Ageing & Society最新文献

'Living well' is an important concept across national dementia strategies, where qualitative research has contributed to understandings of living well for people with dementia. Longitudinal, qualitative approaches are fewer but can explore potential changes in accounts of living well, psychological coping and adaptation to dementia, and if or how people with dementia maintain continuity in their lives. The aim of this longitudinal qualitative study was to gauge what is important for 'living well' with mild-to-moderate dementia and whether this changes over time in a group of older people with mild-to-moderate dementia living at home. Semi-structured, qualitative interviews with 20 people with dementia from the IDEAL cohort study were conducted in 2017 and again one year later and analysed using longitudinal thematic analyses. The overarching narrative was largely that of continuity and adaptation, with incremental not disruptive change. Continuing participation and meaningful occupation were important to maintain living well over time, where individuals pursued new as well as previous interests. As a key psychological coping strategy to support continuity in their lives, individuals emphasised their capabilities to maintain activities in spite of dementia, compartmentalising specific areas which had become more challenging. Maintaining social networks and accommodating changes in social relationships were also central to living well over time including managing the psychological impacts of changes in spousal relationships. People in the earlier stages of dementia emphasise continuity and their capabilities, reporting change over time only in certain aspects of their lives. However, small, incremental changes in their social relationships and opportunities for meaningful occupation may still afford key areas for supporting capability to 'live well'.

The global population is ageing rapidly, emphasising the need to understand the decision-making processes of older adults regarding potential care transitions. Gerontological research has focused on healthcare decisions, with less information on living situation choices of older adults. This review explored older adults' experiences with their involvement in decision-making processes related to transitioning into care facilities in the United Kingdom. From a systematic search of articles, nine were reviewed using thematic narrative synthesis. Four themes with nine subthemes were identified: Involvement in decision-making (Exclusion of older adults, Usefulness of involvement), The necessity of moving (Triggers for moves, The role of family), Timely planning (Helpfulness of planning, Planning avoidance), and Factors for choosing a care home (Non-quality factors, Quality factors, Continuity of life). These themes highlighted the issue of inadequate involvement of older adults in decision-making, often resulting in negative consequences like regret and difficulty settling into new care settings. The necessity of moving arose from sudden events or increased support needs. Some older adults acknowledged the necessity due to declining health or to spare family burden, while relatives grappled emotionally, postponing the choice. Timely planning was found to be beneficial practically and emotionally, facilitating smoother transitions. However, participants would rarely plan and discuss such matters early. Older adults focused on personal experiences and trusted sources rather than publicly available information when considering Factors for choosing a care home. The findings show the need for greater inclusion of older adults in decisions related to their care and the importance of early planning and providing preferred types and formats of information to aid decisions. Future research should focus on a better understanding of older adults' preferences for successful involvement in care decisions, with support and guidance for others involved in the decisions.

Understanding how to improve the physical and cognitive accessibility of visitor economy businesses and organisations wanting to offer nature-based outdoor pursuits for people with dementia is key to supporting their inclusion and agency. The aim of this qualitative study was to understand the experiences, needs and preferences of people with dementia participating in nature-based outdoor pursuits in their leisure time. Semi-structured interviews were conducted with 15 people with dementia and 15 family members and subjected to thematic analysis. Four themes related to inclusion for people with dementia and their family members reflected diversity in individual needs and preferences for engaging with nature-based outdoor pursuits, their own adaptations to maintain access including accommodating risk, how cognitive and physical accessibility can be supported by businesses, and which practical and psychosocial barriers prevent inclusion. Learning from people with dementia and their family members has helped bridge the gap to their inclusion in nature-based outdoor pursuits. Their insights will inform the development of such pursuits by businesses and organisations as well as future work into risk decision-making.

