Self-Perceptions and Behavior of Older People Living Alone.

It is currently acknowledged that older people prefer to live in their own home, even if they are lonely or disabled in some way. The factors that condition aging among older people members of the population living alone include the following: the existence or absence of a social network, gender, the home or place where they live, their capacity to function, and welfare and health resources. The main goal of this study was to explore the perceptions of older peoples over 75 years old about adaptation strategies and the social, gender, physical autonomy, and socio-health resource factors that determine their permanence at home. The authors used a qualitative methodology, within a critical social framework, based on the theories of Pierre Bourdieu. When the interviewees' discourse was analyzed, four main categories were evident: (a) "A desire to stay at home", (b) "Changes and every-day aspects of domestic life", (c) "Reliance on social and family assistance", and (d) "The use of social services and resources". In synthesis, the participants questioned the benefits of the type of home life offered by members of the family. They believed that, in some cases, this option did not overcome the problem of loneliness or the need to hire assistance. The findings of the study revealed that one needs to dispel the notion of geriatric care as a form of charity, and to distinguish between the activities of caring, providing support, and offering companionship to someone. It is important to identify products designed for older people who might live for a long time.

Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making.

BACKGROUND: The patient is observed to acquire a passive role and the nurse an expert role with a maternalistic attitude. This relationship among others determines the capacity for autonomy in the decision making of patients. OBJECTIVES: The aim of this study is to analyse the nurse-patient relationship and explore their implications for clinical practice, the impact on quality of care, and the decision-making capacity of patients. DESIGN: A phenomenological qualitative study was conducted. SETTINGS AND PARTICIPANTS: Thirteen in-depth interviews with nurses and 61,484 nursing records from internal medicine and specialties departments in a general hospital from 2015-2016. METHODS: A discourse analysis and triangulation for these sources were conducted. RESULTS: The category elaborated from nursing records was defined according to the following codes: Good Patient, Bad patient, and Social Problem. Analysis of the interviews resulted in a category defined as Patient as a passive object. DISCUSSION: A good nurse-patient relationship reduces the days of hospital stay and improves the quality and satisfaction of both. However, in contrast, the good relationship is conditioned by the patient's submissive role. CONCLUSION: An equal distribution of power allows decisions about health and disease processes to be acquired by patients, autonomously, with the advice of professionals. The nurse-patient relationship should not pursue the change in values and customs of the patient, but position the professional as a witness of the experience of the health and illness process in the patient and family.

Attitudes and beliefs of Spanish families regarding their family members aged 75 years and over who live alone: a qualitative study.

OBJECTIVE: This study aimed to assess the attitudes and beliefs of Spanish families regarding their elderly family members aged 75 years and over who live alone, with consideration of gender and educational differences among the family members. METHODS: This qualitative study was based on the critical social paradigm, the theory of constructivist structuralism and Bourdieu's theory of sociology of action. Four discussion groups were created with the following distribution of family members based on their gender and educational level: women with higher education, women with basic or secondary education, men with higher education and men with basic or secondary education. Participants were selected using purposive and snowball sampling. Announcements inviting voluntary participation were posted at primary health care facilities, social centres and neighbourhood associations in Mallorca, Spain. RESULTS: Analyses of the group discussions and a field journal revealed that families believe that elderly individuals prefer to live alone to retain their freedom and individual identities. CONCLUSIONS: Families held two main views regarding elderly individuals living alone: a more traditional one in which elderly care is considered a moral duty associated with women, and a more modern view in which elderly care is considered a personal option that can be delegated. Sociomedical resources were considered insufficient and not easily accessible.

Instrumentalisation of the health system: An examination of the impact on nursing practice and patient autonomy.

Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much-needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision-making of nurses through the impact of health institution management models on clinical practice. Based on Foucault's ethical theory, a qualitative study was conducted through a discourse analysis of the nursing records in a hospital unit. The results revealed that the health institution standardises health care practice, which has an impact on professional and patient autonomy as it pertains to decision-making. The results of this research indicate that resistance strategies in the internal structures of health organisations can replace the normalisation and instrumentalisation of professional practice aimed at promoting patient self-determination.

Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting.

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

Análisis reflexivo de la hospitalización domiciliaria en el paciente anciano / Reflexive analysis of home hospitalization in the elderly

Presentamos una scoping review sobre el interés que puede tener desarrollar en nuestro sistema sanitario nuevos esquemas de hospitalización domiciliaria en pacientes ancianos con condiciones complejas asociadas a procesos agudos de salud. Se realizó una búsqueda bibliográfica de ensayos clínicos aleatorizados, revisiones sistemáticas y metaanálisis de los mismos en Pubmed y Cochrane Library, desde enero de1990 a julio de 2013. La búsqueda incluyó los términos hospital-at-home, early supported discharge, hospital in the home y home hospitalization. Se analizaron: modelo de intervención (sustitutivo del ingreso o facilitador del alta), edad, diagnóstico principal, perfiles de pacientes incluidos y tipo de intervención (disciplinas implicadas, duración de la intervención y principales objetivos y resultados). Concluimos que hay diversos modelos de hospitalización domiciliaria con resultados clínicos favorables. Aparte de esquemas sanitarios centrados en agudizaciones de enfermedades crónicas en ancianos más jóvenes, mayoritarios en nuestro país, destacan otros esquemas integrales basados en equipos interdisciplinares de base geriátrica orientados a intervenciones complejas. El desarrollo de esquemas de hospitalización domiciliaria integral, con equipos liderados por geriatras, es una oportunidad como alternativa a la hospitalización convencional adaptada a pacientes ancianos en nuestro entorno asistencial

