Freedom and imperative: mutual care between older spouses with physical disabilities

Curating 'the good story': Care as representative performance in Danish veteran rehabilitation

In this article, we explore the intricacies of veteran care and show how care practices come to incorporate veterans' 'self-performances' to raise political attention and funding for future rehabilitation activities. By bringing into dialogue theories of care and theories of performance and representation, we illustrate how a seemingly classic form of care-veteran rehabilitation-takes the form of representative performance. Drawing on ethnographic fieldwork and interviews with the Danish Invictus Games team, we demonstrate how politics, research and TV documentaries are integrated into veteran care practices. Through this integration, mentally wounded veterans, while performing 'themselves' for shifting audiences with shifting agendas, come to assume the roles of both caregivers and care receivers. Crucially, we highlight that wounded veterans, while undertaking their personal rehabilitation journey, are curated into and (un)willingly positioned as representatives of others. By showing how caring for wounded veterans goes hand in hand with caring for fictive, future wounded veterans and for political, research and media agendas, this article offers new ways of thinking of and with care.

Research on innovative design of community mutual aid elderly care service platform based on Kano model

The mutual aid elderly care model is important to solve the world population's current aging problem. However, although mutual aid elderly care has been developing in China for more than 20 years, there is still a lack of a systematic way to participate in mutual aid elderly care services, which has led to a slow development of mutual aid elderly care. Therefore, in order to promote the development of mutual aid elderly care and the transition of social elderly care towards sustainability, this study analyzes the actual elderly care service needs and proposes new design strategies for mutual aid elderly care service platforms. In this study, first, the actual elderly care needs were obtained through interview methods and offline questionnaire surveys. The results showed that the elderly have a high demand for health, daily life, entertainment, and spiritual needs, which can be used to establish a comprehensive Kano model. Based on the priority of the needs hierarchy, mutual aid elderly care resources can be allocated rationally. For example, when applying the research results to the design of mutual aid elderly care service platforms, the "Must-be quality" is first satisfied, followed by the "One-dimensional quality" and the "Attractive quality" according to the actual situation. Furthermore, the mutual aid elderly care service platform is divided into a basic version and a professional version to promote the actual needs of different groups of elderly people. In conclusion, the study aims to promote the development of mutual aid elderly care and the transition of social elderly care towards sustainability. The research value of this study lies in its potential to alleviate the slow development of the current mutual aid elderly care model in China and provide a reference for solving the problem of global aging population.

Longing for normalcy in couple relationships: How chronic illness and care dependency change the relationship of long-married couples

Introduction

Coping with chronic illness and care dependency in a marital dyad challenges many older couples. In our qualitative research study, we are interested in how long-married spouses in Germany experience their couple relationship while dealing with long-term care and adapting everyday life to the care situation.

Methods

We conducted problem-centered interviews with 17 spouses according to the interpretive-reconstructive documentary method.

Results

We derived four thematic areas: (1) partner(ship) disappears behind the disease; (2) partners struggle with changing tasks and roles; (3) caring partners mourn the loss of intimacy; and (4) partners strive to rebalance the partnership.

Discussion

When chronic illness and care dependency enter couples' lives, the self-image as husband or wife is affected. Primary health care professionals should be sensitive to the specific constellation of care in couple relationships and recognize the significance of this dyadic relationship as living in a satisfying couple relationship is essential for the health and wellbeing of both partners.

Caregiving Role and Psychosocial and Individual Factors: A Systematic Review

Taking care of a person with a physical disability can become a challenge for caregivers as they must combine the task of caring with their personal and daily needs. The aim of this study was to assess the impact that taking care of a person who needs support has on caregivers and to analyze certain characteristics they present, such as self-esteem and resilience. To that end, a bibliographic review was carried out from 1985, when the first article of taking care of a person who needs support was published, to 2020 (inclusive), in the databases of Web of Science (WoS), Scopus, Pubmed, Eric, Psycinfo, and Embase. The search yielded a total of (n = 37) articles subject to review, following the guidelines established in the PRISMA declaration. The results show that caregiving was highly overburdening and negatively affected the physical condition and the psychological and mental states of caregivers. In addition, certain psychological characteristics present in caregivers such as having high self-esteem and being resilient were found to act as protective factors against the caregiving burden.

