Migration and ageing: settlement experiences and emerging care needs of older refugees in developed countries

Migration is a phenomenon usually associated with younger people, so issues of older migrants attract less attention in research, policy making and welfare service provision. On the whole, older refugees are frequently put ‘at the back of the queue’ and overlooked by aid programmes due to assumptions that their needs are of less importance than those of other vulnerable forced migrant groups such as children. Nonetheless, older people who experience forced migration and exile are faced with serious difficulties such as traumatic experiences in origin country and during flight, health deterioration due to migration stresses, severed family and friends’ networks, limited choices of resettlement due to financial difficulties and lack of support. In addition, there is a disparity between service providers’ perceptions of user needs and older refugees’ own priorities. To date, there has been little research on their experiences in receiving countries despite the fact that evidence on settled older migrants depicts them as among the most deprived and socially excluded groups living in developed countries. In this article older refugees' health and social care needs and their implications for policy makers are reviewed

Mental health, trauma and wellbeing of forced and other migrants: effective responses at times of crisis

It is widely recognised that the main impact of forced migrant experience involves serious distress and suffering which may escalate to psychosocial dysfunctioning, trauma and chronic mental health problems. These challenges are often affecting not only migrants’ and refugees’ own lives but also the wellbeing of their families and whole communities. In their majority, these are normal reactions to abnormal situations. To address the mental health needs of such populations, specific skills and approaches are required. The task becomes even more complex as health and mental health infrastructure in host countries are at best unprepared, or at worst non-existent, to respond to these needs. Assumptions, however, are repeatedly made that entire refugee populations become mentally disturbed and are in need of psychiatric care. In fact, psychiatric morbidity and psychosocial dysfunctioning depends on the nature and time span of the conflict, on level and rapidity with which resilience will emerge, based on socio-cultural factors and environmental parameters. Approaches to migrant and refugee mental health care are heavily influenced by Western models of care and not always culturally sensitive or responsive to the needs of these groups. Lack of appropriate care in the mainstream services means that often humanitarian organisations are becoming the main providers of care and support for these populations, posing challenges of dependency on this humanitarian aid and sustainability of support without dedicated funding and resources. In this chapter, I will present a brief critical analysis of access to healthcare, social protection and welfare of forced and other migrants. I will then consider how the concept of refugee trauma and the diagnosis of Post-Traumatic Stress Disorder dominate discussion on the mental health needs of forced and other migrants. I will present some key challenges in assessing needs of these populations and designing appropriate responses by mental health service providers at a time that most European healthcare systems are under pressure to curtail existing resources while being made accountable for compromising quality of care standards. Also, I will discuss innovative and integrated psychosocial models of care in the refugee mental health field, which still remain outside of the mainstream provision rather than embedded responses to the current refugee crisis. Finally, I will argue the necessity of identifying and eliminating existing systemic barriers to recognising the resilience and determination of forced and other immigrants as a key factor in coping with refugee mental health care needs in reception countries. To exemplify the issues addressed, I will draw on studies in relation to the situation of vulnerable refugee and migrant groups, such as women, older people and unaccompanied asylum seeking children in the United Kingdom and Europe

Psychosocial outcomes of the creative communications pilot project for people with dementia

This evaluation was designed in order to explore the impact of the Creative Communications pilot Programme, a six week programme of person‐centred dance, movement and visual arts, on participants at a care home. Timed observations of 12 participants were conducted as well as five semi-structured interviews with care home staff and the project facilitators. Through the use of observation scales, a number of outcomes were assessed including commitment, creative expression, embodiment, verbal and non‐verbal communication, wellbeing and satisfaction. The interviews assisted in exploring from the professionals’ and facilitators’ perspective the impact of the project in these domains as well as exploring further key themes regarding the experiences of those involved in the programme in terms of quality of life and other related factors. Quantitative and qualitative analysis of data indicated positive changes in physical, psychological and social wellbeing , including the opportunity to participate in meaningful activities; behavioural improvements; increased mobility, social interaction, confidence, self‐esteem, mood and concentration; and the learning of new skills. These findings confirm evidence from previous studies about the benefits of non‐pharmacological methods in the care of people with dementia

