Suchergebnisse

Abstract As governments adapt to 'active ageing' policies, care services are increasingly oriented towards helping older adults to stay active in order to maintain their physiological and cognitive capacity. Day centres for the frail old adults are adding more planned activities to their conventional social programmes. Although evidence indicates that they may benefit from physical fitness sessions and brain training, little is known about the way in which the activation agenda influences social interaction among participants. The article aims to fill this knowledge gap by exploring how staff and participants manoeuvre between the new activation agenda and processes of coming to terms with the functional decline of ageing bodies. We draw on ethnographic data, collected in four day centres in Denmark and Norway, constituting participant observation of 18 days, 19 interviews with older participants and 18 interviews with staff members. With reference to the dramaturgical approach of Erving Goffman, we demonstrate how different fitness identities are negotiated on different social stages. Firstly, we identify a social stage at a crossroad between staff acting as motivators in training sessions and older participants as active contributors. We demonstrate how day-care staff assist participants in keeping up appearances as fit for one's age by recognising their performance and concealing flawed performances. Secondly, we identify a social stage where participants socialise with co-participants around the lunch table and other social events. Here the act of 'keeping up appearances' turns into a complex art whereby people strive to retain their fitness identity by comparing themselves with peers. Finally, based on observation 'backstage', we reveal how participants distance themselves from the functional decline of old age by claiming that they are fit enough. We conclude that day centres are contested sites for active-ageing policies. ; publishedVersion

The detrimental effects of social isolation on health and well-being bring forward the need for increasing social inclusion and connectedness for older, homebound adults. Homecare services may be a source of social inclusion, but the inclusive dimensions and mechanisms of care have been less explored. This study aimed to develop more knowledge on how homecare can contribute to social inclusion by exploring older adults' experiences with care visits as social encounters. The study utilised interviews with older adults from four municipalities in Norway and Denmark from 2018 to 2019 and drew on a combination of social inclusion theories and Goffmanian microinteractionism. Positive accounts of care encounters comprised three overlapping thematic dimensions: 1) bringing social life into the house, 2) creating connections to the outside world and 3) providing opportunities to participate in a broader array of social roles and identities. Despite variations, care visits could encompass social inclusive and connective aspects that enhanced thriving and wellbeing. Care visits increased opportunities for social participation and support of a valued self and comprised bonding, bridging and linking social capital. Care workers could be important interpersonal network resources at home, providing support and social stimulation, engagement and fun. Moreover, they could bridge to the outside society through conversations or by linking to services (e.g. day centres) that increased social participation and bonding with peers outside the house. The inclusive resources embedded in homecare need to be supported and utilised in policy and practice to increase older people's inclusion.

Background Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process. Methods The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis. Discussion This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

Background: Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process. Methods: The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis. Discussion: This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science. ; The study is funded by The Research Council of Norway. ; publishedVersion