Promoting the mental well-being of older people from black and minority ethnic communities in United Kingdom rural areas: Findings from an interview study

Drawing from 81 interviews with practitioners in social care and housing with care services in the United Kingdom, this paper explores practice issues in rural areas when supporting the mental health and well-being of older people from Black and minority ethnic groups. The paper begins with a review of the literature which provides evidence that BME older people are likely to be increasingly part of the populations of rural areas. Next it presents interview data revealing that while practitioners are aware of such demographic changes in general terms; some feel that they lack training and skills in adapting their professional practice to support all older people. Others express feelings of professional isolation in seeking to support older people from minority groups and are concerned that older people from minority groups may be at risk of isolation and loneliness. The paper concludes with a discussion of the study's implications for rural practice, policy and research.     

'I know I signed something': older people,families and social workers' understanding of the legal aspects of entry to residential care

This purpose of this paper is to report findings that older people are legally vulnerable when entering an aged care facility, that social workers lack knowledge of the legal aspects of this move and do not necessarily view this information as core to their practice. The structure of social work services mirror the disjuncture older people and their families experience at this time and this may, in part, explain social work's lack of attention to these issues. Although many social workers are in contact with older people, the profession in Australia has been slow to develop a knowledge base to support effective practice with this group.     

Real Men,Real Women,Real Lives? Gender issues in learning disabilities and challenging behaviour

This article seeks to define gender issues and explores the significance of these issues for challenging behaviour in the field of learning disability. It is argued that lack of awareness about these issues contributes to the development of challenging behaviour and to difficulties in identifying the needs expressed through these behaviours, whatever their origin. Specific areas examined include models of residential provision for adults, prioritisation of service activities, attribution processes (needs identification), and the sexuality of people with learning disabilities. In each area issues are raised and the implications for service practice defined.     

Building a Humane Society for Older People: Compassionate Policy Making for Integration,Participation, and Positive Ageing Within a Framework of Intergenerational Solidarity

This article explores the global challenge of population aging with a specific focus on the concepts of integration and participation of older people in society within the context of “realizing a society for all ages” as promoted by the United Nations. It is proposed that governments worldwide need to embrace new ways of thinking about population aging that include strategic initiatives for strengthening the social contract that fosters generational interdependence. The meaning of “positive aging” is explored at both the individual and social levels, with implications for quality-of-life issues involving intergenerational relationships. The point is made that while the promotion of positive aging is commendable on both philosophical and health grounds it can be problematic for those older people who for a range of legitimate reasons are unable to fulfill the notion of positive or active aging. The longevity revolution will require the emergence of a more humane society that undertakes to reconceptualize what older age means, together with exploring new ways of enhancing the citizenship status of older people through the development and promotion of innovative intergenerational relationships. A call is made for a wider engagement of the citizenry in the processes involved in the formulation and implementation of policy making.     

Choice: what,when and why? Exploring the importance of choice to disabled people

Extending choice and control over public services is central to current policies in England. Such policies have immense potential for independence and well‐being. However, it is still not clear how disabled people conceptualise choices, what choices are important, for which groups of people, in what areas of life and why. This paper presents findings from the first phase of a longitudinal qualitative study of choice and control over the life‐course. Semi‐structured interviews were carried out with 111 participants including disabled young people with progressive conditions; their parents; adults and older people with fluctuating support needs and those experiencing sudden deterioration in health. The findings suggest that while most people across all study groups wanted to be able to make choices in all areas of their lives, there are significant differences in the importance they attach to specific choices. The findings have implications for service reforms and identify some policy and practice issues that need to be addressed.     

