Elders' needs and experiences of receiving formal and informal care for their activities of daily living

Examining the social networks of older adults receiving informal or formal care: a systematic review

PURPOSE

To address the care needs of older adults, it is important to identify and understand the forms of care support older adults received. This systematic review aims to examine the social networks of older adults receiving informal or formal care and the factors that influenced their networks.

METHODS

A systematic review was conducted by searching six databases from inception to January 31, 2023. The review included primary studies focusing on older adults receiving long-term care, encompassing both informal and formal care. To assess the risk of bias in the included studies, validated appraisal tools specifically designed for different study types were utilized. Network analysis was employed to identify the grouping of study concepts, which subsequently formed the foundation for describing themes through narrative synthesis.

RESULTS

We identified 121 studies relating to the formal and informal care of older adults' networks. A variety of social ties were examined by included studies. The most commonly examined sources of care support were family members (such as children and spouses) and friends. Several factors were consistently reported to influence the provision of informal care, including the intensity of networks, reciprocity, and geographical proximity. In terms of formal care utilization, older age and poor health status were found to be associated with increased use of healthcare services. Additionally, physical limitations and cognitive impairment were identified as factors contributing to decreased social engagement.

CONCLUSION

This review found that older people were embedded within a diverse network. The findings of this review emphasize the importance of recognizing and incorporating the diversity of social networks in care plans and policies to enhance the effectiveness of interventions and improve the overall well-being of older adults.

Population with Long-Term Care Needs in Six Latin American Countries: Estimation of Older Adults Who Need Help Performing ADLs

The population in Latin America is ageing, and there is an inevitable demand for long-term care services. However, there are no comparative analyses between Latin American countries of the dependency situation of older adults. This study aims to calculate and compare percentages of older adults who need help performing the activities of daily living in six Latin American nations. The study is observational, transversal, and cross-national and uses microdata drawn from national surveys conducted in Argentina (n = 3291), Brazil (n = 3903), Chile (n = 31,667), Colombia (n = 17,134), Mexico (n = 7909), and Uruguay (n = 4042). Comparable indicators of the need for help in performing the basic and instrumental activities of daily living were calculated. The percentages of older adults in need of help for basic activities of daily living ranged from 5.8% in Argentina to 11% in Brazil; for instrumental activities of daily living, from 13.8% in Mexico to 35.7% in Brazil; and combined, from 18.1% in Argentina to 37.1% in Brazil. Brazil thus has the highest indicators, followed by Colombia. The results warn of the frail physical condition of older people and the high potential demand for long-term care services. The information provided could be useful for further research on and planning for long-term care needs in Latin American and middle-income countries.

Exploring Daily Activity Patterns on the Typical Day of Older Adults for Supporting Aging-in-Place in China's Rural Environment

Severe aging in rural China is prompting communities to promote support for older people to age in place. The study of the daily life of older adults in rural areas is conducive to understanding their real life and demands, as well as the way they interact with their environment, to develop feasible strategies. In this study, 171 older adults over 60 years old in two different types of villages in Northern Zhejiang Province were investigated and analyzed in terms of the temporal and spatial features of daily activities, as well as their relationship with population attributes, personal competence, and subjective demands. The results show that: (1) significant association can be seen between working hours and the demand for health services, housework hours and gender and age, as well as leisure hours and ADL and the demand for recreational services. (2) The older adults appear to have inter-group homogeneity in some aspects: basic living activities, leisure hours, the gender difference in housework hours, and recreational preference, while they have higher average paid work hours and fewer leisure alternatives than their urban counterparts. Their definitions of paid work, housework, and leisure activities are vague. (3) The definition of home by the older adults in rural places sometimes seems to go beyond the scope of their own house, and the extensive definition of home may change their recognitions of some activities. They also inclined to assign meaning to a place through frequent use rather than through external definitions. (4) The weak consciousness on buying services and deteriorated financial situation hinders the older adults in rural communities from expressing their real demands. Unspoken demands include economic security, recreational choices, and assistance in housework. The results will help to provide references for the improvement of eldercare services and the community environment.

