'Hopeful adaptation' in health geographies: Seeking health and wellbeing in times of adversity

"When we were allowed to go back … the freedom, the vista, the delight … It was just magic": Disruption and adaptation among people ageing-in-place in Ireland during COVID-19

COVID-19 person-place disruptions may dislocate enabling resources and affect the short- and long-term wellbeing of individuals ageing-in-place. However, outcomes may vary according to individuals' personal experiences and capabilities to put in place adaptive strategies. Underpinned by the Conservation of Resources (COR) Theory, this study aimed to identify shifts in older people's relationships to place during the pandemic and to gain a deeper understanding of their adaptive strategies. We analysed data collected between April-May and October-November 2021 from the [Details omitted for double-blind reviewing], a qualitative investigation of community-dwellers based in Ireland and aged 65 years or over. Participants (n = 57) completed written submissions, narrative interviews and/or go-along interviews detailing their experiences during the pandemic. The mean age of participants was 74.9 years, 53% were female, 46% lived alone, and 86% lived in areas with high urban influence. Our framework analysis identified three thematic categories: 1) Characterization of individuals experiencing flow or disruption of place-resources; 2) Effects of place-resource disruptions; and 3) Adaptive strategies to manage disruption. Findings suggest that during the pandemic individuals ageing-in-place experienced trajectories of resistant flow, resilient flow, chronic disruption, or delayed disruption of place-resources, Participants' health and wellbeing was influenced in diverse ways by the threat of- and actual loss of material, social and affective resources. To compensate for disruptions, participants developed multiple adaptive strategies that highlight older people's potential to transform themselves, others, and their environments during times of adversity. These findings showcase the processes by which health enabling places may be maintained and generated, and present areas of opportunity for public health interventions seeking to support ageing populations during public health emergencies and beyond.

The role of social vulnerability in improving interventions for neglected zoonotic diseases: The example of Kyasanur Forest Disease in India

Forest-based communities manage many risks to health and socio-economic welfare including the increasing threat of emerging zoonoses that are expected to disproportionately affect poor and marginalised groups, and further impair their precarious livelihoods, particularly in Low-and-Middle Income (LMIC) settings. Yet, there is a relative dearth of empirical research on the vulnerability and adaptation pathways of poor and marginalised groups facing emerging zoonoses. Drawing on a survey of 229 households and a series of key-informant interviews in the Western Ghats, we examine the factors affecting vulnerability of smallholder and tribal households to Kyasanur Forest Disease (KFD), an often-fatal tick-borne viral haemorrhagic fever endemic in south India. Specifically, we investigate how different socio-demographic and institutional factors interact to shape KFD vulnerability and the strategies employed by households to adapt to disease consequences. Although surveyed households generally perceived KFD as an important health issue in the study region, there was variability in concern about contracting the disease. Overall results showed that poor access to land (AOR = 0.373, 95% CI: 0.152-0.916), being at or below the poverty line (AOR = 0.253, 95% CI: 0.094-0.685) and being headed by an older person (AOR = 1.038, 95% CI: 1.006-1.071) were all significant determinants of perceived KFD vulnerability. Furthermore, KFD vulnerability is also modulated by important extra-household factors including proximity to private hospitals (AOR = 3.281, 95% CI: 1.220-8.820), main roads (AOR = 2.144, 95% CI: 1.215-3.783) and study location (AOR = 0.226, 95% CI: 0.690-0.743). Our findings highlight how homogenous characterisation of smallholder and tribal communities and the 'techno-oriented' approach of existing interventions may further marginalise the most vulnerable and exacerbate existing inequalities. These findings are important for designing context-specific and appropriate health interventions (including the prioritisation of awareness raising, knowledge networks, livelihood diversification) that enhances the resilience of at-risk social groups within the KFD context. More broadly, our findings highlight how a focus on social vulnerability can help national and international health planners improve health interventions and prioritise among diseases with respect to neglected endemic zoonoses.

A good life? A good death? Reconciling care and harm in animal research

Laboratory animal science represents a challenging and controversial form of human-animal relations because its practice involves the deliberate and inadvertent harming and killing of animals. Consequently, animal research has formed the focus of intense ethical concern and regulation within the UK, in order to minimize the suffering and pain experienced by those animals whose living bodies model human diseases amongst other things. This paper draws on longitudinal ethnographic research and in-depth interviews undertaken with junior laboratory animal technicians (ATs) in UK universities between 2013 and 2015, plus insights from interviews with key stakeholders in laboratory animal welfare. In our analysis, we examine four key dimensions of care work in laboratory animal research: (i) the specific skills and sensitivities required; (ii) the role of previous experiences of animal care; (iii) the influence of institutional and affective environments and (iv) experiences of killing. We propose that different notions of care are enacted alongside, not only permitted levels of harm inflicted on research animals following research protocols, but also harms to ATs in the processes of caring and killing animals. Concluding, we argue for greater articulation of the coexistence of care and harms across debates in geography about care and human-animal relations.

