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    The relationship between loneliness and quality of life in informal dementia caregivers : a thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2024) Jenkins, Brieonie
    Background Informal caregivers are an essential part of dementia support in New Zealand. The number of people affected by dementia is increasing. Previous studies have indicated that informal caregivers are at risk of poor mental and physical health outcomes, due to the stressors in the caregiving role. These stressors have been identified as risk factors for loneliness. Research in other populations highlights strong links between loneliness and poor health outcomes. This research explored the relationship between primary caregiving stressors, loneliness, isolation and quality of life (QOL) within the framework of the Stress Process Model. Methods This research investigated hypothesised factors leading to loneliness and quality of life in a New Zealand sample of informal dementia caregivers (n= 134). It used a cross-sectional survey design and structured questionnaire to explore background and context factors (care duration, hours per week caregiving, relationship length and help hours per week), primary stressors (Activities of Daily Living dependency, frequency of challenging behaviour, caregiver reaction and relational deprivation), loneliness, isolation, and quality of life. Descriptive analysis, correlational analysis, confirmatory factor analysis and path analysis were used to examine the relationships between variables and conduct mediation analyses. Results The findings indicated that QOL was moderate, with the average rating between ‘neither good nor poor’ and ‘good’. The psychological domain was significantly lower than all other domains. Within the sample there was a high prevalence of loneliness (88%) and lower prevalence of isolation (21%). Overall QOL and QOL domains were significantly associated with total loneliness. Among the primary stressors, only the frequency of challenging behaviour correlated to loneliness. Both the frequency of challenging behaviour and caregiver reaction had significant correlations to QOL. Total loneliness partially mediated the relationship between primary stressors and QOL. Social loneliness was also found to partially mediate this relationship while emotional loneliness did not. Conclusions The findings show that there was a high prevalence of loneliness in the sample. They also show that primary caregiving stressors are associated with loneliness and that loneliness is associated with quality of life. This research highlights the importance of addressing loneliness in this population, suggests targeted loneliness interventions and recommends caregivers be screened for loneliness to increase access to appropriate support.
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    MINT pilot study : a text message package as an adjunct to existing mindfulness-based cognitive therapy in an early intervention setting : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
    (Massey University, 2018) Miller, Mary
    Background: Mindfulness-Based Cognitive Therapy (MBCT) is being used in an increasing number of settings including Early Intervention (EI) for psychosis services. People with psychotic symptoms face difficulties including compliance problems with home-based practice, which may affect the utility of MBCT. This study aimed to examine whether text message technology could be used as an adjunct to support home-based practice. Method: A single case multiple baseline design was used to assess the mindfulness text message intervention (MINT) in 11 participants. Results: There was a statistically significant increase of group mean total practice time per week of 7.1 minutes from the baseline to post-intervention phase, with a medium effect size. There were no statistically significant results for change in mindfulness skills or depression and anxiety symptoms. Discussion: Text messages can be used as an adjunct to support home-based practice in an EI setting. The amount of home-based practice required to produce an improvement in clinical outcomes is unclear. Future studies may explore the variation between participants found and the use of MINT in other settings.
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    The experience of whanau caring for members disabled from the effects of stroke : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy at Massey University
    (Massey University, 2003) Corbett, Andrea M
    This thesis explores the experience of whanau caring for members disabled from the effects of stroke. The decision to undertake this study arose from my experience in rehabilitation nursing where I observed Maori accepting the responsibility for the care of their whanau member following a stroke with little assistance from existing rehabilitation and community based services. I wanted to understand why this was so, from the perspectives of the whanau. A review of epidemiological data demonstrated the negative disparity in the incidence of stroke in Maori when compared with non-Maori. Further review of the literature specifically related to Maori health issues revealed that whilst there was acknowledgement of the importance of whanau, kaumatua and kuia to Maori as a society, there was little that dealt with disability issues and stroke in particular. Where issues related to the provision of, and access to, health and disability services had been noted, little appears to have been accomplished. A descriptive qualitative research study was undertaken in the Taranaki region with support of the eight Taranaki iwi. Seven whanau focus groups interviews and three key informant interviews were undertaken. From analysis of the data a descriptive account of the whanau experience of onset of the stroke event, hospitalisation and service delivery following discharge of their whanau member is provided. The impact on the whanau of their ongoing provision of care with limited service provision from health and disability services is explored. On the basis of this analysis a number of recommendations are made. The key recommendation is that there needs to be a review of current rehabilitation service provision in Taranaki. From such a review it is hoped that changes will be implemented that will enable service provision to be more beneficial, accessible and acceptable to Taranaki Maori.