Age-Related Differences in the Evaluation of a Virtual Health Agent's Appearance and Embodiment in a Health-Related Interaction: Experimental Lab Study

Background

Assistive technologies have become more important owing to the aging population, especially when they foster healthy behaviors. Because of their natural interface, virtual agents are promising assistants for people in need of support. To engage people during an interaction with these technologies, such assistants need to match the users´ needs and preferences, especially with regard to social outcomes.

Objective

Prior research has already determined the importance of an agent’s appearance in a human-agent interaction. As seniors can particularly benefit from the use of virtual agents to maintain their autonomy, it is important to investigate their special needs. However, there are almost no studies focusing on age-related differences with regard to appearance effects.

Methods

A 2×4 between-subjects design was used to investigate the age-related differences of appearance effects in a human-agent interaction. In this study, 46 seniors and 84 students interacted in a health scenario with a virtual agent, whose appearance varied (cartoon-stylized humanoid agent, cartoon-stylized machine-like agent, more realistic humanoid agent, and nonembodied agent [voice only]). After the interaction, participants reported on the evaluation of the agent, usage intention, perceived presence of the agent, bonding toward the agent, and overall evaluation of the interaction.

Results

The findings suggested that seniors evaluated the agent more positively (liked the agent more and evaluated it as more realistic, attractive, and sociable) and showed more bonding toward the agent regardless of the appearance than did students. In addition, interaction effects were found. Seniors reported the highest usage intention for the cartoon-stylized humanoid agent, whereas students reported the lowest usage intention for this agent. The same pattern was found for participant bonding with the agent. Seniors showed more bonding when interacting with the cartoon-stylized humanoid agent or voice only agent, whereas students showed the least bonding when interacting with the cartoon-stylized humanoid agent.

Conclusions

In health-related interactions, target group–related differences exist with regard to a virtual assistant’s appearance. When elderly individuals are the target group, a humanoid virtual assistant might trigger specific social responses and be evaluated more positively at least in short-term interactions.

Independence and Caregiver Preferences Among Community-Dwelling Older People in Slovenia: A Cross-Sectional Study

Although Slovenia is becoming an aging society, very little is known about the abilities and needs of home-dwelling older people or their preferences regarding assistance. The aim of the study was to explore the need for assistance in daily activities among older Slovenian people living at home. Older adults aged between 65 and 97 years (N = 358) participated in the cross-sectional survey study. A questionnaire that assessed independence in daily activities and assistance in the home environment was developed. Data were analyzed using descriptive statistics, a nonparametric test (Wilcoxon signed rank test), and the chi-square test. The results showed that older Slovenians were more independent in activities of daily living (ADLs) than instrumental activities of daily living (IADLs). Independence was the highest for using the toilet, feeding, and mobility transfers, and the lowest for bathing. With IADLs, assistance was most often required with shopping and housework; this assistance was usually provided by family members. The provider of assistance was generally compatible with older people’s preferences concerning assistance at home. We found no differences in care preferences between urban and rural settings. Assistance in the home environment was predominantly provided by unpaid helpers, which reflects recent developments in health and social services that put an emphasis on a person’s social network. Due to demographic changes and the decrease in the number of adult children, reliance on close relatives might soon become a challenge. These findings can help policy makers understand older people’s choices and preferences better when planning long-term care.

Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China

The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.

Healthy ageing in Isan-Thai culture--A phenomenographic study based on older persons' lived experiences

Healthy ageing is a concept that concerns older persons' quality of life and is a key factor in promoting well-being. The older population in Thailand is growing. Isan (a region of north-eastern Thailand) has been reported as having one of the most rapidly increasing older populations in the country. In order to care for and promote the health of older people, healthcare providers should understand how healthy ageing is perceived by this target group. Although healthy ageing has been studied in different contexts as well as perspectives, no studies have previously focused on older persons' experiences of healthy ageing from a lifeworld perspective in Isan-Thai. Therefore, the aim of this study is to describe older persons' qualitatively different conceptions of healthy ageing in Isan-Thai culture. A phenomenographic approach with an epistemological base in lifeworld theory was used to disclose the various ways to conceptualize healthy ageing. Individual, qualitative interviews were conducted with 17 people aged 60 and above who live in Isan-Thai. The findings of this study revealed three categories of descriptions: "being independent in dependence," "being at peace," and "being a valuable person." This study also found family members, friends, healthcare providers, and religion important to healthy ageing in the Isan-Thai culture. Understanding how older people conceptualize healthy ageing is valuable for healthcare providers. They can apply these findings regarding healthy ageing in their fieldwork when caring for older people.

