John Bond

Being alone in later life: loneliness, social isolation and living alone

The context for the review of loneliness and social isolation in later life is that of ‘successful aging’ and ‘quality of life’. The term ‘quality of life‘ includes a broad range of areas of life and there is little agreement about the definition of the term. Models of quality of life range from identification of ‘life satisfaction’ or ‘social wellbeing’ to models based upon concepts of independence, control, and social and cognitive competence. However, regardless of how the concept of quality of life is defined, research has consistently demonstrated the importance of social and family relationships in the definition of a ‘good quality of life’.

Balancing rights and risks: Conflicting perspectives in the management of wandering in dementia

Abstract Current Government recommendations in England suggest a national approach to risk management but, in an increasingly litigious society, how do professional carers balance risk management with the promotion of a person-centred approach in dementia care? Wandering behaviour can be both beneficial and harmful to a person with dementia and generate considerable emotional distress in their carers. This study combined a systematic review and qualitative research methods to explore the perspectives of different stakeholders in the management of wandering in dementia. A major theme for carers was the conflict between the prevention of harm and the facilitation of a persons right to autonomy. Such tensions also impacted on carers abilities to provide person-centred care. This dilemma was highlighted through the use of assistive technologies such as electronic tracking devices. Interestingly, people with dementia felt that the use of such technology placed them at greater risk, i.e. as a target to theft, than the process of wandering itself. They spoke of their need for independence and their concern over carer surveillance and the identity of ‘big brother.’ There is a need to develop practical tools for managing risk within dementia care which allow all perspectives to be captured and risk management to be negotiated.

Early supported hospital discharge following acute stroke: pilot study results

Objective: To establish the feasibility and method of evaluation of an early supported hospital discharge policy for patients with acute stroke. Design: A randomized controlled trial comparing an early supported discharge service to conventional care. Setting: Three acute hospitals in Newcastle upon Tyne. Subjects: Ninety-two eligible patients with acute stroke admitted between 1 February 1995 and 31 January 1996. Main outcome measures: Placement, length of stay, readmission rates, mortality, functional ability (Nottingham Extended Activities of Daily Living (ADL) Scale), handicap (Oxford Handicap Scale), global health status (Dartmouth Coop Function Charts) and carer stress (General Health Questionnaire 30 item). Results: The median length of stay for patients randomized to early supported discharge was 13 days compared to 22 days in the conventional care group (p = 0.02). The median Barthel ADL Index at seven days post stroke of patients randomized to early supported discharge was 15, and 13 for those randomized to conventional care (NS). At three months post stroke the median Nottingham EADL score of patients randomized to early supported discharge was 10 compared to 7 for those who received conventional care (NS). There were no statistically significant differences in the global health status of patients or carer stress. Conclusion: An early supported discharge service following acute stroke with individualized rehabilitation in the community is feasible and can be evaluated by a randomized controlled trial but a larger multicentre trial is needed before such a service is widely adopted.

Quality of life for people with dementia: approaches to the challenge of measurement

With the development of possible therapeutic interventions for people with dementia there is an increasing realisation among clinical and health service researchers of the paucity of appropriate outcome measures for people with dementia and their informal caregivers. The different perspectives on dementia within the biomedical, psychological and social models of disability lead to radically different meanings of the concept ‘quality of life’ and approaches to its assessment. This paper examines these different approaches and proposes a broad research agenda which is underpinned by two key principles. First, people with dementia and their informal caregivers should be involved in the development of usable outcome measures relevant to their needs and circumstances. Second, the scientific community in partnership with those directly affected should develop a pluralistic approach to the assessment of outcome taking account of both the meaning of the condition to people with dementia and their informal caregivers and cost utility from a societal perspective.

Older People's Experiences of Loneliness in the UK: Does Gender Matter?

The extent and nature of loneliness in later life does not show a consistent relationship with gender. Our study investigates whether there are differences in the nature and extent of loneliness amongst older men and women in contemporary Britain. Loneliness was measured using a self-report four-point scale in a nationally representative survey of people aged 65+ living in the community. Survey response rate was 77 per cent and the sample of 999 approximates to that of the general population. Approximately half of our sample 53 per cent were women. Compared with males in the sample women were significantly more likely to be widowed, live alone and have direct contact with friends and relatives. Preliminary analysis identified statistically significant differences between men and women in and self-reported loneliness (and changes over the previous decade). Ordered logistic regression, indicated that gender was no longer independently associated with loneliness once the confounding influences of marital status, age and living arrangement were excluded. The overall self-reported prevalence of severe loneliness shows little difference between men and women, challenging the stereotype that loneliness is a specifically female experience.

Chained time trade-off and standard gamble methods

It may be difficult to value palliative health states using health state valuation methods such as the time trade-off (TTO) and standard gamble (SG) where health states are traditionally valued relative to perfect/good health and death. Chained methods have been developed to help in this context. However, few studies have compared the values produced by chained TTO and SG methods. To address this issue, a study was conducted to measure the health state values associated with oesophageal cancer using chained TTO and SG techniques. The methods were found to be acceptable amongst the sample respondents, who had previously been treated for oesophageal cancer. There were no significant differences between the health state values produced by the TTO and the SG methods. Within each method, however, there were significant differences between the health states valued. It is concluded that the use of health state valuation techniques such as the TTO and SG is feasible amongst people with a history of oesophageal cancer.

Loneliness in later life: Preliminary findings from the Growing Older project

Loneliness is consistently presumed to be a specific ‘social problem’, which accompanies old age and growing older. Ninety per cent of the general population of Britain feel that loneliness is particularly a problem associated with old age. Data concerning the prevalence of loneliness amongst the population aged 65 and over are provided from a quantitative survey of 999 people across Great Britain using a special module commissioned from the ONS Omnibus survey. The overall self‐reported prevalence of loneliness shows little change in the post‐war period and challenges the stereotype that the problem of loneliness and isolation has become more prevalent. Socio‐demographic and health factors were associated with loneliness but contact with family and friends was not. Both quantitative and qualitative data sets illustrate the importance of loss as a theme underpinning experiences of loneliness. Further analysis of these data offers the potential to develop a better understanding of what loneliness really is, what it means to those who experience it may offer the potential to develop interventions and strategies to ‘protect’ older people from this problem.