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Changes in commissioning home care: an English survey 委托家庭护理的变化:一项英语调查
IF 1.5 Q2 Nursing Pub Date : 2020-01-24 DOI: 10.1108/qaoa-10-2019-0055
S. Davies, J. Hughes, K. Davies, E. Dalgarno, Rowan Jasper, Helen Chester, A. Roberts, D. Challis
The purpose of this study is to examine changes in the nature, form and range of commissioning arrangements for home care.,Data from two discrete national surveys of English local authorities with social service responsibilities were used. In the first, undertaken in 2007, responses from 111 of the 151 local authorities (74%) were received; in the second, undertaken in 2017, responses from 109 local authorities (72%) were received. A combined data set of 79 complete cases, 52% of local authorities, was created. Percentage point differences across the two time periods were calculated and tested to identify significant changes and a systematic analysis of the free-text responses regarding intended changes to the commissioning process in each data set was undertaken.,Findings identified substantial changes in some aspects of the commissioning of home care in the 2007-2017 decade. Collaboration between stakeholders had increased, particularly regarding the identification of future needs. Improved conditions of service and remuneration for home care workers were evident within the commissioning process. Standardised charges for home care (regardless of time and day) had also become more widespread. Initiatives to prompt providers to deliver more personalised care were more evident.,This paper describes the evolution of commissioning arrangements for home care in localities in response to national policy initiatives. It provides guidance to commissioners in meeting the needs of current service users and emphasises the importance of collaboration with stakeholders, particularly providers, in securing future capacity.
本研究旨在探讨家居护理的性质、形式及范围的变化。数据来自两个独立的英国地方政府的社会服务责任的全国性调查。在2007年进行的第一次调查中,收到了151个地方当局中的111个(74%)的答复;在2017年进行的第二次调查中,收到了109个地方当局(72%)的答复。创建了79个完整案例的综合数据集,占地方当局的52%。计算和测试了两个时间段之间的百分点差异,以确定重大变化,并对每个数据集中关于调试过程预期变化的自由文本响应进行了系统分析。调查结果发现,在2007-2017年的十年中,家庭护理委托的某些方面发生了实质性变化。利益攸关方之间的合作有所增加,特别是在确定未来需要方面。在委托过程中,家庭护理工作者的服务条件和报酬明显改善。家庭护理的标准化收费(不分时间和日期)也变得更加普遍。促使提供者提供更多个性化护理的举措更为明显。本文描述了在响应国家政策倡议的地方委托安排家庭护理的演变。它为专员提供了满足当前服务用户需求的指导,并强调了与利益攸关方(特别是提供商)合作以确保未来能力的重要性。
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引用次数: 2
Carer needs on an organic inpatient unit 护理人员需要有机住院病房
IF 1.5 Q2 Nursing Pub Date : 2019-12-09 DOI: 10.1108/qaoa-08-2019-0048
J. Clegg, Sarah Craven-Staines
The purpose of this paper is to further understand the needs of carers when a relative with dementia is admitted to an organic impatient ward.,A constructivist grounded theory approach was employed to generate a substantive theory to understand the needs of carers and how staff perceive carer needs when a relative is admitted to a dementia ward. Five relatives and six members of staff were interviewed using purposive and theoretical sampling. Interview transcripts were analysed using initial, focused and theoretical coding using constant comparative methods to develop the end theory.,The grounded theory concluded that carers have three categories of needs: “The Safe and Cared for Relative”, “The Informed Carer and “The Understanding, Responsive and Available Service”. Underpinning the needs are the relationships between carers, their relative and staff. Three barriers were identified which can impact on these needs being effectively met. These identified barriers were: Loss, Time and Ineffective Communication.,The grounded theory demonstrates that carers needs fundamentally relate to their relatives being safe and cared for and being included and informed during the admission. Relationships can be ruptured when a barrier prevents the needs from being effectively met. Recommendations are made to aim to reduce the impact of the barriers and to aid staff in developing their understanding of the carer experience.
