Tensions and polarities in the autonomy of family carers in the context of the COVID-19 pandemic in France

This article analyses the impact of the COVID-19 lockdown on ‘monetised’ family carers’ understanding of their own autonomy in a long-term care relation at home. The reduction or suspension of medico-social service deteriorated the situation of family carers of frail older people or people with disability. We develop and apply an analytical grid of 15 interviews of monetised family carers about the reorganisation of care systems and their situation as carers. We identify three types of understandings of autonomy among family carers in the context of the COVID-19 pandemic: preventive autonomy; health protection autonomy; and supported autonomy.

The Capability Approach in Research on Ageing Well at Home for Frail Older People

This chapter describes the work of the Frail Elderly Support Research Group (FRESH) in relation to the capability approach as a theoretical framework. The FRESH research group works with people who are at risk of developing frailty, as well as those who are already frail or very frail. In this chapter, FRESH aims to utilise the capability approach as a theoretical framework for research with and for frail older people, and to focus on the older people’s opportunities to realise their goals in relation to contextual factors that may influence them. A broad understanding of the concept of frailty in general is also presented. The capability approach makes a fundamental contribution to the understanding of the process of becoming frail, and how it may influence people as they age, because it focuses on people’s real opportunities, what it is possible to achieve and what people have reason to value, in relation to the resources that they have at hand. This chapter will hopefully encourage future researchers to consider evaluating the capability approach and implementing it in their own research.

Doing Time: Experiences of Care Home Residents in Germany During the Early Phase of the COVID-19 Pandemic

Residents of care homes across the globe are affected by the spread of SARS-CoV-2 as they have been identified as a high-risk group and because they experienced strict social isolation regulations during the first wave of the pandemic. Social isolation of frail older people is strongly associated with negative health outcomes. The aim of this research project was to investigate how residents in care homes experienced social isolation during the first phases of contact ban in Germany. This paper draws on structured interview data collected from 22 residents in two care homes during early June 2020 in Frankfurt/Main. The findings show that their experiences were shaped by three factors: care home staffs’ approach to handling the contact ban; biographical sense of resilience; and a hierarchy of life issues. The findings highlight the importance of locally specific response mechanisms in care homes, and the need to contextualize residents’ experiences.

‘Don’t forget the mouth!’: a process evaluation of a public oral health project in community-dwelling frail older people

Background Older people are encouraged to remain community dwelling, even when they become care-dependent. Not every dental practice is prepared or able to provide care to community-dwelling frail older people, while their ability to maintain oral health and to visit a dentist is decreasing, amongst others due to multiple chronic diseases and/or mobility problems. The public oral health project ‘Don’t forget the mouth! (DFTM!) aimed to improve the oral health of this population, by means of early recognition of decreased oral health as well as by establishing interprofessional care. A process evaluation was designed to scientifically evaluate the implementation of this project. Methods The project was implemented in 14 towns in The Netherlands. In each town, health care professionals from a general practice, a dental practice, and a homecare organization participated. The process evaluation framework focused on fidelity, dose, adaptation, and reach. Each of the items were examined on levels of implementation: macro-level, meso-level, and micro-level. Mixed methods (i.e., quantitative and qualitative methods) were used for data collection. Results The experiences of 50 health care professionals were evaluated with questionnaires, 22 semi-structured interviews were conducted, and the oral health of 407 community-dwelling frail older people was assessed. On each level of implementation, oral health care was integrated in the daily routine. On macro-level, education was planned (dose, adaption), and dental practices organized home visits (adaption). On meso-level, health care professionals attended meetings of the project (fidelity), worked interprofessionally, and used a screening-referral tool of the project DFTM! in daily practice (dose, adaption, reach). On micro-level, the frail older people participated in the screening of oral health (fidelity, dose), had their daily oral hygiene care observed (adaption) and supported if necessary, and some had themselves referred to a dental practice (reach). The semi-structured interviews also showed that the project increased the oral health awareness amongst health care professionals. Conclusions The project DFTM! was, in general, implemented and delivered as planned. Factors that contributed positively to the implementation were identified. With large-scale implementation, attention is needed regarding the poor accessibility of the oral health care professional, financial issues, and increased work pressure. Trial registration The Netherlands Trial Register NTR6159, registration done on December 13th 2016. URL: https://www.trialregister.nl/trial/6028