Janine Wiles

Landscapes of care

The term ‘landscapes of care’ has increasingly taken hold in the lexicon of health geography. As the complex social, embodied and organizational spatialities that emerge from and through relationships of care, landscapes of care open up spaces that enable us to unpack how differing bodies of geographical work might be thought of in relationship to each other. Specifically, we explore the relation between ‘proximity’ and ‘distance’ and caring for and about. In doing so, we seek to disrupt notions of proximity as straightforward geographical closeness, maintaining that even at a physical distance care can be socially and emotionally proximate.

Home-based activity program for older people with depressive symptoms: DeLLITE--a randomized controlled trial.

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODS We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months’ follow-up. RESULTS The mean age of the participants was 81 years, and 59% were women. All participants scored in the at–risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSION The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.

Resilience: thoughts on the value of the concept for critical gerontology

ABSTRACT This article examines the utility of the concept of resilience to the field of critical gerontology. Resilience is an increasingly popular concept within the social sciences. We explore some key ideas about individual and social resilience from varied fields, and propose new ways to conceptualise these in relation to resilience in later life. This article examines the history of the concept of resilience; explores some of the diverse ways that gerontologists are attempting to apply it to later life; and discusses the strengths and weaknesses of using resilience as a conceptual framework within critical ageing research. We also suggest ways of conceptualising resilience and ageing, highlighting the different scales of resilience that impact on the ability of older people to negotiate adversity, and some key areas of resilience relevant to later life. The example of mobility resilience is used to illustrate how different scales of resilience operate within an area of resilience central to the ageing experience. Finally, some key principles for the use of resilience within critical gerontology are outlined, providing guidance on how to maximise the potential of the concept whilst avoiding some of the limitations associated with its historical usage.

Care of the body: spaces of practice

Care—concept, emotion, practice, politics, moral exhortation—is a starting point for a range of critical geographies. Care affords geographers a richness of possibilities through which to engage critically with a range of politically charged discourses. This special issue offers a suite of ‘think’ pieces on geographies of care which provoke further examination of three challenges. First, we need conceptual strategies to explore the connections of care across different spatialities and temporalities. Secondly, biases within current research on care help make invisible the multiple sites through which our practices are shaped. Thirdly, certain concepts within the care lexicon have gone unchallenged such as dependency and vulnerability. We contemplate the potential of imagining care both as relation and as flow. The nodal characteristic of a relational care shapes how care flows through those nodes to focus on the spatial and temporal unevenness and inequalities in care, the processes eroding situated traditions of care, and the spaces and practices facilitating care of the body.

Re-spacing and re-placing gerontology: relationality and affect

ABSTRACT This paper describes how space and place have been understood in gerontology as phenomenon that are both physical and social in character, yet are relatively bounded and static. The argument is posed as to how, following recent developments in human geography, a relational approach might be adopted. Involving a twist in current thinking, this would instead understand space and place each as highly permeable, fluid and networked at multiple scales. Moreover, it is proposed that the concept of ‘affect’ might also be insightful, recognising space and place as being relationally configured and performed, possessing a somatically registered energy, intensity and momentum that precedes deep cognition. Three vignettes illustrate the relationalities and affects in the lives and circumstances of older people, and how focusing more explicitly on them would allow for a richer understanding of where and how they live their lives. The paper closes with some thoughts on future theoretical, methodological and disciplinary considerations.

Reflections on being a recipient of care: vexing the concept of vulnerability

Focusing on the experiences of older people, I argue that geographers could contribute to understanding what it means to receive care. I explore some geographical literature that does focus on older care recipients, which emphasises both the experiences of changing care provision in different spatial contexts and affectual aspects of care relationships. Emphasising older peoples perspectives and experiences of being a care recipient may illuminate new understandings of care. For example, there may be much to be understood about concepts such as vulnerability from older care recipients. Vulnerability is often seen as fragility or weakness, but it may also be conceptualised as openness, susceptibility, and receptiveness. Ideas about vulnerability as inherent to the self and as formative might be usefully applied to the experiences of older care recipients. To experience and acknowledge ones vulnerability may be a process of renegotiation of ones sense of embodied self and relationships to people and places. More work is needed on what it means to experience vulnerability, and on the meaning of being a recipient of care.

