Older couples' participation in everyday life - when living in changing and shifting contexts

Abstract: The overall aim of this thesis was to explore and develop an understanding about older couples’ participation in everyday life when living in shifting contexts. To achieve the aim, multiple perspectives were sought and a variety of qualitative methods were applied. Data were generated through interviews and observations with older couples and through focus groups with spousal caregivers, healthcare professionals, and other stakeholders and those data were analyzed through a constant comparative method, content analysis, and narrative analysis.From the perspective of spousal caregivers, the findings in study I revealed the complexity and ambiguity that influences participation in everyday life. Being in charge of everyday life was described as challenging in many ways and produced a need for recovery and own time. Interacting with social contexts and being confident with the provided social services, such as respite care, was described as complex. The partner’s wellbeing and participation had an impact on the spousal caregiver’s own participation when living in shifting contexts. The perspective of healthcare professionals related to residential respite care was captured in study II. They described a broad and multifaceted picture of participation in everyday life and how promoting participation for older couples involved building trustworthy relationships, enabling meaningful activities, and arranging a comfortable shared environment. Both of the partners in the older couples needed to be considered by the professionals. In study III, the perspectives of the older couples were explored. In order to understand how meaning and togetherness is created in older couples’ everyday life, the focus has to be on the couples’ whole situation, including their relationship. The results showed that the couples strived to continue living their lives in togetherness. Strategies used by the couples were shifting responsibilities, doing more things together than before, using residential respite care, and rearranging social interactions with family and friends. Study IV offered the perspectives of multiple stakeholders. The findings suggested that the focus has to be on older couples through maintaining abilities and creating comfort. Support is also required from both an engaged civil society and healthcare professionals that are motivated and have both competence and time. Further, social services need to work together to ensure that resources are properly available.Overall, this thesis contributes to a deeper understanding about older couples’ participation in everyday life when living in shifting contexts. The findings showed that acknowledging the couples’ relationship, seeing beyond the client and the spousal caregiver, was vital for supporting their participation. Furthermore, living in shifting contexts was multifaceted and the couples strived to continue living their lives in togetherness. The meaning that the change of life situation and context has on a couple’s participation in everyday life is important to consider when supporting aging in place. In light of demographic changes and challenges, bringing together the interests of older couples, professionals, systems of services, and civil society is vital for a sustainable future. Systems and situations that are both closely and remotely related to the older couples’ daily life need to be addressed in an ideal situation of aging in place. Knowledge from this thesis could be valuable for occupational therapists and other healthcare professionals, as well as social services that are supporting older couples to age in place. Consequently, this knowledge could be used to benefit the situations of older couples and their health and wellbeing when aging in place.