The ends of an assemblage of health

This paper identifies and responds to three key challenges that have emerged in discussions of the assemblage across health geography. These challenges concern the problem of identifying the borders or limits of an assemblage of health; the problem of clarifying how such assemblages change over time; and the more general problem of identifying the affective and material character of the assemblage such that one may distinguish 'therapeutic' from 'oppressive' arrangements. The paper argues that each challenge calls for a novel analytics of power grounded in assessments of the generative forces of stratification and selection expressed within an assemblage. Assemblages of health are composed in relations of power, affect and desire that stratify the assemblage in ongoing processes of selection, acting upon heterogeneous entities (material and immaterial, intensive and extensive, human and nonhuman), bringing them into contact, causing them to affect one another, transforming their activity. Analysis of these processes provides potent tools for rethinking how relations, events, spaces and encounters mediate experiences of health and illness, and novel grounds for intervening in the formation of an assemblage of health.

It's about time: on the need of a temporal language for ecologically dimensioned medical humanities and public health scholarship

The COVID-19 pandemic has highlighted multiple system dependencies that urge us to rethink our relationship with other humans, non-humans and their various environments. Whereas a growing body of literature highlights the need for ecologically dimensioned medical humanities, focusing on where and how our healths unfold relationally through their ecologies, this paper argues that little attention has been paid to the when of health. In reply, this paper sets out to expand this understanding, first by grounding the ecological argument for medical humanities in a wider net of relational ontologies, and second by highlighting the need to think temporally, specifically multitemporally, about the relationalities of health. The paper advances the sociological concepts of 'time' and 'temporalities' to help us think about various tempi, rhythms, urgencies and legacies of how health unfolds unevenly into the future.

Count Your Life by Smiles and Tears: An Integrative Review on Resilience and Growing Older

The concept of “resilience” is considered helpful in understanding how people navigate adversities typical to later life. It is also a concept of growing interest internationally in research and in social policy and (social) practice. This article employs an integrative review methodology to explore current trends in theoretical and empirical research on resilience. A total of 25 quantitative and qualitative studies from 2011 to 2020 are included in this review. Findings indicate how the reviewed studies typically define resilience from three perspectives: resource-based, outcome-based, and process-based perspectives of resilience. In the results of the same studies, the resource-based and outcome-based perspectives are elaborated upon while detailed results from a process-based perspective are lacking. Additionally, even though adversity is recognized as a key element in conceptualizing resilience, it is scarcely defined if defined at all in the reviewed studies. Further research is recommended in this article to contribute to a realistic and encouraging narrative on growing older in social policy and (social) practice.

Hopeful adaptation after acquired brain injury: The case of late referrals in the Netherlands

A substantial number of people with 'mild' acquired brain injury (ABI) suffer from cognitive impairments that are not immediately acknowledged as such. Some are eventually referred to multidisciplinary rehabilitation care after months or years of suffering, which is why we have labelled them 'late referrals'. The aim of this paper is to add to the discussion on hopeful adaptation by focussing on the diverse adaptive strategies of late referrals. Hope is typically discussed as a positive emotion that can contribute to transformative processes, but that is also mirrored by despair. We conducted in-depth interviews with ten late referrals in the Netherlands. Our findings demonstrate that the trajectories of late referrals are characterised by wandering and navigating. Wandering is predominantly associated with feeling lost, and not knowing where one is going. While navigating is more purposeful, we found that our participants sometimes navigated in directions that turned out to be dead-end streets. We conclude that hopeful adaptation encompasses a circuitous way of trying and adapting and trying again. As a key recommendation for practice, we suggest that people with cognitive problems due to mild ABI should be supported in reducing the complexities of their everyday lives by taking up challenges one place at a time.