本文的目的是进一步了解痴呆症亲属入住有机不耐烦病房时护理人员的需求。,采用基于建构主义的理论方法生成了一个实质性理论,以了解护理人员的需求,以及当亲属入住痴呆症病房时,工作人员如何感知护理人员的需要。采用有目的和理论抽样的方法,对5名亲属和6名工作人员进行了访谈。访谈记录使用初始、重点和理论编码进行分析,并使用持续的比较方法来发展最终理论。,有根据的理论得出结论,护理人员有三类需求:“亲属的安全和护理”、“知情护理”和“理解、响应和可用的服务”。支撑需求的是护理人员、他们的亲属和工作人员之间的关系。确定了三个障碍,这些障碍可能影响有效满足这些需求。这些确定的障碍是:损失、时间和无效沟通。,有根据的理论表明,护理人员的需求从根本上与他们的亲属的安全和照顾有关,并在入院期间得到包容和告知。当障碍阻碍了需求的有效满足时,关系可能会破裂。提出建议的目的是减少障碍的影响,并帮助工作人员发展对护理人员体验的理解。
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引用次数: 0
The development and feasibility testing of the Distress Recognition Tool 遇险识别工具的开发与可行性测试
IF 1.5 Q2 Nursing Pub Date : 2019-12-06 DOI: 10.1108/qaoa-06-2019-0030
G. Crowther, C. Brennan, K. Hall, Abbie Flinders, M. Bennett
People with dementia in hospital are susceptible to delirium, pain and psychological symptoms. These diagnoses are associated with worse patient outcomes, yet are often underdiagnosed and undertreated. Distress is common in people experiencing delirium, pain and psychological symptoms. Screening for distress may therefore be a sensitive way of recognising unmet needs. The purpose of this paper is to describe the development and feasibility testing of the Distress Recognition Tool (DRT). The DRT is a single question screening tool that is incorporated into existing hospital systems. It encourages healthcare professionals to regularly look for distress and signposts them to relevant resources when distress is identified.,The authors tested the feasibility of using the DRT in people with dementia admitted on two general hospital wards. Mixed methods were used to assess uptake and potential mechanisms of impact, including frequency of use, observation of ward processes and semi-structured interviews with primary stakeholders.,Over a 52-day period, the DRT was used during routine care of 32 participants; a total of 346 bed days. The DRT was completed 312 times; an average of 0.9 times per participant per day. Where participants had an identified carer, 83 per cent contributed to the assessment at least once during the admission. Thematic analysis of stakeholder interviews, and observational data suggested that the DRT was quick and simple to complete, improved ward awareness of distress and had the potential to improve care for people with dementia admitted to hospital.,This is the first short screening tool for routinely detecting distress in dementia in any setting. Its uptake was positive, and if effective it could improve care and outcomes for people with dementia, however it was beyond the scope of the study test this.
住院的痴呆症患者容易出现精神错乱、疼痛和心理症状。这些诊断与较差的患者预后相关,但往往未得到充分诊断和治疗。在经历谵妄、疼痛和心理症状的人群中,痛苦很常见。因此,对痛苦的筛查可能是识别未满足需求的一种敏感方式。本文的目的是描述遇险识别工具(DRT)的开发和可行性测试。DRT是一个纳入现有医院系统的单一问题筛选工具。它鼓励医疗保健专业人员定期寻找痛苦,并在确定痛苦时向他们指示相关资源。作者测试了在两个综合医院病房收治的痴呆症患者中使用DRT的可行性。使用混合方法来评估吸收和潜在的影响机制,包括使用频率、观察病房过程和与主要利益相关者的半结构化访谈。在52天的时间里,在32名参与者的日常护理中使用DRT;总共346个床日。DRT完成312次;平均每个参与者每天0.9次。如果参与者有一个明确的照顾者,83%的人在入院期间至少参与了一次评估。对利益相关者访谈的专题分析和观察数据表明,DRT快速、简单地完成,提高了病房对痛苦的认识,并有可能改善对住院痴呆症患者的护理。这是第一个在任何情况下例行检测痴呆症患者痛苦的简短筛查工具。它的吸收是积极的,如果有效,它可以改善痴呆症患者的护理和结果,但这超出了研究测试的范围。
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引用次数: 1
Ageing carers and intellectual disability: a scoping review 老年护理人员和智力残疾:范围审查
IF 1.5 Q2 Nursing Pub Date : 2019-11-28 DOI: 10.1108/qaoa-11-2018-0057
Aoife Mahon, E. Tilley, G. Randhawa, Y. Pappas, J. Vseteckova
PurposeIndividuals with intellectual disability(ies) are living longer contributing to an overall increase in the average age of caregivers. The purpose of this paper is to review the literature on the physical, social and psychological needs of ageing carers of individuals with intellectual disability(ies) in the UK.Design/methodology/approachA scoping review framework was used to identify literature from eleven databases, the grey literature and the references lists of relevant studies. Only primary research studies that discussed the needs of non-professional carers, aged 65+ years old, of individuals with intellectual disability(ies) in the UK were included. No date restrictions were applied. Thematic analysis was used to narratively synthesise findings.FindingsSix studies were included. Five key themes were identified: Living with fear, lack of information, rebuilding trust, proactive professional involvement and being ignored. Housing and support information is not communicated well to carers. Professionals require more training on carer needs and trust must be rebuilt between carers and professionals. Proactive approaches would help identify carer needs, reduce marginalisation, help carers feel heard and reduce the risk of care crisis. Greater recognition of mutual caring relationships is needed.Originality/valueThis review highlighted the needs of older caregivers for individuals with intellectual disability(ies) as well as the need for more high-quality research in this field. The information presented in this review may be considered by primary care providers and funding bodies when planning future support for this growing population of carers.