Caring to achieve the maximum independence possible: a synthesis of qualitative evidence on older adults' adaptation to dependency

AIMS AND OBJECTIVES

To understand the process of adaptation to dependency in older adults and their families.

BACKGROUND

Dependency and family care giving are attracting the attention of policymakers, service providers and researchers.

DESIGN

An interpretative synthesis of qualitative studies has been conducted.

METHODS

An extensive search without time and idiom limitations was conducted using the main databases (MEDLINE, CINAHL, EMBASE, PsycINFO, SSCI, LILACS, CUIDEN, Cochrane Library and JBI): personal communication from expert panel was used to detect filters strategies to find qualitative studies; these strategies were combined with search terms for dependence in older adults. The studies (2164 potentially relevant papers) were judged by two reviewers based on reading title, abstract, keywords and/or full text (English, Spanish, French and Portuguese) to determine their inclusion. After, 203 papers were critically appraised by two reviewers (disagreements were resolved by discussions). Finally, the synthesis of the 20 studies with best interpretative character was carried out based on the principles and procedures of Grounded Theory.

RESULTS

The findings were related to the process of adaptation to dependency, the factors and the strategies used, the emotions, perceptions and feelings of care givers and older adults. The central category that emerged was 'Caring to achieve the maximum independence possible', and this could be seen as a transition period in which older adults and their families progressed in a mutually determined adaptation process. This category is made up of several redefinitions of concepts, phases, adaptation strategies and final responses to the process.

CONCLUSIONS

The findings show the interconnected nature of physical, material, social and emotional aspects of care; and the profound social impact of providing and receiving care. Relevance to clinical practice.  The nurses can assist families and older adults to enhance adaptation to dependency, anticipating and helping to redefine the concepts of care.

The experience of family care-givers and migrant paid care-givers' relief of burden: a contrasted qualitative analysis

Older people are increasingly being cared for in the community across Europe. Dependent care in Spain largely remains a private issue involving family carers and migrant women from developing countries. Qualitative research on respite care has contributed to our understanding of respite as a subjective experience. Nonetheless, how care-givers relieve the burden of care is still not fully understood. Migrant care-givers are present in family life but their need for rest remains unseen. The aim of the study presented in this paper was to contrast family care-givers and migrant care-givers' strategies for relief from their caring role. Care-givers rest by thinking, doing and being but in a different manner from that of care-giving, that is: when they are a different person.To leave the life of care-givingis the general strategy that family care-givers use to rest from their care-giving selves whileturning to one's own worlddescribes the way migrant care-givers seek to relieve the burden of care. The comparative analysis shows that both strategies have in common the necessity to disconnect from the care-giving identity and that both migrant and family care-givers employ strategies that arefalse exits to a care-giving identity: they apparently relieve the burden of care. Respite goes beyond places, times and activities; as family care itself, it requires identity.

Older people in long-term care settings as research informants

Conducting nursing research in long-term care facilities and with samples of older people requires careful attention to research ethics and the ethical conduct of the study. This review analysed the research ethics of the empirical studies that focus on older people in long-term care settings as research participants. Articles (n = 66) focussing on older people in long-term care settings as research informants were retrieved from an electronic search of MEDLINE (1990 to February 2012) using the MESH terms ‘Nursing’ AND ‘Long-term care’ (578 citations) and ‘Institutionalization’ and ‘Nursing’ (89 citations). Ethical approval procedure was reported in more than half of the studies (58%) and informed consent in two-thirds of the studies (70%). Ethical issues in data collection were described in most of the articles, but only a few reported ethics in problem statement, reporting or presenting implications. There is a need to focus on reporting research ethics and procedures in empirical research on vulnerable people.

Resident strategies for making a life in a nursing home: a qualitative study

AIM

To identify strategies that older adults use to adapt to live in long-term care.

