Ryan Woolrych

Healthy ageing and home: The perspectives of very old people in five European countries.

This paper reports on in-depth research, using a grounded theory approach, to examine the ways in which very old people perceive healthy ageing in the context of living alone at home within urban settings in five European countries. This qualitative study was part of a cross-national project entitled ENABLE-AGE which examined the relationship between home and healthy ageing. Interviews explored the notion of healthy ageing, the meaning and importance of home, conceptualisations of independence and autonomy and links between healthy ageing and home. Data analysis identified five ways in which older people constructed healthy ageing: home and keeping active; managing lifestyles, health and illness; balancing social life; and balancing material and financial circumstances. Older people reflected on their everyday lives at home in terms of being engaged in purposeful, meaningful action and evaluated healthy ageing in relation to the symbolic and practical affordances of the home, contextualised within constructions of their national context. The research suggests that older people perceive healthy ageing as an active achievement, created through individual, personal effort and supported through social ties despite the health, financial and social decline associated with growing older. The physicality and spatiality of home provided the context for establishing and evaluating the notion of healthy ageing, whilst the experienced relationship between home, life history and identity created a meaningful space within which healthy ageing was negotiated.

Gambling and debt: the hidden impacts on family and work life

This paper discusses the key findings from the first qualitative study focused on understanding the impacts of gambling-related debt on the family and work life of problem gamblers. The paper illustrates how current research priorities marginalise the social impacts of gambling on families and communities and suggests ways in which researchers and practitioners can address the issues and impacts of gambling-related debt on individuals, families and communities.

A more entrepreneurial mindset? Engaging third sector suppliers to the NHS

Purpose – The purpose of this paper is to offer a critical overview of claims and counter claims around increased expectations that the third sector organisations (TSOs) will compete for contracts to deliver public services. It does this through the lens of contested notions of being “businesslike” and “entrepreneurial” across the public and third sectors. Then it assesses how some of these tensions are currently played out between public sector commissioners and third sector service providers.Design/methodology/approach – This paper is based on a one‐year project funded under the ESRC Business Engagement Opportunities scheme (2009‐2010) in which the authors are working with NHS Manchester (responsible for commissioning and directing NHS funds into a wide range of services for communities across the city) and local third sector delivery and infrastructure organisations. The project consists of a set of knowledge exchange activities (scoping, workshops, placements and an on‐line tool) intended to help NHS ...

Supporting meningitis diagnosis amongst infants and children through the use of fuzzy cognitive mapping.

BackgroundMeningitis is characterized by an inflammation of the meninges, or the membranes surrounding the brain and spinal cord. Early diagnosis and treatment is crucial for a positive outcome, yet identifying meningitis is a complex process involving an array of signs and symptoms and multiple causal factors which require novel solutions to support clinical decision-making. In this work, we explore the potential of fuzzy cognitive map to assist in the modeling of meningitis, as a support tool for physicians in the accurate diagnosis and treatment of the condition.MethodsFuzzy cognitive mapping (FCM) is a method for analysing and depicting human perception of a given system. FCM facilitates the development of a conceptual model which is not limited by exact values and measurements and thus is well suited to representing relatively unstructured knowledge and associations expressed in imprecise terms. A team of doctors (physicians), comprising four paediatricians, was formed to define the multifarious signs and symptoms associated with meningitis and to identify risk factors integral to its causality, as indicators used by clinicians to identify the presence or absence of meningitis in patients. The FCM model, consisting of 20 concept nodes, has been designed by the team of paediatricians in collaborative dialogue with the research team.ResultsThe paediatricians were supplied with a form containing various input parameters to be completed at the time of diagnosing meningitis among infants and children. The paediatricians provided information on a total of 56 patient cases amongst children whose age ranged from 2 months to 7 years. The physicians’ decision to diagnose meningitis was available for each individual case which was used as the outcome measure for evaluating the model. The FCM was trained using 40 cases with an accuracy of 95%, and later 16 test cases were used to analyze the accuracy and reliability of the model. The system produced the results with sensitivity of 83.3% and specificity of 80%.ConclusionsThis work suggests that the application and development of a knowledge based system, using the formalization of FCMs for understanding the symptoms and causes of meningitis in children and infants, can provide a reliable front-end decision-making tool to better assist physicians.

