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.

Personalisation of social care for adults is a key policy objective in the UK having gained wide acceptance as essential for the empowerment of service users and as a means of making the system sustainable in the face of the increasing population demand. However, despite huge investment in 'transformational change' over the past decade there is little evidence of its effectiveness. This is particularly true of personalisation policy and practice applied to older people. Evaluative studies show poorer outcomes compared with other user groups and question effectiveness in terms of actual empowerment experienced and value for money achieved. The conditions required for what is essentially a consumerist model of personalisation are frequently stated but rarely, if ever, wholly achieved. A qualitative study of eight cases in two local authority areas in England explored older people's experience of using (or refusing) a direct payment with the aim of obtaining user perspectives to inform future policy and practice. The study was concerned with understanding the relationship between participants' personhood, or experience of 'Self , and personalised services. The locus of personalisation was found to reside within the interpersonal dynamics of helping relationships rather than control over the means of procuring services. Participants experienced personalisation when carers perceived and accommodated their 'special requirements of Self'. This was achieved in most cases despite the consumerist model of personalisation rather than because of it. In a number of cases participants and their front line carers were exposed to considerable risk and dilemma in the process. These user perspectives provide a valuable starting point for the development of an alternative theoretical framework within which existing policy and practice might be reviewed and redeveloped. Key words: Older people, personalisation, personhood, Self, direct payments.

No description available.

The thesis looks at the effect of the social policy of community care for infirm elderly parents on their supporting single daughters and sons. It is a small empirical study of a sample of 58 carers whose parents were on the district nursing records of one area health authority. Most of the parents were in their eighties or nineties and all had multiple impairments. The daughters and sons (the carers) were themselves usually approaching or above retirement age. Common problems arising from parental dependency included broken sleep, few leisure activities outside the home, difficulties in taking a holiday and in maintaining friendships. The majority of the women below retirment age were unable to maintain a full-time job outside the home; but it was rare for a son's employment to be so affected. Several issues were highlighted by the research findings. In practice the policy of community care meant that the burden of care usually fell on one person. Not only did a substantial number of the single men and women totally lack supportive kin, those who had kin were usually given little support by such kin in coping with the parent. Although neighbours gave some form of practical support to about half the carers, the more infirm the parent the less likely were they to be supportive. As far as the statutory health and personal social services were concerned, the carers received relatively little support in the form of counselling or advice from district nurses or social workers. Although the social services departments often gave practical support such as Meals on Wheels or home help, services which would effectively share the burden of care, such as day care or short term places in residential Homes, were not readily available.

No description available.

This research explores what makes it possible for older members to live in intergenerational intentional communities in the South of England. These are uncommon entities within the UK; they are purposefully communally organised living arrangements adopting philosophies of mutual support. There is growing interest in intentional communities as potentially positive housing choices for later life, but no research has been undertaken exploring ageing in them. I used a Bourdesian theoretical framework, exploring the economic, social and cultural capital that individuals commonly drew on in order to become members of their community (habitus) and to live day-to-day. I enhanced this approach by incorporating theorising from the fields of housing, cultural gerontology and care ethics, contributing to debates about the use of Bourdesian methods. I used qualitative research methods: a telephone survey of 22 communities and 23 interviews with members aged over 50, within 9 communities. I found that half the communities had members aged over 60; all were intergenerational. I identified key economic differences between communities: individual-ownership models, which required individual financial investment upon entry (CoHousing) and social-ownership models, which did not (Housing Co-operatives and a squat); two were hybrid models. The social-ownership intentional communities were more open to diverse potential new members. The cost of living was often very low, though this depended on the age of the community (generational capital) and the extent of sharing by members (collaboration). Long-standing housing Co-operatives had accumulated affordability capital and represented more radical transgression of the orthodoxies of UK housing and household formation under neo-liberal capitalist conditions (practical utopias). The cost of living in the CoHousing communities was individualised and similar to conventional homeownership. The CoHousing communities were more aligned with dominant property systems, gaining symbolic power through this. Whilst participants from both types of communities shared certain dispositions and affinities (habitus), there was there was diversity based on traditional distinctions such as social or occupational class, or housing pathways. Bourdesian-type social and cultural capital were important, but in the form of alternative capital - constituted by critical thinking about conventional choices in life (reflexivity) and adoption of alternative, resistant hierarchies of cultural and social values. This enabled interviewees' agency and provided currency within the communities. It was sometimes linked to individual experiences of 1970s counter culture movements. Living in an intentional community at one point in life did not necessarily equate to a lifetime's commitment to this lifestyle - individual affiliation to a community could also be fleeting and ambivalent. Emotional work made living in all communities possible, including tolerance and adaptability. Compromise was structured into all communities decision-making to varying degrees (consensus decision-making). Interviewees considered contributing to community life, friendships, commitment and consideration of the needs of others (informal ethics of reciprocal care) important. Ageing and reciprocal relations of care were delicate matters, not spoken of explicitly in any community. Some interviewees were sure about staying in their community into older age. Most felt ambivalent. There were normative feelings about ageing, such as fears of dependency and determination to remain active (dominant discourses of successful ageing). Whilst intergenerational living was considered positive by all, some tensions were revealed. The ageing of established communities seemed to be challenging their informal and implicit value and mutual support systems. I argued intentional communities might benefit from greater acknowledgement and consideration of issues raised by ageing, to effectively support those moving into later life. By shining a light on these unnoticed, often transgressive experiments in community living, I have shed light onto taken-for-granted housing choices in the UK and to show how limited those choices have become, particularly in older age.

