Ageing & Society最新文献

Care home residents were vulnerable to severe effects from Covid-19 infection and experienced high mortality, especially early in the pandemic. In response, many countries introduced visiting restrictions to limit transmission. These often proved extensive and prolonged, drawing fresh attention to issues of autonomy and human rights in long-term care. We conducted in-depth interviews with 27 family carers in England with relatives living in a care home during the pandemic. Adopting a relational autonomy lens, conceptualised using the capability approach, we examined how family carers considered their relatives’ capabilities to have been impacted by visiting restrictions and how relational support could be strengthened. Family carers were concerned for their relative’s fundamental capabilities, including physical health, emotional well-being, and feeling connected to significant others. Capability deprivations were associated with family separation, ‘adapted’ visits that were inappropriate for their relative’s needs, and lack of opportunity for family carers’ to provide emotional support, help staff identify their relative’s emotional and physical needs, monitor care standards or advocate for their relative. Optimising relational support during a public health emergency requires effective collaboration between care homes and family carers. Specific measures include (1) ensuring there is clarity, a sense of shared purpose, clear accountability and confidence in visiting restrictions, (2) providing family carers regular, personalised updates about their relative using a range of digital communication tools, (3) allowing choice about visiting arrangements where possible, and ensuring visits are appropriate for residents with dementia and (4) ensuring that family carers feel welcomed, involved and enabled to resume in-person visits at the earliest opportunity. Consultation with care homes, families and residents, and workforce and digital readiness should be prioritised.

There is a lack of comparative and quantitative research on how poverty manifests itself in the economic wellbeing of older people across European countries. In this study, we focus in on two central dimensions of economic wellbeing: the ability to pay for usual expenses and unexpected expenses. Our aim is to find out how often older people living at risk of poverty experience hardship on these dimensions, how these dimensions overlap, and whether the incidence of hardship differs between the poor and the non-poor. The study is based on the cross-sectional component of the European Union Statistics on Income and Living Conditions (EU-SILC) 2018 survey, involving 29 countries and 148,432 respondents aged 65+ years. The analysis builds on both descriptive statistics and multinomial logistic regression, which takes into account differences in household characteristics between the poor and the non-poor. The results reveal that for the poor, meeting unexpected expenses is a more common problem than meeting usual expenses, although they typically experience hardship on both dimensions. Hardship among the poor is more frequent in Central Eastern and some Southern European countries, while poor people living in Continental and Nordic countries tend to fare better, even though relatively large numbers in these countries lack cash margin. The non-poor do also experience hardship, but to a lesser extent. The poor experience combined hardship relatively often in Continental European countries. Based on the results, we conclude that studies should pay closer attention to the different dimensions of economic wellbeing in old age.

The COVID-19 pandemic in Australia has profoundly affected older adults, particularly in the state of Victoria, which experienced strict lockdown restrictions six times since the pandemic began in 2020; totalling 245 days over three years. This study explored the experiences of older adults living in retirement villages during the first three lockdowns in Victoria from March 2020 to February 2021. We draw on the concept of the ‘third age’ to explore how residents’ post-retirement social and lifestyle aspirations were disrupted by the pandemic and associated lockdowns. In-depth qualitative interviews were conducted with 14 residents during January and February 2021. All data were analysed using thematic mapping. Five key themes were identified: (1) benefits and frustrations of retirement village living during a pandemic; (2) the loss of amenities and activities; (3) heightened loneliness and social isolation; (4) reaching out to others; and (5) variable experiences of operators’ response. Although the COVID-19 pandemic has highlighted short-term and long-term issues around social isolation and the management of retirement villages, it has also demonstrated the resilience of residents and the strength of community ties and relationships. Retirement villages are promoted as age-friendly environments that enable an active and healthy post-retirement lifestyle. Yet our findings reveal heterogeneity within village populations. When services closed during lockdowns, this revealed a tension between the policy assumption that retirement villages are a housing consumption choice, and the unmet needs of those residents who depend on village services for day-to-day functioning.

