Active and non-active agents: residents’ agency in assisted living

Ageing with Parkinson's: Identification of Personal Needs in the Northern Spanish Context

As individuals diagnosed with Parkinson's disease enter older age, the myriad challenges and complications associated with this condition tend to escalate. Hence, there is a critical necessity to comprehensively discern the perceived needs of these individuals, along with their proposed remedies and essential support requisites. Additionally, understanding the perspectives of their families becomes imperative to formulate tailored interventions aimed at enhancing their overall development, progression, and quality of life. The study's main objective is to assess the perceived needs of individuals with PD and their family members, propose necessary solutions, and suggest future perspectives. The study encompassed a cohort of 268 participants, comprising 179 individuals diagnosed with Parkinson's disease and 89 of their relatives. A meticulously designed structured interview instrument consisting of 93 items was employed to assess various domains encompassing perceived needs, institutional support mechanisms, essential solutions, and future anticipations. Results: Statistically significant differences were found in health resources, social services resources, obstacles, solutions, and future outlook, with higher mean values from the relatives. Conclusions: The results highlight the most concerning needs in this context. Specifically, those needs related to health resources, social services resources, and future outlook present the greatest differences between the two subsamples, with the family members perceiving more needs. This alignment extended to both the categorization of unmet needs and the requisite solutions envisioned to address them. Suggested improvements include a sociosanitary strategy, stakeholder involvement, and prioritizing flexible home assistance to support older individuals with PD and their families.

Accessing a "bounded space": An ethnographic map of a residential care home for old persons during COVID-19

Taking place in a residential care setting in England during COVID-19, this ethnographic study offers a closer look at residents' experiences of residential care, with particular focus on dignity and wellbeing. Viewing experiences of well-being as embedded within interpersonal negotiations, the study turns to experience and stories to reveal complexities and contradictions in this taken-for-granted space. However, the timeline and design for this project has been greatly impacted by COVID-19. In exploring the design of this study and its 'journey' toward the field, the following article takes a critical view in order to view the impacts that 'bounded' and protected care settings may have on the agency and rights of older adult research participants. In this article, I also consider some of the complex ethical issues of conducting qualitative research during a time when older adults are being denied personal visitors, which can further 'bound' the care home space. The article offers timely insight on issues of agency and voice when working with a 'protected population' during a time which highlights the vulnerability of old adults.

Broadening and deepening the understanding of agency in dementia

Agency has become an essential component of discussions concerning selfhood, well-being, and care in dementia studies but the concept itself is rarely clearly defined and the use of this term can be confusing and conflicting. This paper outlines some of the key ways in which agency has been conceptualised in relation to dementia, highlighting the complexities surrounding this concept and focusing on agency in a way that is tied to our ideas about citizenship, legal and human rights. Seven key dimensions of agency are examined: embodiment, emotions, sense of agency, intentional conscious action, the social context of agency, decision-making and moral responsibility. Using a critical realist approach, this paper brings together the diverse ways in which agency has been understood into an interdisciplinary, laminated understanding of agency. This model is then used in an applied example demonstrating that this model can be used to identify the ways in which an arts intervention can support the agency of people living with dementia. This paper proposes that agency is layered, multidimensional and exists on a continuum.

Existential well-being for the oldest old in nursing homes: a meta-ethnography

Ideas of well-being in old age are often anchored in the successful ageing paradigm, foregrounding independence, activeness and autonomy. However, for those oldest old living in nursing homes, these goals are largely out of reach. In this article, we use the meta-ethnographic method to explore and reinterpret existing findings on the ways in which well-being is experienced (or not) by the oldest old in institutional care settings. We frame our findings in existential well-being theory, which understands wellbeing as a sense of ‘dwelling-mobility’. Our analysis resulted in the following themes: (a) institutionalisation as both restrictive and liberating; (b) reciprocity and mattering: the importance of being seen; (c) the need for kinship and the problem of ruptured sociality; (d) rethinking agency: situated, delegated and supported; and (e) lowered expectations: receiving care is not a passive act. We conclude that while institutional care environments are not always conducive to well-being, this does not have to be so. By shifting our focus from successful ageing ideals onto relationally situated care practices, a possibility for existential well-being opens up, even in situations of decline and care dependency.

