Social inclusion through ageing-in-place with care?

Experiences of Older People and Social Inclusion in Relation to Smart "Age-Friendly" Cities: A Case Study of Chongqing, China

Whilst cities can be sites of creativity, innovation, and change, they can also reproduce the conditions for the exclusion of vulnerable groups. Older people report experiencing specific barriers to accessing the city and are often excluded from the resources for ageing well. The smart city agenda has attempted to bring about technological change whilst also delivering improved quality of life for urban citizens. Smart technologies are a key element of the smart city and are viewed as having the potential to support the independence, autonomy, and well-being of older people. Yet, there has been little research exploring the role of the smart city in supporting the social inclusion of older people, nor any attempt to link this with key policy drivers on ageing e.g., age-friendly cities and communities. In response, the aim of this paper is to explore the experiences of older people living in a smart city in China and discuss how the smart city and age-friendly agenda can be brought together to support positive social outcomes for older people. The paper presents qualitative findings from a multi-methods approach, including semi-structured interviews, walking interviews and focus groups. A total of 64 older people participated in the research across three diverse neighbourhoods in the case study smart city of Chongqing, China. The findings identified opportunities in the development and deployment of smart city, including the potential for improved health and well-being and social connectedness. Yet in delivering on these benefits, a number of challenges were identified which may widen social inequalities, including inequities in access, issues of safety and security, and exclusion from the co-production of smart city policy and practise. The paper discusses the implications of the findings for future smart city policy and practise, specifically in delivering interventions that support older adults' social inclusion and the delivery of age-friendly cities and communities.

The impact of community care services on the preference for ageing in place in urban China

This paper examines the relationship between community care services and ageing in place in urban China. Using data from the 2010 Sample Survey on Aged Population in Urban/Rural China, and within the framework of a revised version of Andersen's model, the paper applies multilevel models and analyses the effects of community care on the preference between ageing in place and institutional care, and reveals that ageing in place is preferred even in urban China. However, the existence of community care services had no significant effect on the preference for ageing in place. The paper concludes by arguing that China needs to develop its community care services and promote the idea of community care in both culture and policy. Realising ageing in place also requires a multidisciplinary approach. A model of shared care, between family and state, is particularly appropriate for China.

Creating a Social Learning Environment for and by Older Adults in the Use and Adoption of Smartphone Technology to Age in Place

Smartphone technologies can support older adults in their daily lives as they age in place at home. However, they may struggle to use these technologies which impacts acceptance, adoption, and sustainable use. Peer to peer community learning has the potential to support older adults to learn using (smartphone) technologies. This paper studies such a learning community approach and how it can support older adults to learn using and adopt the smartphone application GoLivePhone. This technology assists older adults in their daily living by supporting them through fall detection and activity tracking. In particular, the interface of this application can evolve and adapt as older adults become more knowledgeable during the use process or as their abilities change. This paper shows a field study with seven older adults learning and using the GoLivePhone technology through a living lab approach. These older adults participated in this research in a technology learning community that was set-up for research purposes. For this we used ordinary Samsung A3 smartphones with the simplified GoLivePhone software, particularly designed for older adults. At the end of the learning class we conducted an additional focus group to both explore factors facilitating older adults to learn using this technology and to identify their main personal drivers and motivators to start and adopt this technology. We collected qualitative data via open questions and audio recording during the focus group. This collected data was subject to a thematic analysis, coding was primarily performed by the first author, and reviewed by the other authors. We provide insights into how peer to peer community learning can contribute, and found both super-users and recall tools to be helpful to support sustainable use of smartphone technology to support older adults to age in place.

