The Capability Approach in Research on Ageing Well at Home for Frail Older People

This chapter describes the work of the Frail Elderly Support Research Group (FRESH) in relation to the capability approach as a theoretical framework. The FRESH research group works with people who are at risk of developing frailty, as well as those who are already frail or very frail. In this chapter, FRESH aims to utilise the capability approach as a theoretical framework for research with and for frail older people, and to focus on the older people’s opportunities to realise their goals in relation to contextual factors that may influence them. A broad understanding of the concept of frailty in general is also presented. The capability approach makes a fundamental contribution to the understanding of the process of becoming frail, and how it may influence people as they age, because it focuses on people’s real opportunities, what it is possible to achieve and what people have reason to value, in relation to the resources that they have at hand. This chapter will hopefully encourage future researchers to consider evaluating the capability approach and implementing it in their own research.

The Capability Approach in Social Work with Older People

This chapter reports the findings from a scoping review of the use of the capability approach in social work with older people. Four peer-reviewed articles using the capability approach and addressing social work practice with older people are discussed. The purpose was to examine how the use of the capability approach is linked to policies, practices and social justice approaches in social work research. Two main applications of the capability approach were found: to explore the subjective sense of well-being, and to address social inequalities at a structural level. The capability approach was framed as congruent with the aims of social work, and as a call for action for social workers to promote social justice, human dignity and well-being. Only a few studies were found in this scoping review; however, more seemed to have been done within the fields of healthcare and developmental studies. Despite these limitations, the conclusion is that the capability approach has attracted some attention in social work with older people, and the number of studies elaborating on the capability approach in social work in general is growing.

The Capability Approach in Epidemiological Studies

Population epidemiology is the science that deals with disorders and certain conditions at the population level, i.e. at the macro-level. In contrast to experimental studies, the scientist in epidemiology cannot manipulate conditions to make studies of associations as pure as possible. The science of epidemiological studies examines the occurrence of diseases, risk and protective factors for diseases, and the prognosis of different disorders and conditions in different populations. The capability approach is an ideal framework for epidemiological studies because it captures the dynamic and multiple processes involved in these types of studies, in relation to both time and space, as well as socioeconomic, psychological and biological factors. Determinants for common disorders and conditions include complex interactions among a multitude of factors acting between and within macro-, meso- and micro-levels during the life-course of an individual. In this chapter, we will discuss how the capability approach can be used in epidemiology in general, and in old age in particular, giving examples from specific conditions, such as cognitive function and dementia, depression, multimorbidity and functional ability, and non-modifiable and modifiable risk factors, such as genetics and nutrition. We conclude that the capability approach is a valuable tool in epidemiological studies. In these types of studies, capability is the final outcome of the dynamic interactions between a multitude of factors at the micro-, meso- and macro-levels leading to disorders and other conditions, which leads to restrictions in the individual’s ability to perform actions in order to reach goals he or she has reason to value.

The AgeCap Conceptual Framework for Research on Capability in Ageing

The overall goal of AgeCap is to contribute to increased wellbeing and participation in life for the older population. While there are several ways to meet this challenge, AgeCap has chosen the capability approach, which focuses on a subjective perceived health- and ability-related perspective, rather than on disease or disabilities. The understanding of capability used within the centre is based on the work of the philosopher and economist Amartya Sen, described as the individual’s ability to perform actions in order to reach goals he or she has reason to value (Sen A. The idea of justice. Belknap Press of Harvard University Press, Cambridge, MA, 2009). The capability approach focuses on what people are able to do and to be – their capabilities – and on their freedom of choice to perform those actions. AgeCap’s multidisciplinary setting was an opportunity to adopt the capability approach within its research. Nevertheless, it also created challenges in establishing a common view of what capability is, and how to apply the concept in collaborations across several different research fields. Thus, at an early stage during the setting up of the Centre, it was decided that a conceptual framework aiming to capture a shared view of capability in ageing should be developed. In addition, in order to facilitate the application of the capability approach within the research setting and make it more accessible to different target groups within society, it was later proposed that a graphic illustration of the AgeCap framework of capability should be created. This chapter describes the conceptual framework and graphic illustration that were developed by the Communication Group in collaboration with the Steering Committee, Principal Investigators, other researchers within AgeCap and the company Explain Artist. Central concepts include available resources, conversion factors, capability set, freedom of choice, goals of value and justice. The purpose of the conceptual framework is mainly to serve as a platform for researchers to use in any way they find relevant from their own perspective. Furthermore, the graphic illustration was developed in order to facilitate the application of the capability approach within AgeCap and make our research more accessible to society in order to dismantle the wall between researchers, older people and the general public.

