How Effective are Helpers to Older Adults’ Life Satisfaction?

The effectiveness of help received from home care workers and volunteers to the life satisfaction of community-dwelling older adults is vital but uncharted. To address the effectiveness, this study aims to optimize the use of social resources for the older adults’ life quality. The study thus surveyed 398 community-dwelling older adults in a city of China about the help and life satisfaction. Results showed a significant positive effect of help from home care workers, but not that from volunteers, on the older adult’s life satisfaction. Moreover, the effect of help from volunteers was significantly greater when the older adult had higher education or lower family income. These effects are explicable with resource theory and need fulfillment theory. They imply the worth of promoting help from home care workers generally and volunteers conditionally to champion older adults’ life satisfaction.     

The welfare state, the individual and the need for care: older people's views

The aim of this qualitative study was to study how older people experience aging and reflect on their need for care in the Swedish welfare context. Sixteen people were interviewed, aged between 77 and 92 years. Staying healthy and independent in their everyday lives were prized values for the informants. Some brushed aside thoughts of being in need of home help services in the future and others had a more reflecting attitude. The informants did not want to burden either society or their children. Through mass media and the experiences of their neighbours, they had gained a negative impression of eldercare. They were uncertain if there would be any helping hand of good quality in the future. On the other hand, informants who already had home help thought that it was helping them to maintain independence in everyday life and they were also satisfied with the help they received.     

“We are not weak,we just experience domestic violence”—Immigrant women's experiences of encounters with service providers as a result of domestic violence

Domestic violence continues to be a serious social problem and represents a challenge for those who are exposed to it and those in public services. In Norway, a variety of services are provided to help victims of domestic violence and improve knowledge among professionals who meet with adults and children exposed to domestic violence. Studies in Norway show that families with immigrant backgrounds are overrepresented among social service users as a result of domestic violence. However, contextualized knowledge to provide background information about this overrepresentation is limited. This paper explores women's need for support and their experience with service providers when faced with difficult and unpredictable situations, namely, escaping from violence and leaving home with no financial resources or limited supportive network and turning to service providers for support. Qualitative interviews were conducted with 18 women who were staying in or were in touch with shelters with their children or alone. Five central themes emerged in the analysis of these interviews: (a) help becoming a burden; (b) timely economic measures; (c) economic support and domestic violence; (d) displaced focus; and (e) flexibility and the victim's background.     

Experiences of the maternal role and support in mothers with cognitive limitations who have children in placement

In Sweden, when needed, children of mothers with cognitive limitations are placed in foster homes. There is a lack of knowledge about the mothers with cognitive limitations, their experiences of their maternal role, whether they get the support needed to maintain the relationship with their children, and whether the support system is adapted to mothers with cognitive limitations. The aim was to describe the experiences of the maternal role and support given in mothers with cognitive limitations who have children in placement. An explorative and qualitative design was used. Eleven respondents were interviewed with support from a study‐specific guide. A model representing the respondents' experiences revealed one theme “Struggling, dependent and frustrated mothers,” and three categories: I am a mother, I am dependent on an incomprehensible system, and I reluctantly accept my situation. Mothers with children in placement experience a threat to their identity and experience a need to alter their maternal role. They need adapted support to understand the decisions made and facilitate the cooperation with child protection services and the foster home. Offering service adapted to their cognitive limitations could be helpful for the struggling, dependent, and frustrated mothers.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

Raising the Quality of Home Care: A Study of Service Users' Views

Raising standards is one of the key objectives of the British government's Modernizing Agenda. The quality of life of vulnerable older people who are being maintained at home is fundamentally dependent on the quality of the home‐care services they receive, so raising standards of home care is clearly central to this agenda. This paper draws on a small‐scale study of service users and providers to examine the aspects of quality of home care of importance to older people, their experiences and barriers to improvement. Six key aspects of quality were investigated: reliability, continuity, flexibility, communication, staff attitudes and skills and knowledge. If performance indicators are to have the desired effect, more work needs to be done to ensure they reflect key aspects of quality from the user perspective. We identify potential areas for improvement in commissioning and organization but these all have resource implications that will need to be met if home care is to realize its full potential in maintaining and improving quality of life for older people.     

