Amanda Grenier

Constructions of frailty in the English language, care practice and the lived experience

The way frailty is conceptualised and interpreted has profound implications for social responses, care practice and the personal experience of care. This paper begins with an exegesis of the concept of frailty, and then examines the dominant notions of frailty, including how ‘frailty’ operates as a ‘dividing-practice’ through the classification of those eligible for care. The definitions and uses of ‘frailty’ in three discursive locations are explored in: (a) the Oxford English Dictionary, (b) the international research literature, and (c) older womens accounts of their lived experience. Three distinctive discourses are found, and applying a Foucauldian analysis, it is shown that the differences reflect overlaps and tensions between biomedical concepts and lived experiences, as well as negative underlying assumptions and ‘subjugated knowledge’. The concept of frailty represents and orders the context, organisational practices, social representations and lived experiences of care for older people. The evidence suggests that if, as the older womens accounts recommended, socially- and emotionally-located expressions of frailty were recognised in addition to the existing conceptions of risk of the body, frailty might no longer be thought of primarily as a negative experience of rupture and decline. To encourage this change, it is suggested that practice focuses on the prevention of frailty and associated feelings of loss, rather than reinforcing the feelings and experiences which render a person ‘frail’.

Older Women and ‘Frailty’ Aged, Gendered and Embodied Resistance

The concept of ‘frailty’, as used within public health and social services, represents a powerful practice where cultural constructions, the global economic rationale of cost restriction and the biomedical focus on ageing collide as inscriptions on the bodies of older women. This article draws on complex forms of resistance witnessed within three separate studies: narrative interviews on ‘frailty’, semi-structured interviews and participant observation in community organizations with older women in Montreal and Boston. Findings reveal how older women exercise resistance in complex ways, both consciously subverting and coopting the notion of ‘frailty’ on an individual and collective level. Such resistance demonstrates the tensions between undermining dominant notions of ageing, and fulfilling prescribed gendered and age-based assumptions about older women and their bodies. The intersections and forms of older women’s resistance challenge social constructs, social expectations and what is recognized as resistance.

THE DISTINCTION BETWEEN BEING AND FEELING FRAIL: EXPLORING EMOTIONAL EXPERIENCES IN HEALTH AND SOCIAL CARE

The concept of frailty provides access to key health and social care services. While health care professionals charged with implementing standard assessments generally agree on what constitutes frailty, lay understandings make a crucial distinction between ‘being’ and ‘feeling’ frail. The distinction between the imposition of a medical/functional classification (being frail) and the emotions related to impairment, traumatic events, and maintaining a continuous identity (feeling frail) reveal how that which is commonly considered ‘frailty’ plays out within the everyday experiences lived in, and in relation to, the body and self. Older womens interpretations illustrate some of the conflicts and emotions within experiences of impairment, disability and decline — showing how these are much more personal than we are led to believe by policies and practices focused on objective criteria and standard measurement. Further, they suggest that older womens identities and strategies are at least partly negotiated in relation to the experience of ‘feeling’ frail, that the identity and self may serve as a protective mechanism from ‘becoming’ frail, and the existence of a threshold between these two conditions. Understanding and addressing the emotional aspects of what professionals know as ‘frailty’ may improve the likelihood of appropriate professional responses to older persons.

Using the life course perspective to study the entry into the illness trajectory: The perspective of caregivers of people with Alzheimer's disease

The research community is showing increasing interest in the analysis of the care trajectory of people with chronic health problems, especially dementias such as Alzheimers disease. However, despite this interest, there is little research on the initial phases of the care trajectory. The fact that the first symptoms of dementia are generally noticed by those surrounding the elderly person suggests that the recognition of the disease is intimately linked to interactions not only amongst family members but also amongst friends, neighbours and health professionals. This study focuses on the period beginning with the first manifestations of cognitive difficulties and ending with the diagnosis of Alzheimer-type dementia. Interviews with 60 caregivers in Montreal, Canada were used to reconstruct how older people with Alzheimer-type dementia enter into the care trajectory. Our methods consisted of the analysis of social networks, social dynamics and action sequences. Our findings are presented in the form of a typology comprised of 5 pathways of entries into the care trajectory that are structured around the following four principles of the Life Course Perspective: family history, linked lives, human agency and organisational effects. We believe that analyses of the initial phases of the care trajectory, such as this one, are essential for the application of effective early detection and intervention policies. They are also central to informing future studies that seek to understand the care experience in its entirety.