BACKGROUND

The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Moving into a long-term care setting has been documented internationally as an overwhelming life change for many older adults. It has been observed that residents adjust differently over time, but the basis for these differences needs further exploration.

DESIGN

A qualitative design using grounded theory method was employed.

METHODS

A total of in-depth interviews were conducted in October 2008-February 2009 with a sample of 21 participants. Participants ranged in age from 65-93 years, 81% women and 19% men; mainly Caucasian with one African American and one Hispanic. Length of stay ranged from 3 days to over 9 years living in long-term care so that all stages of adjustment were included in the study. Ground theory method was used to analyse the data.

FINDINGS

The results of this study yielded 21 facilitative strategies. The core category identified was personal resiliency, which served as the underpinning for the strategies used by the participants. Strategies were identified in making the decision to move into long-term care and in day-to-day living.

CONCLUSION

Understanding the strategies that facilitate residents to make a successful transition to long-term care life will assist nurses to intervene in ways that are supportive. The strategies identified in this study may be used to develop interventions for residents that are having difficulty living in long-term care. Further exploration of how resiliency has an impact on strategies used by residents is clinically relevant, but further research is needed.

Diet quality and social support: factors associated with serum carotenoid concentrations among older disabled women (the Women's Health and Aging Study)

PURPOSE

This study investigated the relationship between social support (including instrumental support, emotional support, social interaction, social space, and family networks) and diet quality, as indicated by serum carotenoid levels.

DESIGN AND METHODS

The sample consisted of participants in the Women's Health and Aging Study with longitudinal carotenoid data (n=325). We performed regression analyses using baseline indicators of social support and changes in social support to determine whether baseline levels and/or change in levels of social support predict changes in serum carotenoid levels. Social support changes were measured over 1 year from baseline to follow-up round 1. Carotenoid level changes were established from follow-up round 1 to round 2. To determine whether or not regression to the mean was driving these results, we performed an analysis that included baseline and change levels of social support indicators.

RESULTS

At baseline, the frequency of leaving one's home was associated with a decrease in carotenoid levels. Leaving one's home more frequently predicted an increase in carotenoid levels and attending fewer activities predicted a decrease in carotenoid levels.

IMPLICATIONS

In older, community-resident disabled women, baseline levels of social support did not consistently predict diet quality. However, change in social support predicted both positive and negative change in diet quality and thus provides supportive evidence that social activity and family interaction may play meaningful roles in the maintenance of diet quality among functionally compromised older women. Further research is necessary to more fully understand the impact of multiple forms of social supports on the diet quality of older adults.

Self-reported activities of daily living and performance-based functional ability: a study of congruence among the oldest old

Although researchers and clinicians tend to use subjective evaluations of functioning and objective assessments interchangeably, there may be important differences between how people view their own abilities and objective indicators. This study aims to examine the relation between self-reported evaluations of function and health and performance-based (PB) measures of functional ability and objective health indicators in a sample of the oldest old. The study is based on data from a sample of 349 individuals aged 80 and older from the OCTO-Twin Study. One member of each twin pair was randomly selected for this study. The result demonstrates that subjective evaluations of functional ability are significantly associated with objective measures of health and PB measures of function although considerable variance remained unexplained. The association of PB measures to the self-report evaluations differed by measure. PB measures had stronger associations with self-reported functioning than objective health indicators such as diseases and medications. PB balance was related to self-reported function in instrumental activities in daily life (IADL) and self-reported mobility, whereas PB upper body strength and flexibility was associated with all three self-reports of function but not to perceived health. The strength of these associations did not differ from one another suggesting that PB balance and upper body strength and flexibility have comparable effects on self-reports of daily life function. From a practical perspective, our findings confirm that self-reported ADL reflects objective measures of functioning, but probably also has subjective components that need further exploration. The result also indicates a need for multiple measures in evaluating functional ability in the oldest old.

Research protocol: a synthesis of qualitative studies on the process of adaptation to dependency in elderly persons and their families

Background

Dealing with dependency in the elderly and their families leads us to explore the life experience of those involved together with the processes of adaptation to this condition. A number of original studies have been published which, following a qualitative methodology, have dealt with both dimensions.