Life and Living in Advanced Age: A Cohort Study in New Zealand -Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

BackgroundThe number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand.Methods/designA total population cohort study of those of advanced age. Two cohorts of equal size, Māori aged 80–90 and non-Māori aged 85, oversampling to enable sufficient power, were enrolled. A defined geographic region, living in the Bay of Plenty and Lakes District Health Board areas of New Zealand, defined the sampling frame. Rūnanga (Māori tribal organisations) and Primary Health Organisations were subcontracted to recruit on behalf of the University. Measures - a comprehensive interview schedule was piloted and administered by a trained interviewer using standardised techniques. Socio-demographic and personal history included tribal affiliation for Māori and participation in cultural practices; physical and psychological health status used standardised validated research tools; health behaviours included smoking, alcohol use and nutrition risk; and environmental data included local amenities, type of housing and neighbourhood. Social network structures and social support exchanges are recorded. Measures of physical function; gait speed, leg strength and balance, were completed. Everyday interests and activities, views on ageing and financial interests complete the interview. A physical assessment by a trained nurse included electrocardiograph, blood pressure, hearing and vision, anthropometric measures, respiratory function testing and blood samples.DiscussionA longitudinal study of people of advanced age is underway in New Zealand. The health status of a population based sample of older people will be established and predictors of successful ageing determined.

DeLLITE Depression in late life: an intervention trial of exercise. Design and recruitment of a randomised controlled trial

BackgroundPhysical activity shows potential in combating the poor outcomes associated with depression in older people. Meta-analyses show gaps in the research with poor trial design compromising certainty in conclusions and few programmes showing sustained effects.Methods/designThe Depression in Late Life: an Intervention Trial of Exercise (DeLLITE) is a 12 month randomised controlled trial of a physical activity intervention to increase functional status in people aged 75 years and older with depressive symptoms. The intervention involves an individualised activity programme based on goal setting and progression of difficulty of activities delivered by a trained nurse during 8 home visits over 6 months. The control group received time matched home visits to discuss social contacts and networks. Baseline, 6 and 12 months measures were assessed in face to face visits with the primary outcome being functional status (SPPB, NEADL). Secondary outcomes include depressive symptoms (Geriatric Depression Scale), quality of life (SF-36), physical activity (AHS Physical Activity Questionnaire) and falls (self report).DiscussionDue to report in 2008 the DeLLITE study has recruited 70% of those eligible and tests the efficacy of a home based, goal setting physical activity programme in improving function, mood and quality of life in older people with depressive symptomatology. If successful in improving function and mood this trial could prove for the first time that there are long term health benefit of physical activity, independent of social activity, in this high risk group who consume excess health related costs.Trial registrationAustralian and New Zealand Clinical Trials Register ACTRN12605000475640

The utility of positioning theory to the study of ageing: Examples from research with childless older people.

Growing older is hard to make sense of. Opposing perspectives are presented on everything from individual to population ageing, and there is widespread ambivalence towards many aspects of ageing. Positioning theory is a research approach that can tolerate such ambiguity and provides a clear, useful framework to make sense of research data, while doing justice to its complexity. It is starting to be used in gerontology; the aim of this paper is to give gerontologists the tools and impetus to use it more. The positioning triad is outlined, comprising positions (how we position ourselves and others within a single conversation or across a lifetime), storylines (the individual and social narratives which furnish those positions), and the speech acts (and acts of research) through which storylines and positions are enacted. In addition, considering the rights and duties associated with different positions and storylines can usefully illuminate some of the tensions around competing positions on ageing. Worked examples from a qualitative study on childless older people (38 participants aged 63 to 93) in terms of their positioning of childlessness, views on residential care, and positioning of emotional support show how the complexity of such diverse topics can be usefully studied using a positioning theory framework.

A rose by any other name: participants choosing research pseudonyms

ABSTRACT How do researchers name people respectfully in research projects? In an interview study on aspects of aging, 38 participants were invited to choose their own pseudonyms for the research. The resulting discussions show that the common practice of allocating pseudonyms to confer anonymity is not merely a technical procedure, but renaming has psychological meaning to both the participants and the content and process of the research. The care and thought with which many participants chose their names, and the meanings or links associated with those names, illuminated the importance of the process of naming. There was evidence of rules and customs around naming that further confirmed its importance both within their sociocultural worlds, and as an act of research, affected by issues of power and voice, methodology, and research outputs. We invite researchers to consider a more nuanced engagement with participants regarding choosing pseudonyms in research.