We are the UK’s leading publisher of books on Ageing and Gerontology and our titles fill a clear gap in the current literature. The list interrogates the challenges of an ageing population, push forward knowledge and reframe perspectives.
Central to this are the international and comparative works in the Ageing in a Global Context series, published in association with the British Society of Gerontology, and the Longitudinal and Lifecourse Studies journal.
Ageing and Gerontology
In the Middle East and North Africa (MENA) region, the commitment to honour parents and keep private ‘issues’ within the home combine to shape caregiving styles and needs. Evidence on the effectiveness of interventions for informal caregivers for people living with dementia in the MENA region is lacking. This study offers an overview of interventions for caregivers. It also explores informal caregivers’ needs, preferences and views on addressing intervention through online content. A middle-range programme theory is developed to provide insight into the mechanisms underpinning the interventions.
A realist review approach was used to explore what intervention types and features support the informal caregivers of people living with dementia throughout the MENA region and to examine in which contexts and how these interventions worked. The realist synthesis included 23 articles and eight interviews with health professionals. Eight context–mechanism–outcome configurations (CMOCs) were extrapolated to build and iteratively refine a middle-range programme theory and finalise it for testing. Contextual conditions that emerged include stigma, long care duration, culture, lack of support and the effect of this on intervention uptake. Mechanisms reported include feeling supported and empowering caregivers with the skills, knowledge and support they need, which led to outcomes such as improved quality of life for people living with dementia and caregivers and reduction in stress for caregivers.
This article contributes to the limited literature by addressing an identified gap in knowledge, providing insights into informal caregivers of people living with dementia in the MENA region to understand why particular interventions work or not, and in what contexts.
Introduction:
Mexico faces unique challenges due to the confluence of population ageing, an increasing burden of chronic conditions and limited resources to address these concerns. Substantial evidence links both independent and co-occurring chronic conditions to the risk of cognitive decline, but the association between common multimorbidity patterns and change in cognitive function has not been examined among older adults in Mexico.
Objective:
The objective of our research was to identify the most common multimorbidity patterns among ageing Mexican adults in 2012, then examine the association between these multimorbidity patterns and change in cognitive function with advancing age.
Methodology:
Data from the Mexican Health and Aging Study (2012–21; n = 6,082) was used to identify multimorbidity patterns in 2012 (including hypertension, diabetes, cancer, lung disease, heart attack, stroke, arthritis and depressive symptoms), then latent growth modelling was used to examine associations between the mean cognitive trajectory and the baseline multimorbidity patterns.
Results:
Several baseline multimorbidity patterns were associated with variation in cognitive function. Diabetes and depressive symptoms were present in the majority of multimorbidity patterns associated with lower cognitive function at baseline, and respondents with either lone diabetes or hypertension+diabetes+arthritis at baseline experienced more rapid cognitive decline than those reporting no conditions at baseline.
Conclusion:
Our findings suggest that prevention and management of diabetes may reduce cognitive gaps that manifest prior to older adulthood and protect against rapid cognitive decline among older Mexican adults. Further examination of depressive symptoms as a component of multimorbidity and cognitive change is also warranted.
Institutionalisation marks a significant transition for older adults, often accompanied by a multitude of challenges encompassing ageing, uncertainty and social dynamics. This qualitative study delves into the lived experiences of institutional older adults, focusing on the intricate interplay between ageing processes, the formation and maintenance of social bonds and the negotiation of ambiguity within institutional settings. Prior to moving into an old-age home, many older adults rely on long-established social networks. However, institutionalisation often disrupts these networks, creating a need for older adults to form new connections within the facility. Through in-depth interviews and thematic analysis, the research elucidates the multifaceted nature of ageing experiences, revealing how older adults navigate the passage of time amid shifting social landscapes and ambiguous circumstances. Findings underscore the centrality of social capital in buffering the effects of uncertainty and fostering resilience among institutional older adults. The themes that emerge highlight the importance of social connections in providing emotional support, practical assistance and a sense of belonging, which serve as critical resources in adapting to institutional life. Moreover, the study illuminates the ways in which older adults actively engage in sense-making processes, renegotiating identities and priorities in light of institutionalisation. By examining these experiences, this research contributes to a nuanced understanding of ageing in institutional contexts, emphasising the significance of social relationships in promoting wellbeing and adjustment. Insights gleaned from this study have implications for the development of interventions aimed at enhancing social support networks and fostering a supportive environment conducive to the holistic needs of institutional older adults.