The COVID-19 global pandemic had a major impact on older people's mental health and resulted in changes in alcohol use, with more older adults increasing than decreasing consumption levels among the general population. So far, no studies have focused on older people who were already experiencing problem alcohol use. This qualitative research is the first to provide a nuanced understanding of changes to drinking patterns among older adults engaged in alcohol treatment during the COVID-19 pandemic, and the implications of these for practice. We conducted 30 semi-structured interviews with people in alcohol treatment aged 55+ living in urban and rural areas across the UK. Data were analysed using thematic analysis. We found that changes in alcohol use varied depending on the social, economic and health impacts of the pandemic on older adults. Boredom, lack of adequate medical or emotional support, and key life changes experienced during the pandemic (such as bereavement or retirement) increased the risk of increased drinking. Moreover, some people in longer-term alcohol treatment were struggling to maintain abstinence due to lack of face-to-face peer support. For others, decreased drinking levels were a side-effect of lockdown policies and restrictions, such as alcohol-related hospitalisations, closure of social spaces or inability to source alcohol; these also supported those who decided to cut down on drinking shortly before the pandemic. Generally, older adults who developed home-based interests and self-care practices managed lockdown best, maintaining abstinence or lower risk drinking levels. Based on these results, we argue that multilevel interventions aimed at strengthening resilience are required to reduce drinking or maintain abstinence among older adults. Such interventions should address three domains: individual (coping strategies and mindset), social (support networks), and structural (access to resources). In preparation for supporting older alcohol users through prospective future pandemics, building digital literacy and inclusion are essential.

Although older people who live alone might be in a vulnerable situation, they have often managed their everyday life for a long time, frequently with health challenges. In this article, we explore how nine older persons who live alone, who receive home care and are identified by home care professionals as being frail, manage their everyday lives by inquiring into their stories about living alone and receiving home care. We conducted three qualitative interviews with each of the nine participants over a period of eight months and analysed the data using thematic analysis and a narrative positioning analysis. Using the concept of resilience as our analytic lens, we identified three thematic threads: continuity, adaptation and resistance. In the narrative positioning analysis of three participants' stories, we identified that the participants used the processes of continuity, adaptation and resistance strategically and interchangeably. The study thus provides insight into how older people who live alone and use home care services narrate their balancing of strengths and vulnerabilities, and engage in the construction and maintenance of a sense of self through positioning in relation to master narratives. Older people's narrations are nuanced and complex, and this study indicates that encouraging storytelling and engaging with older people's narrations might support how older people enact resilience and thus their management of everyday life when living alone and ageing in place.

Older adults who have had a major depressive disorder (MDD) have a high risk of relapse. Although risk factors for depression have been researched extensively, less is known about protective factors, and what experiences might strengthen subsequent resilience and help to prevent relapse. Therefore, this qualitative study explored factors of resilience in older adults who recovered from MDD and did not relapse across at least six years. Twenty-five semi-structured interviews were held with older adults aged 73–85 years who participated in the Netherlands Study of Depression in Older Persons from 2008 to 2014 and were re-interviewed for the present study in 2020–2021. Participants were defined as resilient based on having an MDD diagnosis at baseline but not on two- and six-year follow-up. We used grounded theory coding techniques and thematic analysis to identify factors contributing to resilience. Factors contributing to resilience included: taking agency; receiving social support and engaging in social activities; doing activities individually; and managing thought processes. Resilience after late-life depression appeared to be a dynamic process involving internal and external factors, including finding a balance between rest and activity, between taking initiative and receiving support by others, and between accepting negative emotions and ignoring negative thoughts. Additionally, the ability to learn from depression shows that resilience is not only about avoiding psychopathology, but also about the recovery process and preventing relapse. These findings highlight the need for research and interventions to focus on understanding and influencing the dynamics underlying resilience.