‘All in all it is just a judgement call’: issues surrounding sexual consent in young people’s heterosexual encounters

In the UK, there has been growing concern about young people’s understanding of sexual consent, with the views of young people themselves often lost in academic and educational policy debates. However, the focus on high rates of sexual violence has meant a lack of attention on the everyday negotiation of consensual heterosexual activity, leading to assumptions being made regarding young people’s lack of understanding of sexual consent. This paper emerges from a wider study of over 500 young people which sought to uncover their understanding of the issues. Drawing on data from workshops and the open text responses to an on-line survey the findings presented in this paper show that the majority of heterosexual young people understood the complexity of sexual consent as an embodied process, which can be difficult to define, talk about or practice uniformly. This complex understanding, in which sexual consent is a continuum rather than a dichotomy, has implications for sexual education initiatives. We argue that it is only by providing a closer understanding of how – within consensual sexual activities – young people understand and enact sexual consent through a range of embodied communication strategies that education surrounding sexual assault will become meaningful.     

Being involved in the country: Productive ageing in different types of rural communities

Productive ageing recognises the contribution of older people to economic, social and cultural growth and helps build a sustainable community. Being involved in community life is good for individuals and good for society. However, we know very little about the participation of and contribution by people aged 50 and over in rural communities. This research aimed to develop a better understanding of productive ageing in different types of communities in rural Victoria, Australia. An anonymous self-complete postal questionnaire was distributed to a sample of households in twenty rural communities using the Australia Post Unaddressed Select Service. Those householders 50 years of age and older were invited to complete the survey. Data collected allowed examination of social and civic engagement, familiarity with community, the value placed on social relations by people aged 50 years and over, and how community involvement was linked to community sustainability. In particular it attempts to address the question ‘Does social and civic engagement differ across declining, stable and growing rural communities?’ Despite differences among rural communities, this study showed that older people develop and maintain strong community connections and well-functioning social capital and that participation in social activities was associated with feelings of being connected with community. It also identified health issues and lack of options as the main constraints on participation. A key message for policy makers is that older people play an important role in the sustainability of rural communities. There is much to be gained from actively supporting their participation in activities that are connected to ageing well.     

Identity,selfhood and dementia: messages for social work

Dementia has been identified as a policy priority area for the European Union (EU). Given projected figures on the global increase in dementia over the next few decades, working with people with dementia is likely to become an even more prominent area of activity for social workers in older people's services. Recent research has begun to engage with the subjective experiences of people with dementia and there is considerable focus within nursing literature on their active efforts to maintain identity and selfhood. However, these issues have received little attention within the domain of social work. This paper reviews recent research on the subjective experiences of people with dementia and discusses the implications for social work in relation to: early intervention; communication and assessment, and support arrangements. Based on experience in England, it is argued that the current policy and practice context constrains social work's ability to respond to these issues and that a supportive organisational context, as well as high levels of skill, time and commitment, are required if concepts of personhood and citizenship are to have meaning in practice.     

Listening to Older Women with Dementia: relationships, voices and power

Four older women with dementia were interviewed about their experiences of their services. People with dementia are rarely asked for their opinions or judged to be fully legitimate persons. Gaps in previous research concerning people with dementia is presented, with respect to listening to people with dementia themselves and with respect to gender issues. The present study is described and the methodology for analysis, Brown and Gilligan's Voice Relational Method, is presented. This method was developed to listen to adolescent girls and has been used to listen to the voices of others who are disempowered in society. Its focus on relationships and issues of power was useful in this study. The methodology is presented in the context of debates within feminist and disability research. The results of the interviews are discussed, particularly with respect to power in the women's relationships, and particularly the relationships between the women with dementia and medical staff. Some implications of these power issues are presented and recommendations are made.     

Safer Sex in Later Life: Qualitative Interviews With Older Australians on Their Understandings and Practices of Safer Sex

Rates of sexually transmitted infections (STIs) are increasing in older cohorts in Western countries such as Australia, the United Kingdom, and the United States, suggesting a need to examine the safer sex knowledge and practices of older people. This article presents findings from 53 qualitative interviews from the study Sex, Age, and Me: A National Study of Sex and Relationships Among Australians Aged 60+. Participants were recruited through an online national survey. We consider how participants understood “safer sex,” the importance of safer sex to them, the safer sex practices they used (and the contexts in which they used them), and the barriers to using safer sex. Older adults had diverse understandings, knowledge, and use of safer sex practices, although participants tended to focus most strongly on condom use. Having safer sex was strongly mediated by relationship context, trust, perceived risk of contracting an STI, concern for personal health, and stigma. Common barriers to safer sex included erectile difficulties, embarrassment, stigma, reduced pleasure, and the lack of a safer sex culture among older people. The data presented have important implications for sexual health policy, practice, and education and health promotion campaigns aimed at improving the sexual health and well-being of older cohorts.     

