Filial Piety, Generativity and Older Adults' Wellbeing and Loneliness in Denmark and China.

The article considers the potential of intergenerational encounters and family and social ties for alleviating loneliness and promoting older adults' wellbeing. Loneliness has been widely recognized as one of the factors that are most deeply and pervasively detrimental to older adults' wellbeing. We combine theoretical reflections with a comparative study of older adults in Denmark and China. Both countries have to deal with an aging population and growing number of cases of isolation and loneliness in an increasingly individualized society. They differ, however, with regard to how far they have developed a system of institutionalized care, as well as with regard to their culture-specific views of family life and parent-child relationships. We apply the notions of filial piety, known from Confucian philosophy but often misinterpreted as conservative and conformist, and generativity, to qualitative studies of older adults in Denmark and China. The great potential of intergenerational ties is confirmed. Our study also shows that filial piety is still highly valued, in both China and Denmark, and can be maintained even in a highly individualized society. There is, however, considerable uncertainty among both older adults and their younger relatives as to what is required and what can be expected; realism, and an emphasis on the quality, rather than the quantity of interaction, may be sensible coping strategies, but can also lead to unnecessary acquiescence and self-abnegation. Our study also serves to distinguish different aspects and effects on wellbeing of intergenerational relationships.

The interaction between good life conceptions and psychotherapeutic practice - an interpretative phenomenological study of psychologists' experiences.

Based on qualitative interviews with four Danish psychologists and employing Interpretative Phenomenological Analysis (IPA), this study explored psychologists' understandings about the good life and how these influence the participants' clinical practice. The study found that the participants were quite aware of how their conceptions of the good life play a role in their work. Good life understandings that influenced therapeutic practice were quite similar amongst participants and were largely characterized by traits often associated with good mental health. Themes identified were: "Everyday well-being," "presence", and "taking care of oneself and others," and subthemes were "contact with the self," "awareness of the good things in life," "connectedness," "to mean something to others," "coping with distress," and "compassion for oneself and others." Among participants, these good life conceptions had a similar influence on different areas of their practice in terms of how the participants understand their clients' issues, which impacted what they talk to their clients about, and what they seek to achieve with the clients in therapy. Therefore, the good life conceptions influenced the methods, techniques, personal behaviors, and therapeutic approaches used to provide good and effective therapy. Another finding was that participants' clinical experiences also seemed to impact their good life conceptions. The interpretation of the participants' experiences represented a hermeneutic model suggesting that the participants' good life conceptions and their clinical practice experiences might inform and reinforce each other in a continuously expanding overlap. The actual nature of this interaction and its implications are relevant for future research.

Alcohol in long-term care homes: A qualitative investigation with residents, relatives, care workers and managers.

Introduction: Western societies are aging rapidly, and habitual use of alcohol is changing among older adults. Hence, care facilities are facing novel challenges regarding alcohol use. This pioneering qualitative study seeks to investigate the role of alcohol in care homes, as seen from the perspectives of residents, care workers, relatives, and institution management simultaneously. Method: Five residents, four care workers, three relatives, and two care home managers participated in semi-structured interviews lasting 60 minutes maximum. An interpretative phenomenological analysis framework were utilised for the analysis. Results: It seems that there is a positive attitude towards the use of alcohol in care homes across the four groups of participants. They find that the use of alcohol is presently low among the residents. Importantly there appears to be an important symbolic value in the rituals surrounding alcohol which is upheld by all four groups. Conclusion: While experiences between the four groups seem to converge regarding the use of alcohol, there are still some important differences. Importantly, we suggest that these unique views be utilised in developing methods for handling alcohol use in care homes in the future.

Manipulation and free will in shared decision making.

