Sasha Scambler

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’.

The management of dental anxiety: time for a sense of proportion?

Dental anxiety and fear are common and potentially problematic, both for the patient and for the dental team in managing such patients. Furthermore, dental fear still presents a major barrier to the uptake of dental treatment. This article will take as its premise an assumption that anxiety manifests at different levels and that consequently management of dental anxiety involves both assessment and proportionate intervention. Methods for undertaking both assessment and management are outlined.

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.

Should All Deaf Children Learn Sign Language

Every year, 10 000 infants are born in the United States with sensorineural deafness. Deaf children of hearing (and nonsigning) parents are unique among all children in the world in that they cannot easily or naturally learn the language that their parents speak. These parents face tough choices. Should they seek a cochlear implant for their child? If so, should they also learn to sign? As pediatricians, we need to help parents understand the risks and benefits of different approaches to parent–child communication when the child is deaf.

Back to basics: Re-examining the role of patient empowerment in diabetes

The concept of patient empowerment is currently popular in research and at policy level. As early as 2001, the UK Government proposed a diabetes health strategy, wishing to “ensure that people with diabetes are empowered to enhance their personal control over the day to day management of their diabetes in a way that enables them to experience the best possible quality of life” [1] (p. 21). It went on to say that “users of the NHS should have choice, voice and control over their lives, build confidence and be active partners in their care”. This strategy is reflected in the abundance of papers within the area. A search conducted in July 2010 on Scopus, yielded 17,102 publications, which included ‘empowerment’ in the title, abstract or keywords. Of these, at least 353 were about empowerment in diabetes. There can be no doubt then, that empowerment is a popular topic yet, it is surprising to discover a lack of concordance about the meaning and scope of the term. The UK Government strategy highlighted above, is a case in point. The need to empower diabetes patients is explicitly stated but the means to achieve empowerment in practice is not. This observation reflects a generalised lack of clarity around what ‘empowerment’ actually means.

New Directions in the Sociology of Chronic and Disabling Conditions: Assaults on the Lifeworld

Contributions to the sociology of chronic and disabling conditions might be considered to have entered a transitional phase. It is generally accepted that Western modernity has been characterized by a considerably extended human lifespan accompanied by a growing prevalence of chronic, degenerative disorders; a ‘compression of morbidity’ in the fourth age (Fries, 1983); and a norm of slow as opposed to quick dying. Chronic and disabling conditions, in other words, have become highly significant objects of investigation, attracting increasing politico-economic as well as social, psychological and, of course, biological attention. Their salience has precipitated divisions of orientation, most conspicuously, but not only, between medical sociologists and disability theorists. The fact that these divisions are currently under debate justifies our reference to a ‘transitional phase’. It also underpins the rationale for this book.

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.

The context of empowerment and self-care within the field of diabetes

There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the successful management of their disease. Patients are actively encouraged to become active participants in their care, and there is an expectation that health-care professionals will facilitate this process. This article uses Bourdieu’s concept of field, as a bounded social space in which actors conduct their lives day-to-day, to explore the context within which issues of empowerment are addressed and negotiated. The practice of empowerment within the biologically defined and biomedically ‘policed’ field of diabetes is explored using empirical data from a study of diabetes health-care professionals’ understanding and practices around empowerment. It is concluded that rather than promoting active self-management and empowerment, the nature of the field of diabetes, and in particular its privileging of the biomedical, can mitigate against people with diabetes negotiating the field effectively and taking control of the disease and its management.

A model of patient-centred care – turning good care into patient-centred care

This paper builds on previous work reviewing patient-centred care in dentistry and acknowledges work that has questioned the measurement and effectiveness of patient-centredness in practice. In an attempt to move the debate from rhetoric to practice and enhance the practical utility of the concept, we present a practical hierarchy of patient-centredness that may aid the practical application of patient-centred care in clinical practice by making explicit a series of stages that a dental care professional needs to move through in order to provide care that is patient-centred. The model presented is illustrated through practical examples. The various stages inherent in it are described with the aim of making clear the perhaps automatic and taken for granted assumptions that are often made by dental care professionals and patients through the course of a consultation. Our aim is to encourage dental consultations to have more open, unambiguous communication, both about the risks and benefits of courses of action and about the choices available to patients.

The role of information and choice in patient‐centred care in diabetes: a hierarchy of patient‐centredness

This paper reviews some popular models of patient-centred care and acknowledges work that has questioned the measurement and effectiveness of patient-centredness in practice. In an attempt to enhance testing the concept practically, we propose a practical hierarchy of patient-centredness that we hope will aid the practical application of patient-centred care in clinical practice. The proposed hierarchy is illustrated through a practical example and the various stages inherent in it are described. This paper concludes with a call that this theory-driven hierarchy of patient-centredness be tested out in practice with the view of confirming or revising it where appropriate so that it might serve as a useful clinical tool in future. Copyright