Focused Discussions I
For work that is best discussed or debated, rather than reported on through a formal presentation, these sessions provide a forum for an extended “roundtable” conversation between an author and a small group of interested colleagues. Summaries of the author’s key ideas, or points of discussion, are used to stimulate and guide the discourse.
Re-thinking Reablement Services: Supporting Older Community Dwelling People as Social Participants
Focused Discussion Valerie Anne Ebrahimi
Older adults' rights to social participation have often been referred to in the guise of health and social care initiatives as well as in policy. Yet the reality is, that more often, an approach is taken prioritising personal care (PC) or domestic support (DS) (Greenwood, Ebrahimi & Keeler, 2018; Gardiner, Geldenhuys, & Gott, 2018). Even reablement services which reduce paid care and facilitate independence, tend to focus on these interventions (PC & DS), rather than the more far reaching opportunities gained by addressing social inequality. Having said this, reablement services are nonetheless a useful in-road in identifying people that are isolated or lonely. These services offer a realistic prospect for supporting people at an individual, more personalised level. Of late, the current buzzword in the UK is 'social prescribing', suggesting that solutions can be achieved by referrals from doctors or other health professionals to outside specialist organisations, or charities. This is a juxtaposition with conflicting undertones and to date the effectiveness of this approach is very limited. The word ‘prescribing’ implies medical expertise (and/or treatment) and paradoxically this contradicts the ideology of what social participation is. It perpetuates relationships of inferiority and inequality. The question is, therefore, to what extent can we, as health and social care professionals, start a dialogue about alternative frameworks that have pragmatic use. The aim of this session is to elicit discussion as to how we might contribute to the successful and measurable development of reablement-led social participation in older adult commuity dwelling populations.
The Newly Single Widowed Older Adult African American Woman Navigating Intimacy After a Long-term Monogamous Relationship
Focused Discussion Jeanine Cook-Garard
Little is known how the newly single widowed older adult African American/Black Woman (WOAAW) navigates intimacy after a long-term monogamous relationship, where there is an increased risk of sexually transmitted illnesses. The purpose of this research is to understand the decision-making and planning process involved in navigating sexual intimacy. The newly single older woman who is widowed faces challenges when planning the emotional and social journey of redefining her future. Ending a long-term relationship may leave women uncertain of the future, feeling lonely and vulnerable. Widows are subject to socially unfavorable situations leading to negative health outcomes including STIs. African Americans/Blacks have the most severe burden of HIV of all racial/ethnic groups in the United States. In 2010, African American women accounted for 6,100 (29%) of the estimated new HIV infections among all adult and adolescent African Americans. This number represents a decrease of 21% since 2008. Most new HIV infections among African American women (87% or 5,300) are attributed to heterosexual contact. The estimated rate of new HIV infections for African American women (38.1/100,000 population) was twenty times that of White women and almost five times that of Hispanic/Latino women (CDC, 2015). Spiritually guided decision making for intimacy was identified as the core concept as the WOAAW reported the process of how spirituality was an integral component of decision making after widowhood despite the possibility of STI/HIV exposure. It was identified that the imbalance of spirituality over practical health-promoting behaviors may affect intimacy decision making, predisposing widows to STI/HIV.
Prevention and Treatment Network for Strokes in Shanghai: The Experience of an Integrated Care System
Focused Discussion Bifan Zhu, Fen Li, Changying Wang, Duo Chen, Chunlin Jin
Facing the increasing morbidity and mortality caused by stroke, Shanghai started to build a network in 2012 to prevent and treat stroke. The network consists of eleven municipal hospitals, twenty-five district hospitals and 240 community health centers. We identify experiences and lessons learned from practices of the network. Method are qualitative research and thematic analysis of data. Three themes were identified through analysis: (1) Integration of services: services of different facilities have been re-formed and vertically integrated through treatment and referral standards. A risk stratification scale based on ABCD scores (validated predictors of stroke) is adopted by community health centers to proactively identify population at higher risks. These individuals are referred to district hospitals to receive further screening. District hospitals are responsible for early thrombolysis and rehabilitation of diagnosed patients, and referral services to municipal hospitals. (2) New roles and skills: Municipal hospitals concentrate on high complexity care and emergency rescue services for acute onset stroke. They provide technical assistance and training to lower level institutes regarding neurosurgery, vascular surgery and TCM rehabilitation. Community health centers focus on health management of high risk individuals, secondary prevention and rehabilitation of stroke patients. (3) Incentives and payment: Operation of the network largely relies on administrative regulations. An evaluation system and payment mechanisms are in need to incentivize the health workforces to fulfill their responsibilities and to ensure performance of the network. Treatment capacity and service homogeneity of stroke have been enhanced among different facilities, enabling patients to receive continuous services.
Population Aging and Dementia in an Unequal Country: The Case of Chile
Focused Discussion Daniel Jimenez
Chile has one of the largest proportion of older adults in Latin America and is currently facing an increase in the prevalence of dementia and other non-communicable chronic diseases. Chilean fast population aging has been driven by the increase in life expectancy and the sustained decline in fertility rate during the last decades. The current number of people with dementia in Chile is around 200.000 and it is expected to reach 500.000 by 2050. At the same time, the country has experimented an accelerated economic growth resulting in major inequalities with a significant impact on health and quality of life of the elderly. Inequality in education, health care and income have a direct impact on the risk of dementia. Although recent governmental initiatives have addressed dementia as a national priority, most of the economic, social and emotional costs associated with dementia are still assumed by caregivers and relatives. The aim of this session is to discuss the main challenges posed by a rapidly increase of dementia in a very unequal country. How Chile addresses the modifiable risk factors for dementia and face the health and social needs of people living with dementia in this socioeconomic context is of regional and global interest.
Photovoice Method with Older Adults - International Perspectives
Focused Discussion Yuliya Mysyuk, Anthony Tuckett, Anna F Tresidder
In this focused discussion we will talk about perspectives from different countries on the use of the photovoice method with older adults. We will delve into the experiences of Australia, USA, and the Netherlands. Photovoice is a qualitative visual research method that refers to photographs taken by the participants themselves. It is an effective tool for eliciting older persons’ perceptions of their communities, During this discussion we will explore the use of photovoice in different research contexts and with divergent issues studied. Moreover we will touch upon the important features, advantages, possible challenges, and implications of the photovoice method.
The Role of Social Support in Training and Education of Elderly: Mechanism to Enhance Active Aging
Focused Discussion Kevalin Silphiphat
The aim of active aging is to promote health, participation, and security in order to remain as independent as possible for the longest period of time (EC,2018; WHO, 2002). Researches over past decades indicated that social support is one of the powerful factors influence well-being of elderly. However, the number of older adults living apart from their families and friends has been increasing due to economic and social change. Subsequently, motivation and participation in social activities as well as social support may be decreased. With advanced technology, social media may overcome this problem and provide new possibilities for elderly to engage in social contact, in conjunction with providing and receiving social support. My research aims to examine the role of a social support as a part of mechanism to promote active aging, particularly in the training context. The key character of social support mainly involves behaviors exchange. Types of supportive behavior are in varies forms, such as instrumental aid, expression and emotional concern, or the provision of advice or guidance (Dykstra, 2015; House, 1981). In this study, we propose the use of social media application (group chat) as a form of support group to facilitate social interactions among participants. The outcomes are evaluated one month after attending a market and e-commerce training course.