Within-couple dissimilarities in functional impairment as determinants of spousal care arrangement among older married couples

Existing research on spousal care focuses on one spouse receiving care from the other, which fails to address the complexity that is created when both spouses experience some impairments. Our study included situations in which one or both spouses have functional impairments when examining the extent to which spouses from the same couple hold a (dis)similar level of functional impairment and whether such within-couple (dis)similarity has an impact on the spousal care arrangement. A subsample of 1170 older married couples was selected from the 2014 Health and Retirement Study. Descriptive statistics were used for describing the level of each spouse's functional impairment regarding the number of limitations in activities (activities of daily living [ADL]) or instrumental ADL (IADL). Logistic regressions were used to examine whether spousal dissimilarity in functional impairment (dissimilar, similarly low, similarly high) was associated with spousal care arrangement. Within couples with one functionally impaired spouse, the impaired spouse was more likely to receive spousal care when reporting a higher level of ADL/IADL impairment. Within couples with two functionally impaired spouses, the more impaired person was more likely to receive spousal care (without giving back) when spouses reported dissimilar level of IADL impairment; spouses were more likely to report mutual care when they had similarly high levels of IADL impairment. By documenting the role of spousal dissimilarities in functioning for determining spousal care arrangement, our study can inform couple-based interventions that capitalize on each spouse's capabilities and resources.

Me and You in Caregivinghood - Dyadic resistance resources and deficits out of the informal caregiver's perspective

Objective: To present Specific and Generalized Resistance Resources (SRRs/GRRs) and Deficits (SRDs/GRDs) described by 32 informal caregivers as originating from themselves and their older adult carerecipients as dyads. Method: Salutogenic interviewing was used to assemble data from caregivers. A theory-driven, memo-guided and comparative analysis using within- and across- case analysis was applied to unravel resources and deficits influencing the outcomes when they managed tension associated with caregiving. Findings:Living in fellowship in a well-functioning dyad unites the essence of having access to dyadic SRRs/GRRs. Such access enables dyads to use their specific dyadic tension management to resolve challenges through cooperation, derives 'positive' life-experiences and preserves dyad functioning. Struggling alone in a malfunctioning dyad indicates the presence of dyadic SRDs/GRDs counteracting such a development. If these SRDs/GRDs accumulate, the dyad become less able to resolve challenges, 'negative' life-experiences accumulates, the carerecipient's capability to cooperate decreases, caregiver's workload increases, the dyad becomes increasingly malfunctioning and moves towards the point where caregiving ends due to lack of usable SRRs/GRRs. Conclusions: Findings reveals the complex duality of caregiving and the necessity to assess all available SRRs/GRRs and SRDs/GRDs for caregiving dyads, including out of the carerecipient's perspective. Appropriate 'salutogenic' support reduces SRDs/GRDs, makes available SRRs/GRRs usable or provides alternative SRRs/GRRs, thereby dyadic tension management and dyadic functionality is preserved during this phase of life labelled Caregivinghood. The study adds new knowledge to the salutogenic framework regarding central, theoretical concepts and suggests how data for health promoting initiatives conducted the 'salutogenic way' may be acquired.

Health Promotion Practices in Nursing for Elderly Persons in Municipal Home Care: An Integrative Literature Review

Elderly patients sometimes seek emergency services unnecessarily. Emergency clinics can be detrimental to the elderly. The purpose of this study was to find health promotion practices that enable a registered nurse in community health to reduce the need for home care clients to seek emergency care. The method of integrative literature review was used. Through health promotion work in the home, the registered nurses in community health (in conjunction with other professionals) can strengthen patients’ self-esteem and reduce their emergency care visits. Patient involvement is part of this work, and the registered nurses in community health needs to get to know patients to learn their health needs, design individual care plans, and find out whether they need education about their own health and/or health care services available to them. Registered nurses in community health experience difficulties in performing health promotion because they perceive that other tasks have higher priority.

Reporting adverse events-Swedish Registered Nurses experience in a municipal home care context

AIM

To describe how Registered Nurses in a municipal home care context experience adverse event reports.

DESIGN

A qualitative design was used.

METHOD

Twelve semistructured individual interviews with Registered Nurses in a municipal home care context were collected on two occasions and analysed with qualitative content analysis.

RESULTS

The results show that conflicts exist between being able to trust the managers and their feedback, being loyal to colleagues and retaining professional pride. These are described in the theme "Contradiction" and the three categories: "Awareness"; "Uncertainty"; and "Concealment."

