-synthesis

BACKGROUND

Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and costs less than residential aged care. Understanding meanings and drivers of remaining at home is an area of importance.

OBJECTIVE

The objective of this systematic review of qualitative studies was to synthesise middle and older aged adult's perspective of their home environment and determine the factors that are important when making decisions about future housing.

METHODS

This review and meta-synthesis was conducted in accordance with JBI (formally known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence. Meta-aggregation was used as the method of synthesis. Included qualitative studies involved middle and older aged adults and their views about ageing and housing. Published studies were identified in four electronic databases and grey literature. Critical appraisal and extraction were conducted using JBI tools and findings were categorised and synthesised into findings.

RESULTS

A total of 46 papers with 5183 participants on the concept of home were included. Most of the participants were older (> 65 years old) and the perspectives of middle-aged people were largely absent. Factors impacting on future housing decisions among individuals were identified. Seven synthesized findings emerged-independence, finances, stigma, attitudes towards ageing, attachments with home, aesthetics, and family connection.

CONCLUSION

Older people have a greater sense of independence and autonomy if they remain in their own home. Multiple external factors impacted on their perspectives including a sense of stigma about ageing, fear of being a burden to others and their own financial position which in some cases restricted their options. This review provides a comprehensive description of the different factors that need to be considered when planning future housing needs; both for individuals and for communities.

Research on the Aging-Friendly Kitchen Based on Space Syntax Theory

As a result of aging populations globally, a growing number of older adults prefer to age in place; therefore, it is essential to study the spatial adaptability of the house. This study aimed to explore the relationship between the efficiency of daily activities and the spatial layout of home kitchens in the elderly population, and to assess the moderating role of cognitive function. Twenty-one elderly participants completed the experiment, including non-cognitively impaired (n = 12) and cognitively impaired groups (n = 9). Their home kitchen space was partitioned in plan and elevation based on space syntax theory. They were required to complete three tasks (i.e., an easy task, a medium task, and a difficult task) in their respective kitchens. The relationship between the efficiency of different tasks’ completion and the corresponding kitchen space attributes (integration, mean depth) was examined. The results showed a significant association between the home kitchen space layout of homebound older adults and their kitchen activity efficiency. In addition, a positive moderating effect of cognitive ability was found in the association between moderate and difficult tasks (p < 0.05), and its effect appeared to be stronger under challenging tasks (p < 0.01). The results of this study may help provide a basis for future design and optimization of aging-friendly residential spaces.