Migration, ageing and mental health: an ethnographic study on perceptions of life satisfaction, anxiety and depression in older Somali men in east London

This ethnographic study was carried out in the aftermath of an epidemiological investigation, the first of its kind, on the health and social status of Somalis aged 60 years and over living in Tower Hamlets, east London. The main aims of the study are to explore views on mental health and well-being and identify sources of stress and support so as to gain greater understanding of background factors of life satisfaction and depression in 'first-generation' older Somali migrants in Tower Hamlets (males). Face-to-face interviews were conducted among 28 males in Somali with the help of a bilingual interpreter from the same age, sex and cultural background of participants. Several factors were perceived to decrease life satisfaction and increase vulnerability to depression in male Somalis, in particular low family support in the face of increasing physical disability, loneliness, inadequate access to community services and inability to return home. Social isolation, low level of control over one's life, helplessness and social degradation – ageism, perceived racial/religious discrimination and, to a lesser extent, racial harassment – were common themes identified in people who said to be depressed. Family support was the main buffer against depression; other coping resources were represented by religious practices and reliance on Somali peers. Avoidance coping seemed to encompass denial of depression in participants who had low mood. The study revealed multiple reasons for ill-being, in particular in people who had high expectations about medical and social care. Low levels of distress were found in Somalis who felt supported by their families. There is a need for social workers and other health professionals to advance discussions of mental-health issues in the community and for service providers to promote greater access to culturally relevant medical and social services for Somali elders in Tower Hamlets and strengthen their informal support networks.     

The Single Assessment Process in Primary Care: Older People's Accounts of the Process

Recent government policies have been active in addressing socialinclusion and active participation of older people in many aspectsof societal life. Independence and well-being animate thesedevelopments and are evident in the emphasis on person-centredservices within the single assessment process for older people(Department of Health, 2002b). Drawing on a feasibility study of the Single Assessment Processas a ‘case-finding’ approach, this paper presentsfindings drawn from older people’s accounts of this experience.These accounts indicate the potential of the process for identifying‘low-level’ need, whilst raising issues of accessto formal services and resource constraint; also they underlinethe importance of understanding how older people seek ways ofmanaging their own health and well-being, whilst continuingto contribute to the social cohesion of society by providingsupport to their peers and to younger generations. Interdependence, it is suggested, rather than dependence shouldunderlie any approach to assessing older people’s needs,if we are to appreciate and build upon the complexity of olderpeople’s strategies for actively managing their lives.     

Family Disruption and Support in Later Life: A Comparative Study Between the United Kingdom and Italy

Global population aging has led to considerable disquiet about future support for frail older people; however, the determinants are poorly understood. Moreover, most industrialized societies have witnessed considerable changes in family behavior (e.g., rises in divorce and declining fertility). Such trends may have adversely affected the support systems of older people; nonetheless, only recently has research begun to address this issue. Employing data from the longitudinal British Household Panel Survey (1991–2003) and the 1998 Indagine Multiscopo sulle Famiglie "Famiglia, soggetti sociali e condizione dell'infanzia," we investigated the association between family disruptions due to divorce, separation, or death and three key dimensions of informal support: (i) frequency of contact with unrelated friends (among all respondents aged 65 years and over); (ii) co-residence with children (among unmarried mothers aged 65 years and over); and (iii) regular or frequent help received from children (e.g., household assistance including care) among parents aged 65 years and over. In addition, we conducted a comparative investigation of the relationship between family disruptions and the use of home care services (i.e., health visitor or district nurse; home help; meals-on-wheels) among parents aged 65 years and over. Our findings suggest that in a culture like the U.K.'s, where relations between kin are primarily influenced by individualistic values, support in later life appears to be primarily related to need, whereas in societies with a strong familistic culture (like Italy's), support is received irrespective of the older person's individual characteristics.     