In recent years, there has been an increased focus on patient involvement in treatment planning in the health care system. To reduce the risk of the clinician moving towards paternalism, various methods have been introduced-shared decision making, among others. The goal of shared decision making is for the clinician and patient to share available evidence on the best treatment and to raise awareness on the needs and preferences of the patient as to make a genuinely informed choice. However, in the present article, we discuss to which degree paternalism can be avoided in light of the clinician's role as an authority with certain knowledge and expertise. Through the philosophical theory of reasons-responsiveness, we discuss to which extend free will and control applies to the patient. Through theoretical analysis, we come to suggest that the clinician has a role as an ally rather than manipulator.

What do elderly problem drinkers aim for? Choice of goal for treatment among elderly treatment-seeking alcohol-dependent patients.

OBJECTIVE: The patient's free choice of treatment goals for alcohol use disorder (AUD) is predictive for treatment outcome. Presently there is limited knowledge of whether the age at onset of AUD influences the choice of goal for treatment. The present study investigates whether there are differences in choice of treatment goal between patients with very late onset alcohol use disorder (VLO AUD ≥ 60 years) and those having early or mid-age onset of AUD (EMO AUD < 60 years). METHOD: Participants were 341 persons, voluntarily enrolled in the Elderly Study, who were seeking treatment for AUD in outpatient centres for alcohol treatment in Denmark. Data regarding thoughts about abstinence, alcohol use in the last 90 days, motivation for treatment and psychiatric diagnosis were collected via questionnaires. A logistics regression was used to analyse the data. RESULTS: 32.1% of the participants with VLO AUD chose temporary abstinence goals, compared to 18.2% of the patients with earlier-onset AUD (p = 0.024). Further, 10.7% of participants with VLO AUD chose total abstinence goals compared to 31.3% of participants with early or mid-age onset AUD (p = 0.002). CONCLUSION: There are significant differences in choice of goal between participants with very late onset AUD and early or mid-age onset AUD. Individuals with very late onset alcohol use disorder tend to choose temporary abstinence over any other treatment goal whereas, in general, individuals with early onset alcohol use disorder choose permanent abstinence over other treatment goals.

Practical impressions of interpretative phenomenological analysis from the novice's standpoint.

BACKGROUND: Interpretative phenomenological analysis (IPA) is an approach to qualitative analysis that has increasingly been used in health and psychology over the past 10-15 years. AIM: To address the practical impressions of applying IPA, from the perspective of novice researchers. DISCUSSION: The authors have observed two areas to which they would like to draw novice researchers' attention: interpretations of the six steps of IPA and what 'interpretation' means in IPA. They provide tentative suggestions in these areas for supporting researchers new to IPA. CONCLUSION: More transparency in analysis when publishing work, alongside the introduction of interpretation as the 'seventh' step of IPA, may increase the quality of IPA research and help new researchers to understand the approach better.

Identifying Risk Factors for Late-Onset (50+) Alcohol Use Disorder and Heavy Drinking: A Systematic Review.

This systematic review seeks to expand the description and understanding of late-onset AUD and asks "Which risk factors have been reported for late-onset heavy drinking and AUD?" METHOD: Using PRISMA guidelines, a literature review and search was performed on May 19, 2015 using the following databases: MEDLINE, EMBASE, PubMed, and PsychInfo. Nine studies were included in the final review. RESULTS: The search revealed that only very few studies have been conducted. Hence, the evidence is limited but suggests that stress, role/identity loss, and friends' approval of drinking are associated with an increased risk for late-onset AUD or heavy drinking, whereas retirement, death of a spouse or a close relative does not increase the risk. DISCUSSION: Inherent differences in measurements and methodologies precluded a meta-analysis. Therefore, the results presented here are descriptive in nature. Most studies base their conclusions on a certain preconception of older adults with alcohol problems, which leads to a row of circular arguments. The factors that have been measured seem to have changed over time. CONCLUSION: There has been a lack of focus on the field of late-onset AUD since the 1970s, which possibly has led to misrepresentations and preconceptions on the complex nature of late-onset AUD. There is limited evidence for any specific risk factor for late-onset AUD or heavy drinking. We suggest the adoption of a qualitative approach to uncover what is intrinsic to late-onset AUD followed by quantitative studies with more agreement on methods and definitions.

