Othering Older People's Housing: Gaming Ageing to Support Future-Planning.

The 'othering' of ageing is linked to an integrated process of ageism and hinders planning for the future for both individuals and practitioners delivering housing and health services. This paper aims to explore how creative interventions can help personalise, exchange knowledge and lead to system changes that tackle the 'othering' of ageing. The Designing Homes for Healthy Cognitive Ageing (DesHCA) project offers new and creative insights through an innovative methodology utilising 'serious games' with a co-produced tool called 'Our House' that provides insights into how to deliver housing for older people for ageing well in place. In a series of playtests with over 128 people throughout the UK, the findings show that serious games allow interaction, integration and understanding of how ageing affects people professionally and personally. The empirical evidence highlights that the game mechanisms allowed for a more in-depth and nuanced consideration of ageing in a safe and creative environment. These interactions and discussions enable individuals to personalise and project insights to combat the 'othering' of ageing. However, the solutions are restrained as overcoming the consequences of ageism is a societal challenge with multilayered solutions. The paper concludes that serious gaming encourages people to think differently about the concept of healthy ageing-both physically and cognitively-with the consideration of scalable and creative solutions to prepare for ageing in place.

Understanding Nuance and Ambivalence in Intergenerational Relationships Through Fiction.

BACKGROUND AND OBJECTIVES: The term "intergenerational relationships" is widely used in gerontological literature and age-related policies. However, discussions of the term often tell us surprisingly little about what it means or why it matters. We suggest that this is due to a reductivism and instrumentalism in 2 main discourses within which intergenerational relationships are usually discussed. First, intergenerational relationships are often conceptualized through a binary "conflict/solidarity" lens, reinforcing an entrenched "generationalism". Second, they are predominantly constructed as a problem to be addressed within debates on how to tackle intergenerational segregation. Neither of these discourses provides much room for a more nuanced understanding of how intergenerational relationships are experienced or why they are meaningful. In this paper, we discuss how fictional narratives can introduce imagination and a richer vocabulary into discourses concerning how people of different ages relate to each other. RESEARCH DESIGN AND METHODS: We present findings from reading groups where adults discussed novels depicting themes of older age, intergenerational relationships, and time. RESULTS: In discussing the fictional narratives and characters, participants reflected on the significance and meaning of intergenerational relationships in ways that went beyond dichotomous and instrumentalist discourses. Drawing on the concept of lived ambivalence, we argue that fictional representations of intergenerational themes can elicit more meaningful reflections on the complexities and contradictions of relationships across age groups. DISCUSSION AND IMPLICATIONS: We conclude that a more nuanced understanding of intergenerational interaction can inform gerontological discourses and policy, but also that gerontological awareness of social challenges concerning age relations can inform interpretations of fictional narratives.

Becoming at home in residential care for older people: a material culture perspective.

Residential homes encourage new residents to bring belongings with them, so that they can personalise their room and 'feel at home'. Existing literature on material culture in residential homes views objects as symbols and repositories of home and identity, which can facilitate a sense of belonging in residents through their display in residents' rooms. I suggest that this both misunderstands the processual and fluid nature of home and identity, and conceptualises objects as essentially passive. This article uses ethnographic data and theories of practice and relationality to argue that rather than the meaning of home being inherent in objects, or felt subjectively by residents, meaning is generated through ongoing, everyday interactions between the two. I show that residents became at home by acquiring new things -as well as displaying existing possessions - and also through interacting with mundane objects in everyday social and relational practices such as cleaning and hosting. I conclude that being at home in older people's residential homes need not be so different from being at home at other stages of the life course and in other settings. This challenges conceptualisations of older people's homes - and older age itself - as somehow unknowable and unfamiliar.

Development of Trust in an Online Breast Cancer Forum: A Qualitative Study.

BACKGROUND: Online health forums provide peer support for a range of medical conditions including life-threatening and terminal illnesses. Trust is an important component of peer-to-peer support, although relatively little is known about how trust forms within online health forums. OBJECTIVE: The aim of this paper is to examine how trust develops and influences sharing among users of an online breast cancer forum. METHODS: An interpretive qualitative approach was adopted. Data were collected from forum posts from 135 threads on 9 boards on the UK charity, Breast Cancer Care (BCC). Semistructured interviews were conducted with 14 BCC forum users. Both datasets were analyzed thematically using Braun and Clarke's approach and combined to triangulate analysis. RESULTS: Trust operates in 3 dimensions, structural, relational, and temporal, and these intersect with each other and do not operate in isolation. The structural dimension relates to how the affordances and formal rules of the site affected trust. The relational dimension refers to how trust was necessarily experienced in interactions with other forum users: it emerged within relationships and was a social phenomenon. The temporal dimension relates to how trust changed over time and was influenced by the length of time users spent on the forum. CONCLUSIONS: Trust is a process that changes over time and which is influenced by structural features of the forum, as well as informal but collectively understood relational interactions among forum users. The study provides a better understanding of how the intersecting structural, relational, and temporal aspects that support the development of trust facilitate sharing in online environments. These findings will help organizations developing online health forums.

