Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia

ABSTRACT

The home environment becomes very important for family caregivers of people with dementia as a place of safety, retreat and care provision. Using a gender-based perspective, the authors analyzed thirteen interviews with family caregivers to understand how they perceived their home space. The data was analyzed thematically with the help of adjacency diagrams. Our analysis identified three main themes: compact layout, spatial flexibility, and the wider neighborhood. Given the gendered nature of caring, the findings are discussed drawing on the work of feminist architects regarding the home environment. The authors argue that feminist architectural approaches can usefully inform spatial strategies regarding dementia, ageing friendly housing, accessible living and the wellbeing of the caregiver. Different bodies and users’ needs should be at the epicenter of design, as opposed to conventional design and the current practices by developers, which may create a series of disabling spaces.     

A Descriptive Study of Home Modifications for People with Dementia and Barriers to Implementation

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps both inside and outside the home. The majority of the caregivers had made home modifications that pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient's memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.     

A Qualitative Study on Home Modification of Rural Caregivers for People with Dementia

Opinions about the responsibility for procuring sheltered housing in Norway have been studied among people 50 and older. Until recently, Norway offered standard public provision, where the state has been the central provider and organizer of care for the elderly. The results indicate great support for public responsibility for providing sheltered housing for the frail elderly, which is only marginally affected by background characteristics. However, older people's attitudes as to whether they would choose private housing provision are affected by income, age, and knowledge of the market, and many are uncertain. Women and low-income groups are overrepresented among those who are uncertain.     

Experiences of Family Carers for Persons Using Antipsychotic Medication

Given the emphasis on the use of antipsychotic medication for severe mental illness, it is important to understand family carers’ perspectives on these medications and their effects on consumers’ lives. Such information may enable providers of family interventions to better understand families’ circumstances and more effectively support them in caring for mental health service users. Snowball sampling was used to recruit 29 family carers. Family carers acknowledged the calming effect of antipsychotic medication on service users, but also noted that there were few other therapeutic benefits. Moreover, the positive influence of antipsychotic medication was in most cases largely offset by the detrimental impact of antipsychotic medication on service users’ quality of life. The family carers in rationalising the trade‐off between beneficial and adverse antipsychotic medication effects typically experienced resignation, which was often accompanied by a sense of frustration that resulted from the reliance on medication.     

The Perspective of Younger People with Dementia

Abstract

This paper describes a longitudinally based discharge planning and treatment model. The model proposes to develop linkages between inpatient and community mental health providers during the early stages of hospitalization. The goal is to put the client's need first to ensure a smooth transition from the structure of the inpatient ward to the community, while maintaining continuity of care and reducing potential re-admissions to the hospital. The barriers that prevent such an adoption and implementation of such a system are discussed. Both clinical and policy issues are examined. Part 1 focuses on the background of case management and discharge planning and provides a critique of case management models (Belcher &; DeForge, 2005). Part 2 presents and describes the components of the longitudinally based discharge planning and treatment model (LDPTM) (DeForge &; Belcher, 2005).     

How Do the Professional Lives of Family Therapists Affect their Private Relationships: A Qualitative Study

This article is based on a qualitative research project about how the professional lives of family therapists affect their private relationships. The overarching research question was: How does your professional work as a family therapist affect your private relationships? To answer this question, semi‐structured qualitative interviews were conducted with four therapists from two different Family Counseling Services. Through the use of interpretative phenomenological analysis, three main findings were identified: (1) family therapists’ knowledge and values are a basis for interpersonal encounters; (2) participants describe resonance in relation to clients’ stories; and (3) therapists can be challenged in managing confidential knowledge particularly where they belong to the same communities as clients. The study also explores societal expectations and discourses that accompany the role of therapist, which can affect therapists’ freedom of movement in their private lives. These issues are discussed in relation to family therapy theory and relevant research.     

A Descriptive Study of Home Modifications for People with Dementia and Barriers to Implementation

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps, both inside and outside the house. The majority of the caregivers had made home modifications, which pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient's memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.     

Paving the Way for A Normal Life: A Qualitative Study of Coping Strategies Among Iranian Divorced Women

Regarding the devastating aftermath of divorce among Iranian divorced women, which is mainly affected by sociocultural factors, this qualitative study was conducted to explore their applied strategies in reorganizing their lives. Data collection started through deep unstructured interviews followed by semistructured interviews with 18 divorced women who were chosen by purposive sampling from mental health clinics, social work centers, or available cases. Gathered data were analyzed using the qualitative content analysis method. Two main themes—behaviors of self-preservation and abstinence and struggling for balance—emerged. Subcategories were concealing the divorce, feminine self-restriction, avoidance behaviors, replacement of losses, seeking support, role development, handling the tensions, and defending oneself against the divorce failure. This study provides comprehensive knowledge of how Iranian divorced women reregulate their lives and also highlights their unique and culture-based coping strategies. Therefore, it provides specialists with a context-specific foundation for mental health care and enables them to intervene more effectively.     

