Tamara Sussman

The Impact of Caregiving Older Women’s Experiences of Sexuality and Intimacy

Using an adapted phenomenological approach, the current study explores older women’s stories about the ways in which providing care to their spouse or partner has affected their sexual and intimate lives. Findings suggest that older women’s sexual identities and experiences of sexuality are marked by both ageist constructions of “older woman as asexual” and loss of self associated with taking on the role of caregiver. Findings also suggest that women resist these constructions of self through the development of other forms of intimacy in their lives. Suggestions for increasing opportunities to address women’s realities in service provision are highlighted.

Shared Decision Making to Support the Provision of Palliative and End‐of‐Life Care in the Emergency Department: A Consensus Statement and Research Agenda

BACKGROUND Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED). OBJECTIVE The objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED. METHODS Participants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient-advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time-staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in-person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement. CONCLUSION Key research questions identified by the group related to which ED patients are likely to benefit from palliative care (PC), what interventions can most effectively promote PC in the ED, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the ED to help patients define long-term goals of care, and what policies influence palliative and end-of-life care decision making in the ED. Answers to these questions have the potential to substantially improve the quality of care for ED patients with advanced illness.

Supporting a Relative's Move into Long-term Care: Starting Point Shapes Family Members' Experiences

Cette étude fondée sur la théorie a exploré les expériences des membres de la famille qui soutenaient leurs proches qui sont déplacés dans les foyers de soins de longue durée (FSLD). Chaque étape du processus de transition a été examinée, y compris le rôle du point de départ à façonner l’expérience. Dans les six semaines suivant le déménagement, une vingtaine de membres des familles qui avaient quitté un parent dans un FSLD ont été interviewés. Les résultats ont révelé que le point de départ a eu un effet profond sur les expériences des membres des familles en acceptant la nécessité et le moment où il faut faire le déplacement de leur parent en un FSLD (avant le déménagement), et à croire que le FSLD choisi est un environnement positif pour leur parent (après le déménagement). Les politiques et les processus des FSLD sont aussi importants. Cependant, quand l’acceptation du pré-déménagement a été compromise par des circonstances imputables au point de départ, ces politiques et procédures ont été moins efficaces dans la promotion de l’acceptation de l’après-déménagement. Nous discutons des conditions qui soutient les transitions positives avant, pendant et après le déménagement de chaque point de départ. This grounded-theory study explored family members’ experiences supporting a relative’s move into a long-term care (LTC) home. Each stage in the transition process, and the role of starting point in shaping the experience, were examined. Twenty family members who moved a relative into an LTC home were interviewed within six weeks of the move. The findings revealed that the starting point had a profound effect on family members’ experiences accepting the need for, and timing of, their relative’s move into LTC (pre-move), and on believing that the selected LTC home was a positive environment for their relative (post-move). LTC home policies and processes were also important. However, when pre-move acceptance was compromised by circumstances attributed to the starting point, these policies and processes were not as effective in fostering post-move acceptance. Conditions that support positive transitions before, during, and after the move from each starting point are discussed.

A Literature Review of Homelessness and Aging: Suggestions for a Policy and Practice-Relevant Research Agenda.

Le sans-abrisme chez les personnes âgées est une préoccupation croissante à travers le Canada et devrait augmenter avec le changement démographique (Crane & Warnes, 2010; Culhane, Métraux, Byrne, Stino, et Bainbridge, 2013). Pourtant, les connaissances actuelles, les politiques et les pratiques concernant le sans-abrisme ont tendance largement de se concentrer sur des populations plus jeunes. De même, la recherche et les politiques sur le vieillissement en général négligent le sans-abrisme. Les réponses au problème de sans-abrisme chez les personnes âgées doivent répondre aux besoins complexes liés à la santé, la sécurité du revenu et le logement. Basé sur un examen exhaustif de la littérature, cet article présente les domaines de recherche afin d’éclairer les politiques, les stratégies et les services pour les divers groupes des aînés sans-abri. Nous clarifions les intersections du vieillissement et du sans-abrisme; examinons les statistiques pertinentes, y compris la prévalence estimée; discutons des voies et des variations de l’expérience; et determinons les lacunes dans les connaissances. Nous concluons par un appel à un programme de recherche inclusive qui aidera à créér des politiques et des pratiques visant à réduire et finalement à éliminer le sans-abrisme chez les personnes âgées au Canada.Homelessness among older people is a growing concern across Canada and is expected to rise with demographic change (Crane & Warnes, 2010; Culhane, Metraux, Byrne, Stino, & Bainbridge, 2013). Yet current knowledge, policies, and practices on homelessness largely focus on younger populations. Likewise, research and policies on aging typically overlook homelessness. Responses to homelessness among older people must address complex needs related to health, income security, and housing. Based on a comprehensive literature review, this article outlines the existing and needed research with regards to homelessness among older people. We clarify the intersections of aging and homelessness; review the relevant statistics, including estimated prevalence; discuss pathways and variations in experience; and identify gaps in knowledge. We conclude with a call for an inclusive research agenda that will help build policies and practices to reduce and ultimately to eliminate homelessness among older people in Canada.