The COVID-19 pandemic and ensuing restrictions/lockdowns have caused significant physical and psychological consequences for people with cognitive impairment who are heavily dependent on their care-givers. However, little is known about the impact on care-givers, the factors that exacerbate their situation and what supports they need. The aims of this paper are threefold: (a) to examine the impact of COVID-19 physical restrictions on both formal and informal care-givers of people with cognitive impairment; (b) to identify attributing factors influencing this impact; and (c) to recognise their support needs. Further, this paper informs future research, policy and practice. Guided by the Joanna Briggs Institute framework, a systematic review was conducted using a mixed-methods convergent integrated approach. Eight databases were searched using keywords related to COVID-19 restriction, dementia care-givers, impacts and care settings, followed by a manual search. The study was limited to primary research published in English between January 2020 and December 2021. Of the 840 records identified, 30 met the inclusion criteria. Service withdrawal and social distancing has effectively led to the reprivatisation of care to the family, particularly women. Care-givers experienced negative impacts including reduced psychological wellbeing and physical health, increased care burden and financial difficulties. A number of clinical attributes and socio-demographic factors influenced the COVID-19 impact on care-givers. Consequently, counselling services, assistance with care and financial support were identified as support needs. Implementation of new support and the strengthening of existing services are recommended to enhance resilience, build capacity to support care-givers in any given situation and mitigate the effects of future outbreaks.

Previous research has highlighted the importance of past life experiences in the theoretical and conceptual understanding of loneliness. However, adding a lifecourse perspective to loneliness research remains underexplored. To comprehend the complexity of loneliness in old age, it is crucial to pay attention to the lifecourse perspective. This study addresses an important lifecourse perspective on loneliness through an in-depth, narrative approach. Building on the cognitive discrepancy theory, this study examines how precipitating events and coping strategies throughout the lifecourse may influence current feelings of loneliness in older adults. We qualitatively examined the experienced lifecourse of 20 lonely older adults living in Belgium by applying a modified version of the McAdams life-story interview scheme. Next, we conducted eight member-check interviews. A first finding provided insight into the importance of precipitating events during the lifecourse for current loneliness. The results pointed not only to the lifelong impact of events during childhood and adulthood, which may lead to vulnerability to loneliness later in life: unrealised life events (e.g. not being able to have children) as well as events with no impact earlier in life nevertheless turned out to be relevant in the emergence of loneliness later in life. Second, the narratives revealed that several older adults who experienced loneliness earlier and later in life continued to use the same coping strategies throughout the lifecourse, whereas by contrast some older adults adapted their coping strategies based on previous experiences and improved their loneliness-coping skills. It also appeared that changes in people's resources, such as the presence of physical limitations, may make it more difficult to cope with loneliness in later life. The discussion makes a plea for lifelong prevention of and attention to loneliness.

Older adults were particularly vulnerable to the COVID-19 pandemic, necessitating significant efforts to avoid contamination. This extraordinary situation posed an increased risk of mental pressure, and the ability to handle stressful situations is affected by several aspects. Therefore, this study aims to explore the coping strategies employed by older adults during the early months of the COVID-19 pandemic. A sample of 41 Swedish older adults aged 70–85 participated in phone interviews regarding their experiences with social distancing due to COVID-19. The interviews were conducted between April and May 2020, with nine follow-up interviews conducted in November and December 2020. The findings revealed results that despite the challenging circumstances, the participants demonstrated a strong mindset and resilience. Strategies utilised to improve their wellbeing and manage the situation included following recommendations, accepting the situation and maintaining a positive outlook. The influence of previous experiences on their coping strategies was evident. Additionally, the participants expressed a longing for their relatives and a need to adopt new technologies to manage their everyday lives. The follow-up interviews indicated no significant changes in worry or behaviour; if anything, participants were less worried at the beginning of the pandemic. This study contributes to the ongoing discussion on vulnerability among older adults by highlighting the diverse range of coping strategies employed during a prolonged crisis such as the COVID-19 pandemic. It demonstrated that though they are medically vulnerable, they are situationally resilient and, in many ways, well set to handle a challenging situation. During crises, older adults might need practical assistance. On the other hand, they can be a resource regarding mental preparedness during crises. Further research should explore the possibilities of balancing the needs of older adults and, at the same time, viewing them as a resource during long-time crises.