Older women and craft: extending educational horizons in considering wellbeing

While the social work literature is broader and more holistic than many disciplines, we undoubtedly still limit the knowledge we draw upon in ways that stifle our creativity in conceptualising and attempting to facilitate wellbeing, which flows on to limit our teaching. In particular, the significance to wellbeing of place and social space, the value of informal networks to generate support and opportunities for reciprocity, and the inherent therapeutic value of creative activity appears to be neglected. In this paper we draw upon a small Australian research study around older women and craftmaking to explore how learning from diverse disciplines, such as critical gerontology and textile making, can illuminate our understanding of wellbeing. We relate this discussion to examining notions of ageing that go beyond a focus on illness and deterioration, to enhance positive and diverse concepts of health in the context of everyday life. We then discuss the implications for social work education, with particular emphasis on ageing, and argue that by engaging with a diverse range of disciplines, we are able to think about, teach and advocate for wellbeing in more expansive and useful ways.<br /

Craft groups: sites of friendship, empowerment, belonging and learning for older women

This article reports on a qualitative research project conducted in Victoria,&nbsp;Australia, with nine older women. The purpose of the research was to explore the&nbsp;women&rsquo;s experience of involvement in craft groups, and specifically, the impact of&nbsp;this involvement on their sense of well-being. Traditionally the health of older people&nbsp;has been examined in relation to medical markers of physical well-being, and often, decline.&nbsp;We were interested to widen this perspective to understand the impact of social&nbsp;connection, belonging and ongoing learning and development on the ageing experience.While the focus of the groups was on domestic craftwork, the process of coming together&nbsp;as a collective appeared to have significant bearing on the holistic health of the women&nbsp;involved. Consistent with feminist groupwork literature, the findings indicated that&nbsp;the women we interviewed experienced the group setting as affirming and generative&nbsp;in a number of ways. These include providing an avenue for mutual aid, addressing&nbsp;isolation, affirming individual and collective strength and wisdom, while acquiring new&nbsp;skills, and normalising concerns regarding health and family

Debating the capacity of information and communication technology to promote inclusion

This chapter begins with an exploration of the digital divide in the Australian context. This discussion is followed by an examination of online education, professional development and the capacity of ICT to enhance the well-being of practitioners. The chapter then focuses on the use of ICT in human services and the rise of computer mediated self help and support groups. The potential for ICT to promote and extend political participation is also explored as well as the role of ICT in global development. Throughout, the potential for inclusion and exclusion is highlighted, using examples and critical analysis for exploring the inclusionary and exclusionary capacity of ICT

Older women crafting ethical subjectivities in rural places

Over the last two years my colleagues and I conducted research conversations with older women living in rural Victoria about the meaning of craft in their lives. These conversations are the basis for our speculations on how women constitute ethical subjectivities through specific craft activities and through their engagement with Country Women Association (CWA) craft groups. The CWA is recognised as a &lsquo;community of practice&rsquo; with local, regional, state, national and global networks, aiming to improve the lives of rural people. The focus of this paper, however, is on how ethical subjectivities by rural women are fashioned through specific involvements in craft activities and craft groups. I aim to elaborate on how Foucault&rsquo;s later work on the &lsquo;Care of the Self&rsquo; may open possibilities, even if limited, for understanding the complex ways women take up subject positions in interaction with historical, political, economic and social arrangements, and through engagement with specific institutions. For Foucault, &lsquo;care of the self&rsquo; is an inherently social practice. Currently, modern power relations incite us to relate to our selves through self confessional and self-disciplining technologies. Could a differently constituted mode of self-care be drawn from the Ancient Greeks to offer us ideas for enacting personal and social transformations today?<br /

A new ornithischian dinosaur and the terrestrial vertebrate fauna from a bone bed in the Wealden of Ardingly, West Sussex