Methods/Design

Objectives: 1) To present a synthesis of the qualitative evidence available on the process of adaptation to dependency in elderly persons and their families; 2) to conduct an in-depth study into the experiences and strategies developed by both to optimise their living conditions; 3) to enable standards of action/intervention to be developed in the caregiving environment.

A synthesis of qualitative studies is projected with an extensive and inclusive bibliography search strategy. The primary search will focus on the major databases (CINAHL, MEDLINE, EMBASE, PsycInfo, PSICODOC, Cochrane Library, JBI, EMBASE, LILACS, CUIDEN, CUIDEN qualitative, CUIDATGE, British Nursing Index, SSCI). The secondary search will be conducted in articles taken from the references to studies identified in the articles and reports and the manual search in congresses and foundation papers. Article quality will be assessed by the guide proposed by Sandelowski & Barroso and data extraction done using the QARI data extraction form proposed by the Joanna Briggs Institute for Evidence-Based Practice.

The synthesis of the findings will be based on the principles and procedures of grounded theory: coding, identification and relationship between categories, and synthesis using constant comparison as a strategy.

Discussion

This synthesis of qualitative evidence will enable us to detect health needs as perceived by the receivers in their own interaction contexts.

Sooner or later? A study of institutionalization in late life

BACKGROUND AND AIMS

Existing information about institutionalization of elderly individuals is mainly based on cross-sectional data and does not address the cumulative risk of institutionalization. The purpose of the present study was to analyze longitudinal data prospectively and estimate the risk of placement in an elder care institution for individuals aged 70 years or older.

METHODS

The study was based on a longitudinal investigation (the H70 study) of a random sample of 70- year-olds living in Gothenburg, Sweden, in 1971. Individuals were followed from age 70-100 years. Three different analyses were performed: a descriptive prospective analysis, cross-sectional analyses at ages 70, 79 and 85 years, and a longitudinal analysis of predictors for institutionalization.

RESULTS

The prospective analysis indicated that 50% of the individuals eventually moved to an elder care institution. Significantly more women than men were institutionalized, although for women the move occurred later in life. Cross-sectional analyses demonstrated that various factors were important to institutionalization at different ages. The Cox regression model with time-varying covariates indicated that gender, socio-economic situation, marital status, number of symptoms, having children living nearby, and activities in daily life were related to institutionalization.

CONCLUSIONS

The proportion of elderly persons relocating to institutions was significantly higher than that generally found in cross-sectional studies. It was possible to identify variables that predict institutionalization during a subsequent 30-year period, but different analyses revealed different effects from the factors evaluated.

Care recipients' perceptions of activity-related life space and life satisfaction during and after geriatric rehabilitation

The debate concerning older people's life spaces should be based on subjective priorities of the elderly themselves. The purpose of this study was therefore to improve the understanding of preferences of elderly care recipients regarding activity-related life space (ARLS) and life satisfaction. A mainly qualitative design was used. Fifteen persons aged 80-94 years, undergoing geriatric rehabilitation, were interviewed during hospital stay and on two follow-up occasions after discharge. Transcribed interviews were analyzed in line with the thematic framework approach. The results point to three approaches related to preferences of ARLS: hierarchical limitations, changing continuity, and boundary breaking. Adaptive approaches were employed when physical incapacity was considered a hindrance to activity, adaptations which as a rule resulted in limitations of ARLS preferences. Activity related to the area 'close to one's own body' emerged as one of three identified key activities with importance for life satisfaction, the others being socializing and going out of doors. Continuity of activity in a familiar life space was expressed as a common ideal. If the aim of geriatric rehabilitation is to improve care recipients' life satisfaction, attention needs to be paid to the subjective dimensions of the ARLS in the goal setting.

