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Objective: The study analysed how its participants positioned themselves and other people as actors in daily life, and what matters they portrayed as meaningful in seeking and receiving support in daily life. Background: Family care has traditionally played an important role in elder care in Finland. Current policy goals will further increase the importance of family care, yet research on how people with memory illnesses and their spouses perceive care arrangements is scarce. Method: The study drew from theory of relational agency and positioning theory. The data came from semi-structured, in-depth interviews (10) of home-dwelling people diagnosed with a memory illness and their spouses. The interviewees' age varied from 62 to 88. The analysis focused on the participants' self-descriptions and descriptions of their experiences and actions in relation to informal and formal care arrangements. Results: The participants with a memory illness positioned themselves together with their spouses as a couple, as satisfied service recipients, as active and knowledgeable service users, or even as consumers who critically evaluated social and health care services. People with memory illnesses are capable of expressing their self-reflexive agentic self and adopting different positions to that of a person with dementia. Conclusion: There is need to better acknowledge agency of people with memory illnesses and to develop different data collection and analysis methods that enable them to convey their views. [ABSTRACT FROM AUTHOR]

As the population ages, the number of people with dementia increases. An emerging body of research is focusing on living with dementia and understanding the experience of caring and the care burden. There is much less research on the meaning of dementia from the perspective of an older couple's spousal relationship and related intimacy. This qualitative study explores the meanings of emotional and physical intimacy and the changes brought by dementia in the couplehood of persons with dementia and their spousal carers. The data comprise semi-structured interviews with 35 persons. The interviews were analysed using inductive qualitative content analysis. Four themes describing the meanings of relational intimacy were identified: intimacy as a striving force, intimacy turning into worrisome behaviour, intimacy as physical and emotional dependency, and intimacy turning into one-sided caring for a partner. Dementia changes the intimate relationship in many ways, but shared affection and long-term partnership help maintain the spousal relationship. While dementia may bring about conflicts and behavioural challenges in an intimate relationship, the couple's shared intimacy and a sense of responsibility for one another may serve as a resource and support the continuity of couplehood. [ABSTRACT FROM AUTHOR]

Family members are important providers of care for older people. In residential long‐term care, however, their role is not always simple and straightforward: responsibility for care provision rests officially with staff members, but in practice family members often contribute to providing care. The main reason for admission to long‐term care is functional decline. At the same time, the maintenance of functional ability is a central goal in long‐term care. It is therefore reasonable to assume that functional ability is also an important factor in the relationship between family members and long‐term care residents. This study aims to explore how family members experience their role in supporting the functional ability of older relatives in residential long‐term care. With the approval of the local hospital district's ethics committee, we conducted semi‐structured interviews with family members (n = 16) in Finland in 2016. Thematic data analysis showed that family members supported the functional ability of their older parent or spouse by organising and monitoring care and by bringing forth their relative's personal needs and wishes. They often saw their role alongside staff members as ambiguous, and their understanding of the scope of support for functioning extended beyond physical everyday tasks. In their talk, family members broadened the concept of functional ability from daily chores and independence to meaningful social relations and acknowledgement of person's individual background and preferences. Family members' views offer valuable insights into residents' personal needs, values and preferences and in doing so help care workers to support their functional ability with a person‐centred care approach. [ABSTRACT FROM AUTHOR]

Background: People with memory disorders often need care and help from family carers and health and social care providers. Due to the deterioration of cognitive capacity and language skills, they may be unable to convey their thoughts and care preferences to other people. As a result, their agency may become restricted. We investigated the descriptions provided by people with memory disorders and spousal carers of their influence on care in encounters with formal care providers. Methods: Qualitative thematic analysis was used to identify, analyze, and report themes that describe encounters with professionals in different social or healthcare environments. In-depth interview data were gathered from 19 spouse carers and 15 persons with memory disorders. Findings: Three themes out of four describe how people with memory disorders and their spouse carers influence formal care: Acquiescence, negotiating care decisions, and taking control. The fourth theme describes lack of influence. People with memory disorders and their spouse carers have ways to influence care, but spouse carers identified more ways of doing so. Both either accepted and followed the care guidelines by the formal carers or took control of the situation and made their own decisions. Spouse carers also sought to influence care decisions through negotiations with formal carers. When formal carers' decisions were experienced as inconsistent or the rationale of their actions difficult to follow, the possibilities to influence care were limited. Conclusions: People with memory disorders and their family carers are often in a disadvantaged position as they lack power over the health and social care decision-making during the illness, which is often guided by structural factors. To support the agency of people with memory disorders and to promote shared decision-making, clarification of the service structure and clearer communication between the different parties involved in care are required. [ABSTRACT FROM AUTHOR]