Young Adult Carers: The Impact of Caring on Health and Education

Research has shown that young people who care for parents and relatives (young carers and young adult carers) are at greater risk of mental and emotional difficulties and are more likely to do badly at school or college. To explore the difficulties faced by young adult carers (aged 14–25) in the UK, an online survey was conducted. Almost half (45%) of the 295 respondents reported having a mental health problem. The relationship between the extent of caring and perceived mental health problems and the impact of caring responsibilities on work and education were investigated.     

Divorce and Coparenting: A Qualitative Study on Family Mediation in Italy

This qualitative study intended to assess how intergenerational transformative family mediation is a resource in promoting and supporting coparenting during the transition of divorce. There were 2 goals: to assess parents’ perceptions of key topics of family mediation and to compare their perceptions concerning different moments of the intervention. Fifteen Italian parents were interviewed using an ad hoc semistructured interview. Data were analyzed using the textual analysis software T-LAB. Findings showed mediator, pragmatic aspects, and family relationships as the most salient aspects of mediation. Significant differences emerged among the beginning, the middle phase, and the end of this intervention.     

Experiences of Young People with Harmful Sexual Behaviors in Services: A Qualitative Study

ABSTRACT

Young people are responsible for a significant number of the sexual offenses that are committed every year. These young people are generally referred to specialist services for treatment. This article explores the health characteristics and service experiences of 117 young people with sexual behavior problems, and the issues that services face when working with them. The study is based on analysis of 117 case files, identified from nine specialist services in the UK. The case files were thematically analyzed. Case files provided information on the following topics: the reasons why the young people were referred to harmful sexual behavior services; the young people’s personal characteristics; their medical and mental health problems; the young people’s interests and aspirations; their attitudes toward services and interventions; continued problematic sexual incidents in services; progress in services; and post-service experiences. Overall, the findings of the study indicate that these young people have a number of strengths, but often have problems across a range of personal and health domains. A number of them continue to remain sexually and generally violent in services, particularly in residential settings, which has risk management implications for staff.     

Social Work Student Learning Experiences of Family Therapy: Improving Competency in Pedagogy Through Qualitative Research

The purpose of this qualitative study is to evaluate graduate social work student experiences of pedagogy intended to improve competency in family therapy practice. Students from two classes (N = 37) completed open‐ended surveys assessing: perceptions of most helpful pedagogical practices; understanding of needed competencies; and perceived opportunities offered to them during their graduate training for learning about work with couples and families. Results, analysed using grounded theory methodology, revealed that students: (1) believed that experiential activities were especially critical for learning how to do clinical practice with couples and families; (2) understood important competencies related to professional development, therapeutic engagement with the family, and how to approach family practice; and (3) believed they were ‘somewhat prepared’ for practice. Implications include improving understanding of abstract skills in practice with couples and families, and emphasising relationship dynamics more in graduate social work education and training.     

Home Environment and Its Relation with Quality of Life of Older People

In this cross-sectional study, we tested the relationship between sociophysical environment, quality of life (QOL), and perceived social support among elderly in Iran. The sample includes 128 participants recruited in the city of Shahrekord, Iran. We measured Evaluation of Older People Living Environment (EVOLVE); Control, Autonomy, Self-realization and Pleasure scale (CASP-19) and Multidimensional Scale of Perceived Social Support (MSPSS) tools respectively, through home-based observation and interview. A significant relationship was found between several domains of home environment, QOL, and perceived social support. The interaction effect of the home environment and gender in relation to QOL and perceived social support was statistically significant. Our results support that the home physical environment may not be considered a strong predictor of QOL among the Iranian elderly.     

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT

The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.     