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    The understanding and experience of anxiety in older adults caring for partners with stroke : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Psychology, Massey University
    (Massey University, 2007) Cotton, Elizabeth Helen
    Anxiety has been increasingly recognized as a serious health concern in older adults and is reported by many caregivers. However, still relatively little is known about the experience or presentation of anxiety in later life or about how that anxiety relates to caregiving. Much of the research into late-life anxiety has focused on anxiety disorders and has been carried out with reference to younger age groups, using diagnostic and psychometric measures developed, in the main, for younger people. There appear to be few studies in the literature that explore late-life anxiety as an independent phenomenon or that examine the effects of contextual factors on that anxiety. No studies could be found that investigate non-clinical experiences of anxiety in later life, starting from the perspectives of older adults themselves; neither could any studies be found that specifically investigate anxiety-related experiences of elderly people caring for partners with stroke. The present study explores how older adults, caring for partners with stroke, understand and experience anxiety. Semi-structured interviews were conducted with nine older adults, aged from 65 to 80 years, who were living in the community and were caregivers for partners with stroke. Interpretative Phenomenological Analysis (IPA) was used to identify themes within their accounts. Three master themes were identified: the phenomenon of anxiety, views that influence anxiety, and the experience of anxiety. Emergent themes describe participants' shared, main sources of anxiety, the signs and symptoms by which they recognized anxiety and the strategies that they had developed to cope with anxiety. A range of views about self, caregiving and ageing was identified that appeared to shape the anxiety that participants experienced. Findings highlight the chronic nature of the anxiety experienced by older spousal caregivers and suggest ways in which older caregivers can successfully deal with that anxiety. They provide a useful foundation for further research that seeks to determine which older adults are likely to experience anxiety problems in caregiving and also for programmes that seek to support elderly people who are caring for partners with stroke.
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    The last new home : residential care for the elderly in New Zealand : a thesis submitted in partial fulfilment of requirements for the degree of Master of Philosophy (Sociology), Massey University
    (Massey University, 2006) Stokes, Dianne
    The primary assumptions of government policies for the care and support of older people in New Zealand are that home based care ('ageing in place') is the best option for the frail elderly, and that 'home' and 'rest home' are mutually exclusive concepts. In this context I interviewed eleven rest home residents about their experience of 'home' in relation to residential care. What I found was that, for most of these participants, frailty and increasing dependence on family and friends had meant their own home was no longer the seat of identity and continuing independence, or indeed of close relationships and intimacy, security, comfort and control. Rather, moving to a rest home provided greater independence from family and friends and, for many, increased security, comfort and companionship. For these older people 'home' was not associated with a specific residence and was indeed transferable to a rest home setting. These findings therefore contradict and call into question the primary assumptions on which current ageing in place policies are based.
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    An assessment of community care service provision for older people residing in Feilding : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Work at Massey University
    (Massey University, 1997) Scott, Robyn
    This study sought to assess whether the community care needs of a purposive sample of nine older people aged between sixty-seven and ninety-six years residing in the semi-rural township of Feilding were being met by current service provision. Qualitative interviews were conducted with nine client participants and thirteen key informants selected from service providers to the older population of Feilding. Despite the political turmoil of tendering for contracts for specific community care services, providers were delivering a range of services and were aware of the issues concerning quality, access, appropriateness and coordination of services which were enabling these older clients in Feilding to maintain their independence at home. The major incentive for service providers is to keep clients mobile and out of hospital. However, the lack of information to older clients concerning their eligibility for services provided by service providers, may deter potential clients from accessing community care services, thereby decreasing the demand for services. Providers were constrained by their budget and minimum staffing levels to supply services to meet the potential demand. The older disabled clients of community care in Feilding, faced issues of dependency on formal and informal support services, decreasing mobility, vulnerability and concerns relating to cultural sensitivity, safety in their homes, and the quality of the careworking relationship.
