Older people's exercising of choice in long-term care: a comparative analysis of England and Japan

2015 ◽  
Vol 36 (06) ◽  
pp. 1185-1210 ◽  
Author(s):  
YOSHIMI WADA
Keyword(s):  
Decision Making ◽  
Comparative Analysis ◽  
Older People ◽  
Empirical Data ◽  
Long Term Care ◽  
Care Practice ◽  
Rational Model ◽  
Term Care ◽  
Key Informants

ABSTRACTThere has been an increasing emphasis on choice for older people in long-term care in both England and Japan. However, despite the emphasis on the importance of choice, the perspectives of older people have been given little attention. Considering national and local policies in Bristol, England and Kyoto, Japan, the article explores how older people are exercising (and not exercising) choice in care practice through examining the perspectives of the older people themselves, as well as key informants in the field. Empirical data were collected from interviews with older people and key informants in the two countries, and were analysed using qualitative and comparative approaches. Choice in policy is regarded as a mechanism of the market with an assumption of the independent autonomous individual who can exercise ‘rational choice’. However, the findings have reflected older people's relational decision-making, which does not conform to the rational model of decision-making, and illustrates the value of ‘interdependence’. The findings from care practice have shown that choice was considered an important value in involving older people's views and ensuring their needs are met sensitively and respectfully. The findings also suggested that consideration of the psychological aspects of choice is an important aspect of ‘care’, facilitating the inclusion of older people's views in the process of making judgements, in order to meet their needs.

scholarly journals Standardised functional assessment in long-term care for older people: perspective of Finnish care workers

2021 ◽  
Vol 12 (1) ◽  
pp. 27-47
Author(s):  
Vilhelmiina Lehto-Niskala ◽  
Outi Jolanki ◽  
Jaakko Valvanne ◽  
Marja Jylhä
Keyword(s):  
Older People ◽  
Functional Assessment ◽  
Long Term Care ◽  
Care Delivery ◽  
Care Practice ◽  
Process Of Care ◽  
Term Care ◽  
Care Workers ◽  
Care For Older People

Objective measures and documentation are increasingly used in the care for older people to promote efficiency and productivity. A standardised assessment of functional capacity is one such measure. In this study, we examined the meanings given to standardised functional assessment by care workers who provide long-term care for older people. Gathered from eight Finnish long-term care facilities, the data consisted of one-on-one interviews with practical and registered nurses (n = 24). In the data analysis, we employed the discursive approach. We identified three discourses in the care workers’ talks that differed in the meaning given to standardised functional assessment in the process of care: part of the bureaucracy, a missed opportunity and a threat to person-centred care. Care workers described these assessments as constituting a routine part of their job but expressed uncertainty about their role and the practicalbenefits in actual care work. They even called into question these assessments’ relevance to quality care delivery. To be a meaningful part of care practice, it is essential that there be a shared understanding of the rationale behind functional assessments in the care organisation and that care workers themselves can see the outcomes of these assessments in their daily work.

Deciding on Institutionalization for a Relative with Dementia: The Most Difficult Decision for Caregivers

2006 ◽  
Vol 25 (2) ◽  
pp. 193-205 ◽  
Author(s):  
Chantal D. Caron ◽  
Francine Ducharme ◽  
Jennifer Griffith
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Comparative Analysis ◽  
Family Caregivers ◽  
Healthcare Professionals ◽  
Long Term Care ◽  
Decision Making Process ◽  
Term Care ◽  
Difficult Decision

ABSTRACTThe decision to move a family member with dementia to a nursing home is a difficult experience for caregivers. Complex psychosocial factors are involved and knowledge of predictive factors alone is insufficient. Using grounded theory, this study explores the decision-making process with regards to institutionalization, from the perspective of family caregivers. Fourteen people who moved a relative to long-term care in the preceding 6 months were interviewed. Data analysis using comparative analysis and line-by-line dimensional analysis was used to develop a theoretical model of the decision-making process. Three factors within the model were central to the process: (a) caregivers' perceptions of their ability to provide care, (b) caregivers' evaluations of their relatives' ability to make care decisions, and (c) the evolving influence of contextual factors and interactions with healthcare professionals. The contribution of these findings to new conceptualizations of institutionalization is discussed.

scholarly journals Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zijing Wang ◽  
Wenjia Peng ◽  
Mengying Li ◽  
Xinghui Li ◽  
Tingting Yang ◽  
...  
Keyword(s):  
Older People ◽  
Functional Disability ◽  
Long Term Care ◽  
Strong Association ◽  
Binary Logistic Regression ◽  
Term Care ◽  
Logistic Regression Models ◽  
Disease Pattern ◽  
Long Term Care Insurance

Abstract Background Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. Methods We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. Results Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16–1.41) and IADL (OR 1.41, 95%CI 1.19–1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40–1.72). Conclusions Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

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