Not just old and sick - the 'will to health' in later life

The end of the ‘Golden Age’ of welfare capitalism in the 1970s was the prelude to a period of greater individualisation within societies and was accompanied by an increase in the importance of consumption as a way of organising social relations. During the same period there was also an expansion in the discourses aimed at enhancing the government of the autonomous self. One such discourse operates around what has been termed the ‘will to health’: it suggests that health has become a required goal for individual behaviour and has become synonymous with health itself. The generational groups whose lifecourses were most exposed to these changes are now approaching later life. We explore the extent to which social transformations related to risk, consumption and individualisation are reflected in the construction of later-life identities around health and ageing. We examine how the growth in health-related ‘technologies of the self’ have fostered a distinction between natural and normal ageing, wherein the former is associated with coming to terms with physical decline and the latter associated with maintaining norms of self-care aimed at delaying such decline. Finally, we consider anti-ageing medicine as a developing arena for the construction of later-life identities and discuss the implications of the social changes for researching later life

Giving hope, ticking boxes or securing services? A qualitative study of respiratory physiotherapists' views on goal-setting with people with chronic obstructive pulmonary disease.

OBJECTIVE: To explore respiratory physiotherapists' views and experiences of using goal-setting with people with chronic obstructive pulmonary disease in rehabilitation settings. PARTICIPANTS: A total of 17 respiratory physiotherapists with ⩾12 months current or previous experience of working with patients with chronic obstructive pulmonary disease in a non-acute setting. Participants were diverse in relation to age (25-49 years), sex (13 women), experience (Agenda for Change bands 6-8) and geographic location. METHOD: Data were collected via face-to-face qualitative in-depth interviews (40-70 minutes) using a semi-structured interview guide. Interview locations were selected by participants (included participants' homes, public places and University). Interviews followed an interview guide, were audio-recorded and transcribed verbatim. DATA ANALYSIS: Data were analysed using thematic analysis; constant comparison was made within and between accounts, and negative case analysis was used. RESULTS: Three themes emerged through the process of analysis: (1) 'Explaining goal-setting'; (2) 'Working with goals'; and (3) 'Influences on collaborative goal-setting'. Goal-setting practices among respiratory physiotherapists varied considerably. Collaborative goal-setting was described as challenging and was sometimes driven by service need rather than patient values. Lack of training in collaborative goal-setting at both undergraduate and postgraduate level was also seen as an issue. CONCLUSION: Respiratory physiotherapists reflected uncertainties around the use of goal-setting in their practice, and conflict between patients' goals and organisational demands. This work highlights a need for wider discussion to clarify the purpose and implementation of goal-setting in respiratory rehabilitation

Alleinlebende Männer im Alter

Die deutlich steigende Zahl alleinlebender Männer im Alter ist ein historisch neues Phänomen, das nicht nur auf strukturelle Veränderungen in der Bevölkerung älterer Menschen verweist, sondern gleichzeitig auch Ausdruck der allgegenwärtigen Destandardisierung von Lebensläufen ist: Für die Lebenssituation des Alleinlebens als Mann im Alter, sei es bedingt durch unterschiedliche Familienstandsformen (z.B. Verwitwung, Scheidung im mittleren Lebensalter, lebenslanger Ledigen-Status) oder durch neue Beziehungsstile (z.B. LAT: living apart together), gibt es nur wenige Vorbilder und Orientierungsmuster. Zudem deutet die Forschung zu Gender und Alter(n) darauf hin, dass durch den Übergang in die nachberufliche Zeit, Verluste und Auflösungen von (ehelicher) Partnerschaft sowie den Rückzug in den (weiblich konnotierten) häuslichen Bereich die Konstruktion von (hegemonialen) Männlichkeiten bedroht ist. Hieraus ergeben sich mehrere Fragen: Wie gehen alleinlebende Männer mit dieser Form der Singularität um? Was bedeutet das für ihre Konstruktion von Männlichkeit im Alter? Wie kommen Singularität und Männlichkeitskonstruktion in ihren Gestaltungsmöglichkeiten und -erfordernissen zum Ausdruck. Der Beitrag stellt Ergebnisse aus der Pilotstudie ALMA (Alleinlebende Männer im Alter in der Stadt Frankfurt am Main) vor, in der narrative Interviews mit vier – in Bezug auf Bildung, Einkommen, soziale Eingebundenheit und sexuelle Orientierung – unterschiedlich alleinlebenden Männern im Alter von 67 bis 89 Jahren durchgeführt wurden. Die erhobenen Daten wurden mit der Grounded Theory und Situational Analysis interpretiert, um biographische, zeithistorische, diskursive sowie andere, ‚non-human‘ Einflussgrößen erfassen zu können. Die Datenanalyse deutet an, dass sich die Konstruktion von Männlichkeiten entlang eines Spektrums zwischen traditionell hegemonialer und alternativ nicht-hegemonialer Varianten bewegt. Ausschlaggebend für die jeweilige Positionierung sind der Umgang mit Tätigkeiten, die sich durch das Alleinleben ergeben, mit Beziehungen zu ‚signifikanten‘ Menschen im engeren und weiteren sozialen Umfeld sowie dem Umgang mit körperlichen Veränderungen. Diese Ergebnisse unterstützen die These, dass Alter als ein Feld ‚neuer Männlichkeiten’ konturiert werden kann

