This thesis investigates the effects of national patterns of migration on informal support for older adults in contemporary Scotland. It argues that geography matters, and develops a multi-scale conceptual framework to analyse the relationships among population mobility, contrasting local contexts in which older people live, and care and support from the intergenerational family and the community. 130 older persons from three locales with different migration patterns are recruited to the study and a mixed-method approach is adopted, using data from the census, a questionnaire survey and a set of in-depth interviews with both older people and formal service providers. The findings demonstrate significant differences between the three study locales in terms of the geography of the intergenerational family and the extent and nature of informal support received. Daughters provide more support than sons, suggesting the continuation of traditional gender norms. Local community is important, especially in the rural locale, but friends and neighbours are not providing a substitute for adult children living at a distance. It appears that non-kin respond to need where physical health is compromised but not where the older person suffers from depression. This raises serious questions about the future of family support in an increasingly mobile society with declining fertility and growing numbers of adult daughters in full-time employment. The relationships demonstrated confirm and extend many previous findings, but the discussion concludes that there are some grounds for optimism. The intergenerational family remains important to its members who can and do overcome geographical separation at times of crisis. Further, slowly changing gender norms, combined with contemporary demographic trends, may effect changes in the pattern of intergenerational support, which will, to some extent, offset the worsening older-age dependency ratios predicted for Scotland and other European countries over the next few decades.

Diploma project, the issue of informal care for a close person with Parkinson's disease from the perspective of caregivers is focused on the intensity of care and access to services that could help informal caregivers in the care of their loved ones.In the theoretical section of Parkinson's disease I am describing, its development and changes that the disease brings along. Then I followed with the care of relatives person and support from the social system - the state. In the practical part I have chosen for my research a survey, which was attended by only a small part of respondents from informal carers. Care of long-term sick family member is very difficult. Caregivers feel tired and exhausted, they report that their own health becomes wors. Care also affects cares professional life and there leisure time. Although half of the respondents are still able to find time for their hobbies. Some carers have no idea about the possibilities of helping services and just minimum of them use these services.

In this thesis, I shall discuss the importance of supporting caregivers. I will focus primarily on the introduction and description of problematic phenomena related to caring, to the caregiver's role, then of delivering care and its species. In subsequent chapters I will focus on the pitfalls of care and the implications for caring. Next, I will dedicate the positive aspects of care. At work I will also support informal care from the state. I provide overview of options that can help them in caring for a related. At thesis I try to highlight the care provided by amateurish carers about the importance of their support and also to outline the positive aspects of care. Family carers deserve admiration. Their strength and conviction in many cases is unimaginable. Caregivers must overcome many obstacles and still manage most of the care.