Network-based rehabilitation increases formal support of frail elderly home-dwelling persons in Finland: randomised controlled trial

The AGE study is a national randomised, long-term, multicentre research project aimed at comparing a new network-based rehabilitation programme with the use of standard health and social services. The use of home help services is associated with increasing age, living alone and having difficulties with activities of daily living. During a rehabilitation intervention the elderly participants' need for care can be assessed. The focus of this paper is to investigate the possible effects of the network-based rehabilitation programme on the use of informal and formal support among home-dwelling elderly at a high risk of long-term institutionalisation. The randomised controlled trial with a 12-month follow-up was implemented in 7 rehabilitation centres and 41 municipalities in Finland. The participants were recruited between January and October 2002. A total of 708 home-dwelling persons aged 65 years or older with progressively decreasing functional capacity and at the risk of being institutionalised within 2 years participated. Persons with acute or progressive diseases or poor cognitive capacity (Mini Mental State Examination<18 points), and those who had participated in any inpatient rehabilitation during the preceding 5 years, were excluded. Participants were randomly allocated to the intervention group (n=343) or to the control group (n=365). The intervention consisted of a network-based rehabilitation programme specifically designed for frail elderly people. Main outcome measures included the help received from relatives and municipal or private services. The use of municipal services increased more in the intervention group (P<0.05) than in the control group. Support from relatives decreased in the control group. The rehabilitees' ability to manage with daily activities decreased and they received additional help; hence, in this respect the rehabilitation model seems successful. A longer follow-up within the still ongoing AGE study is needed to verify whether the programme actually can delay long-term care.

Factors influencing the decision of older people living in independent units to enter the acute care system

AIMS AND OBJECTIVES

This South Australian-based study explored and described the factors influencing the decision of older people living in the community in independent living units to enter the acute care system.

BACKGROUND

Community-based older Australians, an increasing population segment, make choices about support needed to optimize health and well-being. This includes when to enter the acute care system. Entering this system has potential risks as well as benefits. The current South Australian Department of Human Services policies of 'keeping older people out' of the acute care system has implications for prevention and early intervention measures and requires an understanding of how and why older people enter the acute care system.

METHOD

In-depth interviews were conducted with older people (N = 31) and their families (N = 10), drawn from three South Australian aged care organizations providing independent living unit accommodation, and focus groups (N = 14) were conducted with stakeholders to identify factors influencing the decision of older people living in independent living units to enter the acute care system.

FINDINGS

Analysis of the data revealed eight facets influencing this group of older people's decision-making with respect to entering the acute care system; they were: expectations of support in the independent living unit not being met; the presence/absence of safety nets; lack of after-hours support; the desire to remain independent; the general practitioner as pivotal; the influence of others; perceptions of the emergency department; and having access to information.

RELEVANCE TO PRACTICE

These facets provide insights into entry processes, links and relationships that form an interface between primary care, community care, the aged care industry and the acute system. Analysis of these insights highlight prevention and early intervention responses that can promote the health and well-being of older people, potential ways to streamline services, as well as gaps in current services.

Determinants and characteristics of help provision for elderly people living at home and in relation to quality of life

The aim of this study was to investigate determinants of help from informal or formal caregivers or a combination of both among people aged 75 or more and living at home, and the characteristics of the recipients, the help they received and their quality of life (QoL). The sample for this study was 448 elderly people, 75-99 years of age, living at home and receiving help with activities for daily living, instrumental or both instrumental and personal. Regression analysis showed high QoL not to be significantly related to who was providing the help, whilst it was related to higher age, living with someone, lower number of complaints and managing to be alone at home. Multinomial regression analysis showed age, number of children, number of complaints, the ability to stay alone at home and living alone to predict receiving help from different kinds of caregivers. Recipients receiving help from informal caregivers were younger, more often married and living together with someone, whilst those receiving help from both informal and formal caregivers had more help with instrumental and personal activities for daily living and were not able to stay alone at home as much as those receiving help from other kinds of caregivers. Those receiving help from formal caregivers had fewer children, were single and were living alone more often than the other recipients. Thus the responsibility for help for elderly people rests heavily on informal caregivers, whom it seems essential to support. As public service at home is preferably given to those living alone or able to stay alone at home, those without relatives may not be able to remain at home when their need of help increases.

