Health and social work practitioners’ experiences of working with risk and older people

The purpose of this paper is to explore interprofessional and multidisciplinary working between health and social care practitioners providing services to older people through the prism of how risk is assessed and managed. It proposes that whilst interprofessional and multidisciplinary working is a broad and commonly researched topic, there is a relative paucity of evidence specifically regarding how health and social care practitioners work together across structural, cultural and ideological divides. The study aims to expand the domain of integrated health and social care by including perceptions, understanding and use of the concept of risk by professionals from different disciplines.Design/methodology/approachThis paper is based upon an exploratory study using an interpretivist phenomenological perspective, including 23 semi-structured individual interviews with health and social care practitioners and 2 non-participant observations of multidisciplinary team meetings.FindingsThe paper provides empirical insights around the complex dynamics of interprofessional and multidisciplinary working between health and social care practitioners, in particular the saliency of the interconnectedness of individual practitioner Personalities with the Process of interprofessional and multidisciplinary working under the auspices of relevant Policy drivers.Research limitations/implicationsThe research was conducted in Wales and, due to the increasingly divergent policy context within the UK, the research results may lack generalisability from a wider UK or international perspective. Therefore, researchers are encouraged to test the propositions of this research further.Practical implicationsThe paper includes implications for both interprofessional and multidisciplinary policy and practice with older people. With new models of integrated care being sought, the findings of this study may offer a timely and valuable contribution, particularly from the inclusion of a social care perspective and in better understanding the interconnectedness of practitioner personalities with process and policy.Originality/valueThis paper fulfils an identified need to study the complex dynamics and interconnectedness between health and social care practitioners who work together to provide services to older people

Using psychological mechanisms to reduce intergenerational ageism via intergroup contact.

Positive social interaction between members of opposing social groups (intergroup contact) is an effective method of prejudice reduction (Allport, 1954; Pettigrew & Tropp, 2006). This thesis explores how intergroup contact theory can be applied to age groups to reduce ageism towards older adults. Chapters 1 to 3 form the theoretical chapters of the thesis. Chapter 1 defines psychological processes underpinning ageism, provides details of its prevalence, outlines its consequences in society, and gives a justification for its reduction. Chapter 2 introduces the psychological processes underpinning intergroup contact theory and its different formations. This is followed by a literature review of intergenerational contact research, which identifies research gaps in the field and research questions addressed in this thesis. Four empirical chapters then present findings from eight studies. In Chapter 4, Study 1 provides initial correlational evidence of the relationships between direct intergenerational contact, ageism and related psychological processes. Chapter 5 addresses the research question of whether extended contact can be successfully applied to age groups. Studies 2, 3 and 4 provide novel evidence that extended intergenerational contact reduces ageism and is effective via reduced intergroup anxiety, ageing anxiety and ingroup norms. These studies also support prior research demonstrating that direct contact reduces ageism via intergroup and ageing anxieties. Chapter 6 presents two studies that extend the focus of the thesis to include age stereotypes. Secondary analysis of national survey data in Study 5 explores the perception of older adults' competence across the lifespan and friendships with older adults. The degree to which young and middle-aged adults perceive that competence declines with age is attenuated by having as little as one older friend. Building on these findings, Study 6 explores the relationships between direct and extended intergenerational contact, ageist attitudes and warmth and competence stereotypes. Corroborating Chapter 4, both direct and extended contact predicted reduced ageism and are effective via increased competence stereotypes and increased warmth stereotypes. In the final empirical chapter in the thesis Chapter 7 presents two studies that explore intergenerational contact theory in applied contexts. Using an experimental design, Study 7 evaluated an intergenerational programme in which students had conversations with older adults about their technology use. Compared to a control group, the experimental group rated older adults as warmer yet more incompetent. However, only warmth and not incompetence stereotypes formed indirect pathways to subsequent attitudes towards older adults more widely. Study 8 examined care workers positively and negatively experienced intergenerational contact with care home residents. Although care workers experienced more positive than negative contact, negative (but not positive) contact was associated with their attitudes towards care home residents and it generalised to older adults more widely. This indirect effect of negative contact to older adults was effective only for subtle and not blatant ageist attitudes. Overall, the thesis provides a range of evidence suggesting that intergroup contact theory can be successfully applied to the reduction of ageism. It presents a detailed overview of current knowledge, corroborates existing evidence and presents novel findings for extended contact and mediators of both direct and indirect intergenerational contact