Trata-se de uma pesquisa de cunho qualitativo que tem como objetivos desvelar as vivências de famílias de classe popular no cuidado a familiares idosos fragilizados, no domicílio, bem como obter subsídios para a sistematização do cuidado de enfermagem a essas famílias. O Referencial Teórico aborda temas relacionados à área temática do estudo: o cuidado de enfermagem domiciliar, a família de classe popular e a pessoa idosa fragilizada. Os sujeitos dessa investigação, intencionalmente escolhidos a partir de critérios previamente estabelecidos, são quatro famílias pertencentes à população adstrita a uma Unidade Sanitária do município de Porto Alegre. O Estudo de Caso do Tipo Etnográfico é a metodologia utilizada. Os instrumentos utilizados para a coleta de dados são a Observação Participante, a Entrevista, a Análise Documental e a Ficha Informativa. Do tratamento dos dados, através da análise de conteúdo, emergiram seis categorias: Características das famílias, Concepções das famílias, A (re)organização da família para o cuidado, A família no cotidiano do cuidado, Relação com as instituições sociais, O cuidado de enfermagem domiciliar. Foi possível perceber que as famílias são multigeracionais. Sobrevivem quase que exclusivamente das aposentadorias dos idosos e enfrentam constantemente o desemprego. Sua concepção de saúde está relacionada à capacidade de trabalho. Valorizam a família, na qual o idoso é reconhecido em sua experiência de vida. Ao necessitar de cuidado, este deve ser assumido, preferencialmente, pelos familiares. Uma pessoa envolve-se mais intensamente no cuidado, mas toda a família, auxiliada por uma rede apoio, constituída de amigos e vizinhos, interage. Nas atividades cotidianas, valem-se da criatividade para adaptar utensílios e o ambiente, bem como do saber popular, como recursos nos cuidados à saúde. As dificuldades destacadas estão relacionadas à condição socioeconômica precária, à moradia, ao vestuário e ao transporte. Percebem que o suporte social a famílias cuidadoras é restrito. Destacam que o acesso aos serviços de saúde é sofrível e ressaltam a urgência em solidificar o Sistema Único de Saúde, em busca da concretização dos seus princípios. Expressam a necessidade de implantação de programas de cuidado domiciliar, interdisciplinares, que assistam a família e o idoso de forma integral, continuada, participativa, contextualizada e humanizada. / This is a qualitative research, which aims to unveil the life experience of families from lower classes at caring for their frail elderly relatives at home, as well as to obtain subsides for creating a model of nursing care for such families. The theoretical model approaches issues related to the thematic area of caring: the family nursing home care, the lower classes families, and the frail elderly. The subjects of this investigation, intentionally chosen upon the criteria previously established, were four families from the Sanitation Unity of Porto Alegre. The design of this case study was an ethnographic type. Tools used for data collection were: participated observation, an interview, a documented analysis, and the informative report. From the analysis of data, through the content analysis, six categories were established: characteristics of the families, conceptions of the families, reorganisation of the family to the care, the family within the routine of the care, the relationship with social institutions, and the nursing home care. It was possible to perceive that families are multigeneration. They survive almost exclusively from the elderlies retirement and frequently they have to cope with unemployment. Their concept of health is related to their work skills. They value the family where the elderly is recognised for his or her life experience. When he or she needs to be cared of, it has to be performed preferably by the family. One is more involved in the care, but the whole family interacts, supported by a social net, composed of friends and neighbours. In the daily activities, they use creativity to adapt goods and the environment, as well as the popular knowledge as resources in the health care. The stressed difficulties are related to the poor social-economic condition, to dwelling, clothing, and transport. They perceive that the social support to caring families is restricted. They emphasise that access to health services is appalling and magnify the urgency in strengthening the "United Health System", aiming to establish their principles. They stress the need to introduce interdisciplinary home care programs, which could assist the family and the elderly in a holistic, permanent, participating, contextural, and humanised way. / Se trata de una investigación de tipo cualitativo que tiene como objetivos descubrir las vivencias de familias de clase popular en el cuidado a familiares ancianos fragilizados, en el domicilio, así como obtener subsidios para la sistematización del cuidado de enfermería a esas familias. El Referencial Teórico aborda temas relacionados al área temática del estudio: el cuidado de enfermería domiciliar, la familia de clase popular y la persona anciana fragilizada. Los sujetos de esa investigación, intencionalmente elegidos a partir de criterios previamente establecidos, son cuatro familias pertenecientes a la población perteneciente a una Unidad Sanitaria del municipio de Porto Alegre. El Estudio de Caso de Tipo Etnográfico es la metodología utilizada. Los instrumentos utilizados para la colecta de datos son la Observación Participante, la Entrevista, el Análisis Documental y la Ficha Informativa. Del tratamiento de los datos, a través del análisis de contenido, emergieron seis categorías: Características de las Familias, Concepciones de las Familias, La (re)Organización de la Familia para el Cuidado, La Familia en la Cotidianeidad del Cuidado, Las Relaciones con las Instituciones Sociales, El Cuidado de Enfermería Domiciliar. Fue posible percibir que las familias son multigeneracionales. Sobreviven casi exclusivamente de las jubilaciones de los ancianos y enfrentan constantemente el desempleo. Su concepción de salud está relacionada a la capacidad de trabajo. Valorizan la familia, en la cual el anciano es reconocido por su experiencia de vida. Al necesitar de cuidado, este debe ser asumido, preferencialmente, por los familiares. Una persona se envuelve mas intensamente en el cuidado, pero toda la familia, auxiliada por una red de apoyo, constituida de amigos y vecinos, interactúa. En las actividades cotidianas, se valen de la creatividad para adaptar los utensilios y el ambiente, tanto del saber popular, como en los recursos para el cuidado de la salud. Las dificultades destacadas están relacionadas a la condición socioeconómica precaria, a la vivienda, al vestuario y al transporte. Perciben que el soporte social a familias cuidadoras es restricto. Destacan que el acceso a los servicios de salud es sufrible y resaltan la urgencia en solidificar el Sistema Único de Saúde (Sistema Unico de Salud), en busca de la concretización de sus principios. Expresan la necesidad de implantación de programas de cuidado domiciliar, interdisciplinares, que asistan a la familia y al anciano de forma integral, continuada, participativa, contextualizada y humanizada.