A Capability Approach to Real Estate Valuation and Value Enhancement

There are numerous financial metrics available in the academic and commercial world to estimate real estate value. Appraisers often use such metrics when advising on the purchase or sale of real estate at a point in time. The first part of this paper proposes a new metric, based on the capability approach, to make an ex-post single period valuation. Further, appraisers often give advice to their clients on actions to take in order to enhance the value of their real estate. This area of value enhancement has received scant attention in the academic literature. In practice, this advice is often based ad-hoc, anecdotal recommendations. The second part of the paper develops seven real estate strengths that can be targeted and provides an ex-ante approach to building real estate value. The valuation model presented in this paper is a pragmatic approach to enhancing both the values of tangible and intangible capabilities of a property by utilizing Expense Leveraged Value Indexes (ELVI).

A Methodological Approximation of the Measurement of Instrumental Social Exclusion from the Capability Approach: The Case of Vulnerable Areas in the City of Murcia, Spain

The indirect effects of social exclusion in different fields of the lives of individuals have been scarcely studied. The literature that addresses social exclusion from the capability approach is sparse, and a methodology for measuring the instrumental effects of social exclusion on capability deprivation has not yet been implemented. Therefore, the main objective of this research is to propose a methodological framework to quantify these effects, based on two techniques: Structural equation modelling and principal component analysis. Likewise, this study presents a practical application in the vulnerable areas of the city of Murcia, Spain. In order to obtain the data, fieldwork was carried out using 464 questionnaires. The theorised model was statistically contrasted, confirming that it is not false. The study revealed that instrumental social exclusion had a moderate impact on the deprivations experienced by the study population.

Care for capabilities: Implementing the capability approach in rehabilitation of patients with neuromuscular diseases. Study protocol of the controlled before-after ReCap-NMD study

Background High quality care of patients with neuromuscular diseases requires a personalised approach that focuses on achieving and maintaining a level of functioning that enables them to be in a state of well-being. The capability approach states that well-being should be understood in terms of capabilities, the substantial opportunities that people have to be and do things they have reasons to value. In this Rehabilitation and Capability care for patients with Neuromuscular diseases (ReCap-NMD) study, we want to investigate whether providing care based on the capability approach (capability care) has an added value in the rehabilitation of patients with neuromuscular diseases (NMD). Methods Two groups of 30 adult patients with facioscapulohumeral muscular dystrophy or myotonic dystrophy type 1 will be included. The first group will receive rehabilitation care as usual with a follow-up period of 6 months. Then, based on theory, and experiences of patients and healthcare professionals, capability care will be developed. During the following 3 months, the multidisciplinary outpatient rehabilitation care team will be trained in providing this newly developed capability care. Subsequently, the second group will receive capability care, with a follow-up period of 6 months. A mixed methods approach is used with both qualitative and quantitative outcome measures to evaluate the effect of capability care and to perform a process evaluation. The primary outcome measure will be the Canadian Occupational Performance Measure. Discussion The ReCap-NMD study is the first study to design and implement a healthcare intervention based on the capability approach. The results of this study will expand our knowledge on how the capability approach can be applied in delivering and evaluating healthcare, and will show whether implementing such an intervention leads to a higher well-being for patients with NMD. Trial registration Registered at Trialregister.nl (Trial NL8946) on 12th of October, 2020.

Aligning Patient’s Ideas of a Good Life with Medically Indicated Therapies in Geriatric Rehabilitation Using Smart Sensors

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values.

Self-Expansion or Internalization as the Two Processes of Vertical Integration: What Informs the Decision?

In vertical integration literature, the two processes leading to vertical integration, namely, (1) self-expansion of the scope of activities based on internal capabilities and (2) internalization of activities with external capabilities have not been distinguished. However, using internal capabilities or incorporating external capabilities is an alternative decision for managers and distinguishing them is crucial in practice. The purpose of this study is to distinguish self-expansion separated from internalization and to explain systematically when they likely occur. This study develops a unique vertical integration model by integrating transaction cost economics and the capability approach. With the model, we systematically analyzed the occurrence of (1) self-expansion and (2) internalization. Results reveal that the firm prefers self-expansion to internalization if it is easy to build the capabilities internally or difficult to procure them from outside the firm and if the costs of acquiring a firm or business with the required capabilities or the governance costs of the activities with external capabilities are high and vice versa. Our model leads to more understanding of vertical integration.