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Background: Negative views towards ageing and older adults may be a reason why nurses do not choose to work in gerontological nursing. Studying in another cultural context can challenge these views. The Objective was to explore nursing students' views on ageing and older adults before and after a gerontology course held abroad. Design and method: A qualitative approach based on content analysis of responses to open-ended questions by 30 Thai nursing students studying a gerontology course in Sweden. Results: Three main categories: positive imprints of ageing, ageing takes its toll, and knowledge leading to action, emerged through sub-categories carrying a view of older adults as not only in need of care, but also as resourceful and competent. Professional healthcare, besides family was seen as potential caregivers in old age. Conclusions: Studying gerontology abroad can widen views towards ageing and older adults, inspiring nurses to work in gerontological nursing.

The overall aim of this thesis was to explore, describe and understand experiences of twinship as told in the life stories of older twins. The 35 older twins who participated in this thesis were part of two longitudinal studies of older twins, SATSA (the Swedish Adoption Twin Study of Aging) and the Gender study. The study design is qualitative and the 35 interviews were collected using a narrative method. The life stories were analysed with narrative analysis (studies I and II) and qualitative, latent content analysis (studies III and IV).

According to the twins in this thesis, twinship, was described from the relationship with the co-twin(I, III, IV) and from an identity perspective (II). Twin relationships are unique and different in their own way. Three relationship patterns were identified and labelled as: nurturing, draining or superficial based on qualitative aspects (I). The differences in the three relationship patterns became even more evident during critical stages in life, for example, when getting married (III) or losing the co-twin through death (IV). These events became turning points which meant that the twins needed to adjust to a more individualized life. Twins in nurturing or superficial relationship patterns did not experience these transitions as particularly dramatic, while for twins in draining relationships these life transitions were more dramatic. From an attachment theory point of view, the older twins remained attachment figures with an unaltered attachment pattern throughout life(I). Bound together with the close twin relationship is how twins define themselves, since the twinship means handling both your individual identity and the twin identity. The self-descriptions, with emphasis on differences, are viewed against the background of how the twins experienced the environment perceiving them as a social unity and were interpreted as a desire to emphasize ones individuality as related to the twin partner and as a message to the environment of desiring to be viewed as a unique individual (II).

In summary twinship was described by most as a close, enriching relationship throughout life and for some, less enriching depending on what kind of relationship they had with their twin partner. An identity work was at the same time taking place, trying to establish a position as an individual in the twin relationship and to assert ones individuality to the rest of the environment in the message:“We are not as alike as you think!”

Based on 35 life stories of aging twins, this study focuses on personal experiences and recollections of their relationships with the co-twin over the life-course. The participants are part of two longitudinal Swedish twin studies on aging, SATSA and Gender. In the narrative analysis, three relationship patterns, labeled 'nurturing', 'draining', and 'superficial', emerged, pointing to qualitative aspects in the co-twin relationship. The dominating aspect was emotional closeness, which differed in the three relationship patterns. In the nurturing twin relationship pattern, emotional closeness was experienced as intimacy and yet independence, while in the draining relationship pattern it was experienced as dependence. The superficial twin relationship was experienced as distant and lacking in emotional involvement. Most of the relationship patterns seemed to remain the same throughout life. However, seen from a life course perspective, this study pointed to complexity and diversity in lifelong twin relationships.

We have explored how older twins experience and describe themselves in relation to their co-twin. The life stories of 20 older twins were analyzed with narrative analysis.Results showed that the twinsdescribed themselves from the point of differences in relation to the co-twin. This was based on experiences of how other people viewed them as alike, as well as on life events along the life course, which contributed to the perception of oneself as an individual in relation to the co-twin. The emphasis on unlikeness was therefore interpreted as a way of trying to establish a position as an individual within theco-twin relationship and to assert ones individuality to the rest of the social environment. To claim oneself as an individual was an ongoing identity work along the life course.

What it is like when a lifelong twin relationship ends through death in later life is the focus of this study. It draws on interview data from seven twins who are part of a longitudinal Swedish twin study (SATSA) and who lost their co-twins in old age. Data were analyzed using qualitative latent content analysis. The results showed that the experience of loss of the co-twin was pro-found, including an emotional as well as a be-havioral dimension. Loss and loneliness were expressed as the dominant feelings related to the quality of the missing relationship as well as the loss of twin identity. However, the grief ex-periences in this study were primarily related to the closeness and quality of the twin relation-ship, rather than identity. Behavioral adjust-ments included the use of outside as well as internal cognitive resources to cope with life after the loss. Despite the devastating experi-ence of losing a co-twin after a lifelong rela-tionship, the participants engaged actively in their own grief processes. It was concluded that twin loss is unique, in the sense of losing the relational twin identity, as well as it is charac-terized by similar features as the loss of a close relationship among non-twins.

Abstract: The aim was to explore, describe and understand experiences of twinship as told in the life stories of 35 older (70+) identical and fraternal twins, participants of the SATSA and Gender-studies in Sweden. Method: The open-ended interviews were analyzed with narrative analysis. Results: Twinship was described as relational, i.e, the relationship to the co-twin and as a negotiation between the individual and the twin identity. Three kinds of twin relationship patterns, characterized by different levels of emotional involvement were identified and labelled: nurturing, draining or superficial relationship. An attachment theoretical perspective was used in interpreting the differences in the relationship patterns. Each set of twins showed a unique balance between individualization and the twin identity which also was linked to the type of twin relationship pattern. In addition, these older twins experienced that their social environment tried to impose a twin identity upon them contradictive to their own experiences.