Creating and sustaining disadvantage: the relevance of a social exclusion framework

Over the last decade, public home-care services for elderly people have been subject to increased rationing and changes in resource allocation. We argue that a social exclusion framework can be used to explain the impacts of current policy priorities and organisational practices. In this paper, we use the framework of social exclusion to highlight the disadvantages experienced by elderly people, particularly those who cannot afford to supplement public care with private services. We illustrate our argument by drawing on examples from previous studies with persons giving and receiving care in the province of Québec. Our focus is on seven forms of exclusion: symbolic, identity, socio-political, institutional, economic, exclusion from meaningful relations, and territorial exclusion. These illustrations suggest that policy-makers, practitioners and researchers must address the various ways in which current policy priorities can create and sustain various types of exclusion of elderly people. They also highlight the need to reconsider the current decisions made regarding the allocation of services for elderly people.

Successful Linkage Between Formal and Informal Care Systems The Mobilization of Outside Help by Caregivers of Persons With Alzheimer’s Disease

Health interventions are currently being revamped to address the specific needs of chronic illness and population aging. In this context, focus has increasingly turned to Alzheimer-type dementia, an illness that is considered to mobilize a large number of social actors into long-term involvement of varying intensity. Linkage problems between families and professional systems have been well documented, yet the reasons for this remain relatively unexplored. In this article, we outline how we used social network data and narrative methods to better understand the linkage processes between formal and informal care systems. We present the trajectories of four caregivers of people suffering from Alzheimer’s disease who were able to establish relationships with resources outside the family. In each of the cases, the dimensions of trust and recognition were central to establishing and maintaining supportive relationships, and must therefore be understood in light of social network dynamics and the broader environment. Although preliminary, this study contributes to the state of knowledge on linkage problems by proposing “bottom-up” solutions that are client centered.

A Literature Review of Homelessness and Aging: Suggestions for a Policy and Practice-Relevant Research Agenda.

Le sans-abrisme chez les personnes âgées est une préoccupation croissante à travers le Canada et devrait augmenter avec le changement démographique (Crane & Warnes, 2010; Culhane, Métraux, Byrne, Stino, et Bainbridge, 2013). Pourtant, les connaissances actuelles, les politiques et les pratiques concernant le sans-abrisme ont tendance largement de se concentrer sur des populations plus jeunes. De même, la recherche et les politiques sur le vieillissement en général négligent le sans-abrisme. Les réponses au problème de sans-abrisme chez les personnes âgées doivent répondre aux besoins complexes liés à la santé, la sécurité du revenu et le logement. Basé sur un examen exhaustif de la littérature, cet article présente les domaines de recherche afin d’éclairer les politiques, les stratégies et les services pour les divers groupes des aînés sans-abri. Nous clarifions les intersections du vieillissement et du sans-abrisme; examinons les statistiques pertinentes, y compris la prévalence estimée; discutons des voies et des variations de l’expérience; et determinons les lacunes dans les connaissances. Nous concluons par un appel à un programme de recherche inclusive qui aidera à créér des politiques et des pratiques visant à réduire et finalement à éliminer le sans-abrisme chez les personnes âgées au Canada.Homelessness among older people is a growing concern across Canada and is expected to rise with demographic change (Crane & Warnes, 2010; Culhane, Metraux, Byrne, Stino, & Bainbridge, 2013). Yet current knowledge, policies, and practices on homelessness largely focus on younger populations. Likewise, research and policies on aging typically overlook homelessness. Responses to homelessness among older people must address complex needs related to health, income security, and housing. Based on a comprehensive literature review, this article outlines the existing and needed research with regards to homelessness among older people. We clarify the intersections of aging and homelessness; review the relevant statistics, including estimated prevalence; discuss pathways and variations in experience; and identify gaps in knowledge. We conclude with a call for an inclusive research agenda that will help build policies and practices to reduce and ultimately to eliminate homelessness among older people in Canada.

Patterns of Shelter Use Among Men New to Homelessness in Later Life Duration of Stay and Psychosocial Factors Related to Departure

People who become homeless for the first time in late life are a growing but understudied population. This study draws on administrative data from one shelter (N = 1,214 first-time homeless) to assess the extent to which age is related to shelter stay and, to examine psychosocial factors that may be associated with shelter departure. Our bivariate and survival analysis results suggest that older homeless men stay in the shelter 2 weeks longer than younger clients. Older men with pending legal issues and mobility concerns were more likely to leave the shelter than those without such concerns. Findings highlight the impact of age and other psychosocial variables on shelter stay, and provide direction from which to address homelessness among men who are new to homelessness in later life.

‘Growing Old’ in Shelters and ‘On the Street’: Experiences of Older Homeless People

ABSTRACT Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.

Social participation at the intersection of old age and lifelong disability: Illustrations from a Photo-Novel Project.

•Participatory discourses on aging may conflict with experiences of aging and disability•The photo-novel represents innovative research and a community based practice of social change•Symbolic and environmental barriers can constrain the full participation of older people with disabilities•New stories locate older people with disabilities at the centre of participation•Collective narratives about participation can make policy and practices more relevant to diverse experiences