Redefining agency in late life: the concept of ‘disponibility’

Stemming the "ageism pandemic": A qualitative inquiry with older adults in residential care facilities during the Covid-19 outbreak

The Covid-19 pandemic added to collective concerns, making health risks salient especially for the older population. The health emergency exacerbated an already widespread negative representation of aging, and phenomena such as ageism. With the present qualitative inquiry, 21 episodic interviews were collected with the aim of understanding the experience of older adults in residential care facilities, exploring their ideas of aging and the viewpoints that helped them to respond to the pandemic successfully. A thematic analysis was conducted using NudIst software. The results show that participants described multiple personal and relational resources they used to cope with the pandemic, and they were able to express counter-narratives to the ideas of aging as coinciding with decline, and of lockdown as a source of distress alone. The paper concludes with reflections on the relevance of research capable of challenging unhelpful dominant discourses and averting the risk of them turning into negative prophecies.

Maintaining autonomy: How older persons with chronic conditions and their significant others interpret, navigate, and overcome everyday difficulties

BACKGROUND

The vast majority of older adults live in their own homes. Many of them live with chronic conditions that lead to activity limitations and participation restrictions. To support them adequately, we need to better understand how they cope with everyday difficulties.

AIM

To identify and examine difficulties in everyday life older people with chronic conditions who live in private homes face and how they and their significant others interpret, navigate, and overcome these difficulties.

MATERIAL AND METHODS

We conducted a focus group interview with 10 participants including eight older adults with chronic conditions and two of their significant others. We then transcribed the interviews verbatim and thematically analysed them.

RESULTS

We generated the three closely interrelated themes struggling not to lose control, a shifting balance between resources and environmental challenges, and negotiating independence and interdependence. Participants interpreted the difficulties they faced as multicausal. Their main goal was maintaining autonomy, agency, and a positive identity. They employed individual, creative strategies to achieve these goals.

CONCLUSIONS

Older persons with chronic conditions prioritise autonomy and agency in order to maintain a positive identity.

SIGNIFICANCE

Interventions to support older persons with chronic conditions should centre their priorities and build on their creativity.

Understanding the subjective experiences of memory concern and MCI diagnosis: A scoping review

INTRODUCTION

Many older people experience memory concerns; a minority receive a diagnosis of Mild Cognitive Impairment (MCI) or Subjective Cognitive decline (SCD). There are concerns that medicalisation of MCI and memory concern may fail to acknowledge subjective experiences.

AIM

We explore the meaning individuals give to their memory concerns, with or without a diagnosis of MCI and SCD.

METHOD

We scoped literature exploring subjective experiences of memory concern, with or without a diagnosis of MCI or SCD. We searched CINAHL, PsycINFO and MEDLINE in March 2020, and updated in Sept 2021.We used (Arksey & O'Malley, 2005) framework to guide our scoping review method and thematic analysis to analyse our findings.

RESULTS

We screened 12,033 search results reviewing the full texts of 92 papers. We included 24 papers, including a total of 453 participants, the majority of whom were female, from White ethnic majority populations (or from studies where ethnicity was not identified) with high levels of education. In 15 out of 24 studies, 272 participants were diagnosed with MCI. We identified two themes; Making a diagnosis personal and Remembering not to forget. We found that subjective experiences include normative comparison with others of the same age and responses including fear, relief, and acceptance, but culminating in uncertainty.

CONCLUSION

Drawing upon sociology, we highlight the subjective experiences of living with memory concerns, SCD and an MCI diagnosis. We identify a gap between the intended purpose of diagnostic labels to bring understanding and certainty and the lived experiences of those ascribed them.

Economic inequality in later life and imagination of the future

The personal futures of older adults are continually in mind, motivating goals, desires and plans. People approach the near and long term with differing agentic traits and dispositions, and they face forward, as well, from differing standpoints according to socio-economic position. This is a study of how persons who are economically privileged diverge in their future thought from persons of modest means, asking how income level qualifies the capacity to imagine, and foresee affecting, the future. We draw upon interviews conducted with 42 older, community-dwelling individuals in the Midwestern United States of America, a sample that was partitioned into two groups, one with below-median incomes versus one with incomes above 200 per cent of median. Interviews disclosed various foci of future thought with common contents among the two groups. Three foci, however, confirmed between-group differences in confidence about handling possible material and support needs, and also in enacting idealised norms of retirement. The underlying theme of these foci – financial security, long-term supports and services, and trips and travel – was the perceived affordability of the future. We conclude that there is indeed a material basis for imagination of and proactivity toward the future. When paradigms about later life set expectations that idealise lifestyle choice, consumption and prudential preparation for the future, these are prospects towards which some can reach more readily than others.

The concept of disability and its causal mechanisms in older people over time from a theoretical perspective: a literature review

Ageing with a disability increases the risk of hospitalization and nursing home admission. Ageing in place interventions aiming to reduce disability are often not sufficiently effective and inadequately theory-based. There are many models available on disability, but it is unclear how they define disability, what their differences are, and how they evolved throughout the years. This paper aims to provide an overview of the evolution of these models and to elaborate on the causal mechanisms of disability. A literature review was conducted as part of the TRANS-SENIOR international training and research network. PubMed and Google Scholar were searched, and snowball sampling was applied to eligible publications. Data were extracted from the included publications, and a thematic analysis was performed on the retrieved data. Overall, 29 publications were included in the final sample. All included models arose from three original models and could be divided into two types: linear models and models on the interaction between the person and the environment. Thematic analysis led to three distinct evolutionary trends: (1) from a unidirectional linear path to a multidirectional nonlinear path, (2) from the consequences of disease towards the consequences of person-environment interaction, and (3) from disability towards health and functioning. Our findings suggest that by optimizing the use of personal as well as environmental resources, and focusing on health and functioning, rather than disability, an older person's independence and wellbeing can be improved, especially while performing meaningful daily activities in accordance with the person's needs and preferences.