智力残疾者的寿命越来越长,导致照顾者的平均年龄总体增加。本文的目的是回顾文献的身体,社会和心理需求的个人智力残疾(ies)的老龄化护理人员在英国。设计/方法学/方法采用范围审查框架从11个数据库、灰色文献和相关研究的参考文献列表中识别文献。在英国,仅包括了讨论65岁以上智力残疾个体的非专业护理人员需求的初级研究。没有日期限制。主题分析用于叙述综合研究结果。研究结果包括6项研究。研究确定了五个关键主题:生活在恐惧中、缺乏信息、重建信任、积极的职业参与和被忽视。住房和支持信息没有很好地传达给护理人员。专业人员需要更多关于照顾者需求的培训,并且必须重建照顾者和专业人员之间的信任。积极主动的方法将有助于确定护理人员的需求,减少边缘化,帮助护理人员感到被倾听,并减少护理危机的风险。需要更多地认识到相互关心的关系。原创性/价值本综述强调了老年照护者对智力残疾个体的需求,以及在这一领域开展更多高质量研究的需求。初级保健提供者和资助机构在规划未来对日益增长的护理人员的支持时,可能会考虑本综述中提供的信息。
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引用次数: 5
Age-friendly communities for older persons with intellectual disabilities 为智障长者而设的长者友好社区
IF 1.5 Q2 Nursing Pub Date : 2019-11-28 DOI: 10.1108/QAOA-11-2018-0058
Caley Miskimmin, S. Shooshtari, V. Menec, K. Duncan, Toby L. Martin, B. Stoesz
The life expectancy for persons with intellectual disabilities (ID) has increased significantly, resulting in an increasing number of aging persons with ID. To promote healthy and active aging of persons with ID, discussions on new initiatives to design age-friendly communities have begun at local and international levels. The purpose of this paper, a qualitative research study, is to identify features of an age-friendly community, and facilitators and barriers from the perspectives of older adults with mild ID and their caregivers who live in the city of Winnipeg in Canada.,Seven older persons with mild ID were interviewed, and 15 caregivers participated in focus group discussions. All participants were asked questions about features of community living and their experiences in eight broad topic areas (i.e. transportation, housing, social participation, respect and social inclusion, opportunities for community involvement, communication and information, community support and healthcare services, and outdoor spaces and buildings).,The results indicated that many of the current features of the city of Winnipeg do not adequately address the needs of aging persons with ID; specifically, participants revealed that issues related to accessibility, social participation, social disrespect and inclusion, and lack of resources were important barriers to independence.,The findings will increase awareness of the needs of aging persons with ID and inform programme planning, service delivery, coordination of community-based services and policies to support healthy and active aging for this vulnerable population.