‘It is not going to change his life but it has picked him up’: a qualitative study of perspectives on long term oxygen therapy for people with chronic obstructive pulmonary disease

BackgroundLong-term oxygen therapy (LTOT) extends life in patients with chronic obstructive pulmonary disease with severe hypoxaemia. Questionnaire-based studies of the effects of LTOT have not suggested uniformly positive findings. The few qualitative studies suggest that patients report benefits but also concerns about dependency on oxygen therapy. The aim of the study was to explore the views and experiences of COPD patients, their carers and the healthcare professionals who deliver these services, on the long-term use of oxygen therapy.MethodsFocus groups were conducted with 16 patients with from the LTOT service, six carers, and nine healthcare professionals (n = 31). Eleven patients with COPD, four carers and one staff manager (n = 16) participated in semi-structured interviews. Interviews and focus group were digitally recorded and field notes were taken. Data were analysed using the thematic network analysis approach.ResultsPatients and carers reported the benefits of LTOT including increased social activity, perceived improvements in health status and self-management in routine daily activities. Concerns were raised regarding stigma, dependency on LTOT and deterioration in health status. Staff accounts included negative perceptions, suggesting that LTOT was often inappropriately prescribed and under-used but recommended active patient management to address this challenge.ConclusionsLTOT has some beneficial effects in improving daily activities and social interaction of patients with COPD but also some limitations. Increased support and monitoring by healthcare professionals would address some concerns, as would better information for patients, carers and the general public.

The power(s) of observation: theoretical perspectives on surveillance technologies and older people

ABSTRACT There is a long history of surveillance of older adults in institutional settings and it is becoming an increasingly common feature of modern society. New surveillance technologies that include activity monitoring, and ubiquitous computing, which are described as ambient assisted living (AAL), are being developed to provide unobtrusive monitoring and support of activities of daily living and to extend the quality and length of time older people can live in their homes. However, concerns have been raised with how these kinds of technologies may affect users privacy and autonomy. The objectives of this paper are (a) to describe the development of home-based surveillance technologies; (b) to examine how surveillance is being restructured with the use of this technology; and (c) to explore the potential outcomes associated with the adoption of AAL as a means of surveillance by drawing upon the theoretical work of Foucault and Goffman. The discussion suggests that future research needs to consider two key areas beyond the current discourse on technology and ageing, specifically: (a) how the new technology will encroach upon the private lived space of the individual, and (b) how it will affect formal and informal caring relationships. This is critical to ensure that the introduction of AAL does not contribute to the disempowerment of residents who receive this technology.

eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop

Background The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions This paper describes the health care professionals’ competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.

An evaluation of preventive sensor technology for dementia care

We evaluated a commercially-available monitoring system for older people with dementia living at home. The system was designed to detect problems before they require crisis intervention. Fourteen clients from two healthcare organisations in the Netherlands used the system over a 9-month period. The formal and informal caregivers were interviewed, project group meetings were observed, nurse diaries were analysed and a cost analysis performed. Clients and informal caregivers reported enhanced feelings of safety and security as a result of having the system installed in the home. The system appeared to reduce the burden of care on the informal caregiver and had the potential to allow people to live at home for longer. There were financial savings for clients staying at home with the technology compared with the costs of staying in a nursing home: for 10 clients living at home for 2 months, the savings were 23,665 euro. The study showed that the monitoring system represents a potentially useful early warning system to detect a situation before it requires emergency intervention.

Toward integrated services for dementia: a formal carer perspective

Purpose – Policy has identified the need for integrated dementia services for older people. However, the role of the formal carer within an integrated framework of service delivery has not been well articulated in practice. The aim of this paper is to understand the experiences of formal carers working with the context of an integrated dementia service by exploring findings from a research‐based evaluation.Design/methodology/approach – The evaluation captured the experiences of formal carers working within the service via observations, semi‐structured interviews and focus groups.Findings – Working with an integrated service brings about individual, social and organisational challenges to the role of the formal carer, in terms of: delivering flexibility and responsiveness, providing continuity of care, ensuring cross‐organisational working and acquiring skills, knowledge and expertise.Originality/value – To facilitate the successful delivery of integrated care, the emerging role of the formal carer needs t...

Placing well-being and participation within processes of urban regeneration

Purpose – The concepts of well‐being and participation are prevalent in current regeneration policy, being seen as crucial to alleviating disadvantage and marginalisation in deprived communities. However little is understood about how such ambiguous concepts are articulated within urban regeneration practice. This paper seeks to present a reflective case study of research in a New Deal for Communities (NDC) area designed to understand different conceptualisations of well‐being and participation in community places and regeneration practices.Design/methodology/approach – The perspectives of regeneration professionals, local residents and academics were revealed through the development of a multi‐method and participatory research approach using interviews, observations, video diaries and workshops. An action oriented event aimed at developing overlapping communities of practice was held to engage in active dialogue and develop shared understandings between the resident, professional and academic communities...