Fears and freedoms: A qualitative analysis of older adults' basic psychological needs for autonomy, competence, relatedness and beneficence

OBJECTIVES

Self-determination theory posits three universal psychological needs: autonomy, competence and relatedness. Beneficence has recently been proposed as an important behaviour for improved well-being and eudaimonia. This study sought to qualitatively examine older adults' experiences of basic psychological needs satisfaction and frustration.

METHODS

Three separate and simultaneous national online focus groups were undertaken over four consecutive days. Older Australians (n =103) explored home and community life. Themes were identified using reflexive thematic analysis.

RESULTS

Older adults are challenged in satisfying their psychological needs, especially around the time - and after- they retire and as mobility decreases. Beneficence emerged as important for well-being, congruent with evidence that beneficence influences well-being beyond basic psychological need fulfilment.

CONCLUSIONS

Satisfactions and frustration may manifest differently for older adults than for other groups. Thus, their experiences may not adequately be captured by self-report measures. Novel themes of 'fears and freedoms' were identified in the study. Fear pertained to the loss of autonomy and the freedom to spend time as one wishes.

Bearing the Burdens we (don’t Tend to) Bare

The burdens of older life, during what Peter Laslett calls the fourth-age, exaggerate feelings of fear and desire while resourcing despair. Some such burdens are borne from human corporeality. Others are socially constructed and afflict older persons further. A typology of burdens is introduced, identifying reflexive, transitive, and accusative burdens. The reflexive dirge of the person grieving their losses of competence, self-sufficiency, and independence includes a transitive counterpart, where a person’s self-perceived burden includes also the sense that one has become a burden to others. The accusative burden is experienced when persons are marked by others, catastrophically, as a burden. Regardless, these burdens must be given attention while attending to the ideations that prioritise independence but risk despair. Thus the relation between burdened self-image, despair, and late modern and policy preoccupations with independence will further focus such attention. Specifically, the prominence of independence in narratives of successful ageing will be interrogated, while inviting theological reflection on the reality of dependence and the nature of bodily life, together. That the Christian theological tradition teaches that human beings are bodies and are mutually dependent presses back against dogmas that prioritise independence and other icons of discrete subjectivity. Pointing toward Dietrich Bonhoeffer’s understanding of vicarious representative action, the reader is invited to consider again the kind of language in policy and for practice that might humanise persons in exchanges of responsible care(giving) and mutual dependence throughout the life course.

Membership, Neighborhood Social Identification, Well-Being, and Health for the Elderly in Chile

The world’s elderly population is growing, and in Chile they represent 16.2% of the total population. In Chile, old age is marked by retirement, with a dramatic decrease in income that brings precariousness. Older adults are economically, socially, and psychologically vulnerable populations. This condition increases their likelihood of disengaging from their usual social environment, facilitating their isolation, sadness, and discomfort. From the perspective of social identity, well-being (WB) can be explained by two principles: social groups’ importance for health and people’s psychological identification with those groups. This study analyzes the relationships between belonging to the neighborhood and extra-neighborhood groups and neighborhood social identification with WB. Urban or rural location and gender are measured, and the sample is 1,475 older Chilean adults of both sexes. The results show that the majority are not members of social groups (52%), and the remaining 48% are members of one or two groups or organizations (42.65%). Only 4.47% belong to three groups or organizations. Those who belong to groups obtain higher scores, emotional–mental WB, and positive emotions than older adults who do not belong to any organization. Urban and rural older adults have the same level of WB. Membership in close social organizations (neighborhood councils) or distant ones (clubs for the elderly and religious groups) causes different WB associations. Membership in neighborhood councils reduces gender differences in self-assessment of health. This result supports the idea that participation in heterogeneous groups with a shared sense of belonging to the neighborhood is associated with higher WB and lower perceived loneliness. Social identification with the neighborhood, rather than belonging to the group, had the most widespread impact on WB and health indicators. The variable social identification with the neighborhood was consistently associated with indicators of hedonic WB.

Navigating care in rural areas: Strategies employed by older adults with continuing care needs and their impact on social exclusion

The literature recognizes the great diversity of care arrangements among rural-dwelling older people. However, little is known about the complex relationships between spatial, social and infrastructural characteristics of place and the strategies that older people develop to navigate care. Even less is known about how navigating care impacts social exclusion from the perspective of older adults themselves. To fill this gap, in this secondary analysis we draw on data from twenty-one in-depth interviews from two studies conducted in rural environments in Germany and Poland. We identify three main strategies of navigating care in the rural environment: adaptation to circumstances, making use of the environment, and shaping circumstances. We present details from four cases that exemplify how strategies are interconnected with characteristics of place. The relationships between place and navigating care in rural environments is discussed with reference to the overall level of social exclusion experienced by rural-dwelling older adults with continuing care needs.