Laura Soulsby

What are the factors that facilitate or hinder resilience in older spousal dementia carers? A qualitative study

Objectives: Much is known about the factors making caring for a spouse with dementia burdensome. However, relatively little is known about factors that help some spouses become resilient. We define resilience as ‘the process of negotiating, managing and adapting to significant sources of stress or trauma’. We aimed to assess whether spousal dementia carers can achieve resilience and to highlight which assets and resources they draw on to facilitate or hinder resilience, using an ecological framework . Method:Twenty in-depth qualitative interviews with spousal carers from two carer support groups and a care home in North West England. Results: Eight participants were resilient and 12 were not. A resilient carer was characterised as someone who stays positive and actively maintained their relationship and loved ones former self. Resilient carers were knowledgeable and well supported by family but especially friends, with whom they shared this knowledge. They were more actively engaged with services such as respite care. Conclusion: There is a need to move towards more ecological models of resilience. We propose that access to assets and resources is not always sufficient to facilitate resilience. Implications of these findings are discussed.

Wellbeing in Bereavement and Widowhood

This article will examine how beveavement and widowhood affect wellbeing drawing on psychological, gerontological, and sociological research. The article will begin with an outline of what is meant by bereavement and widowhood. It will then present an overview of the effects that bereavement and widowhood has on wellbeing. In the next section, a brief history of approaches to bereavement will be presented. Next, more recent approaches will be discussed including the Dual Process Model of Bereavement (Stroebe & Schut, 1999), and a discussion of the debate concerning continuing and relinquishing bonds. The focus will then turn to factors which influence wellbeing with a focus both on pre- and post-bereavement experiences, and on such factors as age and gender. Finally, there will be a discussion of factors which may enhance wellbeing, such as resilience, identity reconstruction, and coping strategies.

When Two Become One: Exploring Identity in Marriage and Cohabitation

We examine the psychosocial impact of marital status change, and the spontaneously emerging theme of identity. In-depth interviews were conducted with 82 cohabiting, married, widowed, and divorced British adults, focusing on changes in daily routine, social relationships, and social support. We draw attention to findings of interviews with men and women who entered a married (n = 30) or cohabiting (n = 8) relationship for the first time. The interviews provide an insight into the complex process of identity change in marriage and cohabitation. Participants described an identity shift from “I” to “we” which was associated with social and personal changes in how they understood themselves. Marriage and cohabitation were viewed as positive transitions facilitating personal growth. However, importantly, marriage, in particular, was also associated with a process of depersonalization which posed a challenge to private identity. We conclude with a discussion of the ways in which participants managed this identity conflict.

Family close but friends closer: exploring social support and resilience in older spousal dementia carers

ABSTRACT Objectives: Spousal dementia carers have unique support needs; they are likely to disengage from their existing social networks as they need to devote more time to caring as the disease progresses. Previously we showed that support resources can facilitate resilience in carers, but the relationship is complex and varies by relationship type. The current paper aims to explore social support as a key component of resilience to identify the availability, function and perceived functional aspects of support provided to older spousal dementia carers. Method: We conducted 23 in-depth qualitative interviews with spousal carers from two carer support groups and a care home in North West England. Results: Family and friends served a wide range of functions but were equally available to resilient and non-resilient participants. Family support was perceived as unhelpful if it created feelings of over-dependence. Participants were less likely to resist involvement of grandchildren due to their relatively narrow and low-level support functions. Friend support was perceived as most helpful when it derived from those in similar circumstances. Neighbours played a functionally unique role of crisis management. These perceptions may moderate the effect of support on resilience. Conclusion: Family and friend support is not always sufficient to facilitate resilience. Support functions facilitate resilience only if they are perceived to match need. Implications of these findings are discussed.

“We Were in a Partnership That Wasn’t Recognized by Anyone Else”: Examining the Effects of Male Gay Partner Bereavement, Masculinity, and Identity

Research with older gay “widowers”1 is relatively rare and the majority focuses on the AIDS/HIV context, rather than on broader causes of death. However, drawing on studies of heterosexual spousal bereavement, we suggest that older widowers are faced with two competing challenges that impact on their identity. They are expected to grieve in a socially acceptable manner, while at the same time conform to hegemonic masculine identity. We investigate whether gay widowers face the same challenges and whether there are additional challenges compared to heterosexual widowers following the loss of their partners. We interviewed twenty older gay widowers about their experiences. We illustrate our findings with four case studies. We find that gay men, like heterosexual men, manage the challenges of normative grieving as defined by hegemonic masculinity. However, gay men also face challenges of gay identity. We discuss the ways in which these men negotiate the intersectionality of grieving, masculinity, and being gay. In addition, identities are reconstructed in response to the expectations of the gay community. Finally, gay men have to negotiate their position as grieving widower within the wider social context.

Exploring the nature of illness perceptions in people with end-stage kidney disease

BACKGROUND Diagnosis and treatment for End-Stage Kidney Disease (ESKD) results in vast lifestyle changes. Despite the high prevalence of depression in people with ESKD, the psychosocial impacts of ESKD are still often overlooked. Illness perceptions enable people to make sense of their illness and are closely associated with depression. Due to the high levels of depression within ESKD, this study sought to understand the nature of illness perceptions in people with ESKD. METHODOLOGY In this qualitative study, eleven participants were identified through hospital and online patient support groups. Semi-structured interviews were audio-taped, transcribed and analysed using grounded theory techniques. RESULTS Three themes emerged from the data: Renal Conflicts, Forced Adjustment and Coping. The main dimensions of illness perception discussed by participants were Consequences, Control, Timeline and Identity. CONCLUSION The results of this study have practical implications for informing practitioners about the psychosocial effects of ESKD diagnosis and treatment.

Resilience amongst Older Colombians Living in Poverty: an Ecological Approach

Older Colombians face significant adversities: poverty, violence and displacement. However, there is evidence that Latinos are often resilient. We examine resilience in older Colombians living in poverty using an ecological framework that identifies three levels: individual; community; and societal. In this paper we examine data from 16 semi-structured interviews with older Colombians that explore resilience within the context of poverty. We analyze our data using three stages: (1) modified grounded theory; (2) assignment of resilience status; (3) identification of components of the ecological framework which contribute to resilience in these participants. The most striking feature is that some participants are able to adapt to their situation, demonstrating resilience, whilst others are not. Individual characteristics such as psychological and material resources contribute to resilience. At the community level, family, social support, participation and cohesion promote resilience. Finally, at the societal level, social and welfare services, finance, religion and social policy, are important factors. These different levels of resilience are co-dependent, and we illustrate how this is so. We suggest that older Colombians living in poverty often demonstrate resilience, but that more can be done to enhance their lives. This includes interventions at the individual and community levels alongside changes in social policy.