Sense-Making of Loneliness and Exclusion From Social Relations Among Older Adults in Sweden.

BACKGROUND AND OBJECTIVES: Loneliness and exclusion from social relations (ESR) are frequently addressed as public health issues for older adults. Public discourses potentially influence how loneliness and ESR are understood in society and experienced by the individual. The aim of this study was to analyze how older adults in different parts of Sweden use the discourses and concepts available to them to describe experiences of ESR and loneliness, and how these descriptions are used to construct a self-identity. RESEARCH DESIGN AND METHODS: Qualitative semi-structured interviews were conducted with 30 individuals (14 men, 16 women) aged 67-87 years and living in Sweden. Emphasis was, in line with perspectives of discursive psychology, on how individuals draw on discourses to make sense of experiences. The empirical material was analyzed through an inductive process where we were open to finding concepts and themes. RESULTS: Most participants emphasized the importance of not being lonely, considered achievable through maintaining an active lifestyle. "Othering" was taking place, where a general image of a "lonely" older adult was referred to when speaking about "others" loneliness. Those who expressed feelings of loneliness related these feelings to loss, being omitted, and other difficult life circumstances. DISCUSSION AND IMPLICATIONS: States of ESR were discussed more comfortably than loneliness, whereas various linguistic resources were used to distance themselves from loneliness. These findings indicate the need for further studies elaborating on how older adults make sense of ESR and loneliness and what implications this has for older adults' well-being and identity making.

Policy Narratives on Palliative Care in Sweden 1974-2018.

In Sweden, efforts to govern end-of-life care through policies have been ongoing since the 1970s. The aim of this study is to analyse how policy narratives on palliative care in Sweden have been formulated and have changed over time since the 1970s up to 2018. We have analysed 65 different policy-documents. After having analysed the empirical material, three policy episodes were identified. In Episode 1, focus was on the need for norms, standards and a psychological end-of-life care with the main goal of solving the alleged deficiencies within end-of-life care in hospital settings. Episode 2 was characterised by an emphasis on prioritising end-of-life care and dying at home, and on the fact that the hospice care philosophy should serve as inspiration. In Episode 3, the need for a palliative care philosophy that transcended all palliative care and the importance of systematic follow-ups and indicators was endorsed. Furthermore, human value and freedom of choice were emphasised. In conclusion, the increase of policy-documents produced by the welfare-state illustrate that death and dying have become matters of public concern and responsibility. Furthermore, significant shifts in policy narratives display how notions of good palliative care change, which in turn may affect both the practice and the content of care at the end of life.

Dying as an issue of public concern: cultural scripts on palliative care in Sweden.

In Sweden, palliative care has, over the past decades, been object to policies and guidelines with focus on how to achieve "good palliative care". The aim of this study has been to analyse how experts make sense of the development and the current state of palliative care. Departing from this aim, focus has been on identifying how personal experiences of 'the self' are intertwined with culturally available meta-level concepts and how experts contribute to construct new scripts on palliative care. Twelve qualitative interviews were conducted. Four scripts were identified after analysing the empirical material: 1. script of paths towards working within palliative care; 2. script of desirable and deterrent reference points; 3. script of tensions between improvement and bureaucracy; and 4. script of low status and uncertain definitions. The findings of this study illustrate how experts in complex ways intertwine experiences of 'the self' with meta-levels concepts in order to make sense of the field of palliative care. The participants did not endorse one "right way" of "good" deaths. Instead, palliative care was considered to be located in a complex state where the historical development, consisting of both desirable ideals, death denials and lack of guidelines, and more recent developments of strives towards universal concepts, "improvement" and increased bureaucracy altogether played a significant role for how palliative care has developed and is organised and conducted today.

What are we talking about? Constructions of loneliness among older people in the Swedish news-press.

Loneliness among older people is an issue that engages the general public and various professions and organizations in contemporary Swedish society. One public arena where this engagement is particularly evident is within the Swedish news-press, where articles on loneliness among older people are frequently published. Loneliness is commonly perceived as significantly related to ageing and older people. In addition, the mass media is considered to have a crucial influence in shaping general perceptions of older people. The aim of this study is to examine how loneliness among older people is constructed in the Swedish news-press and whether there is a prevailing "loneliness discourse" within this context. The empirical material consists of 94 articles from the Swedish news-press from the years 2013-2014. Two dominating discourses was found. Loneliness - within the discourse of eldercare, politics and the welfare society, is primarily written about in news articles and debate articles by a variety of authors, such as politicians and representatives from organizations. Within this discourse, loneliness is utilized as a concept to motivate the need for political change and the allocations of resources and to amplify deficiencies within eldercare, politics and the welfare society. The second discourse, Loneliness - within the discourse of volunteer work, is addressed in reportage articles written by journalists. In this discourse focus was on depicting volunteers and enhancing the importance of volunteer work. Here, loneliness serves as a motive for performing volunteer work. In addition, the discourse of Research reports on older people's health was found, although less significant compared to the two major discourses. Within this discourse ageing is presented as a risk, where loneliness is one of these risk factors. Despite some minor differences, loneliness, within all three discourses, is given the meaning of being a problem that needs to be solved. A central finding in this study is that focus in the articles, from Swedish news-press, is not mainly on loneliness but rather on eldercare, politics and the welfare state, volunteer work and health among older people. Loneliness is, consequently, used as a concept to motivate the need for political change and the allocation of resources for older people, to enhance the values of volunteer work and to emphasize the risks associated with ageing.