Aim: There is a growing number of older people (65+) with dementia and many family care partners are involved in making help-seeking choices. The aim of this study was to reveal how family care partners with an old relative with dementia proceed in the name of dignity in their desire to secure the best care possible while still maintaining their own dignity. 

Methods: Data were collected in 2009-2010 in open semi-structured interviews and follow-up contacts with seven family care partners with an old relative with dementia on 14 occasions. From this collected data and for this study, a design based on patterns labelled archetypes was chosen to permit an in-depth data analysis.

Results: In the analysis, three archetypes emerged, emanating from three specific family care partners. A prominent feature in the findings was that the dignity of an old relative with dementia was hard to separate from the dignity as a family care partner, which gave rise to their need to express accounts in terms of excuses and justifications.

Conclusion: This study provides an important insight into the connection between the different elements of dignity and it contributes to explain the complexity behind family care partners’ decisions in the care of an old relative with dementia. This multifaceted meaning of dignity needs more attention for a better understanding and thereby implementation in practice and in the follow-up of policy for older people.

This article addresses the dilemmas concerning legislation, individual autonomy and the reality of everyday life for people coping with dementia. We describe and analyse decision-making in relation to older people with dementia in Sweden, within the area of social work regulated by the Social Services Act and the Parental Act. Swedish legislation is based on the individual's autonomy and capacity to consent to services without anyone having legal authority to decide on behalf of the individual. Based on data from interviews with family caregivers living at home, decision-making through family caregivers is discussed and formal guardianship is also considered. Swedish legislation leaves individuals with dementia and family caregivers in a vacuum between self-determination and full autonomy with the ideal of citizenship emphasised and recognised in the Social Services Act on the one hand, and on the other, a strong need for support in everyday life and with decision-making.

The austerity measures in social welfare implemented by street-level bureaucrats in their practice are changing the direction of social policy. This article examines the strategies used by public officials in implementing austerity measures in needs assessment for personal assistance in Sweden. The article is based on a document study with N = 100 records of needs assessment for personal assistance for persons with serious functional disabilities. Findings show that the public officials at the Swedish Social Insurance Agency either limit or extend their discretion as a strategy, as well as use weak warrants as strong warrants in recommending decisions. Other strategies involve the organisational logic, fragmentation of the content in the needs assessment and division of work among the public officials. Implementing the cost-cutting goals causes severe consequences for persons with disabilities who bear the brunt by being excluded from participation in society. The social policy values of fifty years, emphasising the right to equal participation in society, are traded for economic austerity goals.

Living with dementia, care and social care systems The aim of this article is to find out what impact national guidelines have on municipality dementia care. Furthermore, the aim is to compare organization of social care to the local adaptation of nationally invoked values. This article is connected to Living with dementia, care and social care systems , an interdisciplinary project between Health Sciences at Lund University and Social Sciences at Linnaeus University. The national guidelines for care and services to people with dementia recommend specialized units, and professional specialization in dementia care. Based on values of self-determination, integrity, accessibility, equity, rights and safety, they are meant to guide the dementia care in the community. In this article the organization of care is compared to how nationally invoked values are discussed in local policy documents in nine municipalities. These two aspects of dementia care are central to the national guidelines. The organization of care was explored by a mapping study of 19 municipality services. Type of organization was determined based on when, throughout the progression of the disease, services were made available, the existence of specialized dementia care units, and level of professional specialization. Information about values in local policies was examined by utilizing policy as discourse analysis of local policy documents. Four types of relationships between organization and value implementation were found. Eight out of nine municipalities failed to adapt to both aspects of the national guidelines.

Becoming alone in old age can be a decisive life event that brings major changes depending on various causes as health status, financial resources, family situation, and available welfare services. This article discusses the situation of older people in Sweden who have transitioned from a two-person to single-person household in recent years and what impact this might have on their everyday lives. Through in-depth interviews with 18 older people, age 67–90, their experiences about life conditions and opportunities were examined. Findings showed large differences between the men and women. They all tried to live as they always had done and they used the same personal life strategies that they always had. But the men could live as before on their own financial merits, while the women needed assistance from children, grandchildren and the welfare system. Transportation options were central and clearly related to both private economy and social services available. Shortcomings in the welfare state's way of caring for the elderly were clearly uncovered. The gap between social policy promises of opportunities for autonomy and independence to live an active life in old age and the everyday reality for older people still seems to be wide.

