Virpi Timonen

Depressive symptoms among older adults: The impact of early and later life circumstances and marital status

Objective: This article contributes to the literature on depression and the life course by examining the impact of both early and later life circumstances on depressive symptoms among men and women aged 65 and over in Ireland. Method: Data are from the first wave of The Irish Longitudinal Study on Ageing, a nationally representative sample of 8504 community-dwelling adults aged 50 years and older. About 3507 respondents aged 65 years and over were included in the analysis. Multinomial logistic regression was used to examine the childhood and early adult life circumstances associated with marital status. A series of nested models were estimated to evaluate which childhood and adulthood circumstances are associated with depressive symptoms. Models were estimated separately for men and women. Results: Ill health in childhood and in later life has a strong and direct effect on depression in later life for both men and women. Other early stressors are mediated by later circumstances. Marital status is a significant independent predictor of depression in later life. Later life circumstances mediate between some marital statuses and depressive symptoms. When later life circumstances are included, widowhood and, for men, divorce, are directly associated with depression, but singlehood is not. Income in later life is strongly associated with depressive symptoms for women. Conclusion: Both early and later life circumstances affect late-life depressive symptoms. Our findings indicate that previous studies which did not consider both may have underestimated or overestimated the effect of marital status, education, current health and education on depressive symptoms.

Patients' perceptions of services and preferences for care in amyotrophic lateral sclerosis: A review.

Abstract Service providers and service users often have different perspectives on health and social care services. We have undertaken a systematic review of empirical data between 1988 and March 2011 relating to ALS service users’ perspectives on health and social care services. Forty-seven texts were extracted and a narrative synthesis conducted. Few studies have explored ALS patients’ experiences in relation to their satisfaction with services. Our review showed that ALS patients expect dignified care but they are often dissatisfied with health care services and have unmet expectations of their care. Most studies of decision-making and preferences for care have focused on end-of-life intervention. Various factors influence preferences for care from the service user perspective and people with ALS may adjust their use of services as they negotiate change. In conclusion, further research on the timeliness of services to meet changing needs of service users is required. The service user experience of allied health care services prior to end-of-life care also warrants investigation. Service providers need to support people with ALS as they negotiate feelings of acceptance and independence. Research to identify the key parameters of the ALS patient experience of services is required.

Poland’s Health Reform: Politics, Markets and Informal Payments

This article analyses the pre-reform Polish healthcare system, the theory of the recent reform, the early experiences, and the likely future developments. The reform aims to preserve a state-guaranteed egalitarian healthcare system while ensuring optimal use of resources by the introduction of market-type mechanisms. These mechanisms cannot function as intended while sub-national governments, which have little incentive to support restructuring, remain a vital part of the system. An even greater impediment to the proper functioning of the system is the practice of informal payments. Therefore, smaller than expected gains in efficiency and equity, together with demographic and technological pressures on health costs and a political and economic climate which is unlikely to deliver large increases in public spending, are likely to result in a more privatised and unequal health system than is intended.

Migrant Care Workers’ Relationships with Care Recipients, Colleagues and Employers:

The literature on migrant care workers has tended to place little emphasis on the multiple relationships that migrant carers form with care recipients, employers/managers and work colleagues. This article makes a contribution to this emerging field, drawing on data from qualitative interviews carried out with 40 migrant care workers employed in the institutional and domiciliary care sectors in Dublin, Ireland. While the analysis revealed generally positive carer—care recipient relationships, significant racial and cultural tensions were evident within the vertical and especially the horizontal relationships in the care workplace. The article argues that these findings highlight the need for additional research on the relationships formed in the long-term care sector and further theorizing on the meaning and importance of the affective components of care work within increasingly commodified care markets.

Lessons From a Community-Based Participatory Research Project: Older People’s and Researchers’ Reflections

The ethical and practical importance of actively involving older people in the research process is increasingly articulated in the gerontology literature. This article contributes to the literature by outlining a community-based participatory research project that centered on the design and administration of a questionnaire exploring older people’s use and perceptions of community services. The authors discuss both older adults’ and the researchers’ views of the participatory process. The key lessons and challenges that emerged from the research are analyzed using the nine principles of community-based participatory research outlined by Israel et al. The authors question whether older people in all instances seek extensive involvement in all aspects of participatory projects and raise a number of questions that require further analysis before a robust and viable understanding of participatory research that safeguards against the tokenistic involvement of older people can be developed.

Exerting control and adapting to loss in amyotrophic lateral sclerosis

People with amyotrophic lateral sclerosis (ALS) engage with a broad range of health care services from symptom onset to end-of-life care. We undertook a grounded theory study to identify processes that underpin how and why people with ALS engage with health care services. Using theoretical sampling procedures, we sampled 34 people from the Irish ALS population-based register during September 2011 to August 2012. We conducted in-depth interviews with participants about their experiences of health care services. Our study yielded new insights into how people with ALS engage with services and adapt to loss. People with ALS live with insurmountable loss and never regain what they have already lost. Loss for people with ALS is multidimensional and includes loss of control. The experience of loss of control prompts people with ALS to search for control over health care services but exerting control in health care services can also include rendering control to service providers. People with ALS negotiate loss by exerting control over and rendering control to health care services. Our findings are important for future research that is attuned to how people with terminal illness exert control in health care services and make decisions about care in the context of mounting loss.

