Volunteering through my eyes: an older person’s journey before, during, and after the pandemic

As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the views of frail older persons and their significant others concerning existential loneliness are in concordance. To contrast frail older (>75) persons' experiences with their significant others' perceptions of existential loneliness. A case study design was chosen for this study. Individual interviews with frail older persons (n = 15) and interviews with their significant others (n = 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. This study was conducted in accordance with the principles of research ethics. The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. Knowledge about the tensions between older persons' and their significant others' views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person.

Many different “domains” of older persons’ living environments potentially influence their residential satisfaction and thereby their well-being. Factors that might impact on older persons’ residential satisfaction were explored in a busy Asian city, Hong Kong, in terms of a number of “domains” with elements: the Structural domain (interior and exterior dwelling characteristics, security concerns), the informal domain (informal social support including family, friends, and neighbours) and the formal domain (social services and community facilities) around or near the neighbourhood. Face-to-face interviews were conducted with a random sample 518 Hong Kong residents aged 60 and over, who lived in various housing arrangements including private/public and new/old housing establishments. Hierarchical regression analysis models revealed that the structural domain had the strongest tie with residential satisfaction. Formal and informal types of support for older persons’ needs were generally unrelated to residential satisfaction. Further investigations showed that all three elements of the structural domain contributed unique variance to residential satisfaction. Satisfaction with community facilities, an element of the formal domain, was related to residential satisfaction even when variations from other domains were accounted for. When all the three domains were simultaneously analysed for their contributions to residential satisfaction, all of the elements of the structural domain and the community facilities element of the formal domain contributed to unique variance. The implications of the findings for policy makers in designing home settings for older persons in Hong Kong and some other Asian cities are discussed.

ABSTRACTSense of security is important throughout the lifespan not at least in advanced age with increased risks of functional declines and decreased social capital. Despite this, knowledge concerning older person’s perceptions and experiences of sense of security when moving into nursing homes is scarce. This study is a longitudinal, descriptive, exploratory case study with in-depth interviews and observations of three older persons in the age of 87, 88, and 91 years in a mid-sized municipality in the south of Sweden, in order to highlight how sense of security is experienced when moving into and living in a nursing home. Data were analysed using qualitative content analysis, which resulted in one main theme and four categories. The main theme, ‘Adaptation and sense of security’, indicates older persons’ need to adapt to the new context of the nursing home, and how this relates to their sense of security. The categories – ‘Control’, ‘Struggling for understanding’, ‘Lack of influence’, and ‘Grasping’ – suggest that older persons’ sense of security is reduced when they must adjust to routines without sufficient management and understanding. When able to maintain control over daily routines, and felt as a part of the new context, they perceived a sense of security.

Background: The potential to influence the design of one’s local environment is especially important to older people since age-related problems, in combination with a less supportive environment, can prevent the performance of meaningful activities. It is unclear how best to tailor a participatory approach to support the task of collaborating with older persons about their local environment. Life filming was used in such a project.Objective: To describe Life filming as a means of participatory approach in relation to older community-dwelling persons and the design of their local environment.Material and method: A descriptive single case study. Data were generated through field notes and memos, and analyzed utilizing thematic analysis. Participants have validated the findings.Findings: Five themes describe central aspects of Life filming in the given context: Anchoring the concept of participation, Practical application of Life filming, The film as a product, Making a real difference, and An identity as a capable older person.Conclusion: Life filming supported participation, both as a process and an outcome. It had benefits on multiple levels: for the individual person, for older persons as a group, and for the municipality. Life filming could constitute a useful digital tool for practice when a participatory approach is desired.

BackgroundDespite decades of study, debates exist surrounding the relationship between education and functional health status transition among elderly populations. This study aims to add evidence to the debates using China as a case study. Specifically, this study analysed the association of education with functional health status transition and then the mechanism behind that association using the budget constraint relax hypothesis and the efficiency improvement hypothesis among elderly population in China.MethodsBased on data from the Chinese Longitudinal Healthy Longevity Surveys from 2008 and 2011, this study focussed on adults aged 65 years and above, with a final sample size of 12,112. A generalised structural equation model was used to analyse the relationship between education and functional health status transition and the mechanism behind that association.ResultsDuring the three examined years, among elderly adults who were nondisabled at baseline, 53.1% stayed nondisabled, 14.6% became disabled, and 32.3% died; among those disabled in 2008, 8.1% recovered, 21.6% stayed disabled, and 70.3% died. Compared with older adults without any education, those who had attended primary schools had both lower mortality and disability, whereas those who had attended high schools and above only had a lower mortality rate. The budget constraint relax hypothesis and the efficiency improvement hypothesis explained the majority of the relationship between education and transition from non-disability to death, but hardly explained the transition from non-disability to disability. Furthermore, once a person was disabled, education had no significant relationship with functional ability recovery or mortality.ConclusionsAttending primary school seems to provide the highest benefit to functional health status transition among older and nondisabled persons in China. Those who attended high schools and above are expected to live a longer life with disability. The mechanism between education and the onset of disability needs more discussion.