Older adults' experiences and perceptions of living with Bomy, an assistive dailycare robot: a qualitative study

An aging global population and preference for aging-in-place pose the opportunity for home-based robots to assist older adults with their daily routines. However, there is limited research into the experiences of older adults using robots in their own homes. In this descriptive qualitative feasibility study, older self-supporting and community-dwelling adults with various age-related health needs used Bomy, a dailycare robot in their homes for up to one week. The study explored the usefulness of the robot and participants' perceptions and experiences of using it. Bomy reminded them of daily activities and delivered cognitive stimulation games. Semi-structured in-person interviews were conducted, and data were analyzed thematically. Findings revealed an acceptance toward robots and the value of assistive dailycare robots. Participants perceived Bomy as a companion and made suggestions for improvement, including resolving technical issues associated with long-term use. Future functions should be personalizable, to accommodate each user's health needs and could also include smoke detection and reading aloud functions. Dailycare robots show promising potential in elderly care, especially in providing reminders for medication, health and wellbeing. This study highlights the importance of co-design and testing robotics in the environments for which they have been developed. Widespread implementation of Bomy might be feasible in the future, with some further adjustments.

Exploring patient-centered aspects of home care communication: a cross-sectional study

Background

Communication is a cornerstone in nursing and aims at both information exchange and relationship building. To date, little is known about the naturally occurring communication between older persons and nurses in home care. Communication might heal through different pathways and a patient- or person-centered communication could be important for health and well-being of older persons. However, the delivery of individualized home care is challenged by routines and organizational demands such as time constraints. Therefore, the aim of this study was to explore the patient-centered aspects of home care communication between older persons and registered nurses.

Methods

In total 37 older persons (aged 65 years or older) and eleven RNs participated in 50 audio-recorded home care visits. Roter Interaction Analysis System (RIAS) was used to code verbal communication. A ratio from these codes, establishing the degree of patient-centeredness, was analyzed using a Generalized Linear Mixed Model.

Results

The present home care communication contained more socio-emotional than task-oriented communication and the emotional tone was largely positive. The global affect ratings reflected an overall positive tone (m = 39.88, sd = 7.65), with higher ratings on dimensions of, for example, responsiveness/engagement and interactivity or interest were more frequent than those that may be considered as less-positive emotions (m = 15.56, sd = 3.91), e.g. hurried, dominance or anger. The ratio of the degree of patient-centered communication in the home care visits was an average of 1.53, revealing that the communication could be considered as patient-centered. The length of the visits was the only characteristic significantly associated with the degree of patient-centeredness in the communication, with a peak in patient-centeredness in visits 8–9 min long. Sex, age or procedural focus showed no significant effects on the degree of patient-centeredness.

Conclusion

Overall, the degree of patient-centeredness and a positive emotional tone, which might have a positive outcome on older persons’ health, was high. Longer visits provided a higher degree of patient-centeredness, but no linear increase in patient-centeredness due to length of visit could be observed. The findings can be used for education and training of nurses, and for providing individualized care, e.g. patient- or person-centered care.

“Circles of support”: social isolation, targeted assistance, and the value of “ageing in place” for older people

Purpose

This study aims to explore the experiences of older people “ageing in place”, focussing on the implementation of “Circles of Support”, a pilot intervention aimed at mitigating the risk of hospitalisation amongst socially-isolated older people.

Design/methodology/approach

The study draws on qualitative research, taking in semi-structured interviews with participants in the intervention and with community networkers involved in delivering the programme.

Findings

The research provides indicative findings supporting the idea that social isolation is linked to health issues amongst older people. It also suggests that targeted interventions can go some way to mitigating this problem. The findings presented here also indicate the importance of a deeper understanding of the lived experiences of socially-isolated older people in designing and delivering interventions.

Originality/value

The study contribution is in three areas. It presents findings based on the pilot programme relating to the experiences of older people at risk of social isolation and provides an indication of the value of interventions aimed at tackling social isolation, connecting these to the risk of hospitalisation.

