"I'm not terribly lonely": Advancing the understanding of intimacy among older adults.

BACKGROUND AND OBJECTIVES: Intimacy, a social relationship component, continues to be essential in later life, including for older adults in long-term care such as assisted living. Yet, no previous study has conceptualized how individuals experience intimacy holistically (i.e., broadly defined) and within the context of later life, health decline, and long-term care. The purpose of this analysis was to provide an in-depth understanding of intimacy in the lives of older adults in assisted living. RESEARCH DESIGN AND METHODS: Using grounded theory methods, we analyzed data from the "Convoys of Care" (Kemp, PI: R01AG044368) longitudinal, qualitative research project. Data consisted of 2224 h of participant observation and interviews with 28 assisted living residents (aged 58-96), and their care partners (n = 114) followed over two years from four diverse assisted living communities. RESULTS: Residents' experience with intimacy was a process involving four dimensions: emotional, intellectual, spiritual, and physical. Intimacy occurred in platonic or romantic forms and was dynamic over time alongside residents' intimacy needs. Residents engaged in an ongoing process requiring that they manage their needs while negotiating intimacy opportunities and constraints. DISCUSSION AND IMPLICATIONS: Our findings expand the current conceptualization of intimacy in later life, specifically in the context of long-term care. Findings indicate the need for an approach to long-term care that addresses individuals' intimacy needs and preferences.

Communicative Competence: Responding to Residents' Health Changes in Assisted Living.

BACKGROUND AND OBJECTIVES: Frail and disabled individuals, including assisted living (AL) residents, are embedded in care convoys composed of dynamic networks of formal and informal care partners. Yet, little is known about how care convoys operate over time, especially when health changes occur. Thus, our aim was to provide an in-depth understanding of care convoy communication during times of residents' health changes in AL. RESEARCH DESIGN AND METHODS: Data for this analysis come from a Grounded Theory study that involved 50 residents and their care convoy members (n = 169) from 8 diverse AL communities followed over 2 years. Researchers conducted formal and informal interviewing, participant observation, and record review. RESULTS: We identified "communicative competence" as an explanatory framework in reference to a resident's or care partner's ability, knowledge, and action pertaining to communication and health change. Individual and collective competencies were consequential to timely and appropriate care. Communication involved: identifying; assessing significance; informing, consulting or collaborating with others; and responding to the change. Variability in communication process and properties (e.g., pace and timing; sequencing, timing, content, and mode of communication) depended on multiple factors, including the nature of the change and resident, informal and formal caregiver, convoy, AL community, and regulatory influences. DISCUSSION AND IMPLICATIONS: Formal and informal care partners need support to establish, enhance, and maintain communicative competence in response to health changes. Findings reinforce the need for timely communication, effective systems, and well-documented accessible health care directives and have implications that are applicable to AL and other care settings.

Exposing the Backstage: Critical Reflections on a Longitudinal Qualitative Study of Residents' Care Networks in Assisted Living.

In this article, we analyze the research experiences associated with a longitudinal qualitative study of residents' care networks in assisted living. Using data from researcher meetings, field notes, and memos, we critically examine our design and decision making and accompanying methodological implications. We focus on one complete wave of data collection involving 28 residents and 114 care network members in four diverse settings followed for 2 years. We identify study features that make our research innovative, but that also represent significant challenges. They include the focus and topic; settings and participants; scope and design complexity; nature, modes, frequency, and duration of data collection; and analytic approach. Each feature has methodological implications, including benefits and challenges pertaining to recruitment, retention, data collection, quality, and management, research team work, researcher roles, ethics, and dissemination. Our analysis demonstrates the value of our approach and of reflecting on and sharing methodological processes for cumulative knowledge building.