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Factores que inciden en la soledad residencial de las personas mayores que viven solas / Factors affecting lonesomeness of older people living alone

El aumento de la esperanza de vida, los cambios sociales y los cambios en la estructura familiar hacen que cada vez sean más y durante más tiempo las personas mayores que prefieren vivir solas, incluso cuando necesitan cuidados. Este trabajo tiene como objetivo describir el problema de la soledad residencial de las personas mayores profundizando en los factores que pueden influir en esta circunstancia. Se ha realizado una estrategia de búsqueda bibliográfica a partir de los conceptos nucleares: "personas mayores de 75 años que viven solas", "persona mayor frágil", "soporte social y entorno", "nivel de instrucción» y "familia". La información recopilada de las aportaciones científicas realizadas en este campo pone de manifiesto la necesidad de considerar prioritario conocer la opinión de las personas mayores y sus familias sobre los factores que modifican la permanencia en el domicilio

Increased life expectancy, social changes and changes in family structure make increasingly more and longer, elderly prefer to live alone even when they need care. This paper aims to describe the problem of loneliness of the elderly residential delving into the factors that may influence this circumstance. There has been a search strategy based on the core concepts: "Elderly people over 75 years living alone", "Elderly Person fragile social support and environment", "level of education» and «family". The information gathered from the scientific contributions made in this field highlights the need to give priority to the views of older people and their families about the factors that modify the stay at home

Estrategias de cuidados de las familias con las personas mayores que viven solas / Care strategies of the families with elderly people living alone

Los cambios en el envejecimiento hacen una llamada a trasformar los cuidados dirigidos a las personas mayores que viven solas. Objetivo: Conocer la percepción de la familia sobre el cuidado a los mayores que viven solos. Metodología: Estudio cualitativo mediante análisis de discurso a partir del referencial crítico social y los conceptos de la teoría de Bourdieu. Se realizaron 4 grupos de discusión agrupando a los participantes por género y nivel de instrucción. Resultados: los participantes consideran que la red sociofamiliar puede actuar sobre la discapacidad. Preocupa la manera en la que la persona mayor cubre sus necesidades. Destacan como fundamental el apoyo en la realización de los cuidados. Comparten la idea de que las mujeres mayores se adaptan mejor que los hombres a vivir en soledad. Las mujeres cuidadoras tienden a intervenir precozmente ante los problemas. Los hombres esperan y si pueden delegan. Conclusión: la familia cuestiona los beneficios de la convivencia. La orientación profesional en el cuidado es escasa. Los servicios sociales deben mejorar su accesibilidad (AU)

Changes in the aging make a call to transform the managed care for the elderly living alone. Objective: To know the perception of the family on care to seniors who live alone. Methodology: Qualitative study using analysis of referential discourse from social critic and concepts of the theory of Bourdieu. There were four discussion groups grouping the participants by gender and educational level. Results: The participants consider that the social and family network may act on disability. Concerned about the way in which the older person meets your needs. Stand out as key support in the delivery of care. Share the idea that older women are better suited than men to live in solitude. Women caregivers tend to intervene early with problems. Men expect and if they can delegate. Conclusion: The family questions the benefits of coexistence. Vocational guidance in the care is scarce. Social services should improve their accessibility (AU)

Divulgación en prensa de la Ley de Dependencia / Press disclosure Law Dependence

El presente trabajo tiene como objetivo analizar la aportación que la prensa escrita hace durante un período concreto a la visibilidad de las posibles mejoras que supondrá la implementación de la Ley de Promoción de Autonomía Personal y atención a las personas en situación de Dependencia, para el mayor y su familia. Diversos autores constatan que la prensa escrita es buen recurso para divulgar, promover la salud, crear opinión pública e influenciar en las conductas de las personas. Para la realización de este trabajo se revisaron 5 periódicos durante 239 días recopilando noticias relacionadas con la Ley. El mayor número de noticias encontradas hace alusión a la cartera de servicios y su coste. Conclusión principal: destaca el elevado número de textos que hacen referencia más a gestos políticos que a aspectos concretos de la ley (AU)

This study aims to analyze the contribution that the written press makes to the visibility of the possible improvements which might lead to the implementation of the Law Autonomy Promotion and care for people in a situation of dependency,for the elderly person and his family. Several authors note that the press is a good resource to publicize, promote health, create public opinion and influence in the conduct of the people. For this work, were checked five newspapers for 239 days to collect related news to the Law. The largest number of news found alludes to the portfolio of services and their cost. Stress the large number of texts that are more about political posturing than specific aspects of the law (AU)

Formación universitaria en geriatría: encuentros y desencuentros / Universitary training in geriatrics: meetings and misunderstandings

Los profesionales que se están formando en las universidades deberán hacer frente, en los países industrializados, a una población envejecida. La universidad debe adecuar la formación a las necesidades de la sociedad en la que está inserta. Por ello nos planteamos estudiar los contenidos en geriatría y gerontología que reciben los futuros profesionales. La revisión de los planes de estudios españoles refleja una formación desigual en este campo, por lo que se sugiere un replanteamiento desde la docencia que ayude a mejorar la calidad de vida de los ancianos (AU)