Introduction: This paper presents the social security institutions used by older persons in selected countries from the perspective of the well-being of the elderly. The authors consider social security institutions for older persons to be old-age pension systems and long-term care systems and, to a limited extent, benefits under the health care system, which, although targeted not only at older persons, in many cases have become the starting point for the development of long-term care institutions.Purpose: The aim of this study is to draw attention to the need of a holistic approach in the protection of older persons and the need for further analysis from the perspective of their well-being. The main assumption is that to obtain the protection picture for older persons it is necessary to assess not simply old age pensions but also other benefit systems.Materials and methods: Description of the social security institutions for older persons with the aim to assess the extent of the social protection they provide. In these assessments the authors employ quantitative data as well as the opinions of national and international experts. This methodology draws on a case study approach.Results: (1) Older persons with decreasing pension amounts will face difficulties in the financing or co-financing of their long-term care costs. The health care for older persons often overlaps with long term care. There are requests for the co-ordination of these two institutions, but in practice this is not easy to achieve. Financial incentives as well as institutional traditions play a role in this respect.(2) Countries that have introduced long-term care systems and are facing rising costs are undertaking many studies on the effectiveness or efficiency of their operations. Some countries have introduced long-term care within the context of population ageing, such as in Korea; unlike in Germany, where the system targets all dependent people. (3) The early application of generous solutions (for example in Sweden or Germany) may foster claimant attitudes and hamper the reduction of pension systems. In Eastern countries, such as Korea, on the other hand, poverty levels are very high because older persons were simply not prepared to be left unsupported.

The impact of natural disasters on the older population is unlikely to diminish in the years to come due to the increasing number of older persons in Malaysia. Recent trends with respect to management of natural disasters have highlighted the role of NGOs in all phases of disaster management namely preparedness, response, recovery and mitigation. Research showed a notable difference emerged between the perceptions of the older persons, and those of the respondents from aid agencies (government and NGO) dealing with emergencies. In this research paper, information on specific needs and problems faced by older persons during the 2014 flood as well as the NGOs perceptions towards them were identified. It also studied the impact of flood disaster on older persons. Their preparedness to face emergencies and the suitability of the relief programs organized by NGOs were investigated. A mix method approach was adobted in this research which include qualitative (Focus Group Discussion) and quantitative (face-to-face interview) survey. Data was analyzed using Statistical Package for Social Science (SPSS). Based on findings from the FGDs conducted, there was no Standard Operating Procedure on flood relief for the older persons adopted by the NGOs. There is a clear need for SOPs to ensure proper guidelines and procedures in meeting the special needs of the older persons in times of disasters.

This paper discusses the economic reforms initiated by Cuban President Raúl Castro in 2008 and its effect on the country's fast-growing, vulnerable population of older persons 60+ years of age. Cubans are living longer and the country has a very low birthrate. These two factors combined have reduced the proportion of the population in the work force. This adversely affects the economy. Population aging is a major reason why the government has introduced structural reforms and reduced social spending, which have weakened the welfare state on which older persons depend. Many older persons have become critical of the reforms over time. Policy makers need to address the impact the reforms are having on older Cubans and consider them as active participants in economic reform. Data for this paper come from qualitative, case study research carried out in Havana between the years 2008-15 and from a review of the literature on aging and economic reforms in Cuba. Two case studies illustrate the impact of the economic reforms on older persons.

Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices. Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested. After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step.

Malaysia is recognised an ageing nation, with over 7% of its population aged 60 years and above, a figure predicted to rise to 15% by 2030. This demographic shift calls for proactive measure to address the needs of the growing ageing population. While facilities and infrastructure are in place, the support from community is essential. The main objective of this study is to explore the personal experiences of older persons participating in the social activities offered at the Activity Centre for Older Persons (PAWE) in Jenjarom, Selangor. A qualitative research method was employed, involving older persons who were participating in PAWE to explore the drives behind the older persons’ participation at the centre. The findings demonstrated that: (1) emotional connection; (2) mitigating loneliness; and (3) social solidarity as the major drives. It is learnt that sustainable communities hold immense potential in empowering older persons to lead active and healthier lifestyles. The study aligns with Sustainable Development Goal (SDG) 11, which emphasizes the need for safe, inclusive, resilient, and sustainable urban environments—an essential consideration for nations with rapidly ageing populations.