A qualitative evaluation of psychosocial outcomes of the Creative Communications pilot project for people with dementia

This evaluation was designed in order to explore the impact of the Creative Communications pilot programme (a six week programme of person-centred dance, movement and visual arts) on participants at a care home. Timed observations of the sessions were conducted as well as semi-structured interviews with care home staff and the project facilitators. Through the use of observation scales, a number of outcomes were assessed including commitment, creative expression, embodiment, verbal and non-verbal communication, wellbeing and satisfaction. The interviews assisted in exploring from the professionals’ and facilitators’ perspective the impact of the project in these domains as well as exploring further key themes regarding the experiences of those involved in the programme in terms of quality of life and other related factors. The evaluation demonstrated that Creative Communications sessions provided physical, psychological and social benefits to the participants, including the opportunity to participate in meaningful activities; behavioural improvements; increased mobility, social interaction, confidence, self-esteem, mood and concentration; increased skills; and higher levels of wellbeing. These findings confirm evidence from previous studies about the benefits of non-pharmacological methods in the care of people with dementia. Recommendations include ensuring further collaborative work between artists and care homes takes place; the involvement of care home staff and relatives of residents in future sessions; consultation with participants prior to and throughout the intervention; and encouragement of commissioners to consider supporting arts for health projects involving older people, which incorporate comprehensive evaluations

Cultural health capital and professional experiences of overseas doctors and nurses in the UK

Drawing on autobiographical narratives of a small sample of overseas doctors and nurses working in the UK, this study analysed emerging subjective theories of their professional experiences and explored how these are related to the theoretical framework of cultural health capital, an expert theory on a form of cultural capital which is leveraged in healthcare contexts and may result in more optimal healthcare relationships. The findings of our analysis demonstrate that there is a wealth of expertise and experience among overseas healthcare professionals, and that it is underutilised because of structural and institutional barriers. Healthcare professionals with temporary migration status faced longer delays in their career progression than those with EU citizenship or work permits. Irrespective of migration status, career aspirations were thwarted by external circumstances with negative consequences for individuals’ well-being, with doctors being affected more severely than nurses. Structural and institutional barriers that have an impact on professionals’ ability to progress into the UK healthcare system are discussed. The paper concludes with a discussion of the potential of cultural health capital as a framework for capturing and explaining the career trajectories experienced by overseas healthcare professionals

Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study.

The aim of the study was to identify the most prioritized strategies in improving access to primary care services (PCS) for homeless immigrants. The issue of improving access to PCS for homeless immigrants is a complex and multifaceted one, and yet there is limited research on the strategies aimed at improving these services. Hence, the need for more studies that directly engage homeless immigrants and service providers in understanding their barriers to accessing PCS and their preferences for improving access to these services. The study used a two round Delphi method to elicit the views of stakeholders. The Delphi process utilized a web-based questionnaire. The stakeholders included healthcare providers and voluntary sector providers. The first round had a total of 58 items belonging to 14 categories. The second round comprised a total of 25 items belonging to 12 categories which were preselected based on participants' ranking of their importance in the first round. Participants were required to rank the relative importance of all the items on a 5-point Likert scale. Data were analysed using the STATA-15 software package. A total of 12 stakeholders participated in both rounds of the Delphi survey. The top three strategies encompassed fighting against discrimination and prejudice, improving and promoting mental health services, and empowering homeless immigrants. These evidence-based strategies hold the potential to support the implementation of healthcare interventions aimed at improving access to PCS and healthcare outcomes for homeless immigrants. However, it is crucial to conduct further research that includes homeless immigrants in the Delphi study to gain insights into the strategies that are most important to them in enhancing access to PCS, as they are the primary target users. Such research will contribute to the development of comprehensive and effective interventions tailored to the specific needs of homeless