Time to care? Temporal variations of agency of the Finnish adult foster carers

This article analyses a hybrid form of housing and care service for older people called adult foster care. In Finnish adult foster care model, an older person moves to a foster care home and is cared for by a semi-professional foster carer who is not related to them. A foster care home is thus simultaneously a personal dwelling and a site of intensive care work which also changes the rhythms and routines of both the foster carer and older person. In the article I ask, how do foster carers express their temporal agency and its variations (identity, pragmatic, life course) through time work? By temporal agency I mean individuals' ability to impact on their experience of time, which is done through time work. The article is based on 12 thematic interviews that were analysed using thematic content analysis. The analysis shows that as a resource, time itself was the most valued aspect of foster care work. Being a foster carer was in fact a way of resisting clock-driven, institutional-like care work. The foster carers were able to exercise their professional identity agency, that is, act like 'a good carer' should act, but they found it difficult to allocate time for themselves and to their families. This can. endanger their well-being and the continuity of foster care relationship. In order to develop the adult foster care scheme to a real housing and care option for older people and a tenable work option for potential foster carers, several issues should be carefully considered. To ensure foster carers' well-being, their statutory right to days-off should be increased, and the support and substitute system should be enhanced so that foster carers can allocate more time for themselves and their families, even when this would mean more costs to the municipalities. Also, older people in need of care should be placed to foster care much earlier.

The temporal aspects of mobility intentions: older people's reflections on present and future support arrangements

Discourses on later-life housing and care are polarised. Ageing in place – typically in one's long-term dwelling – is often presented as the most desirable living arrangement, while moving to a congregate environment tends to be regarded as a last resort. Such polarised discourses obscure older people's experiences as they contemplate needs for housing, health and social care. To expand current understandings of mobility intentions, this paper examines ‘time work’ – or actions undertaken to exert some agency over time – as older people with chronic health conditions and disabilities navigate present and future support arrangements. Based on an interpretive analysis of qualitative interviews with 22 older persons receiving home care in Ontario, Canada, I identify three themes that highlight the temporal aspects of mobility intentions: (a) maintaining continuity with the past and present, (b) constructing alternative futures and (c) facing precarity. Focusing on time work shows how people make sense of ageing in place and/or relocating not only in relation to their physical, social and psychological capacities, but also in relation to perceptions of the past, present and future. Time work, moreover, has implications for feelings of security in the present and a sense of control over the future. Based on these findings, I make suggestions for developing a comprehensive continuum of supports, so all older people can make meaningful choices concerning housing and care.

Ageing in extra-care housing: preparation, persistence and self-management at the boundary between the third and fourth age

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.

Assisted living facilities as sites of encounter: implications for older adults’ experiences of inclusion and exclusion

Most of the existing literature on inclusion and exclusion among older adults focuses on community-dwelling individuals. In this article, we draw on the results of a comparative case study to explore how older adults in two assisted living settings experience inclusion and exclusion. One site was a low-income facility and the other a higher-end facility in a mid-sized Canadian city. Bridging together geographies of encounter and gerontological approaches on social inclusion, we analyse interviews with tenants and key informants to explore when, where and in what ways these groups experience inclusion and exclusion in these particular settings. Tenants’ narratives reveal how their encounters, and in turn their experiences of exclusion and inclusion are shaped by experiences throughout their lifecourse, the organisation of assisted living spaces, communities beyond the facility, and pervasive discourses of ageism and ‘dementiaism’. We argue that addressing experiences of exclusion for older adults within these settings involves making more time and space for positive encounters and addressing pervasive discourses around ageism and ‘dementiaism’ among tenants and staff.

Living on the Edge: Social Exclusion and the Receipt of Informal Care in Older People

Older people have been identified as being at risk of social exclusion. However, despite the fact that care is commonly required in later life and the majority of that care is provided by informal carers, a connection between social exclusion and informal care-receipt has rarely been considered. The aim of this study was to examine how informal care-receipt is related to social exclusion. A face-to-face questionnaire survey on social exclusion and informal care-receipt was carried out among older people (n = 1255) living in Barnsley, United Kingdom. Multivariable analyses examined the association between social exclusion and categories of informal care-receipt: care-receiver; assurance-receiver; nonreceiver with no need; and nonreceiver with need. Compared to being a nonreceiver with no need, participants were more likely to be care-receivers or assurance-receivers if they had higher levels of social exclusion. The highest level of social exclusion, however, was found in nonreceivers with need. Despite a lack of informal care and support, formal practical support and personal care were also low in this latter group. Findings are discussed in relation to the conceptualisation of care-receipt and how contact with medical services could be an opportunity for identification and appropriate referral of nonreceivers with need.

