International insights on researching and providing for longer-lived communities
As the proportion of older people grows worldwide, this raises expectations of and responsibilities placed on families and support services, which cannot have been envisaged a few decades ago. In turn, these pressures demand a corresponding variety of types of research to generate the depth and complexity of insights required for policymakers to develop appropriate responses. The international spread of the articles offered in this issue enable appreciation of what distinct challenges are now being raised, how they are beginning to be addressed, but also what kinds of research can provide appropriate information to achieve this.
The opinion piece on the direct impact on Tanzanian older peoples’ health of HIV/AIDS, provided by Leshbari et al., sets out a stark reminder of what contemporary risks which older peoples’ need to manage, could not have been imagined 50 years ago when this disease did not exist. Even between three or even two most recent census dates, the authors’ statistical analysis reminds us that as the population ages and can also access successfully treatments, it is important to remember that older people are now more likely to be living with unmet HIVE/AIDS-related needs than younger people whose needs may have been more readily identified and provided for.
Alternative means of transport mobility are increasingly valued by older people seeking to extend their physical and mental well-being, but may be problematised in car-dependent communities when older people are less able to drive. Kotval’s study uses a spatial approach based on the US geographical information systems to assess the more flexible transit infrastructure that older adults can use in the Michigan Region of the USA. This approach helps underline the need for more diverse policy and community-led transit initiatives.
The diversity of intergenerational family responses worldwide is acknowledged by Mohd Suki et al. who go on to examine whether in one region of Malaysia, there is a relationship between family members’ quality of provision of and motivation to care and their access to emotional and social support for individuals. Here, a quantitative questionnaires study of 250 young adults in caregiver roles for older parents or older relatives across a range of multi-ethnic groups. They went on to use structural equation modelling to model the effects. Their findings indicated that higher levels of emotional and social support did encourage closer and better intergenerational caring ties particularly for male caregivers.
Swarbrick et al. provide an original single case study carried out within a larger study in England and Scotland, to encourage reflective consideration of researcher dilemmas of ethics and research practice for carrying out research with a person with dementia, close to the end of their life. The authors identify the particular need to ensure any associated research captures more than only words, to take a holistic approach which can more fully comprehend their lived experience. This is reframed to argue that a focus on compassion in research approaches will be particularly appropriate for ensuring the inclusion of the experience of this rarely-heard group of people.
Finally, Texeira, Azevedo et al. consider how in Portugal, the three main kinds of care services (nursing homes, day centres and home care services) available for older people are allocated based on complex socioeconomic and functional criteria which may not readily predict higher or lower risk of adverse outcomes. This paper aimed to characterize the client profile for each type of service for 224 service users, the relative risks they run (of institutionalisation, hospitalisation and death) according to the service type. They then consider the potential usefulness and ease of use of the Risk Instrument for Screening in the Community (RISC) to identify the risk profiles according to type of older service user characteristics, and of the services. Their results helped underline the particular relevance of recognising mental health concerns and, potentially a place for the RISC instrument for easing the collection of the information needed.
As institutional and policy recognition grows of older people as citizens of their communities and wider societies and nations, so too does the need to more widely acknowledge central relevance of providing comprehensive, accessible information to underpin their rights to appropriate support.