Sheltered Housing and Community

This paper considers the role of sheltered housing following the introduction of new community care arrangements in 1993 and examines the continuing uncertainty about its exact role as community care continues to develop. It reports on a study conducted in Shropshire, using a postal survey and interviews with older people and service professionals. The study highlights the importance of sheltered housing for older people, particularly in relieving them of concerns about maintenance and repairs, social isolation and security. These factors were crucial for their overall peace of mind and quality of life. While only a small proportion of tenants received help under social services' community care arrangements, the additional support, monitoring and service coordination provided by wardens helped some of them to remain in sheltered housing when residential or nursing home care might otherwise have been necessary. Sheltered housing was overwhelmingly popular with older people — but their satisfaction was closely associated with the availability and quality of the warden service. Although sheltered housing is not currently in vogue in housing policy, the paper argues that it plays a vital role in local provision for older people and needs to be more closely integrated into community care policy, while at the same time preserving the characteristics that make it popular with its residents.     

Unemployment and mental health among white‐collar workers – a question of work involvement and financial situation?

We examine whether it is a psychosocial or an economic need for employment that affects mental health among the unemployed. The relevance of both aspects are examined, concentrating on two measures of each dimension. Two perspectives of work involvement – the degree of connection to working life and the perceived employment commitment – and two perspectives on financial situation – economic security and perceived economic concern – have been analysed, using empirical data collected by means of a cross-sectional survey of 1297 unemployed white-collar workers from the public sector in Sweden. The degree of connection to working life was not significantly linked to the mental health of the unemployed, although there was a strong link between the perceived employment commitment and mental health among this group. The stronger the perceived employment commitment, the poorer the state of the person's mental health. Perceived economic concern was also tightly linked to mental health: the greater the economic concern, the poorer the mental health. Economic security also played – at least, partly – a moderate but significant role. The results provide strong support for the existence of both a psychosocial need and an economic need for employment. The analysis demonstrates that it is the perceived assessed measures of work involvement and financial situation that are linked to mental health.     

Rethinking Needs Assessment in Planning Services for Older Adults

ABSTRACT

Needs assessments are widely used in the field of aging, and are considered valuable tools for planning service responses to unmet and undermet needs of older adults. This article describes a comprehensive needs assessment of Bermuda's older population and presents some of its findings to illustrate concerns about needs assessments that emerged from this experience. We suggest that even when needs assessments are carefully planned and adhere to generally recognized best practice principles, they may not be able to fully provide desired information. A revision of key assumptions about needs assessment is offered for researchers, planners, and community workers.     

Distribution of home help services in an elderly urban population: data from the Kungsholmen Project

Data from the total urban population 75 years and older in Kungsholmen, Stockholm were used to calculate the distribution of home help services. A structured questionnaire was used to collect information about education, occupation, living conditions, Katz Activities of Daily Living Scale, contact with the family, medical treatment and also questions about help needed and functional ability. Home help was considered to be provided when the subjects reported receiving home help service from the municipality. The number of hours of home help and the services received were registered. The results show that 86% of the elderly population in the Municipality of Kungsholmen live in their own homes, even when they are very old. Twenty-seven percent of those over 74 years and 33% of those over 80 years received home help services. The people receiving help were mostly women, single living, older and with disability detected by the Katz Activities of Daily Living Scale. The predicting factors of hours of home help are older age, condition of single living, disability detected by the Katz Activities of Daily Living Scale and less years of education. Our results also show that, among those who receive home help service, those with disability in the activities of daily living get more hours of help. However, a considerable group of elderly people are disabled but do not receive any home help. Our data stress the need for more attention by health care planners of domiciliary and intensive care and residential facilities for the high risk population (very old, living alone and with disability).     

Receipt of Formal and Informal Help with Specific Care Tasks among Older People Living in their Own Home. National Trends over Two Decades

Sweden is seen as a typical example of a social democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older people. This study aimed to examine trends in sources of care‐receipt in older people (77+) living in their own home and with a perceived need for help with two specific tasks: house cleaning and/or food shopping. Trends in care‐receipt were examined in relation to gender, living alone, having children and socio‐economic position. Data from the 1992, 2002 and 2011 data collection waves of the national study, Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), were used. Response rates varied between 86 and 95 per cent, and the sample represents the population well. Trends and differences between groups were explored in bivariate and logistic regression analyses. There was a reduction in formal care‐receipt regarding house cleaning and food shopping over the study period. It was more common for women than men to receive formal care, and more common for men than women to receive informal care. Reductions in formal care have affected older women more than older men. Still, living alone was the most influential factor in care‐receipt, associated with a greater likelihood of formal care‐receipt and a lower likelihood of informal care‐receipt. It can be concluded that public responsibility for care is becoming more narrowly defined in Sweden, and that more responsibility for care is placed on persons in need of care and their families.     