Promoting reflective practice with older people: Learning and teaching strategies

Social work with older people is often characterised as low status employment and is dominated by medicalised constructions of old age. Consequently, there is a need for educational responses that address students' negative attitudes toward older people and enable the development of practice skills in this area. The present paper evaluates an elective course for third year social work students that challenged their perceptions of their own and others' ageing, and stimulated a reflective approach to practice with older people. Reflective learning techniques were employed in the course, including observations in aged care service settings. Students in the course showed a high degree of interest in working with older people in the future and, although this did not increase much throughout the course, they evaluated it positively, noting greater awareness of issues affecting older people.     

Powerlessness of older people in Hong Kong: a political economy analysis

Gerontologists agree that old age can be associated with an increase in powerlessness both in the personal domain and in the social and political fields. This paper is an attempt to understand the concept of powerlessness in old age within a political economy theoretical framework. The paper argues that the powerlessness of older people is not biologically determined. Rather, it is socially constructed. It has its roots in the social, economic, and political structure of society. For this reason, the paper argues that (a) the capitalist economic system discriminates against and marginalizes older people in the labor market. The current unfavorable economic climate will make the economic situation of older people worse. (b) The residual welfare system does not counteract the unfavorable impact of the economic system. Rather, it deprives older people of the necessary financial resources and social service supports that would enable them to lead independent and dignified lives. (c) The authoritarian political system creates adverse conditions that make it very difficult for older people to participate in the decision-making process on issues that affect their lives, as well as on broader political issues that affect the whole of society. It is the interplay among these economic, social, and political forces in Hong Kong that creates the political economy of powerlessness in old age and prevents older people from using their powers to master and control their lives.     

Elder abuse in the United Kingdom

In recent years there has been an increased emphasis on violence and abuse within society generally. Following a focus in the United Kingdom (UK) on child abuse in the 1970s and domestic violence in the 1980s, in the 1990s the abuse and neglect of older people began to elicit concern. The initial focus of interest was of situations arising in the domestic setting. More recently, however, much needed attention has shifted to situations involving institutional settings. This paper will discuss abuse and neglect occurring in the UK. It aims to provide a brief overview of the status of current knowledge concerning abuse of older people followed by a discussion of some of the issues relating to the prevention of abuse and neglect from a UK perspective. An exploration of some of the issues involved will contribute to our understanding of abuse and neglect of older people in the UK.     

Same Difference? Older People's Organisations and Disability Issues

This paper addresses some important areas of commonality in the political interests of older and disabled people. The paper reports findings from survey and interview research with local organisations representing older people, and their engagement with disability issues. We begin by reviewing similarities in the claims and mobilisation of older and disabled people, and by reviewing the groups that participated in the study. The main part of the paper identifies substantive policy issues that were perceived as important to older people. Here, there are considerable areas of overlap with the claims of disabled people's organisations (for example, in relation to information, independent living, accessible housing, transport, social support, and incomes). We review these commonalities and offer some thoughts on the potential for political alliance between the two movements. The paper concludes that, while there are considerable areas of common ground, there remain cultural barriers to the mobilisation of such alliances.     

Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users

Significant numbers of older people worldwide have a drinking level or pattern which places them at risk of harm. In England, older people are more likely to be admitted to hospital for an alcohol-related condition than younger people and levels of alcohol-related harm are increasing fastest in this population. Whilst alcohol problems in older people are highly treatable, they frequently go undetected or ignored. The aim of this study was to develop guidelines for health and social care workers on what intervention strategies are likely to work best with older drinkers. Insight from alcohol practitioners who specialise in working with older people and the perspectives of older people receiving alcohol treatment were gained through focus groups and individual interviews. This paper reports some of the key findings including a perception that health and social care workers often did not intervene when alcohol misuse was suspected because of ageist attitudes and false beliefs about older people's drinking. Participants however acknowledged that social workers faced difficult choices in relation to the ‘right’ of older people with alcohol problems to continue to drink and the ‘risk’ associated with them doing so. The implications for social work education and training are discussed.     