Family Environment and Adolescents' Well‐Being Before and After Parents' Marital Disruption: A Longitudinal Analysis

Although previous research has noted that children of divorce tend to fare less well than peers raised in families with two biological parents, much less is known about how parents' marital disruption affects children as a continuous process in its different phases. Based on two waves of a large, nationally representative panel, this study demonstrates that even before the disruption, both male and female adolescents from families that subsequently dissolve exhibit more academic, psychological, and behavioral problems than peers whose parents remain married. Families on the verge of breakup are also characterized by less intimate parent‐parent and parent‐child relationships, less parental commitment to children's education, and fewer economic and human resources. These differences in family environment account for most well‐being deficits among adolescents in predisrupted families. Furthermore, the deterioration in different domains of the family environment appears to be associated with maladjustment in different aspects of children's lives. The postdisruption effects on adolescents can either be totally or largely predicted by predisruption factors and by changes in family circumstances during the period coinciding with the disruption. Finally, the analyses indicate that female adolescents are as likely to be affected by the parental divorce process as male adolescents.     

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

Family‐based treatment (FBT) is an evidence‐based approach to anorexia nervosa in young people. Because it is not always successful, attention has been given to how families experience the treatment. A number of therapists have proposed possible additions to, or improvements in, the model. In successful cases relational containment may be achieved in the first phase of treatment. The treatment is often successful, but when initial goals, such as weight recovery, are not achieved, continuing to use the techniques described in the manual may become unhelpful. Sometimes therapists may need to address issues such as emotion coaching that are not specifically addressed in the FBT model. We describe a case in which the therapist addressed the family's emotional style in the first stage of treatment. This focus enabled progress to be achieved despite the adolescent's continuing difficulty in eating without parental support, and her escalating symptoms of anxiety and obsessional compulsive disorder (OCD). Therapy helped the adolescent and family understand that anorexic and OCD symptoms can be understood as a way of distracting from and managing distress. When this connection was made in therapy, the parents could help their daughter to manage distress in more adaptive ways. Parents may need help with their own difficulties in processing distress. In this case the parents needed the opportunity to resolve feelings of grief about a miscarriage in order to do so. We propose that therapy should address family difficulties with managing distress from an early stage.     

Managing Conflicting Roles: A Qualitative Study with Female Faculty Members

The interface and transactions between the roles individuals need to play in their family and employment environments are a source of both positive and negative stressors for women, their employers, and family members. Drawing on interviews with female faculty members working in three types of higher education institutions in Michigan, the paper first suggests that female faculty members’ current employment-household management is influenced by past decisions. In addition, the complexity of their family and employment careers positively and negatively influences their lives.     

Producing Family Time: Practices of Leisure Activity Beyond the Home

Family life is conducted in public as well as at home, but the public aspect of family activity is seldom studied (a pattern that tends to reproduce privatized notions of family life). This observational study examines one site for public family activity, the community zoo. I show that visiting the zoo involves the group in a routinized activity that reinforces significant social boundaries, including those of family membership. Conceptually, the analysis identifies parental work practices—based on mostly implicit ideologies of family life—whose skills are treated at some moments as unremarkable and in other circumstances as key signifiers of good parenting. My aim is to bring into view the settings and circumstances within which parents pursue such activities with children, thereby illustrating an analytic approach that locates these practices within a broader social landscape.     

Measuring the Effectiveness of Experiential Date Nights: A Qualitative Study

ABSTRACT

This qualitative study examines the experience of 13 couples who attended a relationship education date night in two metropolitan areas in a western state. The intent of these date nights was to reach audiences that may not attend traditional classroom relationship education. Reasons for, benefits of attending, and impacts were explored with participants. Findings indicate that most participants had fun and enjoyed spending time together, learned qualities and skills of healthy relationships, and had positive learning experiences with other couples. Additionally, although most individuals’ reason for attending was to have fun, most experienced a positive impact on their relationships after the event, such as improved communication, increase in affection and gratitude, or spending more time together. This finding may indicate that regardless of the reasons for attending, it is possible to create an environment for learning relationship skills that can, and most likely will, extend beyond the night of the event and could potentially lead to long-term positive impacts in relationships. Based on findings and existing research, activity-based relationship education, such as date nights, needs to be taken seriously as a model for couple education and considered as part of a well-rounded approach to relationship education.     

Sexual Life of Women with Multiple Sclerosis: A Qualitative Study

Objectives: To define the thoughts, emotions, experiences and perceptions of women with multiple sclerosis (MS) and to determine sexual, physical, and emotional effects of MS on patients. Methods: Twenty-one women were included into this qualitatively designed study. Results: Three baseline themes were defined as “uncertainty” arising from complaints due to numbness in extremities and loss of sense, balance or vision, “alterations in sexual life,” and “inability” as a result of deformities in marital status and gender role. Conclusion: Healthcare providers should evaluate MS patients meticulously as to sexual life and refer such patients to appropriate health centers.