Quality of life in older people with cancer - a gender perspective

The aim of this study was to investigate quality of life (QoL) and its association with sense of coherence (SOC), complaints, comorbidity, social resources, perceived economic situation and receiving help for daily living, investigating differences between women and men aged 75 and above with cancer and comparing women and men aged 75 and above without cancer. A further aim was to identify which of these factors were associated with low QoL in older people with cancer. The sample consisted of women (n = 74) and men (n = 76) with the inclusion criteria aged 75 and above and a cancer disease, and a matched comparison group of women (n = 64) and men (n = 74) without cancer. EORTC QLQ C-30, SF-12 and SOC-13 were used. Women with cancer were more vulnerable than their male counterparts in QoL, SOC, perceived economic situation and social resources. Factors associated with low QoL in older people with cancer were receiving help for daily living, comorbidity, degree of complaints and pain. From a caring perspective the findings suggest a focus on symptoms and treatment, to acquire an understanding of how a cancer disease, comorbidity and various complaints affect QoL and independence in older women and men and to intervene accordingly. It also suggests that socio-economic and social problems and needs influence their treatment and care and therefore should be in focus.

Quality of life among older people in Sweden receiving help from informal and/or formal helpers at home or in special accommodation

The present study describes and compares quality of life (QoL) and factors which predict QoL among people aged 75 years and over who receive help with activities of daily living (ADLs) from formal and/or informal helpers. The subjects were living at home or in special accommodation in Sweden. A postal questionnaire was sent to a randomly selected and age-stratified sample of 8500 people. The response rate was 52.8% (n = 4337), and 1247 people [mean age (+/- SD) = 86.4 +/- 5.9 years] received help and indicated who helped them with ADLs. The findings suggest that a greater age, being a woman, being a widow/widower, a higher number of health-related complaints, needing more help with ADLs and a lower QoL were found among those receiving help in special accommodation in comparison with those receiving help at home. The extent of help was highest among those receiving help in special accommodation. Having help with ADLs every day at home indicated having help from both informal and formal helpers, while respondents receiving help from only informal or only formal helpers received the smallest amount of help with ADLs. A need for greater help with ADLs, and a higher number of self-reported diseases and complaints determined low QoL, whilst a social network (contact with more than three people) and a greater age determined high QoL. However, who the helpers were did not have a significant influence on QoL; it was the extent of help with ADLs that influenced QoL negatively and the density of the social network that influenced QoL positively.

Attitudes towards rehabilitation needs and support from assistive technology and the social environment among elderly people with disability

This study aimed to survey the attitudes of elderly people with disabilities who were living at home regarding their support from assistive technology and the social environment. These attitudes were compared with their identified needs by an occupational therapist and in relation to perception of social engagement, loneliness and overall contentment with life. From a sample of 102 participants who were interviewed using a standardized procedure, 53 persons were included in the study. The results indicated that attitudes among elderly people towards social and occupational engagement and change have a greater influence on their rehabilitation status than their disability as indicated by their health condition and limitations in activities of daily living and instrumental activities of daily living. The elderly people who accepted rehabilitation were more able, and were better equipped and better supported with assistive technology, than those who declined rehabilitation. Rehabilitation needs that the occupational therapists recognized were not always shared by the disabled elderly people, for several reasons; one reason of particular importance was the elderly person's attitude towards change and social engagement. However, the small sample size limits the generalization of the findings to the population of elderly people with disabilities. An ethnographic research design that allows for repeated interviews and observations of elderly people with disabilities for a prolonged period of time in their ordinary everyday lives may present an avenue for future research and lead to a deeper understanding of the issues.

Elders' perceptions of formal and informal care: aspects of getting and receiving help for their activities of daily living

A purposive and convenience sample of 16 women and four men receiving informal and formal care for their activities of daily living either at home or institutions in Southeast Washington, USA was interviewed. Qualitative findings related to asking for help, getting and receiving help, interpersonal aspects of receiving help, and met and unmet needs are reported. Some seniors found it more difficult to ask for and accept help and there were gender differences, with men tending to adopt a more logical and pragmatic approach while women viewed receiving help as a loss of independence and an invasion of privacy. Intimacy and nudity were also threats for women. Three styles of adjustment and acceptance were identified within the data and related to positive acceptance, resigned acceptance and passive acceptance. There appeared to be a relationship between independence and control, with elders losing some independence but retaining control through choice, payment and involvement in decision making. Reciprocity was found to bring added value to relationships between care providers and elders, with a rhythm and symmetry developing in relationships where needs were known, anticipated and met. Seniors should be encouraged to plan for their future and to find out about local help and services available to them in advance of their requiring any assistance.