Deconstructing agency in the G20 leaders' declarations in the last decade: A corpus-assisted discourse study

Investigating agency has become a pivotal issue in discourse studies, especially organizational discourse. This study aims to identify the controlling agency (who/what) behind G20 leaders' declarations in the last decade and how such agency is constructed. To this end, this study offers a concise examination of relevant literature investigating fundamental concepts like discourse and agency in light of the overlapping relationship between form and function in language studies. Further, an eclectic methodological approach has been devised to arrive at a multi-leveled analysis. Two stages of analysis were designed. First, a corpus of the declarations between 2012 and 2021 was created and analyzed using #LancsBox v.6.x. and Wmatrix. At this stage, we was established as a prime agent in the corpus and proven to collocate heavily with agentive speech acts. One sample declaration, Riyadh 2020, was used for minute discourse analysis in the second stage. Inspired by transitivity system, process type analysis, and multivalence frameworks, this stage revealed the profound presence of non-human agency alongside the human one. Nevertheless, further examination demonstrated that this sample still constrains non-human agency due to semantic and textual constraints.

Structure and agency attributes of residents' use of dining space during mealtimes in care homes for older people

Research stresses that mealtimes in care homes for older people are vital social events in residents' lives. Mealtimes have great importance for residents as they provide a sense of normality, reinforce individuals' identities and orientate their routines. This ethnographic study aimed to understand residents' use of dining spaces during mealtimes, specifically examining residents' table assignment processes. Data were collected in summer 2015 in three care homes located in England. The research settings looked after residents aged 65+, each having a distinct profile: a nursing home, a residential home for older people and a residential home for those with advanced dementia. Analyses revealed a two-stage table assignment process: 1. Allocation - where staff exert control by determining residents' seating. Allocation is inherently part of the care provided by the homes and reflects the structural element of living in an institution. This study identified three strategies for allocation adopted by the staff: (a) personal compatibilities; (b) according to gender and (c) 'continual allocation'. 2. Appropriation - it consists of residents routinely and willingly occupying the same space in the dining room. Appropriation helps residents to create and maintain their daily routines and it is an expression of their agency. The findings demonstrate the mechanisms of residents' table assignment and its importance for their routines, contributing towards a potentially more self-fulfilling life. These findings have implications for policy and care practices in residential and nursing homes.

Time- and place-dependent experiences of loneliness in assisted living facilities

The purpose of the study is to explore feelings of loneliness among residents in assisted living facilities in terms of how loneliness is experienced and articulated, and what specific factors are related to the experiences. The study used a mixed-method approach. We individually interviewed 13 residents twice over six months. We conducted two focus group interviews and noted our observations each time we met the respondents. Data analysis leaned on abductive reasoning. The respondents described loneliness in versatile, rich ways. It proved to be time and place dependent. It was dependent on the time of day, days of the week and seasons. Lonely time was meaningless and filled with a feeling of waiting. Loneliness was also intertwined with place. None of the respondents called their apartment home; instead they called it a hospital, even a prison. They had to spend long periods of time in their apartments against their will, and their desire to interact with other residents was not met. The respondents felt invisible. Residents’ experiences of loneliness in assisted living facilities are unique and distinctive. Time- and place-dependent experiences of loneliness act as important signals for reflection on how care practices in these facilities could be more satisfying. Loneliness should therefore be a key topic and the target of prevention and interventions.

Older people nursing in care homes: An examination of nursing professionals' self-assessed competence and its predictors

BACKGROUND

The need for older people nursing expertise is increasing, and every effort is required to ensure that personnel taking care of older people are capable of providing high-quality care.

AIMS

To explore care home nursing professionals' self-rated competence in older people nursing and to identify predictors of this competence.

DESIGN

A cross-sectional survey design.

METHOD

Data were collected in August-September 2017 via an electronic questionnaire using the newly developed Nurse Competence in Care Home Scale (NCCHS). Participants (n = 781) were recruited via nurses' associations and social media. They were working in care homes either as licensed practical nurses (n = 680) or as registered nurse and/or in managerial position (n = 101).

FINDINGS

Approximately 65% of the respondents had "adequate competence," and 35% had "inadequate competence" in older people nursing based on self-assessed overall competence. Respondents rated their competence highest in "observation, communication, interaction" and lowest in "group guidance and activities" subscale. Age and further training were predictors of licensed practical nurses' competence, and length of work experience predicted registered nurses' competence.

CONCLUSIONS

Self-assessments revealed the need for competence development especially in relation to holistic support of a person's well-being. It is recommended that care home nurses, managers, educators and curriculum developers all strive to develop care home staff's ability to support residents' well-being holistically.

IMPLICATIONS FOR PRACTICE

Nursing personnel should consider all aspects of older people's well-being holistically. In care homes, it is essential to assess nursing staff competence and to provide possibilities for competence development for personnel.