<p>Two main goals of geriatric rehabilitation are to re-establish ability for physical function in order to facilitate independence in activities of daily living (ADL), and to promote an optimal degree of well-being, i.e. life satisfaction, in the individual. In this research a new scale, the General Motor Function assessment scale (GMF), was developed and evaluated. Subsequently, factors perceived as important for the life satisfaction of people undergoing geriatric rehabilitation were investigated. </p><p>The GMF includes both mobility and upper limb functions and comprises three subscales covering different aspects of functioning, namely performance-related Dependence, Pain and Insecurity. The clinical practicality of the GMF was evaluated by a field test. Its psychometric properties were analysed in both hospital and community-based settings of geriatric rehabilitation, using non-parametric statistical methods. The results indicated that the GMF is clinically adequate, possesses good reliability and is sensitive enough to demonstrate changes from pre- to post-intervention in different forms of geriatric rehabilitation. </p><p>For investigation of perceptions of life satisfaction, individual qualitative interviews were conducted with old (80+) care recipients and with their significant others, who had a helping relationship with them. The results revealed that habitual activity, independence and adaptation were generally considered to be important for the life satisfaction of the care recipients. Recalling of pleasant past memories in an effort to achieve current life satisfaction was a commonly used adaptive strategy among the care recipients. This strategy created a temporary sense of life satisfaction, with a potential for concealing dissatisfaction with conditions that might otherwise be correctable. From the perspective of the significant others, protection of the continuity of the care recipients’ self was seen as vital for the latter's life satisfaction, and was thus an underlying general purpose of the informal caregiving. </p>

Two main goals of geriatric rehabilitation are to re-establish ability for physical function in order to facilitate independence in activities of daily living (ADL), and to promote an optimal degree of well-being, i.e. life satisfaction, in the individual. In this research a new scale, the General Motor Function assessment scale (GMF), was developed and evaluated. Subsequently, factors perceived as important for the life satisfaction of people undergoing geriatric rehabilitation were investigated. The GMF includes both mobility and upper limb functions and comprises three subscales covering different aspects of functioning, namely performance-related Dependence, Pain and Insecurity. The clinical practicality of the GMF was evaluated by a field test. Its psychometric properties were analysed in both hospital and community-based settings of geriatric rehabilitation, using non-parametric statistical methods. The results indicated that the GMF is clinically adequate, possesses good reliability and is sensitive enough to demonstrate changes from pre- to post-intervention in different forms of geriatric rehabilitation. For investigation of perceptions of life satisfaction, individual qualitative interviews were conducted with old (80+) care recipients and with their significant others, who had a helping relationship with them. The results revealed that habitual activity, independence and adaptation were generally considered to be important for the life satisfaction of the care recipients. Recalling of pleasant past memories in an effort to achieve current life satisfaction was a commonly used adaptive strategy among the care recipients. This strategy created a temporary sense of life satisfaction, with a potential for concealing dissatisfaction with conditions that might otherwise be correctable. From the perspective of the significant others, protection of the continuity of the care recipients’ self was seen as vital for the latter's life satisfaction, and was thus an underlying general purpose of the informal caregiving.