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    Living at home after 95 years : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand
    (Massey University, 2013) Russell, Julia May
    Globally the number of older people is increasing with the largest increases occurring in those aged over 85 years. Historically little has been written about this group and because of increasing numbers more information is needed to inform the development of future services. The question was how people live in their own home independently after 95 years? This work was informed by narrative gerontology overlaid with a critical gerontological lens to give voice to this group. Through a purposive sampling strategy ten narrators were identified and were interviewed using a semi-structured format. Data analysis was undertaken using thematic analysis with three themes; staying socially connected, managing the physical environment and keeping and ageing well emerging. Further to this, there were associated subthemes, which support and further illuminate the detail of the theme itself. These findings also unsettled the ageist, biomedical view of the oldest-old and what we think we know about them. In this study the narrators gave voice to their lives and what contributed to them living at home independently. Not everyone will live to 95+ years and how this was achieved by this group was the result of their entire lives and showed itself in the resilient characters of these narrators. All of whom considered the benefits of social connectedness, hard work and keeping well as reasons for living independently at home. As well as this, the need to stay mobile and the current contribution of help and support from both family were contributing factors. This research provides considerations for changes in not only the way we view those over 95 years but also the way we consult and provide services to them. There is an urgent need to promote achieving resilience, eliminate ageism and promote a more balanced view of the oldest-old.
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    From the ward to the home : caring for a family member diagnosed with schizophrenia in New Zealand : this thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy and Social Work at Massey University
    (Massey University, 1996) Richards-Ward, Leigh Anne; Richards-Ward, Leigh Anne
    The research question examined in this thesis is: 'What are the characteristics and complexities of the informal care provided within a family to a member diagnosed with schizophrenia, in New Zealand? This research question is divided into two parts. The first part examines the characteristics and complexities of the unpaid caring work provided to a family member diagnosed with schizophrenia and the second part explores how this care provision is influenced by the social, political, cultural, legal and economic context of New Zealand. This research is important because first, very little is known about the process and interpretation of care provided to a family member diagnosed with schizophrenia and second, New Zealand places great emphasis upon deinstitutionalisation and community care. Ten women and four of their husbands were invited to participate in this research. These women were the primary informal care-givers of a family member who had experienced the cyclical acute and chronic episodes of schizophrenia. The women's husbands filled a secondary supporting role in relation to the women. The women met to identify themes related to their informal care provision. These themes were translated into an interview guide which acted as a prompt for the researcher while the women and men were articulating their stories of care-giving. Foremost amongst the findings of this research was that the dominant understandings of care should be extended in order to reflect the informal care provided to a family member diagnosed with schizophrenia. The men supported the women's care provision which reflected their family member's unpredictable, changeable and cyclical symptoms of schizophrenia. It was characterised by the primacy of supervision and monitoring and was provided on a continual (flat-line) basis. It was also established that the women were finding it increasingly difficult to meet their informal caring responsibilities, these responsibilities being increased and extended by the Government's actions to reduce both state expenditure and state caring responsibilities. The difficulty the women were experiencing in meeting the complex and changing care needs of their family member indicated that a continuum of care needs to be provided. It is argued that a continuum of care will need to include early intervention services, a range of community-based and institutionally-based mental health services, and a review of the definition of 'mentally disordered' contained within the Mental Health (Compulsory Assessment and Treatment) Act 1992. In order to coordinate and provide such a continuum of care, state, community and family caring responsibilities need to be combined, these three caring agents working collaboratively.
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    Recovery : a journey and a destination : a phenomenological study of older people recovering at home after surgery : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand
    (Massey University, 2002) Wootton, Rayna Margaret
    As world populations age there are more older people having surgery. Hospitalisation for surgery is commonly for the day only or short stay, so most of the period of recovery is spent at home where the older person lives either alone or with a spouse / partner. The purpose of this study was to understand the phenomenon of recovery at home for older people who have had surgery. Thirteen older people, ten men and three women, were interviewed after they returned home following surgery. Four interviews were conducted over an eight week period. Participants were aged between 69 and 88 years with most being in the 70-80 years age group. Hermeneutic phenomenology underpinned by the work of Heidegger was used to examine the phenomenon of recovery as experienced by the participants. The essence of recovery was revealed as enduring my world, caring for and about myself, relating to people and place in my world, and continuing my life. These arose out of four themes -disturbance of one's being-in-the-world; being concerned with; being-with others, and recapturing being-in-the-world. The four lifeworld existentials of lived time, lived body, lived other and lived space were used to illustrate the nature of recovery for the older person. Lived time was of particular significance. Age per se was not perceived by participants as a major factor affecting their recovery. Being at home, the effects of surgery on the body and on daily life, being actively involved in their recovery, the support of others, and knowledge and understanding, were significant in the participants' experience of recovery. Recovery was revealed to be both a journey and a destination.