Elder Abuse in the United Kingdom

ABSTRACT

In recent years there has been an increased emphasis on violence and abuse within society generally. Following a focus in the United Kingdom (UK) on child abuse in the 1970s and domestic violence in the 1980s, in the 1990s the abuse and neglect of older people began to elicit concern. The initial focus of interest was of situations arising in the domestic setting. More recently, however, much needed attention has shifted to situations involving institutional settings. This paper will discuss abuse and neglect occurring in the UK. It aims to provide a brief overview of the status of current knowledge concerning abuse of older people followed by a discussion of some of the issues relating to the prevention of abuse and neglect from a UK perspective. An exploration of some of the issues involved will contribute to our understanding of abuse and neglect of older people in the UK.     

Autonomy in long‐term care: a need,a right or a luxury?

Doyal and Gough’s theory of human need highlighted that personal autonomy is a universal need and human right, essential for well‐being. In applying their theory to older disabled people in the UK the author suggests that their ‘minimally autonomous’ threshold would exclude some older people in long‐term care who still have a fundamental need for autonomy or, alternatively, extant autonomy. The disability movement has highlighted that independent living is fundamental to achieving self‐determination for disabled people and debate on equality and caregiving emphasises the autonomy of carers. However, there is a lack of recognition in both academic research and government policy of autonomy as a need and right of older disabled people. The author argues that autonomy is a human right of older people living in long‐term care settings, but that social rights are necessary to facilitate their autonomy.     

Normalisation and 'Normal' Ageing: the social construction of dependency among older people with learning difficulties

This paper discusses the new phenomenon of the survival into old age of the increasing numbers of people with learning difficulties. This raises both theoretical and practical policy issues. In the UK health and social services for older people and for people with learning difficulties have followed quite different paths. One has been based on a limited, age discriminatory view of 'normal' ageing; the other has focused on a potentially liberating concept of normalisation. This distinction is being challenged by the advent of older people with learning difficulties, which is raising questions such as, what is the meaning of normalisation in older age? We focus on this key question, illustrating the different principles behind service provision for these two groups and argue that the concept of normalisation is flawed when applied to older people. The alternative of social integration is proposed as the basis for organising health and social services for both older people and those with learning difficulties.     

Health and Aging-in-Place: Implications for Community Practice

ABSTRACT

There is increasing interest in helping elders to remain independent in their homes. As the nation experiences the unprecedented growth among its oldest residents, public and private efforts are emerging to facilitate aging-in-place. However older people, particularly the oldest old, experience a myriad of issues impacting their health and ability to remain at home. This article presents the findings from a needs assessment of a Naturally Occurring Retirement Community (NORC) (n?=?114) that revealed multiple health-related issues among older people residing in high-need neighborhoods. The study utilized a holistic perspective of health to measure physical, mental, and social well-being among the older residents. Implications for community-based health interventions to enhance aging-in-place are discussed.     

Older Adults and Their Vulnerabilities to the Exposure of Violence

According to US Census Bureau projections, there will be an estimated 72 million people over the age of 65 in the USA by the year 2030. Exposure to violence and crime victimization has serious physical, emotional, mental, and economic consequences for the growing older population in the USA. It should thus come as no surprise that much sociological attention has focused more on examining the correlates of violence for the older American population. We intend to provide an overview of the typologies, empirical research, and the pertinent factors associated with older people and their exposure to violence. We then discuss necessity to further research and our understanding of the important social problem of the exposure of violence for older people in the USA. In conclusion, implications of research findings of how to address the vulnerabilities of older people in relationship to their exposure to violence are discussed.