This dissertation studies factors that predict use of public eldercare, informal care, and purchase of private services in relation to an individual’s needs, social network characteristics, and sociodemographic factors. A further purpose is to examine whether use of public eldercare is correlated to receipt of informal care and purchase of private services in the Swedish welfare state. The dissertation is based on the Kungsholmen Study, a population-based longitudinal study. Studies I–III used cross-sectional data from community-dwelling people aged 81-100 and examined (I) gender, (II) marital and parental status, and (III) dementia and depressive symptoms as predictors of use of home help. Study IV analyzed factors related to moving into institutional care and receipt of home help from 1994/96 to 2000. The majority of support provided to elders living in the community comes from informal sources, even among people living alone. There was considerable overlap between home help and informal care. When all sources of care were considered, childless individuals had comparatively lower odds of receiving care. Factors predicting use of public eldercare and informal care differed depending on whether or not elders coresided. No gender differences in use of formal and informal care were found when controlling for household composition. Living alone, dementia, need of help with household chores, and walking limitations increased the likelihood of using public eldercare. Coresidence, informal care from outside the household, and use of private services decreased the likelihood. Depressive symptoms increased the likelihood of receiving home help and institutionalization when using longitudinal data, but not in the cross-sectional studies. Educational level was of importance and interacted with several factors; persons with higher levels of education were advantaged. Very few people moved into institutional care without previously having received home help services. Essentially the same factors that predicted receipt of home help services also predicted institutionalization.

This is a qualitative study that explores the involvement of the relatives in the special housing based on the perspective of fourteen interviewees working in elderly care, at special housing. The purpose of this study is to analyze the nursing staff's view of the involvement of the relatives and the presence of care provision at special housing. The study is to find out what can constitute support or obstacles to the relatives. Three questions have been presented as the structural basis upon which the objective finds its conclusion. These questions try to explore and identify the forms of support that can help relatives in their involvement in elderly care. There are opportunities and obstacles for the involvement of the relatives in the care of the elderly as well as expectations of nursing staff on the role of the relatives in the care of the elderly which the following study focuses on. The research reflected in this study involves the care staff and their experiences and views on the relatives who have their older live permanently in residential care. In conclusion, the study identifies similar reasoning among respondents regarding to key aspects of the relatives at the special housing. They emphasizes that relatives are needed there and they are important resource for both the residents and the staff. The results indicate that there may be both opportunities and obstacles for the involvement of the relatives. On one side, factors that prevent relatives from their involvement are lack of communication, poor attitude, different views of relatives and staff about care and conflicts between them. On the other side, there are opportunities that can facilitate relatives' involvement, namely the fact that they need support from the staff. The interviewees pointed out that the relationship between relatives and the elderly is the basis of the relatives' involvement.

Background: The elderly Chinese group is growing in Sweden but no studies about their experiences of being cared for were found. In order to meet the elderly Chinese need for care, it is necessary to understand their perspectives of being cared for. Aim: To describe the meaning of the experiences of being cared for by elderly Chinese immigrants in a Swedish context. Method: For this phenomenological study, open-end interviews were carried out with 7 informants originally from Mainland China and Hong Kong. Result and Conclusion: For the elderly Chinese in Sweden, ‘being cared for’ means being involved in a caring community, to have a mutual relationship with someone who can see and understand their needs. In such a relationship, they felt that they were included and respected. They were being treated as valuable with a genuine manner. They had a feeling of satisfaction, happiness, peacefulness, closeness, togetherness, and wholeness when ‘being cared for’. For these elderly Chinese immigrants, informal care was indispensable even when they were receiving formal care. They wished that their family could show concern and formal caregivers could understand and give space to the informal caregivers on caregiving.