"Being in-Between": Spouses That Cohabit With and Provide Care for Their Partners in Nursing Homes

It is increasingly possible for couples with differing care needs to move to nursing homes together. To our knowledge, this is the first study about spousal caregiving in this context. This study explores spouse and staff experiences when relatively healthy spouses cohabit with and provide care to their partners in Swedish nursing homes. The overarching theme, "being in-between," reflects the spouse's overlapping role transition and the staff's unfamiliarity with the spouse's role. The spouses are both "insiders" and "outsiders" and are torn between maintaining and letting go of caregiving. Meanwhile, the staff express concern about the spouse's need for respite yet being constantly present, and struggle to balance the staff's and the spouse's control of the caregiving situation. This article provides insight into the challenges experienced by spouses who accompany their partners to residential care and how to best support them in this unfamiliar role.

Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study

Background

Existing models for forecasting future care needs are limited in the risk factors included and in the assumptions made about incoming cohorts. We estimated the numbers of people aged 65 years or older in England and the years lived in older age requiring care at different intensities between 2015 and 2035 from the Population Ageing and Care Simulation (PACSim) model.

Methods

PACSim, a dynamic microsimulation model, combined three studies (Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II) to simulate individuals' sociodemographic factors, health behaviours, 12 chronic diseases and geriatric conditions, and dependency (categorised as high [24-h care], medium [daily care], or low [less than daily] dependency; or independent). Transition probabilities for each characteristic were estimated by modelling state changes from baseline to 2-year follow-up. Years in dependency states were calculated by Sullivan's method.

Findings

Between 2015 and 2035 in England, both the prevalence of and numbers of people with dependency will fall for young-old adults (65–74 years). For very old adults (≥85 years), numbers with low dependency will increase by 148·0% (range from ten simulations 140·0–152·0) and with high dependency will almost double (increase of 91·8%, range 87·3–94·1) although prevalence will change little. Older adults with medium or high dependency and dementia will be more likely to have at least two other concurrent conditions (increasing from 58·8% in 2015 to 81·2% in 2035). Men aged 65 years will see a compression of dependency with 4·2 years (range 3·9–4·2) of independence gained compared with life expectancy gains of 3·5 years (3·1–4·1). Women aged 65 years will experience an expansion of mainly low dependency, with 3·0 years (3·0–3·6) gained in life expectancy compared with 1·4 years (1·2–1·4) with low dependency and 0·7 years (0·6–0·8) with high dependency.

Interpretation

In the next 20 years, the English population aged 65 years or over will see increases in the number of individuals who are independent but also in those with complex care needs. This increase is due to more individuals reaching 85 years or older who have higher levels of dependency, dementia, and comorbidity. Health and social care services must adapt to the complex care needs of an increasing older population.

Funding

UK Economic and Social Research Council and the National Institute for Health Research.

Couples in Need of Home Care Services: Experiences With Support From Care Professionals

Many older people desire to remain in their homes and be cared for by a family member, but this arrangement requires support from care professionals. The aim was to describe how couples in need of home care services experienced the received support from care professionals. A qualitative design with content analysis was used. Data were collected through diaries and focus groups consisting of eight couples between 65 and 80 years, and two registered nurses. The main findings are described by the following categories: Organizational adapted, Withholding, Being in a gap, resulting in the theme Lack of professional support. Couples experienced shortcomings that were related to the organization, the care professionals, and the couples themselves. The theme Lack of professional support requires more knowledge.

The family accompaniment of persons with dementia seen through the lens of the capability approach

Using the capability approach initially developed by A Sen as a theoretical framework, this paper analyses both what people with dementia and their families do in response to difficulties in their daily life brought about by the disease, and the reasons they give for acting as they do. Individual and collective interviews and ethnographic observations with 15 persons with dementia and one or more of their family members were conducted. Follow-up interviews were possible for nine families. Results highlight a great diversity in ways of doing things and in accompaniment by family members. Daily adjustments are often hidden or minimized, at least at the onset of the dementia. Later, they become more frequent, repetitive and indispensable but remain influenced by the social and gender roles that existed prior to the illness. The inventiveness of families, in a context marked by various kinds of constraints, is primarily motivated by their desire to maintain the apparently intact abilities of the person with dementia but especially to preserve forms of liberty and what counted for the person, what that person valued before the disease. There are some ways of living with dementia, even when accompanied, which may long remain preferable to others, which better answer to the past and present aspirations of persons with dementia and the purposes of the accompanying persons. It is thus essential that health professionals, as well as society in general, recognize and address this issue.