Rethinking needs assessment in planning services for older adults

Needs assessments are widely used in the field of aging, and are considered valuable tools for planning service responses to unmet and undermet needs of older adults. This article describes a comprehensive needs assessment of Bermuda's older population and presents some of its findings to illustrate concerns about needs assessments that emerged from this experience. We suggest that even when needs assessments are carefully planned and adhere to generally recognized best practice principles, they may not be able to fully provide desired information. A revision of key assumptions about needs assessment is offered for researchers, planners, and community workers.     

伯林特的城市美学观刍议

城市美学是伯林特环境美学思想的重要组成部分。伯林特从纠正我们习惯上对城市的错误认识出发,提出城市不是物理实体,而是我们获取城市经验的有机语境的观点。伯林特认为,城市没有确定的物理边界,而是一个包含一切的、综合的、动态的人类—环境综合体,其特征是连续性而非分离性。现代城市在建设规划上往往只顾追求城市的片面利益,比如政治的、经济的利益等,却忽略了真正属于人性的整体需求。城市美学的任务就是帮助人们将美学的价值融入到城市规划中去,使城市在追求功利价值的同时不以丧失美学价值为代价,从而创造出适宜人类栖息的、真正人性化的城市环境。     

“The Wisdom of Age”: Perspectives on Aging and Growth among Lesbian Older Adults

Older lesbian-identified women are a health disparate yet resilient population about whom knowledge is limited and emerging. Among the areas in need of research are older lesbians’ experiences of later life and stress-related growth. This article presents the findings from a qualitative study that investigated older lesbians’ experiences of adversity and adaptation as they age. In-depth, exploratory interviews were conducted with 12 lesbian-identified women who were between the ages of 65–80. This study applied grounded theory methodology to identify respondents sources of stress and fear, their strengths and coping strategies and how those relate to each other and to their growth in later life. We advance a model of adaptive change that shows how spirituality, social support, and resistance to cultural norms help older lesbian adults cope with loss, illness, and discrimination and develop wisdom in later life. Knowledgeable practitioners can help older lesbian women identify and maintain sources of social support, explore spirituality, and facilitate continuous growth through the end of life. Social workers can advocate for services that are welcoming and affirmative so as to reduce fears of isolation and dependence associated with health decline.     

Managing the Care Home Closure Process: Care Managers' Experiences and Views

This paper reports case study research that set out to identifywhat care managers do during independent care home closures.Little research has focused on the way in which care homes forolder people are closed in England, or what those involved thinkabout the process. This paper reports the activities and viewsof care managers directly involved in helping older people relocatefrom care homes that were closed by their owners. During suchclosures, residents and their families have no choice but tomove, usually to a deadline, and with little control over theprocess. Care managers have a responsibility to help arrangealternative care for those current residents who are publiclyfunded, and to offer information and support to those fundingtheir own care (the ‘self-funded’). Closure relatedactivities could involve considerable staff time. Care managementarrangements, including the organization of teams and provisionof needs assessments, varied across authorities. The care managersdescribed drawing on emotional counselling and inter-personalskills, as well as practitioner knowledge and experience, particularlywhen offering support and advice about finding appropriate newhomes. Tensions between aims, constraints on their actions andviews of good practice are identified.     

Psychosocial Assistance for Youth: Toward Reconstruction for Peace in Angola

Following decades of war, Angolan youth are at risk of continuing cycles of violence and need support in developing positive behaviors and social roles. Accordingly, a community-based program, conducted in Angola 1998–2001, taught youth life skills, provided peer support and peace education, educated adults about youth, and engaged youth as workers on community development projects. The main results included increased adult awareness of the situation and needs of youth, improved youth-adult relations, reduced perceptions of youth as troublemakers, reduced fighting between youth, increased community planning, and increased perceptions that youth make a positive contribution to the community. The results suggest that a dual focus on youth and community development contributes to peacebuilding and the disruption of cycles of violence.