자연주의적 탐구조사(Naturalistic Inquiry)

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Why People Die by Suicide

Operating room planning and scheduling: A literature review

Integrated care is a burgeoning field. As is often the case in new areas of inquiry and action, conceptual clarification is demanded. Without such attention, it would be difficult to advance theory and practice in this increasingly important professional arena. In the following discussion paper, the authors explore the intellectual territory of integrated care, and underscore the need for a patient-centric imperative and meaning. They also examine the practical applications and implications arising from their views. The intention is to stimulate fruitful dialogue and debate about what ‘integrated care’ could and should be.

/pdf/integrated-care-meaning-logic-applications-and-implications-4wgwua33q4.pdf

Integrated care: meaning, logic, applications, and implications – a discussion paper

Although often associated with older age, loneliness and social isolation are not well understood in terms of their prevalence, risk and protective factors. Evidence suggests that only a minority of community-dwelling older people are "severely" lonely or isolated, however a number of factors need to be considered to fully understand the extent and significance of the problem. Community-based studies have identified a variety of risk factors for loneliness/isolation including widowhood, no (surviving) children, living alone, deteriorating health, and life events (eg, loss and bereavement). Having a confidant has been identified as a protective factor for loneliness. However, evidence is often unclear or inconclusive, especially within residential settings. We identified the need to conduct more residential care-focused research; the importance of addressing a variety of methodological concerns; and the need for practitioners to develop intervention programs that are appropriately targeted, evidence-based and evaluated.

/pdf/social-isolation-and-loneliness-among-older-people-issues-4yrshs1exr.pdf

Social isolation and loneliness among older people: issues and future challenges in community and residential settings.

The social environment is one of the key factors determining the quality of life of older people. Research has consistently demonstrated a strong and positive relationship between social engagement in all forms but especially participation within kin and wider social networks, and a high quality of life. However, this recognition of the importance of this relationship is not new. In the early 1960s, the ‘activity theorists’ of aging posited that the key to a good old age was the maintenance of high levels of activity, including social participation and the maintenance of kin- and friendship-based relationships. This resonates with the ideas of Rowe and Kahn who suggest that a high level of social engagement is a key factor in achieving the individually and socially desired goal of ‘successful aging’. Furthermore, they argue that, with advanced age, the social context, in combination with the physical environment, exerts a more potent influence upon the experience of later life than either intrinsic genetic or biological factors. Whilst the prescriptive strictures of activity theory and successful aging remain the subject of debate, there seems little doubt that the social environment continues to exert both a powerful influence upon, and provides a context within which people experience old age, both individually and collectively.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0959259805001723

Measuring loneliness in later life: a comparison of differing measures

Aim: To investigate ‘ageing in place’ in terms of house, locality and support, related to the Western Australia members of National Seniors Australia.



Methods:  A postal survey of 6859 members, followed by structured interviews with a subsample of respondents.



Results:  A similar proportion of respondents (nearly 30%) had either moved house recently or not for at least 20 years. Almost half were intending to stay in their current residence as they aged, this proportion increasing with age. A key reason for staying was having a ‘comfortable’ home. Related to moving, lifestyle change was particularly important for younger respondents and upkeep/maintenance difficulties for older respondents.



Conclusion:  For varied and complex reasons, many adults choose to move between the ages of 55 and 75. Government policy can further support older Australians to have choices of ‘places’ to live in that maximise their ability to retain independence.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1741-6612.2010.00469.x

Older people's decisions regarding 'ageing in place': a Western Australian case study.

Purpose: The aim of this study was to identify the important factors influencing residents’ satisfaction in residential aged care and to provide a better understanding of their interrelationships. Design and Methods: A cross-sectional survey design was used to collect the required information, including resident satisfaction, resident dependency levels, and staff satisfaction. A stratified random sampling approach was utilized to select facilities. All residents satisfying the selection criteria (i.e., understand English, be sufficient cognitive competence, have a sufficient energy level to participate in the survey, and live in the facility for more than 4 weeks) and all care staff were invited to participate. A total of 996 residents and 895 staff from 62 facilities (36 hostels and 26 nursing homes) provided the required data. Structural equation modeling was used to examine the interrelationships among three sets of contributing factors, related to the facility, staff and residents, and resident satisfaction components, separately for nursing home and hostel residents. Results: Overall fits of both nursing home and hostel models were satisfactory. This study has revealed that staff satisfaction plays a crucial and central role in determining resident satisfaction in nursing homes, whereas it has less impact in hostels. The provision of more care hours has only a small, yet positive, impact on resident satisfaction. Larger facility size has a negative impact on resident involvement. Older residents were found to bemore satisfied withstaff care. Implications: The results provide a comprehensive understanding of what influences resident satisfaction. By accounting

/pdf/factors-influencing-residents-satisfaction-in-residential-18z6ku06gj.pdf

Factors Influencing Residents' Satisfaction in Residential Aged Care

A randomised controlled trial was conducted to test the effectiveness of the Home Independence Program (HIP), a restorative home-care programme for older adults, in reducing the need for ongoing services. Between June 2005 and August 2007, 750 older adults referred to a home-care service for assistance with their personal care participated in the study and received HIP or 'usual' home-care services. Service outcomes were compared at 3 and 12 months. Subgroups of 150 from each group were also compared on functional and quality of life measures. Data were analysed by 'intention-to-treat' and 'as-treated'. The intention-to-treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care [Odds ratio (OR) = 0.18, 95% CI = 0.13-0.26, P < 0.001; OR = 0.22, 95% CI = 0.15-0.32, P < 0.001]. Both subgroups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living (IADL) in the as-treated analysis. Contamination of the control group by an increased emphasis on independence across the home-care agency involved, together with other methodological problems encountered, is thought to account for the few differences between groups in individual outcomes. Despite no difference between the groups over time in their overall ADL scores, a significantly smaller proportion of the HIP group required assistance with bathing/showering, the most common reason for referral, at 3 and 12 months. The results support earlier findings that participating in a short-term restorative programme appears to reduce the need for ongoing home care. The implementation of such programmes more broadly throughout Australia could substantially offset the projected increase in demand for home care associated with the five-fold projected increase in numbers of the oldest old expected over the next 40 years.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2524.2012.01088.x

Duncan Boldy

Papers

Social isolation and loneliness among older people: issues and future challenges in community and residential settings.

Measuring loneliness in later life: a comparison of differing measures

Older people's decisions regarding 'ageing in place': a Western Australian case study.

Factors Influencing Residents' Satisfaction in Residential Aged Care

A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults