Beatrice Hale

Evaluation of a peer-led falls prevention program for older adults.

OBJECTIVE To evaluate measures of strength and balance and falls incidence in participants attending fall prevention exercise classes taught by volunteer peer leaders, paid professional (Age Concern Otago group), or a comparison class (comparison group). DESIGN Quasi-experimental evaluation with 12-month follow-up. SETTING Community. PARTICIPANTS Older adults with increased fall risk (N=118; mean age, 75.5 y; age range, 65-94 y), with 23% drop out at 12 months. INTERVENTION Peer-led group (n=52) and Age Concern Otago (n=41) weekly 1-hour strength and balance classes adapted from a home-based nurse/physical therapist-administered program and comparison group (n=25) 1-hour weekly seated exercise classes. MAIN OUTCOME MEASURES Timed Up and Go test, 30-second chair stand, functional reach, step touch, Single Leg Stand, and balance confidence at baseline, 10 weeks, and 6 and 12 months. Falls diaries collected monthly for 12 months. Continued exercise participation questionnaire at 6 and 12 months. RESULTS At baseline, the peer-led group achieved normative standards on most tests and performed significantly better than the Age Concern Otago and comparison groups (overall P<.05). The Age Concern Otago group reached normative standards on most tests at 10 weeks. Functional improvements were similar in the peer-led group and Age Concern Otago groups from 10 weeks to 12 months, and all functional measures were significantly greater than in the comparison group (overall P<.02). Poisson regression showed a tendency for a 27% decrease in falls for the peer-led group compared with the comparison group (incidence rate ratio [IRR], .73; 95% confidence interval, .48-1.1; P=.07). Continued participation in strength and balance classes at 12 months was greater in the peer-led group and Age Concern Otago groups compared with the comparison group. CONCLUSIONS This peer-led model maintained measures of strength and balance and was superior to seated exercise. People in the Age Concern Otago group chose to continue these classes over other activities, whereas the comparison group had discontinued exercise classes by 12 months. Peer-led classes may decrease the fall incidence, although larger studies are needed to confirm this finding.

Social inclusion through ageing-in-place with care?

ABSTRACT The onset of ill-health and frailty in later life, within the context of the policy of ageing-in-place, is increasingly being responded to through the provision of home care. In the philosophy of ageing-in-place, the home provides for continuity of living environment, maintenance of independence in the community and social inclusion. The provision of assistance to remain at home assumes continuity in the living environment and independence in the organisation of daily life and social contact. This paper explores the changes that occur as a result of becoming a care recipient within the home and concludes that the transition into receiving care is characterised by discontinuity and upheaval which tends to reinforce social exclusion. We draw on the rites of passage framework, which highlights social processes of separation, liminality and reconnection, in analysing this transition to enhance understanding of the experience and gain insights to improve the policy and practice of home care. Separation from independent living leads to a state of liminality. The final stage in the rites of passage framework draws attention to reconnections, but reconnection is not inevitable. Reconnection is, however, an appropriate goal for the care sector when supporting frail or disabled older people through the transition into becoming a home-care recipient.

Family Care and Social Capital: Transitions in Informal Care

Chapter 1: Family Care and Social Capital.- Chapter 2: Informal Care in Social Context: An Expression of Social Relationships.- Chapter 3: The Dynamic Experience of Caregiving.- Chapter 4: Informal Caring and Early Childhood.- Chapter 5: Caring for Family Members with a Lifelong Disability.- Chapter 6: Caring for Adults with Acquired Disabilities.- Chapter 7: Caring for Older People.- Chapter 8: Caring across the Generations.- Chapter 9: In support of Informal Carers.