Ageing-in-place for persons with dementia and informal caregivers is encouraged by governments and society. However, individuals with non-Western migration backgrounds are at higher risk of dementia yet underrepresented in research and care. This study aims to identify ageing-in-place care preferences of persons with dementia and their informal caregivers in the Netherlands. Semi-structured interviews (n=8 participants with dementia, n=20 informal caregivers) were analyzed using reflexive thematic analysis. Findings reveal that informal caregivers feel a strong duty to care, assisting with various daily tasks. While they desire shared care with professionals, identifying concrete care needs is challenging, highlighting the need for proactive professional support. Participants also emphasized the importance of culturally sensitive in-home care, home adaptations, social care, and accessible dementia information. Additionally, the emotional impact of dementia on care recipients and caregivers underscores the need for emotional support. These insights enhance understanding of the care preferences of persons with dementia and their informal caregivers, aiding more efficient and culturally responsive health service planning.

Longitudinal studies can provide insights into how family members negotiate the caring role and carer identity over time. Within longitudinal, qualitative interviews on 'living well' with dementia from the IDEAL cohort study, the aim of the analyses was to identify the shifting, embedded narratives of family members of people with dementia as they negotiated the caring role and carer identity over time. 20 semi-structured, qualitative interviews were conducted with family members of people with dementia, 14 repeated one year later, and analysed using cross-sectional and longitudinal thematic and structural narrative analyses. Longitudinal, interrelated themes, including the care needs and decline of the person with dementia, relationship change, and variable service support, framed the narrative types of family members. Six shifting narratives, apparent as dominant and secondary narrative types, characterised negotiating the caring role over time: absent/normalising, active role adoption/carer identity, resistance, acceptance and resignation, hypervigilance/submergence and role entrapment, and foreshadowed future. The presence or absence of a carer identity was also evident from interviewees' accounts, although, even where family members were overburdened by the caring role, they did not necessarily express a carer identity. Rather than considering transition into a carer identity, hearing different narratives within the caring role is important to understand how family members experience caring, whether they see themselves as 'carers', and when and how they need support. Timely and continued post-diagnostic support, where different caring narratives are recognised, is needed, as well as international initiatives for carer identification.

Loneliness and social isolation among older adults are emerging public health concerns. Older adults from ethnic minority communities or with immigration backgrounds may be particularly vulnerable when encountering loneliness and social isolation due to the double jeopardy of their old age and minority status. The goal of this study is to conduct a scoping review of published journal articles on ethnic minority/immigrant older adults' loneliness and social isolation experiences to show the extent, range and nature of empirical studies in this area across several high-income countries (i.e. European countries, United States of America (USA), Canada, Australia and New Zealand). This review uses Arksey and O'Malley's five-state framework, a well-established scoping review method. We identify and analyse 76 articles published between 1983 and 2021. This evidence base is largely US-focused (54%) with the vast majority (76%) having a quantitative design. We summarise and map factors of loneliness and social isolation into a multi-dimensional socio-ecological model. By doing so, we show how ethnicity/immigration-specific factors and general factors intersect in multiple dimensions across places and time, shaping ethnic minority/immigrant older adults' heterogeneous experiences of loneliness and social isolation. Several critical gaps that should be at the forefront of future research are highlighted and discussed.

Few previous studies have investigated how socioeconomic differences in labour market exit have changed after restrictions in social insurance policies. The aim of this register-based study is to investigate how early labour market exit pathways among older men and women with different levels of education changed after major restrictive social insurance and retirement policy reforms in Sweden. Cohort 1 (pre-reform) consisted of individuals who were 60 or 61 years old in 2005 (N = 186,145) and Cohort 2 (post-reform) consisted of individuals who were 60 or 61 years old in 2012 (N = 176,216). Educational differences in four labour market exit pathways were investigated using Cox proportional hazards regression; the exit pathways were disability pension, early old-age pension with and without income respectively, and no income for two consecutive years. As expected, exits through disability pension were rarer in Cohort 2. Lower education was also more strongly associated with disability pension in Cohort 2. Parallel to this, lower education showed a stronger association with both early old-age pension types in Cohort 2. Additionally, a tendency towards a relatively higher likelihood of earning no income was seen among the less educated. Increases in inequalities tended to be greater for women. Our results indicate that educational inequalities in labour market exit have grown significantly after restrictions in social insurance and changes in retirement policies, which can have negative financial repercussions for those already in a vulnerable position. These results indicate that careful analyses of effects on disparities are needed before making major changes in welfare systems.

