Exploring care relations in later life: disentangling notions of care and choice

The experience of later life varies widely and is often framed in terms of the active lifestyles of the Third Age and the frailty and abjection of the Fourth Age. This thesis sought to understand how the concepts of care and choice are enacted, experienced and interrelated in the context of both informal and formal care in later life and how older people themselves, their families and significant others understand and experience these concepts. The discourse of personalisation that dominates care services has led to an emphasis on individual choice, control and independence so that those in need of care are faced with what has been described as the ‘logic of choice’, a focus on individual responsibility rather than care. Adopting a Feminist Foucauldian theoretical approach and drawing on Tronto’s (1993) ethic of care, this thesis explores the experiences of older people and their informal carers through dialogical narrative analysis. The stories begin with the recognition by individuals that there is a need for care and how this need is met through negotiations with families and significant others. As needs increase the physical and logistical limits of informal care by individuals are reached, often leading to a need to ‘choose’ formal care. Rather than impacting solely on the care recipient, formal care is shown as being an experience that is shared with informal carers. Indeed, the participants depict how informal care continues alongside formal care and how the boundaries between them become blurred. I argue that a binary division between actively making choices and being a passive recipient are not appropriate to understandings of care. By disentangling the notions of care and choice this thesis explores the extent to which these concepts are relevant to the experience of older people in specific care situations.

Health changes in Hispanic older adults in a Spanish arthritis self -management education program

Arthritis is the most common chronic condition affecting older people and is a major cause of limited activity. Arthritis education programs in English have demonstrated a positive impact on health but these programs have not reached the Hispanic communities where arthritis is the leading cause of disability. Minorities, such as Hispanics, have traditionally been reluctant to pursue self-help programs, and have been identified as an under-served population in terms of medical care. This study examined the effectiveness of one community health adult education program targeting Hispanic older adults with arthritis, the Spanish Arthritis Self Management Education Program (SASMEP), by evaluating changes in the participants' general health, pain, disability, self-efficacy, health perceptions, frequency of physician visits, and exercise. A pre and post control group experimental design and analyses of covariance were used to determine the pre and post differences in health status and health behaviors for a group participating in the SASMEP and a group who did not using gender and age as covariates. A repeated measures design was also used, and repeated measures analyses of variance and post hoc tests were done on health status and health behavior data collected pre, post and one-year post education to determine long-term differences. ^ Results indicated the participants' health status significantly improved in general health, significantly decreased in pain, and significantly decreased in arthritic disability immediately following the education. Self-efficacy and health perceptions increased for both groups but not significantly. The participants' health behaviors showed significantly fewer physician visits and significantly increased time spent performing stretching and strengthening exercise and time spent performing aerobic exercise. No group differences were found in the frequency of arthritis physician visits. ^ The improvements seen immediately after the SASMEP participation were not reflected in the post one-year scores. No significant differences were found for the participants' health status or health behaviors one year following the education. Health status and health behaviors did not return below baseline scores after one year suggesting the participants' health, although not improved, did not deteriorate. Therefore, the SASMEP education provided short-term health benefits for older Hispanic adults with arthritis, but not long-term health benefits. ^

Computer interaction : its effect on attitude and performance in older adults

This study examined the interaction of age, attitude, and performance within the context of an interactive computer testing experience. Subjects were 13 males and 47 females between the ages of 55 and 82, with a minimum of a high school education. Initial attitudes toward computers, as measured by the Cybernetics Attitude Scale (CAS), demonstrated overall equivalence between these older subjects and previously tested younger subjects. Post-intervention scores on the CAS indicated that attitudes toward computers were unaffected by either a "fun" or a "challenging" computer interaction experience. The differential effects of a computerized vs. a paperand- pencil presentation format of a 20-item, multiple choice vocabulary test were examined. Results indicated no significant differences in the performance of subjects in the two conditions, and no interaction effect between attitude and performance. These findings suggest that the attitudes of older adults towards computers do not affect their computerized testing performance, at least for short term testing of verbal abilities. A further implication is that, under the conditions presented here, older subjects appear to be unaffected by mode of testing. The impact of recent advanced in technology on older adults is discussed.

Incidentally Raised Cardiac Troponin I Has a Worse Prognosis in Older Patients Compared to Those with Normal Cardiac Troponin I and Patients with Acute Coronary Syndrome : A Cohort Study

Acknowledgement J.H.B.-S. was supported by the Norfolk and Norwich University Hospital (NNUH) Research and Development (R&D) research capability funds between July 2013 and December 2014.

Older woman with cello in senior citizens band

General note: Title and date provided by Bettye Lane.

Older woman for senior action

General note: Title and date provided by Bettye Lane.

Older woman at NOW conference, Phildelphia

General note: Title and date provided by Bettye Lane.

Older women play cards at the YWCA

General note: Title and date provided by Bettye Lane.

Older woman at "Women learn from Women" conference at Barnard College

General note: Title and date provided by Bettye Lane.

Older woman on Women's Day in Battery Park

General note: Title and date provided by Bettye Lane.

Older woman on bench (loneliness)

General note: Title and date provided by Bettye Lane.

Older woman takes part in Mine-Marathon in Central Park

General note: Title and date provided by Bettye Lane.

Older woman at a Pablo Casals concert

General note: Title and date provided by Bettye Lane.

Older woman blueberry farmer

General note: Title and date provided by Bettye Lane.

National Council of Jewish Women Older women workshop

General note: Title and date provided by Bettye Lane.