Handling the Dilemma of Self-Determination and Dementia: A Study of Case Managers' Discursive Strategies in Assessment Meetings.

In assessment meetings concerning care services for people with dementia, Swedish case managers face a dilemma. On the one hand, according to the law, the right to self-determination of every adult citizen must be respected, but on the other hand cognitive disabilities make it difficult to fulfill obligations of being a full-fledged citizen. In this article, we examine 15 assessment meetings to identify discursive strategies used by case managers to handle this dilemma. We also examine how these affect the participation of persons with dementia, and indicate implications of our study for social work practice and research.

How are decisions on care services for people with dementia made and experienced? A systematic review and qualitative synthesis of recent empirical findings.

BACKGROUND: During recent decades, there has been a growing recognition that people cannot be assumed incapable of making decisions about their own care solely on the basis of a dementia diagnosis and international agreements and legislative changes have strengthened the formal right for people with dementia to participate in decisions on care services. This raises important questions about how these decisions are currently made and experienced in practice. In this review, we address this question and highlight directions for further research. METHODS: We searched CINAHL, PsycINFO, ASSIA, Social Services Abstracts, Science Direct, Academic Search Premier, and PubMed. Twenty-four pertinent articles were identified, all representing qualitative studies. Relevant findings were extracted and synthesized along dimensions of involvement of the person with dementia in decisions on care services, using an integrative approach to qualitative synthesis. RESULTS: We identified three overarching ways in which people with dementia are involved, primarily, in the informal part of a process of decisions: excluded, prior preferences taken into account, and current preferences respected. Several (10) articles seemed to be based on the assumption that decisions on care services are invariably and solely made within the family and without participation of the person with dementia. CONCLUSIONS: The review emphasizes the need for more updated research about international debates and agreements concerning capabilities and rights of people with dementia and about the (potential) formal contexts of care decisions in the country concerned. This, we argue, is vital for future knowledge production in the area.

A long life with a particular signature: life course and aging for people with disabilities.

What does it mean to live a long life and grow old with disabilities? Or to be an aging parent and still be a caregiver to a disabled adult child? These are questions discussed in this article, the aim of which is to show how a life course perspective adds insight to the lived experience of disability and ageing of adults with disabilities. It is argued that the time concept is fundamental to the understanding of the lives of disabled people. Results are presented which challenge established knowledge regarding disability policies, autonomy, body, biographical disruption and prerequisites of active aging.

Communication officers in local authorities meeting social media: On the production of social media photos of older adults.

European local authorities increasingly use social media to present services and activities organized for citizens living in the particular area. Previous studies found that authority-managed social media visually depicted older adults as being active, sociable, happy, and physically capable, reflecting the normative "third age" representation. Yet few studies to date have examined how local authorities produce the photos of older adults for social media posting. Drawing on semi-structured interviews with communication officers in a Swedish municipality, the purpose of this study is to investigate the production process for social media photos of older adults within local authorities from an institutional logics perspective. The analysis illustrates that communication officers strive to create a good image of the municipality and its services, follow municipal policy and EU law on data protection, seek photos through particular sources, adjust to and develop photographic standards of good photos, and endeavor to promote social media engagement in the photos. These motives and work practices of communication officers contribute to the visual representations of older adults as engaging in municipal services, being socially active, and staying physically capable. The analysis also indicates that both social media and bureaucratic logics encourage officers to produce photos of older adults that highlight the bright side of later life. The findings contribute to previous studies on online representations of older adults generated by local authorities, by showing how the third age representation may come about in practice, and which logics may influence officers to generate such representation. Furthermore, the knowledge provided could be used as a basis for assessment and improvement on authorities' production for social media photos of older adults, which in turn contributes to more diverse and thoughtful representations of older adults and later life in authority-managed social media.

Ageism in Health Care: A Systematic Review of Operational Definitions and Inductive Conceptualizations.

PURPOSE: International and national bodies have identified tackling ageism in health care as an urgent goal. However, health professionals, researchers, and policy makers recognize that it is not easy to identity and fight ageism in practice, as the identification of multiple manifestations of ageism is dependent on the way it is defined and operationalized. This article reports on a systematic review of the operational definitions and inductive conceptualizations of ageism in the context of health care. DESIGN AND METHODS: We reviewed scientific articles published from January 1995 to June 2015 and indexed in the electronic databases Web of Science, PubMed, and Cochrane. Electronic searches were complemented with visual scanning of reference lists and hand searching of leading journals in the field of ageing and social gerontology. RESULTS: The review reveals that the predominant forms of operationalization and inductive conceptualization of ageism in the context of health care have neglected some components of ageism, namely the self-directed and implicit components. Furthermore, the instruments used to measure ageism in health care have as targets older people in general, not older patients in particular. IMPLICATIONS: The results have important implications for the advancement of research on this topic, as well as for the development of interventions to fight ageism in practice. There is a need to take into account underexplored forms of operationalization and inductive conceptualizations of ageism, such as self-directed ageism and implicit ageism. In addition, ageism in health care should be measured by using context-specific instruments.

To protect and to support: How citizenship and self-determination are legally constructed and managed in practice for people living with dementia in Sweden.

Since living with dementia implies increasing difficulties in taking charge of rights due to cognitive as well as communicative impairments, many people with dementia are vulnerable and in need of support in order to realize full citizenship. In Sweden, all adults right to self-determination is strongly emphasized in law, regulations, and policies. Further, and in contrast to the situation in many other countries, people living with dementia cannot be declared as incompetent of making decisions concerning social care and their right to self-determination cannot legally be taken away. The article shows that in the Swedish welfare system, the focus is more on protecting the self-determination of citizens than on supporting people in making decisions and exercising citizenship. Subsequently, this causes legally constructed zones of inclusion and exclusion. This article examines and problematizes how different institutional contexts, legal constructions, norms, and practices in Sweden affect the management of issues concerning guardianship, supported decision-making and self-determination, and outline the implications for people living with dementia.