Improving access to high-quality primary care for socioeconomically disadvantaged older people in rural areas: a mixed method study protocol

Introduction: The UK has an ageing population, especially in rural areas, where deprivation is high among older people. Previous research has identified this group as at high risk of poor access to healthcare. The aim of this study is to generate a theory of how socioeconomically disadvantaged older people from rural areas access primary care, to develop an intervention based on this theory and test it in a feasibility trial. Methods and analysis: On the basis of the MRC Framework for Developing and Evaluating Complex Interventions, three methods will be used to generate the theory. First, a realist review will elucidate the patient pathway based on existing literature. Second, an analysis of the English Longitudinal Study of Ageing will be completed using structural equation modelling. Third, 15 semistructured interviews will be undertaken with patients and four focus groups with health professionals. A triangulation protocol will be used to allow each of these methods to inform and be informed by each other, and to integrate data into one overall realist theory. Based on this theory, an intervention will be developed in discussion with stakeholders to ensure that the intervention is feasible and practical. The intervention will be tested within a feasibility trial, the design of which will depend on the intervention. Lessons from the feasibility trial will be used to refine the intervention and gather the information needed for a definitive trial. Ethics and dissemination: Ethics approval from the regional ethics committee has been granted for the focus groups with health professionals and interviews with patients. Ethics approval will be sought for the feasibility trial after the intervention has been designed. Findings will be disseminated to the key stakeholders involved in intervention development, to researchers, clinicians and health planners through peer-reviewed journal articles and conference publications, and locally through a dissemination event

Loneliness, social relations and health and wellbeing in deprived communities

There is growing policy concern about the extent of loneliness in advanced societies, and its prevalence among various social groups. This study looks at loneliness among people living in deprived communities, where there may be additional barriers to social engagement including low incomes, fear of crime, poor services and transient populations. The aim was to examine the prevalence of loneliness, and also its associations with different types of social contacts and forms of social support, and its links to self-reported health and wellbeing in the population group. The method involved a cross-sectional survey of 4,302 adults across 15 communities, with the data analysed using multinomial logistic regression controlling for sociodemographics, then for all other predictors within each domain of interest. Frequent feelings of loneliness were more common among those who: had contact with family monthly or less; had contact with neighbours weekly or less; rarely talked to people in the neighbourhood; and who had no available sources of practical or emotional support. Feelings of loneliness were most strongly associated with poor mental health, but were also associated with long-term problems of stress, anxiety and depression, and with low mental wellbeing, though to a lesser degree. The findings are consistent with a view that situational loneliness may be the product of residential structures and resources in deprived areas. The findings also show that neighbourly behaviours of different kinds are important for protecting against loneliness in deprived communities. Familiarity within the neighbourhood, as active acquaintance rather than merely recognition, is also important. The findings are indicative of several mechanisms that may link loneliness to health and wellbeing in our study group: loneliness itself as a stressor; lonely people not responding well to the many other stressors in deprived areas; and loneliness as the product of weak social buffering to protect against stressors

Making it real of sustaining a fantasy? Personal budgets for older people

The restructuring of English social care services in the last three decades, as services are provided through a shifting collage of state, for-profit and non-profit organisations, exemplifies many of the themes of governance (Bevir, 2013). As well as institutional changes, there have been a new set of elite narratives about citizen behaviours and contributions, undergirded by modernist social science insights into the wellbeing benefits of ‘self-management’ (Mol, 2008). In this article, we particularly focus on the ways in which a narrative of personalisation has been deployed in older people’s social care services. Personalisation is based on an espoused aspiration of empowerment and autonomy through universal implementation to all users of social care (encapsulated in the Making it Real campaign [Think Local, Act Personal (TLAP), no date)], which leaves unproblematised the ever increasing residualisation of older adult social care and the abjection of the frail (Higgs and Gilleard, 2015). In this narrative of universal personalisation, older people are paradoxically positioned as ‘the unexceptional exception’; ‘unexceptional’ in the sense that, as the majority user group, they are rhetorically included in this promised transformation of adult social care; but ‘the exception’ in the sense that frail older adults are persistently placed beyond its reach. It is this paradoxical positioning of older adult social care users as the unexceptional exception and its ideological function that we seek to explain in this article