Why do some older adults start drinking excessively late in life? Results from an Interpretative Phenomenological Study.

INTRODUCTION: This is a pioneering qualitative phenomenological hermeneutical study investigating a so far under-investigated group of older adults with very late-onset alcohol use disorder. The number of older adults is increasing, and the number of older adults with alcohol problems is increasing accordingly. We investigated older adults with very late-onset alcohol use disorder to identify what causes some people to develop problems with alcohol after the age of 60. METHOD: We interviewed 12 Danish individuals (seven men) whose alcohol use disorder started after the age of 60. For our analysis, we used the Interpretative Phenomenological Analysis framework, rigorously following the six steps it prescribes. Participants were included until data saturation was achieved. FINDINGS: After a lifelong unproblematic (at times heavy) use of alcohol, it seemed that using alcohol as a coping strategy was one of the main factors in very late-onset alcohol use disorder among our participants. We found that the participants experienced a marked loss of identity when they had no activities to fill up their time after retirement. Social activities involving alcohol were also closely related to very late-onset alcohol use disorder. CONCLUSION: Loss of identity, coping with physical and psychological problems, an overarching societal and social culture surrounding alcohol and the interrelationship between social life, alcohol use and heavy drinking are important factors that need be addressed clinically and preventively, and specifically for individuals experiencing very late-onset alcohol use disorder.

How do family pressure, health and ambivalence factor into entering alcohol treatment? Experiences of people aged 60 and older with alcohol use disorder.

AIM: This qualitative study is concerned with the motivations that lead older adults to enter treatment for alcohol problems. There is a need to expand our understanding of the unique characteristics and problems of this population to be able to devise specialised and effective treatments and preventive measures. METHOD: We conducted an analysis of secondary findings from interview data collected in a qualitative interpretative phenomenological analysis (IPA) study. Our participants were 12 elderly people aged 60 years or more who had experienced late-onset alcohol use disorder. Transcription, categorisation, collapsing and analysis were conducted rigorously in accordance with the IPA standards. FINDINGS: Family can function as a pressure structure in terms of fostering motivation for treatment. Participants were to a certain extent ambivalent about treatment, which led them to devaluing treatment and its effects. Our results are on par with comparable results from other studies. CONCLUSION: Older adults who experience very-late-onset of alcohol use disorder experience familial pressure and health concerns which lead them to enter treatment. Our participants seemed ambivalent about treatment and its necessity, which seems to lead to a devaluation of therapy.

Alcohol use and generational masculinity: An interdisciplinary approach.

INTRODUCTION: Alcohol ranks as a major risk factor for health-related harm and mortality. Older males who encounter alcohol problems late in life are an under-studied part of the affected population. This article seeks to broaden our understanding of this group by combining empirical data with humanistic cultural analysis. Specifically, it seeks to show how the desire to cope alone can be linked to generationally specific constructions of hegemonic masculinity. METHOD: Clinical empirical methods are fused here with those of literary analysis. The subjects which the clinical researcher chooses for scrutiny are different from those most natural to literary study, yet the interpretive approaches of qualitative phenomenological investigation and literary close reading are in fact quite similar, and we argue that new knowledge can be generated by evaluating cultural texts alongside the testimony of phenomenological research subjects. FINDINGS AND DISCUSSION: Our findings illustrate a thematic connection between subject testimony and literary texts from the relevant historical period. In the sources we compared - a qualitative study conducted in Denmark and a British novel, Kingsley Amis's 1954 Lucky Jim - we found a strong link between the values of masculinity and the values of independence. Older men's resistance of institutional treatment for alcohol problems has motivations which go beyond the desire not to rely on outside aid, a desire which may apply to any illness. As Lucky Jim helps us show, alcohol use functions for men of a certain generation as a symbol of rebellion against institutions, and having institutions play a dominant role in their alcohol cessation may create resistance in these men.