智障人士的预期寿命大幅增加,导致智障老年人的数量不断增加。为了促进智障人士健康、积极地老龄化,已经开始在地方和国际层面讨论设计老年友好社区的新举措。本文是一项定性研究,旨在从居住在加拿大温尼伯市的轻度ID老年人及其照顾者的角度,确定老年友好社区的特征,以及促进因素和障碍。,采访了7名轻度ID的老年人,15名护理人员参加了焦点小组讨论。所有参与者都被问及社区生活的特点及其在八个广泛主题领域的经历(即交通、住房、社会参与、尊重和社会包容、社区参与的机会、沟通和信息、社区支持和医疗服务以及户外空间和建筑)。,结果表明,温尼伯市目前的许多特点并不能充分满足有身份证的老年人的需求;特别是,参与者透露,与无障碍、社会参与、社会不尊重和包容以及缺乏资源有关的问题是独立的重要障碍。,研究结果将提高人们对ID老年人需求的认识,并为方案规划、服务提供、社区服务的协调和政策提供信息,以支持这一弱势群体的健康和积极老龄化。
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引用次数: 4
Intellectual disability and dementia: perspectives on environmental influences 智力残疾与痴呆:环境影响视角
IF 1.5 Q2 Nursing Pub Date : 2019-11-28 DOI: 10.1108/qaoa-11-2018-0060
A. Sheth
The purpose of this paper is to improve understandings of environmental influences on participation in routine and familiar activities for people with intellectual disabilities and dementia from first-person and caregiver perspectives.,Four adults with intellectual disabilities and dementia participated in 2 nominal group technique sessions and 12 family and staff caregivers participated in 5 standard focus groups. Transcripts were analyzed utilizing thematic analysis centering the findings from nominal group technique sessions and an ecological systems lens.,Participants with intellectual disabilities and dementia identified six important themes: activity access, caregiver assistance, social interactions, responsibilities, privacy, and health and wellness. Their perspectives focused primarily at an immediate environment level, while caregiver input added additional understandings from broader ecological systems levels.,This study provides a beginning point to establishing a framework for creating supports and addressing barriers to participation for adults with intellectual disability and dementia based on direct input from potential service consumers and their caregivers. People with intellectual disabilities and dementia provide valuable insights into their experiences through engagement in accessible research.
本文的目的是从第一人称和照顾者的角度,提高对环境对智障和痴呆症患者参与日常和熟悉活动的影响的理解。,4名智力残疾和痴呆症成年人参加了2次名义小组技术会议,12名家庭和工作人员护理人员参加了5个标准重点小组。利用主题分析对转录本进行分析,该分析以名义小组技术会议和生态系统视角的研究结果为中心。,智障和痴呆症参与者确定了六个重要主题:活动准入、护理人员援助、社交互动、责任、隐私以及健康和身心健康。他们的观点主要集中在直接的环境层面,而护理人员的投入增加了对更广泛的生态系统层面的理解。,这项研究为建立一个框架提供了一个起点,该框架基于潜在服务消费者及其照顾者的直接投入,为智障和痴呆症成年人的参与创造支持和解决障碍。智障和痴呆症患者通过参与无障碍研究,对他们的经历提供了宝贵的见解。
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引用次数: 3
“One does not forget, it all comes back”: elderly people with intellectual disability review adversities and stress-protection in their lives “人不忘,一切都会回来”:智障老年人回顾生活中的逆境和压力保护
IF 1.5 Q2 Nursing Pub Date : 2019-11-28 DOI: 10.1108/qaoa-11-2018-0061
H. Schepens, Joris Van Puyenbroeck, B. Maes
People with intellectual disability are reported to encounter many negative life events during their increasingly long lives. In the absence of protective elements, these may cause toxic stress and trauma. Given the reported negative effects of such adverse events on their quality of life (QoL), the perspective of older people with intellectual disability themselves may be of relevance. The paper aims to discuss these issues.,The authors questioned nine participants with mild intellectual disability, aged 61–88 years old, in four 90-min focus group sessions and thematically analysed the data.,Many recent and bygone negative life events still weighed heavily on the participants. Negative interactions, experiences of loss, lack of control and awareness of one’s disability caused stress. Their emotional response contrasted with their contentment, compliance and resilience. Having (had) good relationships, having learnt coping skills, remaining active, talking about past experiences and feeling free of pain, safe, well supported, capable, respected and involved seemed to heighten resilience and protect participants from toxic stress.,Monitoring and preventing adverse (childhood) experiences, supporting active/emotional coping strategies, psychotherapy and life story work may facilitate coping with negative events and enhance QoL of elderly people with intellectual disability.,Elderly people with mild intellectual disability run a higher risk of experiencing (early) adverse events in life. They are very capable of talking about their experiences, QoL, and the support they need. Focus groups were a reliable method to capture their insights.