Introduction To assess how health care professionals outline the management of care and explore which health or social care professionals were involved in the patient's treatment. Methods A survey with a patient vignette for general practitioners (n = 31) and registered nurses (n = 31) working daily in Finnish health centres located in four cities. Respondents answered structural questions and explained in detail the care process that they tailored for the patient. The care process was examined using content analysis. Results A physician–nurse working pair was declared to be in charge of the care process by 27% of respondents, a registered nurse by 9% and a general practitioner by 11%. However, 53% reported that no single person or working pair was in charge of the care process (response rate 72%). The concluding result of the analyses of the presented process was that both treatment practices and the professionals participating in the patient's treatment varied. Collaboration with social services was occasional, and few care processes included referrals to social services. Conclusion For the patient who needs both health and social care services, the management of care is a challenge. To improve the chances of patients being actively involved in making treatment plans at least three factors need to be addressed. Firstly, a written treatment plan should explicate the care process. Second, collaboration and interaction between health and social care services should be strengthened, and third, a contact person should be named to avoid care gaps in primary health care. Next-step data from patients need to be collected to get their views on care management and compare these with those from general practitioners and registered nurses. [ABSTRACT FROM AUTHOR]

Recent changes in older people's public care services in Nordic countries in particular in Finland and Sweden are based on implicit expectations that family members will increase their involvement in care. In Nordic countries, the care of small children has been acknowledged to be a social matter that concerns gender equality and the work life participation of both men and women, while the situation of working carers of older people is much less acknowledged. This study addressed the question of how Finnish working women who give care to their older parents argue for and against their decisions of working and caring and the meaning of work and care in these decisions. Majority of the interviewees emphasised the importance of work and refuted the idea of leaving work for care. The decision not to leave work for care was justified with worker identity, commitment to work, having no innate skills to be a carer, availability of support services and other carers and financial necessity. On the other hand, a few interviewees brought forward their willingness to leave work which was justified by constructing care as meaningful and valuable activity as opposed to meaningless paid employment, and with the intensification of work, and with ageing. Lengthy argumentation and several discursive tools indicate that women anticipated moral blame for the decision of giving work primacy over care, but also for leaving work. Thus, working carers balance between contrasting expectations to care and to work. [ABSTRACT FROM AUTHOR]

This study reports on a discourse analysis of how responsibilities for the care of older people are defined and distributed in the interview talk of working caregivers in Finland. The analysis focuses on how the interviewees depict their encounters with professionals (e.g. social care and healthcare workers) and the responsibilities attached to the position of a family member vs a professional. In the interview talk, the roles of the professionals range from authorities and experts who ally with family members, to adversaries or failing experts whose actions require involvement of the client's family members. Being a trustworthy professional requires not only having expert knowledge and technical skills but taking overall responsibility for the wellbeing of the client. The findings show that family members categorise professionals as competent or as failing to fulfil their responsibilities. The central question is whether both parties have an equal opportunity to express their views and whether open communication is possible to develop professional decision-making and client interaction. [ABSTRACT FROM AUTHOR]

As an inevitable process, the number of older adults is increasing in many countries worldwide. Two of the main problems that society is being confronted with more and more, in this respect, are the inter-related aspects of feelings of loneliness and social isolation among older adults. In particular, the ongoing COVID-19 crisis and its associated restrictions have exacerbated the loneliness and social-isolation problems. This paper is first and foremost a comprehensive survey of loneliness monitoring and management solutions, from the multidisciplinary perspective of technology, gerontology, socio-psychology, and urban built environment. In addition, our paper also investigates machine learning-based technological solutions with wearable-sensor data, suitable to measure, monitor, manage, and/or diminish the levels of loneliness and social isolation, when one also considers the constraints and characteristics coming from social science, gerontology, and architecture/urban built environments points of view. Compared to the existing state of the art, our work is unique from the cross-disciplinary point of view, because our authors' team combines the expertise from four distinct domains, i.e., gerontology, social psychology, architecture, and wireless technology in addressing the two inter-related problems of loneliness and social isolation in older adults. This work combines a cross-disciplinary survey of the literature in the four aforementioned domains with a proposed wearable-based technological solution, introduced first as a generic framework and, then, exemplified through a simple proof of concept with dummy data. As the main findings, we provide a comprehensive view on challenges and solutions in utilizing various technologies, particularly those carried by users, also known as wearables, to measure, manage, and/or diminish the social isolation and the perceived loneliness among older adults. In addition, we also summarize the identified solutions which can be used for measuring and monitoring various loneliness- and social isolation-related metrics, and we present and validate, through a simple proof-of-concept mechanism, an approach based on machine learning for predicting and estimating loneliness levels. Open research issues in this field are also discussed. [ABSTRACT FROM AUTHOR]