The aim was to explore and describe how older twins reared apart and reared together experience the twin relationship over a life course. Method: The data consisted of life stories of 30 Swedish older (70+) identical and fraternal twins which were analyzed with qualitative content analysis. Results: The relationship patterns among twins reared apart were related to the time of separation, family upbringing, time spent together after re-union and over the life course. Twins who spent their first years in the biological family and thereafter separated, could continue their relationship over the life course, showing the same kind of relationship patterns that twins reared together. Twins who were separated during their first year after birth and reunited several years later showed a more complex relationship pattern, where some lacked an emotionally close relationship and others gradually developed such a relationship over the years. This challenges popular views on twins reared apart being emotionally close. In comparison to twins reared together the results implies the importance of spending time together in order to develop emotional closeness in the relationship.

Background

Worldwide, there is a growing population of older people who develop dementia in a country other than that of their origin. When their dementia has reached an advanced stage, residential care is most often needed. People with dementia in Sweden are often cared for in group homes. For immigrants, this may mean a linguistically challenging care environment for both healthcare staff and the patients’ family members.

The aim of this study was to explore and describe the experiences of family members and professional caregivers regarding the care provided to immigrants with dementia in group homes in Sweden.

Methods

An exploratory, descriptive study with a qualitative approach was chosen. In-depth semi-structured interviews were conducted with nine professional caregivers and five family members of people with dementia with Finnish, Estonian, Hungarian and Ingrian backgrounds; all were chosen purposefully. All people with dementia had lost their Swedish language skills as their second language. The data was analysed using qualitative content analysis.

Results

Three main categories and seven subcategories were identified. The first main category: A new living situation comprised the subcategories: adjusting to new living arrangements and expectations regarding activities and traditional food at the group home, the second main category: Challenges in communication with the subcategories: limited communication between the immigrant with dementia and the Swedish-speaking nursing staff and the consequences of linguistic misunderstandings and nuanced communication in a common language and the third main category: The role of the family member at the group home with the subcategories: a link to the healthy life story of the family member with dementia andan expert and interpreter for the nursing staff.

Conclusions

The family member played a crucial role in the lives of immigrants with dementia living in a group home by facilitating communication between the nursing staff and the PWD and also by making it possible for PWD to access the cultural activities they wanted and which professional caregivers were either not able to recognise as needed or could not deliver.

Background: The total number of people with dementia symptoms is expected to double every 20years and there will also be an increase in the number of older immigrants in several countries. There are considerable deficiencies in the present knowledge of how to conduct well-functioning health care for immigrants with dementia symptoms. The aim of this study was to explore caring and uncaring encounters between assistant nurses and immigrants in two group homes for persons with dementia symptoms in Sweden: a Finnish-speaking as well as a Swedish-speaking context. In addition, this study aims to describe how caring and uncaring encounters are manifested in these two contexts according to Halldorsdottir's theory of Caring and Uncaring encounters. Method: Descriptive field notes from 30 separate observations were analyzed using qualitative deductive content analysis. Results: The main category caring encounters focused on reaching out to initiate connection through communication, removing masks of anonymity by acknowledging the unique person, acknowledgment of connection by being personal. Reaching a level of truthfulness by being present and showing respect, raising the level of solidarity by equality and true negotiation of care, based on the residents' needs. The main category, uncaring encounters, focused on disinterest in and insensitivity towards the other, coldness in the connection and lack of humanity in care situations. The observations showed that caring encounters occurred more in the Finnish-speaking context and uncaring encounters more often in the Swedish context. Conclusion: Encounters could be caring, uncaring, and carried out using a person-centered approach. Communication and relationships could be facilitated using the same language but also through learning to interpret residents' needs and desires.

The total number of persons living with dementia is estimated to double every 20 years and ageing migrant populations are growing in several countries. There are gaps in the health and social care of people from other countries, regardless of the efforts made when someone has a dementia diagnosis; similarly, receiving care in sheltered accommodation is less common. The aim of this study was to explore and describe the nursing staff’s experiences of caring for non-Swedish speaking persons living with dementia in a Finnish speaking group home in relation to a Swedish speaking group home in Sweden. 27 qualitative semi-structured interviews were analysed using qualitative content analyses. The first main category, “communication”, concentrated on language abilities and deficiencies, non-verbal language, highlighting the consequences of not understanding and the benefits of a common language. The second main category, “culturally oriented activities”, focused on being served traditional food, celebrating holidays at the group home, the importance of traditions and the importance of familiar music as cultural elements. The Swedish speaking nursing staff could provide qualitative and equitable care, but the challenge was greater for them than for the bilingual nursing staff who spoke the same language as the residents.

Background

Thai older adults are valuable resources in their society. The Thai health service system is challenged when it comes to ensuring that older Thai adults can continue to live healthy and independent lives in society. It is of great value to support independence and improve older people’s active ageing. Promoting lifestyle changes by applying the Plan-Do-Study-Act cycle (PDSA cycle), at group meetings in a municipality context, is a way of focusing on active ageing. This study aims to describe older adults´ experiences of lifestyle change six months after finishing group meetings applying the PDSA cycle.

Methods

A qualitative approach with individual interviews and a qualitative content analysis were used with 12 Thai older adults who participated in the meetings applying the PDSA cycle.

Results

Six months after finishing applying the PDSA cycle, some older adults kept their individual goals and were influenced by their family surroundings. They also formulated additional goals. Three categories and six sub-categories emerged: Keeping individual goals, influenced by the surroundings, and formulation of additional goals were the overall categories.

Conclusions

These Thai older adults showed that they had the ability to make lifestyle changes with the support of the PDSA cycle, but not all maintained their planned activities after six months. The question is how healthcare professionals and the surroundings, may further support and motivate these people to maintain these changes based on their own preferences in a sustainable way.