Supporting Residents Moving Into Long-Term Care: Multiple Layers Shape Residents’ Experiences

This interpretive grounded theory study explores 10 residents’ retrospective accounts of the relocation process, including the decision to move into a long-term care home, the pre-move preparations, the moving day circumstances, and the initial adjustment period following the move. Analysis of the data revealed a complex intersection of conditions at multiple layers that shaped residents’ experiences of the transitional process. Recommendations to enhance circumstances at individual, interpersonal, and systemic layers, for each temporal stage of the relocation process are proposed. Implications for social work practice across the continuum of care are also discussed.

A mixed methods exploration of family members’/friends’ roles in a self-care intervention for depressive symptoms

Objectives The aims of this exploratory study were to examine the: (1) family and friend (F/F) support patients reported receiving and F/F reported providing to patients while participating in a self-care intervention (SCI) for depressive symptoms and (2) associations between different types of F/F support and patients’ use of the self-care tools in the SCI. Methods Fifty-seven patients aged 40 + participating in an uncontrolled feasibility study of an SCI, completed structured telephone interviews about the support they received from F/F while participating in the SCI. Eighteen F/F completed questionnaires on the support they provided to patients during the SCI. Seven F/F participated in a post-study qualitative interview on their involvement in the SCI. Results About 35% of patients reported receiving F/F support with the SCI. Patients’ use of the behavioral tools was positively associated with patients’ report of F/F support, and with F/F’s report of instrumental support provided. F/F reported uncertainty about the type of support they should offer to patients in the SCI. Discussion F/F involvement in SCIs for depressive symptoms may be helpful to patients and may foster adherence to these interventions. More research is warranted on the nature of such involvement from the perspective of patients and F/F.

Patterns of Shelter Use Among Men New to Homelessness in Later Life Duration of Stay and Psychosocial Factors Related to Departure

People who become homeless for the first time in late life are a growing but understudied population. This study draws on administrative data from one shelter (N = 1,214 first-time homeless) to assess the extent to which age is related to shelter stay and, to examine psychosocial factors that may be associated with shelter departure. Our bivariate and survival analysis results suggest that older homeless men stay in the shelter 2 weeks longer than younger clients. Older men with pending legal issues and mobility concerns were more likely to leave the shelter than those without such concerns. Findings highlight the impact of age and other psychosocial variables on shelter stay, and provide direction from which to address homelessness among men who are new to homelessness in later life.

‘Growing Old’ in Shelters and ‘On the Street’: Experiences of Older Homeless People

ABSTRACT Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.

Family members’ or friends’ involvement in self-care for patients with depressive symptoms and co-morbid chronic conditions

Objectives To describe the support that patients reported receiving from family or friends (F/F) while participating in a self-care intervention for depressive symptoms; examine associations between patient-reported F/F support and use of self-care materials; and describe F/F perceptions of involvement in a subsample of F/F. Methods One hundred eighty-nine of 223 (85%) patients aged 40+ with chronic physical conditions and co-morbid depressive symptoms participating in a randomized self-care intervention trial, completed structured telephone surveys at three months about the F/F support received. Ten F/F participated in post study qualitative interviews on the support provided. Results 30%, 44%, and 91% of patients reported overall F/F support with self-care, F/F involvement with the self-care intervention and emotional support, respectively. 61% felt positively and 10% felt negatively or conflicted with F/F support. F/F involvement in the self-care intervention was the only variable associated with patient use of self-care materials when examined alongside all F/F support variables (Proportional Odds Ratio = 1.21; 95% C.I. = 1.01, 1.45). F/F perceived less involvement in the self-care intervention than patients. Discussion Patients engaged in a self-care intervention for depressive symptoms use more self-care materials when they perceive F/F involvement in the intervention. Patients and F/F may perceive involvement differently and benefit from discussions about potential F/F roles.

How Field Instructors Judge BSW Student Readiness for Entry-Level Practice

Social work field instructors are responsible for the gatekeeping function of evaluating student performance and determining practice readiness. Yet little empirical literature elucidates how field instructors of graduating BSW students judge competence, suitability, or readiness for practice. This qualitative study reports findings from 6 focus groups attended by 28 experienced BSW field instructors aimed at (a) exploring criteria used to judge student readiness for entry-level practice and (b) examining differences in expectations based on micro and macro placements. Two capacities emerged as being paramount in supporting the development of practice skills, personal attributes, and areas of practice in both micro and macro placements: conceptualization and self-reflection. Implications for evaluating student competence and supporting student learning in the field are discussed.