Quality in residential care: exploring residents’, family members’, managers’ and staff perspectives

Purpose The purpose of this paper is to explore the indicators of quality in care for people working and living in aged residential care (ARC) settings. Design/methodology/approach This research was conducted using an ethnographic design in two distinct ARC facilities in a New Zealand city, a large facility with residential, dementia and hospital level care, and a small family owned facility providing residential care only. In total, 50 hours of observational data were collected, and semi-structured interviews were conducted with 21 people, including managers, careworkers, nurses, family members and residents. These data were thematically analysed using the constant comparative method. Findings The main indicators of quality for staff, family and residents included: a home-like, friendly and safe environment; good medical and personal care; respect for the residents; and good staff. Participants also acknowledged the need for adjustments by residents to living in aged care; and the challenges of caring for increasingly frail residents. Originality/value Findings support the growing recognition of a need for resident-centred approaches to ARC that are reflected in government policy and regulatory apparatus. Managers in ARC facilities must balance adherence with health and safety standards, and providing an environment where their residents can enjoy a meaningful life that has purpose and value.

Family Care and Social Capital

There is a growing scholarly interest in family and informal caregiving. In this chapter introduces this field of study and makes a case for giving greater recognition to family caregiver needs. It reviews the broad approaches to the study of informal caregiving and traces how the carer movement has developed alongside the emergence of new and critical insights from the disability movement. We recognise informal and family care as complex work deserving greater recognition, and make a case for bringing the voices of informal caregivers to the policy-making table.

Caring for a Family Member with a Lifelong Disability

In this chapter we move the discussion to care for adolescents and adults with lifelong disabilities. Caregivers in this situation are confronted daily with the ongoing dependency of the person with disability and, for parents, this can lead to a state of continuous parenthood. Caring across the life course, however, can lead to the development of expertise in care practice, in working with professionals, and in advocacy for the person with disability and for others in similar situations. As they develop in this way, we can begin to see lifelong caregivers as making an important contribution to social capital. The chapter will conclude by considering the types of supports necessary to facilitate effective caring in these contexts.

Adding self-management of chronic conditions to fall prevention: A feasibility study.

Assess feasibility and impact of adding a long‐term condition self‐management program (Living a Healthy Life, LHL) into Steady as You Go (SAYGO) fall prevention exercise classes.

Recognising and Supporting Informal Care

We conclude the arguments in the book by reviewing the commonalities of the different caregiving situations. This includes outlining the particular insights obtained by analysing the caregiver experience at key transition points. By framing the experiences of caregiving as a series of transitions, and by relating these to the changing needs of the person in need of care, we draw attention to both the experience of informal caregivers and the particular needs they face at key junctures. Doing so provides a basis for recognising the increasingly critical role of family and informal caregivers in supporting people within the community. It also provides a basis for considering the specific supports that can be provided to individual caregivers by health professionals and other sectors within the social service network. Further, it leads to consideration of broader policy measures to build society’s capacity, or social capital, to support such care. We bring together our preceding observations about how to support effectively family caregivers, and we make a case for policy settings which facilitate greater recognition of the informal care sector and the critical role it plays in meeting contemporary demands for health and social care. We recommend the informal care sector be supported through a variety of policy instruments and that efforts be made to carefully integrate the activities of governments with those of families in the care of those most in need.

Informal Caring and Early Childhood

We begin our focus on the everyday experience of caregiving by examining the issues of caring for young children with congenital conditions or impairments from early childhood injuries. Caring for people in this life stage, especially by parents, presents distinctive challenges. We follow through the stages of separation, liminality and the notion of reconnection(s) to highlight the immediacy of the carer experiences. Our ideas about reconnection are discussed, in terms of outreach and the wider social recognition of the new role and identity.

Caregiving Across the Generations

This chapter focuses on carers who are themselves vulnerable in particular ways – young carers and older carers. There has been growing awareness of a group of young people who play a critical role in caring for parents, grandparents or siblings. Young carers face particular challenges as they carry responsibility for the care of another while negotiating the demands of adolescence, schooling and the transition into adulthood. Caregiving at this age presents a variety of developmental challenges. At the other end of the life course are grandparent carers. Here, too, there is a growing awareness of a group of people who face particular challenges from a caregiving role. Many fully substitute for the role of parents and become exclusive caregivers for, usually, their grandchildren. We focus on the experience of taking up this role and reflect on the consequences.