Feeling in control: comparing older people's experiences in different care settings

The promotion of choice and control for older people is a policy priority for social care services in the United Kingdom and is at the heart of recent drives to personalise services. Increasingly, we are seeing a move away from institutionalised care (e.g. in care homes) towards enablement, with more services being delivered in community-based settings. Extra care housing has been promoted as a purpose-built, community-based alternative to residential care for older people. However, whilst accounts of users' experiences in particular service types are plentiful, the use of different instrumentation and measures makes comparison between settings difficult. We combined data from four studies where participants were older people either living in care homes or extra care housing or receiving care at home. All of these studies asked participants to rate their control over daily life, using the Adult Social Care Outcomes Toolkit (ASCOT). This paper presents the results of an ordinal logistic regression analysis indicating that, after controlling for differences in age, ability to perform activities of daily living and self-rated health, setting had a significant effect on older people's sense of control. Residents in care homes and extra care housing report similar levels of control over daily life but consistently report feeling more in control than older people receiving care at home. Implications for policy and practice are discussed.

Aerobic Activity Preferences among Older Canadians: A Time Use Perspective

Numerous health benefits are associated with a physically active population. This study sought to discover the aerobic activity preferences among older Canadians. Four cycles of nationally representative time use data were fused with energy expenditure information to determine both participation rates and time spent in the 10 most frequently reported aerobic activities. Aerobic activity preferences are dominated by domestic chores (15% to 30% participation for about two hours per day), recreational walking (15% to 30% participation for about one hour per day), and active transportation (generally less than 5% participation for less than 30 minutes per day). Although there have been several changes in older Canadians’ revealed preferences for aerobic activities over the past three decades, the prevalence of domestic chores points towards the importance of policies that support older Canadians remaining in their homes, whereas the popularity of walking suggests that “walkability” needs to be considered in neighbourhood design.

Moving beyond ‘ageing in place’: older people's dislikes about their home and neighbourhood environments as a motive for wishing to move

Ageing in place has been promoted by policy makers as the optimal residential solution for later life, premised on older people's reluctance to contemplate relocation, their declining residential mobility and high levels of residential satisfaction. This paper takes a critical perspective to the notion of ageing in place by examining older people's dislikes about, rather than levels of satisfaction with their home and neighbourhood environments, and establishing whether such dislikes influence a desire to move. Analysis of the 2004 Living in Wales Survey shows that despite high levels of residential satisfaction, a significant proportion of older people do wish to move. Logistic regression results indicate this desire is strongly associated with dislikes about their immediate home environment, more than neighbourhood factors. Contemplating a move in later life may be shaped more by a desire to ‘attach’ to people, than to remain in situ to preserve an attachment to place.

Social inclusion in an ageing world: introduction to the special issue

This paper provides an introduction to a special issue focusing on diverse examples of policy practice in social inclusion and ageing across different regions of the world. These examples illustrate the multifaceted nature of the concept of social inclusion, and how it is applied in the context of global demographic ageing. The paper begins with an exploration of the history and development of the concept of social inclusion, as applied to ageing policy, and how the concept has emerged following its initial association with economic disadvantage. Now commonly defined as relating to social participation in key activities of the society in which people live, a social inclusionary approach highlights the risks of social exclusion and isolation faced by older people. Social inclusion thus incorporates core issues in ageing such as civil engagement, an ageing workforce, age-friendly communities, and civic involvement. There are some particular challenges to implementing social inclusion policies within the current environment, which are addressed within this special issue, and these include the impact of social and cultural change, particularly across some of the East Asian countries, and the impact of global financial crises on work and retirement.