The Wealden Supergroup of south-east England has long been of interest to palaeontologists because of its diverse flora and fauna. The Supergroup is Early Cretaceous in age, occupying the time period immediately after the enigmatic end-Jurassic extinction. Wealden faunas therefore have the potential to be informative about the tempo and mode of post-extinction recovery, but due to lack of exposure in this densely populated part of southern England, are difficult to sample. In the summer of 2012, a number of ex situ fossiliferous blocks of sandstone, siltstone and limestone were discovered from building excavations at Ardingly College, near Haywards Heath in West Sussex. The sedimentology of the blocks indicates that they are from the Valanginian Hastings Group, and that Ardingly College is underlain by the Grinstead Clay Formation, rather than the Ardingly Sandstone Member. The blocks contain a diverse invertebrate fauna and flora, as well as vertebrate remains, which are found in a distinct sandstone horizon that probably represents the Top Lower Tunbridge Wells pebble bed. A tooth from an ornithschian dinosaur cannot be referred to any of the ornithischian taxa known from the Wealden Supergroup, and therefore represents a new taxon. Teeth of the crocodilian Theriosuchus extend the known range of this taxon in the Wealden, while teeth of an ornithocheird pterosaur confirm the presence of these animals in the skies above the Wealden sub-basins. Fusainized plant remains and the wing-case of a cupedid beatle indicate that wildfire was a ubiquitous feature of the Weald Sub-basin during the Valanginian

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

Background More older people are living in the community with multiple diagnoses and medications. Managing multiple medications produces issues of unrivalled complexity for those involved. Despite increasing literature on the subject, gaps remain in understanding how, why and for whom complex medication management works, and therefore how best to improve practice and outcomes. MEMORABLE, MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation, aimed to address these gaps. Methods MEMORABLE used realism to understand causal paths within medication management. Informed by RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines, MEMORABLE involved three overlapping work packages: 1) Realist Review of the literature (24 articles on medication management exploring causality); 2) Realist Evaluation (50 realist-informed interviews with older people, family carers and health and care practitioners, explaining their experiences); and 3) data synthesis and theorising from 1) and 2). Results Medication management was viewed from the perspective of ‘implementation’ and structured into five stages: identifying a problem (Stage 1), getting a diagnosis and/or medications (Stage 2), starting, changing or stopping medications (Stage 3), continuing to take medications (Stage 4), and reviewing/reconciling medications (Stage 5). Three individual stages (1, 3 and 4) are conducted by the older person sometimes with family carer support when they balance routines, coping and risk. Stages 2 and 5 are interpersonal where the older person works with a practitioner-prescriber-reviewer, perhaps with carer involvement. Applying Normalisation Process Theory, four steps were identified within each stage: 1) sense making: information, clarification; 2) action: shared-decision-making; 3) reflection/monitoring; and 4) enduring relationships, based on collaboration and mutual trust. In a detailed analysis of Stage 5: Reviewing/reconciling medications, adopting the lens of ‘burden’, MEMORABLE identified five burdens amenable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Two initial improvement propositions were identified for further research: a risk screening tool and individualised information. Conclusions Older people and family carers often find medication management challenging and burdensome particularly for complex regimens. Practitioners need to be aware of this potential challenge, and work with older people and their carers to minimise the burden associated with medication management. Trial registration PROSPERO 2016:CRD42016043506

Systematic review investigating multi-disciplinary team approaches to screening and early diagnosis of dementia in primary care:what are the positive and negative effects and who should deliver it?