Loneliness is a growing public health concern among the ageing population. Increasingly, scholars have recognised that even married and partnered persons experience loneliness and that loneliness is associated with the health and wellbeing of both partners. Prior research has linked individual loneliness with impaired kidney functioning, but to date no study has explored dyadic associations of both one’s own and a partner’s loneliness with biological measures of kidney function. This study uses dyadic data from the 2015 wave of the Survey of Health, Ageing and Retirement in Europe (SHARE; n = 10,139 individuals from 5,290 couples) to examine associations of both partners’ loneliness with Cystatin C, a blood-based biomarker of kidney function, in a large sample of midlife and older couples in Europe. Multilevel models analysed dyadic data, wherein individuals were nested within couples. Results indicated that both individuals’ own reports of loneliness and their partners’ reports of loneliness were uniquely associated with higher Cystatin C levels. This extends prior research on dyadic loneliness and cardiovascular biomeasures, suggesting Cystatin C may be a physiological pathway for long-term health effects of loneliness – for oneself and a partner. These findings suggest that both being lonely and having a lonely partner may be risk factors for poorer kidney function, which could have implications for the overall health of both partners. We discuss implications of these findings for theory and future research and suggest Cystatin C as a potential biological pathway for harmful effects of dyadic loneliness on health among ageing couples.
Doing empirical research and developing a theory is about constructing knowledge. This and the following chapter contain a general discussion of the construction of knowledge, in particular about care and caring. Chapter 5 focuses on empirical research and Chapter 6 on conceptual thinking. Both are quintessential to acquiring a grounded understanding of care and caring. An essential element of the practising of presence is a radical turn to particularity and the everyday life. This turn is connected with the empirical turn, the practice turn and the relational turn. This chapter discusses the empirical turn, emphasising an oscillating movement between empirical work, theory development and ethical reflection. It sheds a specific light on research ethics. The chapter presents the idea of phenomenological, theory-oriented N=N case studies. The quality of the findings is based on the exemplariness and extensiveness of the case descriptions, the rigour of the analysis, the innovative power of the concepts developed and the resonance validity, the approval the findings receive from participants in the practice.
This chapter discusses conceptual thinking and its contribution to knowledge construction. In the presence-theoretical perspective, care is conceptualised as a practice, or more precisely: as the intersection of many practices. Practice theory is therefore an indispensable heuristic device in our inquiry into care practices, even more appropriate than advanced complexity theories. Practices rarely come alone. They intersect each other, forming associations or networks of practices. The chapter briefly discusses the concept of form of life – inert bundles of social practices that form instances of problem solving. The chapter further addresses the complexity, dynamics and emergence of many practices of care, help and support, moving beyond reductionism and doing justice to the practical and ethical wickedness of professionalism in handling critically social issues. The chapter ends by arguing why it is not a good idea to use complexity theories.
Learning to work according to the conception of relational caring/practising presence endorsed in this book is foremost a process of professional subjectification, formation, Bildung. This differs greatly from the idea that the professional is and should be an obedient applicator of rules, providing superior and decisive knowledge based on their ‘expertise’ or evidence-based knowledge. Instead of a formational model, this chapter presents a map of domains and formational goals in each of these domains, which are: the relational caring approach, perception, interpretation, knowledge and practical wisdom. The formational process requires exposure, that is, a supervised mode of exposing oneself to the reality of a particular situation, context or practice, by a thorough, methodical and intentional immersion into the situation, context or practice in question and the lifeworld of the people involved in it. It further requires deep learning and the learning context of communities of practice. It is embedded in an ongoing practice and will continue. Working from a presence theoretical perspective requires interested inquiry as a continuous learning process in practice and for the sake of practical wisdom.
At some point, the question arises: but is this good care, and can you give an account of it and publicly account for it properly? This chapter discusses the Care-Ethical Model of Quality Enquiry (CEMQUE). Also, when working relationally, the quality criteria must be clear and accountable. The traditional approach is often inadequate or insufficient here. To think about good care and to be able to give an account of it, one has to think about care as relational work, about acting – and refraining from acting – as a practically wise professional, and about cultivating (self-)reflective quality awareness, instead of developing external quality criteria and systems. CEMQUE is helpful to describe, evaluate and improve the quality of existing practices. It has four dimensions: of the care receiver and their concerns, the caregiver and their solicitude, the care organisation and its hospitality and the societal, institutional and scholarly context. Raising the finality question is conditional. The ultimate criterion of good care is not quality of life, but achieving a satisfactory relationship with the fragility of one’s existence.
The presence theoretical perspective is predicated on several meta-theoretical and political background theories. The choices concerning these background theories stem from how good care is found and conceptualised and how care receivers are regarded, recognised and treated in good care. In this sense, practice is paramount, and not theory. The position of the authors is more contextualist than universalist and more critical realist than social constructivist.
This chapter introduces the kinds of puzzles of good caring in healthcare and social work that the book is interested in. In these puzzles there is really something at stake. In today’s late modern societies in the Global North, clients and professionals in healthcare and social work find themselves in precarious situations. Six disturbing observations are made. For example, a strong, often protocol-driven emphasis on efficiency and safety is observed, which suppresses substantive, moral understandings of what good care, help and support is about. In response to these puzzles of good care the book presents a conception of care that is relational, empirically grounded, theoretically well informed, complex, critical, morally scrutinised and politically keen. This conception is the result of thorough empirical research but it is also a proposition, to be tested, supplemented and elaborated in new situations and in response to new issues. The chapter further explains the structure of the book and how to read it.