Social engagement is considered a relevant modifiable factor for older adults' wellbeing. Theory and policies highlight its importance for ageing well. Empirical evidence shows that social activities are associated with positive psychological outcomes and might buffer wellbeing declines in late life. Despite growing research, social engagement lacks conceptual clarity, it is difficult to adopt standardised measures and findings are sometimes inconsistent. Previous systematic reviews either take a different approach to this topic or were published over a decade ago. Therefore, the present study aimed to review the literature systematically regarding the relationship between social engagement and wellbeing in community-dwelling older adults. Papers published from 2000 to 2021 were searched in five databases using a combination of terms. The reviewers screened the records according to predefined inclusion and exclusion criteria. After identifying eligible articles, the authors extracted data and produced a narrative synthesis covering conceptualisation, measurement and main findings. The review includes 42 papers. Despite great conceptual and methodological diversity, research supports that older adults with higher participation in social activities have improved wellbeing. Findings also suggest that these associations are stronger for individuals with disadvantages and have a cumulative nature whereby the greater the social engagement, the higher the wellbeing. Conversely, for more demanding activities, there might be optimal participation levels. Regardless of accumulating knowledge, social engagement remains diffuse and difficult to measure. This paper summarises the current state of research on this topic, showing encouraging evidence of social engagement benefits, but also questions that deserve further inquiry. Future studies should be anchored in a clear conceptual framework, use robust measures, and explore hedonic and eudaimonic wellbeing. Social engagement can be an important developmental resource for social interventions and policies aimed at improving people's lives.

The aim of this article is to critically review the scientific literature about the changes in travel behaviour and mobility amongst older adults caused by the COVID-19 pandemic across various countries, identify unmet travel needs and highlight patterns of inequalities in older adults' mobility. We have collected articles from four academic databases: PubMed, Scopus, Transportation Research International Documentation (TRID) and Web of Science. Papers were considered for inclusion if they were published online in 2020 or later, written in English, and referred to urban or rural changes in travel behaviour and mobility of older adults over 50 years old. We examined the pre-existing models developed before the outbreak and classified the articles based on Musselwhite and Haddad's hierarchy of older adults' travel needs. The synthesis of the selected 25 articles shows a general decline in literal mobility amongst older adults, an increased share of virtual travel and their decreased capacity to fulfil different levels of travel needs. Findings also indicate an increased gap in older adults' mobility across geographical regions with various levels of transport infrastructure and digital capital. We conclude the paper with the lessons learned, the opportunities ahead, and the challenges that must be overcome to achieve sustainable development and the United Nations Decades of Healthy Ageing goals in the post-pandemic world.

During the COVID-19 pandemic, the media provided daily coverage of this unprecedented crisis in the history of the 21st century. Some topics, such as how the virus affected older adults, were widely covered. The way in which COVID-19 was documented evoked a ‘tragedy’ narrative through consistent reporting about the suffering it was causing and the deleterious consequences it had on specific populations, including residents of long-term care homes (LTC). This article explores how reports on COVID-19 in LTC homes in a national newspaper (The Globe and Mail) fuelled a tragedy discourse that modulated the value of life of older adults living in those environments. We used critical discourse analysis and analysed 74 articles focusing on older persons residing in LTC homes in two Canadian provinces (Quebec and Ontario) during COVID-19. This article offers a brief overview of the notion of tragedy and how the discourse of tragedy is intertwined with humanitarian crises, life and death, and the value of life. Our findings revealed the construction of three types of tragedies that shape our societal values around life and death in LTC: the tragedy of the threat to life, the tragedy of the unfortunate (old, vulnerable and lacking in agency) and, finally, the tragedy of historical neglect and abandonment. Our findings suggest that the nature of reporting on life and death in LTC homes during the COVID-19 pandemic provoked a sense of fear and pity for a passive other. Re-thinking what gets reported in the media, including whose voice is represented/missing and how tragedy narratives are balanced with contesting stories, could elicit more sentiments of solidarity and action rather than reinforce pity, distancing and immobilisation.