BackgroundMore than half of older persons admitted to an emergency department after a fall have a hip fracture and require surgery for a total hip replacement. This procedure has a high risk of postoperative complications and consequences for older persons, their informal caregivers, and the healthcare system. This study aimed to explore the perceptions of older persons, their informal caregivers and health professionals about intra-personal, inter-personal and extra-personal stressors arising from hip surgery following the fall of an older person hospitalised in orthopaedics, as well as the coping strategies used and the results obtained.MethodsA qualitative multiple case study. The sample consisted of eight cases. Each case consisted of one older person, their informal caregiver and the professionals involved in their care: a nurse, an orthopaedic surgeon and a physiotherapist. A total of 32 participants were recruited. Data were collected between August 2018 and February 2019 in a public hospital in French-speaking Switzerland. Intra- and inter-case analyses were performed.ResultsFive topics emerged: two concerning stressors for older persons (the physical and psychological consequences of the fall and hospitalisation; the loss of relational and environmental markers and habits); two relating to the coping strategies used to face the stressors (being resilient and involved in their own care; partially meeting the older person’s needs); and one regarding the results of the strategies used (reassurance through consideration of some of their needs).ConclusionsOlder persons hospitalised for hip surgery after a fall are confronted with various intra-, inter- and extra-personal stressors and have to explore, together with their informal caregivers, strategies to cope with the consequences of these stressors. Healthcare professionals should possess efficient intervention strategies to help identify and support older persons who experience various types of stressors during hospitalisation for hip surgery following a fall.

Purpose “My Story” is based on a life story approach. This study aims to facilitate therapeutic alliances by providing a format for older and younger people to interact. Design/methodology/approach Three pairings were studied to explore the experiences of the older and younger person using “My Story”. The focus of the case studies was on how and if any therapeutic alliance emerged. Findings This study found that in the two of the pairings, “My Story” helped to create a bond and mutual benefit for the participants’ central to a therapeutic alliance. This led one of the pairings to develop into an intergenerational friendship and potentially help with loneliness. Research limitations/implications As this was an exploratory and small pilot, more cases and research are required to fully assess if “My Story” is a useful approach to develop intergenerational befriending. Practical implications Intergenerational befriending may be one solution that could help with loneliness and social isolation through forming a therapeutic alliance to make the befriending successful. Social implications Loneliness and social isolation for older people remain a problem. Originality/value An original pilot was undertaken to test the approach by bringing together older people identified as lonely by a voluntary sector provider and pairing these with a student volunteer. The students visited the older person over six weeks to discuss their life story and create an artefact based on the story for the older person.

Elder abuse is a global issue, with an estimated 4–10% of older persons in Canada abused each year. Although Canadian legislation has been created to prevent and punish the abuse of older persons living in nursing homes and other care facilities, community-dwelling older persons are at greater risk of abuse. This paper highlights the importance of evidence-based actions targeted at three determinants of health: (a) personal health practices and coping skills, (b) social support networks, and (c) social environments. Two research studies are profiled as case studies that illustrate the ready possibility and value of two specific types of actions on community-based older-person abuse. This paper argues for the immediate and widespread adoption of these evidence-based measures and for additional empirical evidence to guide the correction of underreporting of abuse, raise awareness of its serious nature, and increase options to not only stop it but ultimately prevent it.

Caring for persons with disabilities is challenging, yet it is assumed that people would care for their relatives with disabilities because of a feeling of closeness. Using a convergent mixed methods design, this article examines attitudes towards older persons with disabilities in the context of home care using Trinidad as a case study. The analytical framework involves (a) measuring attitudes towards the inclusion of older persons with disabilities in the home and (b) identifying the reasons for these attitudes. This framework is applied to a representative sample of 868 adult Trinidadians as well as the subsamples of adult Trinidadians dwelling and not dwelling with older persons with disabilities. Not all adult Trinidadians agreed that older persons with disabilities should be included in the home, and integrated findings indicate the need for monitoring systems for both home care and at homes for the aged.

PurposeThe purpose of this paper is to discuss trends in demographic ageing in West Africa and asks the question of what policy challenges are posed by the increasing presence of older persons in the subregion. We explore the unique dimensions of population ageing in the subregion, including its rural‐urban and gendered distributions, the occupational history of older persons, among others with the view to identifying the health, housing, and income security implications of ageing. The paper discovers and reviews what policy initiatives are being pursued in respect of older persons and suggests ways for their improvement.Design/methodology/approachThe paper draws on the existing literature on ageing and policy in both published and grey sources, including national and international policy documents. The discussion looks at policy responses in Ghana as a case example for the West African context. Policy information pertaining to Ghana is interpreted in light of the first author's personal familiarity with the context as a national of that country. The age of adults in this context is hard to determine due to low birth registration. In this paper older persons are defined as those 60 plus in chronological years, the age of retirement in Ghana.FindingsIt is established that older persons are concentrated in the rural areas of West Africa and a higher proportion of this demographic group is female. Further, the majority of older persons in West Africa has low formal literacy, is in the informal economy, and has no income security in old age. Yet, older persons continue to play the significant role of grandparenting. This examination of Ghana's policy on ageing revealed inadequacies which need to be addressed. A key recommendation is a policy of universal non‐means‐tested old age security to provide basic income for persons aged 60 years and above.Originality/valueA recommended policy of universal non‐means‐tested old age security to provide basic income for persons aged 60 years and above in Ghana is the original contribution of this paper.