Public attitudes towards alcohol control policies in Scotland and England: Results from a mixed-methods study.

The harmful effects of heavy drinking on health have been widely reported, yet public opinion on governmental responsibility for alcohol control remains divided. This study examines UK public attitudes towards alcohol policies, identifies underlying dimensions that inform these, and relationships with perceived effectiveness. A cross-sectional mixed methods study involving a telephone survey of 3477 adult drinkers aged 16-65 and sixteen focus groups with 89 adult drinkers in Scotland and England was conducted between September 2012 and February 2013. Principal components analysis (PCA) was used to reduce twelve policy statements into underlying dimensions. These dimensions were used in linear regression models examining alcohol policy support by demographics, drinking behaviour and perceptions of UK drinking and government responsibility. Findings were supplemented with a thematic analysis of focus group transcripts. A majority of survey respondents supported all alcohol policies, although the level of support varied by type of policy. Greater enforcement of laws on under-age sales and more police patrolling the streets were strongly supported while support for pricing policies and restricting access to alcohol was more divided. PCA identified four main dimensions underlying support on policies: alcohol availability, provision of health information and treatment services, alcohol pricing, and greater law enforcement. Being female, older, a moderate drinker, and holding a belief that government should do more to reduce alcohol harms were associated with higher support on all policy dimensions. Focus group data revealed findings from the survey may have presented an overly positive level of support on all policies due to differences in perceived policy effectiveness. Perceived effectiveness can help inform underlying patterns of policy support and should be considered in conjunction with standard measures of support in future research on alcohol control policies.

Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey.

BACKGROUND: Public knowledge of the association between alcohol and cancer is reported to be low. We aimed to provide up-to-date evidence for England regarding awareness of the link between alcohol and different cancers and to determine whether awareness differs by demographic characteristics, alcohol use, and geographic region. METHODS: A representative sample of 2100 adults completed an online survey in July 2015. Respondents were asked to identify which health outcomes, including specific cancers, may be caused by alcohol consumption. Logistic regressions explored whether demographic, alcohol use, and geographic characteristics predicted correctly identifying alcohol-related cancer risk. RESULTS: Unprompted, 12.9% of respondents identified cancer as a potential health outcome of alcohol consumption. This rose to 47% when prompted (compared to 95% for liver disease and 73% for heart disease). Knowledge of the link between alcohol and specific cancers varied between 18% (breast) and 80% (liver). Respondents identified the following cancers as alcohol-related where no such evidence exists: bladder (54%), brain (32%), ovarian (17%). Significant predictors of awareness of the link between alcohol and cancer were being female, more highly educated, and living in North-East England. CONCLUSION: There is generally low awareness of the relationship between alcohol consumption and cancer, particularly breast cancer. Greater awareness of the relationship between alcohol and breast cancer in North-East England, where a mass media campaign highlighted this relationship, suggests that population awareness can be influenced by social marketing.

Developing a social practice-based typology of British drinking culture in 2009-2011: implications for alcohol policy analysis.

BACKGROUND AND AIMS: The concept of national drinking culture is well established in research and policy debate, but rarely features in contemporary alcohol policy analysis. We aim to demonstrate the value of the alternative concept of social practices for quantitatively operationalizing drinking culture. We discuss how a practice perspective addresses limitations in existing analytical approaches to health-related behaviour before demonstrating its empirical application by constructing a statistical typology of British drinking occasions. DESIGN: Cross-sectional latent class analysis of drinking occasions derived from retrospective 1-week drinking diaries obtained from quota samples of a market research panel. Occasions are periods of drinking with no more than 2 hours between drinks. SETTING: Great Britain, 2009-11. CASES: A total of 187 878 occasions nested within 60 215 nationally representative adults (aged 18 + years). MEASUREMENTS: Beverage type and quantity per occasion; location, company and gender composition of company; motivation and reason for occasion; day, start-time and duration of occasion; and age, sex and social grade. FINDINGS: Eight occasion types are derived based primarily on parsimony considerations rather than model fit statistics. These are mixed location heavy drinking (10.4% of occasions), heavy drinking at home with a partner (9.4%), going out with friends (11.1%), get-together at someone's house (14.4%), going out for a meal (8.6%), drinking at home alone (13.6%), light drinking at home with family (12.8%) and light drinking at home with a partner (19.6%). CONCLUSIONS: An empirical model of drinking culture, comprising a typology of drinking practices, reveals the dominance of moderate drinking practices in Great Britain. The model demonstrates the potential for a practice perspective to be used in evaluation of how and why drinking cultures change in response to public health interventions.