据报道,智障人士在他们日益延长的寿命中会遇到许多负面的生活事件。在缺乏保护元素的情况下,这些可能会导致毒性应激和创伤。鉴于这些不良事件对他们的生活质量(QoL)的负面影响的报道,老年智障患者本身的观点可能是相关的。本文旨在探讨这些问题。作者在四次90分钟的焦点小组会议中询问了9名年龄在61-88岁之间的轻度智力残疾参与者,并对数据进行了主题分析。许多最近和过去的负面生活事件仍然给参与者带来沉重的负担。消极的互动、失去的经历、缺乏控制和意识到自己的残疾都会造成压力。他们的情绪反应与他们的满足、顺从和适应力形成鲜明对比。拥有良好的人际关系,学会应对技巧,保持活跃,谈论过去的经历,感觉没有痛苦,安全,得到良好的支持,有能力,受到尊重和参与,似乎可以增强恢复力,保护参与者免受有毒压力的影响。监测和预防不良(童年)经历、支持积极/情绪应对策略、心理治疗和生活故事工作可促进智障老年人应对负面事件,提高他们的生活质量。轻度智力残疾的老年人在生活中经历(早期)不良事件的风险更高。他们非常有能力谈论他们的经历、生活质量和他们需要的支持。焦点小组是捕捉他们见解的可靠方法。
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引用次数: 4
Ageing and increased longevity amongst people with intellectual disabilities: an editorial 智障人士的老龄化和寿命延长:一篇社论
IF 1.5 Q2 Nursing Pub Date : 2019-11-28 DOI: 10.1108/qaoa-12-2019-066
M. Redley
Men and woman with intellectual disabilities are living longer and comprise a growing proportion of this vulnerable population (Emerson and Hatton, 2008). Seen in the light of policies promoting equal rights, this increase in longevity flags up how important it is to understand ageing and longer life in that part of the citizenry which can be defined by life-long deficits in intellectual and social functioning. What kinds of lives are older adults with intellectual disabilities living? Few, if any, will have acquired the properties, pensions and incomes that their peers in the baby boomer generation are enjoying. Nor will their lives have been punctuated by the milestones of career marriage, and parenthood. What, if anything, could reaching retirement-age mean for people who may have spent almost their entire lives in an enclave of welfare services? This can mean encountering services that often fail to meet the needs of older persons with disabilities and in the case of specialist disability services, often struggle to meet their age-related frailties (National Institute for Health and Care Excellence, 2018).
智障男性和女性寿命更长,在这一弱势群体中所占比例越来越大(Emerson和Hatton,2008年)。从促进平等权利的政策来看,寿命的增加表明,理解这部分公民的老龄化和长寿是多么重要,而这部分公民可以被定义为智力和社会功能的终身缺陷。有智力残疾的老年人过着什么样的生活?很少有人(如果有的话)会获得婴儿潮一代同龄人正在享受的房产、养老金和收入。他们的生活也不会被职业婚姻和为人父母的里程碑所打断。对于那些几乎一生都在福利服务区度过的人来说,达到退休年龄意味着什么?这可能意味着遇到的服务往往无法满足残疾老年人的需求,而在专业残疾服务的情况下,往往难以满足他们与年龄相关的弱点(国家健康与护理卓越研究所,2018)。
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引用次数: 1
Encouraging managers of care homes for older adults to participate in research 鼓励老年人护理院的管理人员参与研究
IF 1.5 Q2 Nursing Pub Date : 2019-08-29 DOI: 10.1108/qaoa-04-2019-0017
N. Smith, A. Towers, Grace Collins, Sinead Palmer, S. Allan, J. Beecham
PurposeResearch in care homes requires the co-operation of care home managers. Noting the challenges faced by the care home sector, the purpose of this paper is to consider ways in which research studies can encourage care home managers and their homes to participate in research.Design/methodology/approachThe discussion is informed by two research projects which are used to explore methods of encouraging managers of care homes to participate in research. One of the studies included interviews with care home managers to understand their reasons for taking part in research.FindingsThis paper outlines and assesses three strategies for encouraging care home managers to participate in research: working in partnership, providing payment and providing personalised feedback on findings. Whereas all the strategies have the potential to encourage care home managers’ participation in research, partnership working in particular was found to be fraught with difficulties.Research limitations/implicationsThis paper suggests that the research projects could employ any of these strategies to encourage managers of care homes to participate in research. It also suggests that proactive measures could help ameliorate the pitfalls of partnership working.Originality/valueThis paper shows the advantages and disadvantages of using a combination of strategies for encouraging the participation of care home managers in research.