The differential impact of subjective and objective aspects of social engagement on cardiovascular risk factors

BackgroundThis article provides new insights into the impact of social engagement on CVD risk factors in older adults. We hypothesized that objective (social participation, social ties and marital status) and subjective (emotional support) aspects of social engagement are independently associated with objective measures of cardiovascular risk.MethodsData from the English Longitudinal Study on Ageing (ELSA) were analyzed. The effects of social participation, social ties, marital status, and emotional support on hypertension, obesity, high sensitivity C-reactive protein, and fibrinogen were estimated by logistic regression controlling for age, sex, education, physical function, depression, cardiovascular disease, other chronic diseases, physical activity, and smoking.ResultsSocial participation is a consistent predictor of low risk for four risk factors, even after controlling for a wide range of covariates. Being married is associated with lower risk for hypertension. Social ties and emotional support are not significantly associated with any of the cardiovascular risk factors.ConclusionOur analysis suggests that participation in social activities has a stronger association with CV risk factors than marital status, social ties or emotional support. Different forms of social engagement may therefore have different implications for the biological risk factors involved.

Nutritional status of Irish older people in receipt of meals-on-wheels and the nutritional content of meals provided.

BACKGROUND Research has suggested that meals-on-wheels recipients can be at risk for poor nutritional status. Despite this, few countries have statutory minimum requirements for the nutrient content of meals-on-wheels. This study examined both the nutritional status of a sample of Irish recipients and the nutrient content of a sample of meals provided to determine whether Irish recipients would benefit from statutory minimum nutritional standards. METHODS The study had two phases. First, a nutritional assessment was carried out to analyse the nutritional status of a sample of Irish meals-on-wheels recipients (Mini Nutritional Assessment and 24-h dietary recall with 63 self-selected respondents). Second, an assessment of the nutrient content of a sample of 46 meals from eight meals-on-wheels services was undertaken to characterise the nutritional content of the meals. RESULTS Over one-third of recipients (38.5%) were malnourished or at-risk of malnutrition and over half (52.3%) were overweight or obese. The mean (SD) energy [kJ (kcal)] content of the meals assessed was 3008 (498) kJ [719 (119.1) kcal], contributing 35-40% of the recommended dietary allowance (RDA) for males aged 65 years and over and 42-45% of the RDA for females aged 65 years and over. In the meals assessed, the levels of vitamin C (25.3%), vitamin D (11.6%), folate (24.8%) and calcium (20.9%) were below one-third of the Irish RDA for these nutrients. CONCLUSIONS Irish recipients may not be receiving adequate micronutrients from meals-on-wheels. Legislation that sets out minimum standards for the nutrient content of meals-on-wheels and greater variation in the portion sizes offered may benefit recipients.

Family, state, class and solidarity: re-conceptualising intergenerational solidarity through the grounded theory approach

The relationship between class and intergenerational solidarities in the public and private spheres calls for further conceptual and theoretical development. This article discusses the findings from the first wave of a qualitative longitudinal study entitled Changing Generations, conducted in Ireland in 2011–2012, comprising 100 in-depth interviews with men and women across the age and socioeconomic spectrums. Constructivist grounded theory analysis of the data gives rise to the following postulates: (1) intergenerational solidarity at the family level is strongly contoured by socioeconomic status (SES); (2) intergenerational solidarity evolves as family generations observe each others’ practices and adjust their expectations accordingly; (3) intergenerational solidarity within families is also shaped by the public sphere (the welfare state) that generates varying expectations and levels of solidarity regarding State supports for different age groups, again largely dependent on SES; (4) the liberal welfare state context, especially at a time of economic crisis, enhances the significance of intergenerational solidarity within families. We conclude by calling for research that is attuned to age/generation, gender and class, and how these operate across the family and societal levels.

Women (Re)Negotiating Care across Family Generations Intersections of Gender and Socioeconomic Status

Changing Generations, a study of intergenerational relations in Ireland undertaken between 2011 and 2013 by the Social Policy and Ageing Research Centre (SPARC), Trinity College, Dublin, and the Irish Centre for Social Gerontology (ICSG), NUI Galway, used the Constructivist Grounded Theory method to interrogate support and care provision between generations. This article draws on interviews with 52 women ages 18 to 102, allowing for simultaneous analysis of older and younger women’s perspectives. The intersectionality of gender and class emerged as central to the analysis. Socioeconomic positions shape contrasting forms of interdependency among family generations, ranging from “enmeshed” lives among lower socioeconomic groups to “freed” lives among higher socioeconomic groups. Women are initiating changes in how care and support flow across generations. Older women in higher socioeconomic groups are attuned to how emotional capital women expend across family generations can constrain (young) women’s lives. In an expression of solidarity, older women are renegotiating the place of care labor in their own lives and in the lives of younger women. A new reciprocity emerges that amounts to women “undoing gender.” This process is, however, deeply classed as it is women in higher socioeconomic groups whose resources best place them to renegotiate care.