BACKGROUND: Primary care services frequently provide the initial contact between people with dementia and health service providers. Early diagnosis and screening programmes have been suggested as a possible strategy to improve the identification of such individuals and treatment and planning health and social care support. OBJECTIVE: To determine what early diagnostic and screening programmes have been adopted in primary care practice, to explore who should deliver these and to determine the possible positive and negative effects of an early diagnostic and screening programme for people with dementia in primary care. METHODS: A systematic review of the literature was undertaken using published and unpublished research databases. All papers answering our research objectives were included. A narrative analysis of the literature was undertaken, with the CASP tools used appropriately to assess study quality. RESULTS: Thirty-three papers were identified of moderate to high quality. The limited therapeutic options for those diagnosed with dementia means that even if such a programme were instigated, the clinical value remains questionable. Furthermore accuracy of the diagnosis remains difficult to assess due to poor evidence and this raises questions regarding whether people could be over- or under-diagnosed. Given the negative social and psychological consequences of such a diagnosis, this could be devastating for individuals. CONCLUSIONS: Early diagnostic and screening programme have not been widely adopted into primary care. Until there is rigorous evidence assessing the clinical and cost-effectiveness of such programmes, there remains insufficient evidence to support the adoption of these programmes in practice

Medication management in older people: the MEMORABLE realist synthesis

Background The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting The setting was in the community. Participants Older people, informal carers, and health and care practitioners. Interventions Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Main outcome measures Not applicable. Data sources MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners. Study registration This study is registered as PROSPERO CRD42016043506

TAMSAT-ALERT v1: a new framework for agricultural decision support

Early warning of weather-related hazards enables farmers, policy makers and aid agencies to mitigate their exposure to risk. We present a new operational framework, Tropical Applications of Meteorology using SATellite data and ground based measurements-AgricuLtural EaRly warning sysTem (TAMSAT-ALERT), which aims to provide early warning for meteorological risk to agriculture. TAMSAT-ALERT combines information on land-surface properties, seasonal forecasts and historical weather to quantitatively assess the likelihood of adverse weather-related outcomes, such as low yield. This article describes the modular TAMSAT-ALERT framework and demonstrates its application to risk assessment for low maize yield in northern Ghana (Tamale). The modular design of TAMSAT-ALERT enables it to accommodate any impact or land-surface model driven with meteorological data. The implementation described here uses the well-established General Large Area Model (GLAM) for annual crops to provide probabilistic assessments of the meteorological hazard for maize yield in northern Ghana (Tamale) throughout the growing season. The results show that climatic risk to yield is poorly constrained in the beginning of the season, but as the season progresses, the uncertainty is rapidly reduced. Based on the assessment for the period 2002–2011, we show that TAMSAT-ALERT can estimate the meteorological risk on maize yield 6 to 8 weeks in advance of harvest. The TAMSAT-ALERT methodology implicitly weights forecast and observational inputs according to their relevance to the metric being assessed. A secondary application of TAMSAT-ALERT is thus an evaluation of the usefulness of meteorological forecast products for impact assessment. Here, we show that in northern Ghana (Tamale), the tercile seasonal forecasts of seasonal cumulative rainfall and mean temperature, which are routinely issued to farmers, are of limited value because regional and seasonal temperature and rainfall are poorly correlated with yield. This finding speaks to the pressing need for meteorological forecast products that are tailored for individual user applications

The importance of detecting and managing comorbidities in people with dementia?

Dementia is a debilitating condition characterised by global loss of cognitive and intellectual functioning, which gradually interferes with social and occupational performance. It is a common worldwide condition with a significant impact on society. There are currently 36 million people worldwide with Alzheimer's disease (AD) and other dementias [1]. This is expected to more than double by 2030 (65 million) and reach ∼115 million in 2050, unless a major breakthrough is made. The worldwide societal costs were estimated at USD 604 billion in 2010 and rising [2]. To date research on the specific physical healthcare needs of people with dementia has been neglected. Yet, physical comorbidities are reported as common in people with dementia [3] and have been shown to lead to increased disability and reduced quality of life for the affected person and their carer [4]. Dementia is most frequently associated with older people who often present with other medical conditions, known as co-morbidities. Such co-morbidities include diabetes, chronic obstructive pulmonary disorder, musculoskeletal disorders and chronic cardiac failure and are common, 61% of people with