Lay epidemiology and the interpretation of low-risk drinking guidelines by adults in the United Kingdom.

AIMS: To explore how the concept of lay epidemiology can enhance understandings of how drinkers make sense of current UK drinking guidelines. METHODS: Qualitative study using 12 focus groups in four sites in northern England and four sites in central Scotland. Participants were 66 male and female drinkers, aged between 19 and 65 years, of different socio-economic backgrounds. Data were analysed thematically using a conceptual framework of lay epidemiology. RESULTS: Current drinking guidelines were perceived as having little relevance to participants' drinking behaviours and were generally disregarded. Daily guidelines were seen as irrelevant by drinkers whose drinking patterns comprised heavy weekend drinking. The amounts given in the guidelines were seen as unrealistic for those motivated to drink for intoxication, and participants measured alcohol intake in numbers of drinks or containers rather than units. Participants reported moderating their drinking, but this was out of a desire to fulfil work and family responsibilities, rather than concerns for their own health. The current Australian and Canadian guidelines were preferred to UK guidelines, as they were seen to address many of the above problems. CONCLUSIONS: Drinking guidelines derived from, and framed within, solely epidemiological paradigms lack relevance for adult drinkers who monitor and moderate their alcohol intake according to their own knowledge and risk perceptions derived primarily from experience. Insights from lay epidemiology into how drinkers regulate and monitor their drinking should be used in the construction of drinking guidelines to enhance their credibility and efficacy.

The provision of emotional labour by health care assistants caring for dying cancer patients in the community: a qualitative study into the experiences of health care assistants and bereaved family carers.

BACKGROUND: While previous research has suggested that health care assistants supporting palliative care work in the community regard the provision of emotional labour as a key aspect of their role, little research has explored the experiences of family carers who are the recipients of such support. OBJECTIVE: To explore the emotional labour undertaken by health care assistants working in community palliative care from the perspectives of both health care assistants and bereaved family carers. DESIGN: We conducted a qualitative interview study in 2011-2012 with bereaved family carers of cancer patients who had received the services of health care assistants in the community, and health care assistants who provided community palliative care services. Transcripts were coded and analysed for emergent themes using a constant comparative technique. SETTINGS: Three different research sites in the United Kingdom, all providing community palliative care. PARTICIPANTS AND METHODS: Semi-structured interviews were conducted with 33 bereaved family carers and eight health care assistants. RESULTS: Health care assistants view one of their key roles as providing emotional support to patients and their family carers, and family carers recognise and value this emotional support. Emotional support by health care assistants was demonstrated in three main ways: the relationships which health care assistants developed and maintained on the professional-personal boundary; the ability of health care assistants to negotiate clinical/domestic boundaries in the home; the ways in which health care assistants and family carers worked together to enable the patient to die at home. CONCLUSION: Through their emotional labour, health care assistants perform an important role in community palliative care which is greatly valued by family carers. While recent reports have highlighted potential dangers in the ambiguity of their role, any attempts to clarify the 'boundaries' of the health care assistant role should acknowledge the advantages health care assistants can bring in bridging potential gaps between healthcare professionals and family carers.

Food provision for older people receiving home care from the perspectives of home-care workers.

Malnutrition is a significant cause of morbidity and mortality, particularly among older people. Attention has focused on the inadequacies of food provision in institutions, yet the majority suffering from malnutrition live in the community. The aim of this study was to explore barriers and facilitators to food provision for older people receiving home care. It was a qualitative exploratory study using semi-structured interviews with nine home-care workers in June 2013 employed by independent agencies in a large city in northern England. Data were analysed thematically, based on the principles of grounded theory. Findings showed that significant time pressures limited home-care workers in their ability to socially engage with service users at mealtimes, or provide them with anything other than ready meals. Enabling choice was considered more important than providing a healthy diet, but choice was limited by food availability and reliance on families for shopping. Despite their knowledge of service users and their central role in providing food, home-care workers received little nutritional training and were not involved by healthcare professionals in the management of malnutrition. Despite the rhetoric of individual choice and importance of social engagement and nutrition for health and well-being, nutritional care has been significantly compromised by cuts to social care budgets. The potential role for home-care workers in promoting good nutrition in older people is undervalued and undermined by the lack of recognition, training and time dedicated to food-related care. This has led to a situation whereby good quality food and enjoyable mealtimes are denied to many older people on the basis that they are unaffordable luxuries rather than an integral component of fundamental care.