Perspectives on ageing, later life and ethniciy: Ageing research in ethnic minority contexts

This special issue focuses broadly upon questions and themes relating to the current conceptualisations, representations and use of ‘ethnicity’ (and ethnic minority experiences) within the field of social gerontology. An important aim of this special issue is to explore and address the issue of ‘otherness’ within the predominant existing frameworks for researching those who are ageing or considered aged, compounded by the particular constructions of their ethnicity and ethnic ‘difference’. The range of theoretical, methodological and empirical papers included in this collection provide some critical insights into particular facets of the current research agendas, cultural understandings and empirical focus of ethnic minority ageing research. The main emphasis is on highlighting the ways in which ethnic cultural homogeneity and ‘otherness’ is often assumed in research involving older people from ethnic minority backgrounds, and how wider societal inequalities are concomitantly (re)produced, within (and through) research itself – for example, based on narrowly defined research agendas and questions; the assumed age and/or ethnic differences of researchers vis-à-vis their older research participants; the workings of the formalised ethical procedures and frameworks; and the conceptual and theoretical frameworks employed in the formulation of research questions and interpretation of data. We examine and challenge here the simplistic categorisations and distinctions often made in gerontological research based around research participants’ ethnicity, age and ageing and assumed cultural differences. The papers presented in this collection reveal instead the actual complexity and fluidity of these concepts as well as the cultural dynamism and diversity of experiences within ethnic groups. Through an exploration of these issues, we address some of the gaps in existing knowledge and understandings as well as contribute to the newly emerging discussions surrounding the use of particular notions of ethnicity and ethnic minority ageing as these are being employed within the field of ageing studies.This special issue is one of the outcomes from the Economic and Social Research Council (ESRC) seminar series on ‘Ageing, Race and Ethnicity’ (project reference ES/J021547/1),held in the UK during 2012-2014. Open access for this editorial has been provided through the University of Nottingham open access funds

Lessons learned from the London Exercise and Pregnant (LEAP) Smokers randomised controlled trial process evaluation : implications for the design of physical activity for smoking cessation interventions during pregnancy

BACKGROUND: The challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved. METHODS: Two focus groups, with independent facilitators, were conducted with six researchers who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis. RESULTS: Five themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention; (2) personal characteristics of trial participants; (3) practical issues; (4) researchers' engagement with participants; (5) training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants' friends and family, and post-natal return to smoking. CONCLUSIONS: Future exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers' friends and family, as well as for avoiding post-natal return to smoking. TRIAL REGISTRATION: ISRCTN48600346 , date of registration: 21/07/2008

The role of empowerment and agency in the lives of older men living alone

Longevity and changes in family status are leading to a growing number of men living alone in later life. They are often considered an at risk group in terms of deprivation, suicide and mental health problems, a perspective that has informed community services. This paper reports on a study that set out to get a better understanding of this historically new group, particularly in light of significant structural and cultural changes to later life and ageing. The study used interviews with stakeholders and biographical interviews with older men living alone in Frankfurt/Main, a city with a particularly high rate of men over 65 in single occupancy households. The analysis suggests that service providers were interested in encouraging men to recognise and act on their needs, an approach informed by empowerment as well as active ageing strategies. The analysis from the biographical data shows that living alone was a learning process and involved the ability for men to care for themselves as well as others. Learning to live alone enabled them to maintain an identity as an independent individual. (DIPF/Orig.