The number of informal carers in the UK is rising, yet the dynamics of care within informal care relationships remain poorly understood. The present research examined adaptation of informal care relationships affected by Acquired Brain Injury. The research addresses four pairs of questions: (1a) Are there any disagreements and/or misunderstandings between carers and people with Acquired Brain Injury (PwABI) regarding carer identity? (1b) How can the pattern of divergences be explained? (2a) Are there any disagreements and/or misunderstandings between carers and PwABI regarding PwABI identity? (2b) How can the pattern of divergences be explained? (3a) What strategies do carers and PwABI use in collaboration on a joint task? (3b) Is the type of input provided by carers on the joint task comparable to scaffolding as described in the child development literature? (4a) What happens when carers and PwABI collaborate to fill in the Disability Living Allowance (DLA) claim form? (4b) Why do carers see more disability than PwABI when filling in the DLA form? Four mixed-method data sets were used to answer these questions: (1) numerical ratings given by PwABI and carers to map out convergences and divergences (2) videos of discussions between participants and researcher during rating tasks (3) videos of carers and PwABI engaging in a joint task - planning inviting a friend or relative round for a meal and (4) videos of carers and PwABI filling in part of the DLA claim form. All data was collected from the same 28 PwABI/carer dyads who were two or more years post injury. Chapter 4 addresses questions 1a and 1b. Carers’ and PwABIs’ perspective ratings revealed a number of disagreements regarding carer identity. Carers perceived themselves negatively compared to their partners’ view of them. Regarding question 1b, carers feel negatively about themselves due to difficulties in the transition to the role of ‘carer’. They experience a lack of recognition for this caring role as a result of concealing the burden of care. Carers require more long term support from health services to help them achieve recognition for their role, such as facilitating attendance at support groups. Chapter 5 addresses questions 2a and 2b. Carers’ and PwABIs’ perspective ratings revealed only one disagreement and corresponding misunderstanding regarding PwABI identity. Regarding question 2b, alignment was found between the perspectives of carers and PwABI regarding PwABI due to the relational rating method used. It is carer identity which is the source of most divergences of perspective, not PwABI identity as commonly assumed. Using a relational rating method shows promise as a tool to explore perspectives as it treats all viewpoints as equal and avoids pathologising the perspective of PwABI. Chapter 6 addresses questions 3a and 3b. Analysis of strategies shows that completing a joint task is a collaborative process. Carers direct the background of the task but PwABI are in charge of the foreground, making task decisions. However, carers dominate the process and control where and how PwABI contribute. Regarding question 3b, the interaction meets the criteria for scaffolding in the strategies chosen and the flexibility of collaboration. However, removal of supports is often an unrealistic goal, leading to frustration in carers. Examination of processes of collaboration has elucidated the strategies used by carers and PwABI and can enhance theoretical discussion of the applicability of the scaffolding metaphor for a cognitively impaired adult sample. Chapter 7 address questions 4a and 4b. Disagreements were frequent when completing the DLA form. Contestations were almost exclusively in the direction of carers seeing greater disability than PwABI. Regarding question 4b, carers see greater disability due to the communication required to complete the form. Dyads are forced to confront disability, a pattern of interaction they avoid in everyday life. Carers marginalise PwABI point of view and position themselves as ‘expert’ on the PwABI. Differences in frames of reference regarding audience, aim and scope lead carers to maximise the disability and PwABI to minimise this. The impact of completing complex forms on relationships and identity needs to be considered during development of disability benefit assessment methods. A relational approach which studies both halves of informal care partnerships simultaneously allows us to go beyond outcomes of ABI and affords a greater understanding of processes of adaptation.