Background Exercise has well known health benefits for older people, however, for some older people with compromised health and mobility participating in exercise is challenging. Chair based exercise is a pragmatic and accessible form of exercise that may be offered in this context, however, there is a lack of good quality evidence and a lack of standardisation in delivery. Method This thesis used the Medical Research Council’s framework for the development and evaluation of complex interventions to develop a community delivered chair based exercise intervention – Progressive Assisted Chair Exercise (PACE). Multiple research methods were undertaken to develop a theoretically driven intervention with a clear rationale for how it was anticipated to work. This included an expert consensus development process, a systematic review of randomised controlled trial literature, and identification of literature on the physiological and behaviour change principles of exercise for older people. The PACE intervention was then tested in a pre and post cohort study in an NHS community service to establish the feasibility of the intervention and whether it resulted in the anticipated outcomes. The acceptability of the intervention was explored through focus groups with older people. Results Experts agreed on a set of 46 principles of chair based exercise through a Delphi technique. The systematic review of randomised controlled trials identified a lack of consistent and good quality evidence for the health benefits of existing programmes. Greater focus on the development of programmes that were underpinned by a sound theoretical framework was recommended. Using the findings from the expert consensus, the systematic review and published guidelines on exercise for older people the PACE intervention was developed to include a 12 week multi-component progressive group or home based programme delivered by a healthcare professional with the knowledge and skills of working with older people and targeted at older people who were unable to participate in standing exercise programmes. The pre and post cohort study demonstrated that the programme was feasible to deliver when tailored to account for individual preferences and the fluctuating health needs of older people. The programme was acceptable to older people when targeted appropriately at those unable to participate in standing programmes and when individual preferences and needs were accounted for. The primary criteria for success of clinically meaningful improvements in lower limb muscle strength and progression to supported standing exercise were observed. Conclusions The PACE intervention as a complex intervention was sufficiently developed and modelled to warrant formal evaluation. Further feasibility work is needed to optimise the evaluation method through a feasibility randomised controlled trial. Further development work for care home and acute rehabilitation populations is indicated.

No description available.

This thesis is concerned with the issue of continuities and discontinuities between adverse family experiences in childhood, and the psychosocial functioning of young adult women, with particular reference to parenting behaviour. The thesis seeks to determine whether intergenerational links between adverse childhoods and adult functioning arise through the direct effects of adversity on personality development or through its impact on subsequent life chances and circumstances. The processes promoting discontinuities are also examined. These issues are explored in two studies, using reception of children into care as in index of family problems and adversity. In the first study a consecutive sample of 48 women with children multiply admitted to Residential Care by one London borough and a contrast group of 47 from the same area were interviewed concerning their early experiences, subsequent life histories and current functioning to determine retrospectively whether their current problems were associated with similar difficulties in their own childhoods, or whether they arose predominantly in response to current family and environmental stresses. The second study concerned 93 women admitted to long stay Children's Homes in early childhood and a contrast group of 31 brought up in inner London but who had never been in care. Both groups were interviewed concerning their early experiences, their life histories and their current psychosocial functioning, with a particular focus on parenting skills. This study was concerned to establish the extent of intergenerational continuities in psychosocial problems, and the factors involved in continuities and discontinuities. The results from the studies show that although the great majority of families with currently marked parenting problems are drawn from those who had markedly adverse childhoods, such problems occur in a minority of those who suffered such experiences. Where continuities occur the links are predominantly) indirect, involving complex chains of circumstances and adverse environments. These links are partly independently determined by earlier environments experienced by the young women and partly selected through their impact on individual functioning at particular times. The data show marked beneficial effects of positive changes in experience in adulthood, especially where marital relationships are good.

Self-care restriction is proposed in the World Health Organization’s International Classification of Functioning (ICF) as an important functional consequence of health conditions. In contrast to traditional approaches which focus only on an individual’s physical capacity, the ICF model also acknowledges the potential role of contextual factors such as environmental factors and personal needs. This thesis aims to understand the occurrence, course, and determinants of self-care restriction, as defined in the ICF, in community-dwelling adults aged 50 years and over, particularly in relation to joint pain and from a novel perspective: personperceived participation restriction in which individuals judge whether their self-care needs are met “as and when I have wanted”. Data collected at three time points, by postal questionnaire across 6 years in the North Staffordshire Osteoarthritis project, were used in the analysis (n=7725 at baseline). The prevalence of person-perceived restricted self-care was 11.5% (95% CI 10.8, 12.2). A parsimonious model of factors associated with self-care restriction included age, activity limitation, depression, cognitive impairment, perceived inadequacy of income and low educational attainment. Older adults with joint pain were more likely to report self-care restriction, although this association was not independent of other factors. The frequencies of onset and persistence of restricted self-care at three years were 6.6% (95% CI 5.9, 7.5) and 38.9% (95% CI 33.7, 44.3) respectively. The key factors associated with restricted self-care at baseline were also predictive of the onset of self-care restriction at three years, but only depression was predictive of persistence. Unmet need for help and assistance was associated with restricted self-care in older adults with joint pain. However, those who received help were also more likely to report restriction. These analyses suggest a range of potential health and social targets for reducing self-care restriction in individuals with joint pain in middle and old age.