Uncaring landscapes and HIV peer support in the rural Southern United States

Despite social determinants being central to LGBTQ health inequities, they are scarcely targeted by federal public health interventions. Racism, sexual stigma, and social disconnection, in particular, contribute to numerous LGBTQ health inequities including HIV. This article explores the case of a peer support group at a federally supported HIV care center in a rural Southern (US) location alongside oral history interviews with queer-identifying Black men recorded in the same region. Geographies of care literature center trusting social relations in care provision. For the narrators, unchecked harmful social relations vis a vis stigma and disconnection from queer collectivity produce an 'uncaring landscape' in the geographic environment. The peer support group diverged from the stipulated context of HIV to offer space for queer collectivity and destigmatizing social care. The findings support a more radical, expansive provision of state-supported care for sexual minorities.

The toxic effects of subjective wellbeing and potential tonics

The paper offers a provocation to the geographies of health in relation to one of our governing concepts, that of wellbeing. The paper brings together government survey data from the United Kingdom with other published research into a critical argument that the dominant ways of conceptualising and practising subjective wellbeing have become toxic and harmful to wellbeing outcomes. The paper argues that a 'hyper-individualised and thwarted self' and 'supermarket model' of social resources for individual wellbeing underpins the contemporary dominant understanding of subjective wellbeing. This approach neglects wider spatial and temporal considerations such as inequality, inter-generationality and sustainability, and the rise of wellbeing as a technology of soft capitalism. The paper discusses the potential for relational approaches from the social sciences to provide a more 'wholesome tonic' to current understandings of subjective wellbeing that might rehabilitate its capability to do helpful rather than harmful work and argues for an ethical obligation to sustain critical engagement.

'None of my ancestors ever discussed this disease before!' How disease information shapes adaptive capacity of marginalised rural populations in India

Smallholder farmer and tribal communities are often characterised as marginalised and highly vulnerable to emerging zoonotic diseases due to their relatively poor access to healthcare, worse-off health outcomes, proximity to sources of disease risks, and their social and livelihood organisation. Yet, access to relevant and timely disease information that could strengthen their adaptive capacity remain challenging and poorly characterised in the empirical literature. This paper addresses this gap by exploring the role of disease information in shaping the adaptive capacity of smallholder farmer and tribal groups to Kyasanur Forest Disease (KFD), a tick-borne viral haemorrhagic fever. We carried out household surveys (n = 229) and in-depth interviews (n = 25) in two affected districts-Shimoga and Wayanad-in the Western Ghats region. Our findings suggest that, despite the generally limited awareness about KFD, access to disease information improved households' propensity to implement adaptation strategies relative to households that had no access to it. Of the variety of adaptation strategies implemented, vaccination, avoiding forest visits, wearing of protective clothing and footwear, application of dimethyl phthalate (DMP) oil and income diversification were identified by respondents as important adaptive measures during the outbreak seasons. Even so, we identified significant differences between individuals in exposure to disease information and its contribution to substantive adaptive action. Households reported several barriers to implement adaptation strategies including, lack of disease information, low efficacy of existing vaccine, distrust, religio-cultural sentiments, and livelihood concerns. We also found that informal information sharing presented a promising avenue from a health extension perspective albeit with trade-offs with potential distortion of the messages through misinformation and/or reporting bias. Altogether, our findings stress the importance of contextualising disease information and implementing interventions in a participatory way that sufficiently addresses the social determinants of health in order to bolster households' adaptive capacity to KFD and other neglected endemic zoonoses.

The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting

Background

There is limited understanding of the contribution made by older people and their caregivers to acute healthcare in the home and how this compares to hospital inpatient healthcare.

Objectives

To explore the work of older people and caregivers at the time of an acute health event, the interface with professionals in a hospital and hospital at home (HAH) and how their experiences relate to the principles underpinning comprehensive geriatric assessment (CGA).

Design

A qualitative interview study within a UK multi-site participant randomised trial of geriatrician-led admission avoidance HAH, compared with hospital inpatient care.

Methods

We conducted semi-structured interviews with 34 older people (15 had received HAH and 19 hospital care) alone or alongside caregivers (29 caregivers; 12 HAH, 17 hospital care), in three sites that recruited participants to a randomised trial, during 2017–2018. We used normalisation process theory to guide our analysis and interpretation of the data.

Results

Patients and caregivers described efforts to understand changes in health, interpret assessments and mitigate a lack of involvement in decisions. Practical work included managing risks, mobilising resources to meet health-related needs, and integrating the acute episode into longer-term strategies. Personal, relational and environmental factors facilitated or challenged adaptive capacity and ability to manage.

Conclusions

Patients and caregivers contributed to acute healthcare in both locations, often in parallel to healthcare providers. Our findings highlight an opportunity for CGA-guided services at the interface of acute and chronic condition management to facilitate personal, social and service strategies extending beyond an acute episode of healthcare.