养老院的研究需要养老院管理者的合作。注意到养老院行业所面临的挑战,本文的目的是考虑研究研究可以鼓励养老院管理者和他们的家庭参与研究的方法。设计/方法/途径讨论由两个研究项目提供信息,这两个研究项目用于探索鼓励养老院管理人员参与研究的方法。其中一项研究包括对养老院经理的采访,以了解他们参与研究的原因。研究结果本文概述并评估了鼓励养老院管理者参与研究的三种策略:合作、提供报酬和提供针对研究结果的个性化反馈。尽管所有的策略都有可能鼓励养老院管理者参与研究,但研究发现,合作工作尤其充满了困难。研究的局限/启示本文建议研究项目可以采用这些策略中的任何一种来鼓励养老院管理者参与研究。报告还指出,积极主动的措施可能有助于改善伙伴关系运作的缺陷。原创性/价值本文展示了使用组合策略来鼓励养老院管理者参与研究的优点和缺点。
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引用次数: 9
Intergenerational exchange and the possibilities of role substitution for older people 代际交流和老年人角色替代的可能性
IF 1.5 Q2 Nursing Pub Date : 2019-08-29 DOI: 10.1108/qaoa-03-2019-0013
J. Macfarlane, C. Stephens, Joanne E. Taylor
PurposeRole loss or substitution are common experiences of older adults, and a role typically held by older people – great grandparent or grandparent – is now under threat. Set within the context of a retirement village where an Intergenerational Programme (IGP) was taking place, the purpose of this paper is to understand older people’s perspectives on preschool-aged children, and the roles they adopt with them.Design/methodology/approachThe authors conducted semi-structured interviews and analysed the data using narrative analysis (n=19).FindingsFour narratives were identified, revealing that older adults adopt the roles of teacher and compromiser when interacting with children, believe they are “plugging a gap” in society through their involvement with younger generations and are reminded of life when with them.Research limitations/implicationsThe study does not feature the voice of younger children within intergenerational contact; information which would have provided a different perspective on the roles identified.Social implicationsThe bulk of global IGP practice is targeted at bringing together older and younger people who are not as young as preschool age, but this may be an opportunity missed. Retirement village operators may also want to consider intergenerational activity with preschool-aged children as a way for them to provide opportunities for role substitution within this environment.Originality/valueThe findings identify a positive perception older people have about young children in today’s society, expanding on very limited literature. How older adults perceive their role with young children is also identified within this research, highlighting how interacting with non-related preschoolers can provide some older people with a substitute role in later years.
目的角色丧失或替代是老年人的常见经历,而通常由老年人担任的角色——曾祖父母或祖父母——现在正受到威胁。本文的背景是一个正在进行代际计划的退休村,目的是了解老年人对学龄前儿童的看法,以及他们与他们一起扮演的角色。设计/方法/方法作者进行了半结构化访谈,并使用叙事分析对数据进行了分析(n=19)。发现共确定了四种叙事,揭示了老年人在与儿童互动时扮演教师和妥协者的角色,相信他们正在通过与年轻一代的交往“填补社会空白”,并在与他们相处时想起生活。研究局限性/含义该研究没有以代际接触中年幼儿童的声音为特征;这些信息将为所确定的角色提供不同的视角。社会影响全球IGP实践的主要目标是将年龄不到学龄前的老年人和年轻人聚集在一起,但这可能是一个错失的机会。退休村经营者可能还想考虑与学龄前儿童的代际活动,作为他们在这种环境中提供角色替代机会的一种方式。原创性/价值研究结果在非常有限的文献基础上,确定了当今社会中老年人对幼儿的积极看法。这项研究还确定了老年人如何看待他们在幼儿中的角色,强调了与非相关学龄前儿童的互动如何为一些老年人在晚年提供替代角色。
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引用次数: 1
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Quality in Ageing and Older Adults
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