In this discursive study of four group discussions, I examine how the study participants respond to questions about the possibilities of individuals to influence their own health and their responsibility for health, and what is the role of old age in this context. One key finding was that the participants balanced between seeing health as a do-it-yourself matter and on the other hand as a matter of fate or chance. The participants did not question the idea that they could influence their health or assume responsibility for their own health, but they did raise several factors that limit individual influence. Focus groups proved to be an appropriate data collection method for studying morally laden and potentially sensitive issues. It is suggested that the findings of this small-scale study echo broader western discourses on health and old age and contemporary cultural and social developments. [ABSTRACT FROM AUTHOR]

Older peoples' independent living in their own homes and their ability to move around and maintain social relations in their communities have been acknowledged as important aims to support their well-being. In this article, we study Special Transport Services as a means to support older persons with 'aging in place' – that is, within their communities. From "go-alongs" (shared dial-a-ride bus journeys) and "sit-down interviews" (at participant's home or a café) with 12 older people living in a Finnish suburb, we explored their everyday dial-a-ride bus trips to the local mall. We used actor-network theory and the concept of motility to show how at first glance what appeared to be simple dial-a-ride journeys were in fact produced by a complex and fluid actor network consisting of people, rules, norms, practices, technical devices, as well as other objects and tools. Associations between various human and non-human actors compensated for the functional limitations experienced by the participants, but also created difficulties during the journeys. Our main finding is that the actor network of dial-a-ride bus did physically help older people be more mobile, but at the same time the service required a wide range of know-how and skills. We argue that developing a truly age-friendly environment – with inclusive services to help older individuals age well within their community – requires a detailed understanding from their perspective of the actor networks that produce those services. When planning old age services, there is a need to engage with older people from different social backgrounds to develop services that are genuinely supportive and easy to use for a heterogeneous group. Our findings can be utilized in developing physical and social environments that better support older people's mobility and enable them to age well in the community. • Dial-a-ride bus enabled older people to manage their own affairs independently. • Dial-a-ride bus offered support for building and maintaining social relationships. • The bus helped older persons be mobile, but using it required know-how and skills. • Inclusive old age services require detailed knowledge of actor networks involved. • Diverse service users need to be involved as co-producers in planning the services. [ABSTRACT FROM AUTHOR]

Background: In different parts of the world new models of senior housing have rapidly appeared, which indicates that existing housing and care models are not fulfilling the hopes and needs of current and new generations of older people. Material and Methods: This qualitative study focuses on one type of communal senior housing complex located in a mid-sized town in Central Finland. The complex was designed to have accessible low-maintenance apartments and common spaces, and to be near easily accessible green spaces, amenities, services, and public transport. The complex has a part-time community coordinator. The minimum age limit is set at 55 years. The data consists of 36 qualitative interviews with residents (21 women, 15 men) aged 66-93, conducted between November 2018 and February 2019. The semi-structured interviews were recorded and transcribed. The data analysis focused on how different aspects of the manmade, natural, and social environment were portrayed in residents' descriptions of day-to-day life. Theoretical framework adopted for the study draws from the ideas of environmental and geographic gerontology. The data was analyzed using positioning analysis which is one form of discourse analysis. Results: The senior housing in this study fulfilled its promise of providing accessible a physical and social environment which encourages and enables residents to be physically active and independent, yet which also provides social activities and feeling safe. In this respect, the senior housing complex offered an environment which supports well-being and healthy aging. However, the residents' interpretations of what the senior housing complex represented varied. For some of the residents it was first and foremost a social place, which provided opportunities for social contacts and social activities. For some of the residents the most important were maintenance-free apartments and outdoor areas. The question remains as to how social practices, in the form of government policies and market systems can support the development of different kinds of senior housing which are affordable and accessible for all., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Jolanki.)