Att bli ensam på äldre dar kan vara en avgörande händelse som ger stora förändringar i livet beroende på orsaker som hälsotillstånd, ekonomiska resurser, familjesituation och tillgängliga välfärdstjänster. I denna artikel diskuteras situationen för äldre personer i Sverige som har flyttat från ett två-personers till ensamhushåll under de senaste åren och vilken betydelse det kan få för deras vardag. Genom djupintervjuer med 18 äldre personer i åldern 67–90 år, belyses deras erfarenheter, livsvillkor och möjligheter till ett liv som tidigare. Resultaten visade stora skillnader mellan män och kvinnor. Alla försökte leva som de alltid hade gjort och de använde samma personliga livsstrategier som de alltid hade haft. Men männen kunde leva som förut på egna finansiella meriter, medan kvinnorna behövde hjälp från barn, barnbarn och välfärdssystemet. Tillgången till allmänna kommunikationer var en central fråga tydligt relaterad till både den privata ekonomin och tillgänglig social service. Bristerna i välfärdsstatens sätt att ta hand om de äldre blev tydliga. Gapet mellan socialpolitiska mål och löften om möjligheter till självständighet och oberoende för att leva ett aktivt liv i ålderdomen, och den vardagliga verkligheten för äldre människor verkar fortfarande vara stort.

The aim of this article is to reach a deeper understanding of women's decision-making process regarding non-attendance at mammography screenings. The article also discusses the health care social workers' role in providing support to women during this decision. Eighteen qualitative semi-structured interviews were conducted with women who had abstained from mammography screening in Malmö, Sweden. Thematic analyses were used as a method and The Rational Choice Theory, The Health Belief Model and the notion of Cross-Pressure were used as a theoretical framework. A prominent feature was that the relationship between the women's decision to abstain and the normative perception that mammography is an important examination led to ambivalent thoughts. It can be seen as an adjustment to the structure to be invited and a cross-pressure between performed and expected actions. Moreover, the decision to abstain from mammography screening was preceded by thoughts about the right choice, specifically in relation to what would happen to these women if they got breast cancer. Women who abstain need to think about their decision to a larger extent than women who attend the screening and we argue that they should be offered support by health care social workers in the invitation letter to mammography screening.

Background

Mammography screening can reduce breast cancer mortality. The aim of the present study was to investigate non-attendance in mammography screening in relation to different aspects of a women’s social network, attitudes and cancer in close relations.

Methods

Data from the Malmö Diet and Cancer Study baseline examination in 1991–1996 was used. A re-examination began in 2007, and 1452 women participated. Family composition, social support, sense of belonging, attitudes on screening and breast cancer risk and on previous cancer in close relations were investigated in relation to self-reported participation in mammography screening using logistic regression analysis, yielding odds ratios with 95 % confidence intervals.

Results

Both attendees (98.0 %) and non-attendees (95.2 %) considered mammography screening important. Non-attendance in mammography screening was associated with being unmarried vs. married (2.40:1.30–4.45) and with not having vs. having children (1.77:1.08–2.92). Non-attendees planned to abstain from mammography screening in the future more often than attendees (4.78:2.56–8.90), and they had often abstained from cervical cancer screening (1.69:1.04–2.75). No other statistically significant association was found.

Conclusions

This study indicates that family composition, but not necessarily the presence or absence of social support, perceived cancer risk or cancer in close relations, may affect non-attendance in mammography screening. A positive attitude towards mammography screening was found among both attendees and non-attendees, although the latter group planned to a lesser degree to attend mammography screening in the future.

By applying a theoretical point of departure, the overarching aim of this article is to describe, analyze, and try to understand why care managers in their everyday occupational practice normalize the restrictive approach when older people consider relocation to a residential home. While earlier research to a large extent has drawn attention to how the care managers carry out the restrictive approach, this article pays attention to the circumstances paving its way. The focus is on influences from different sociological levels, thereby ‘stratified’, and from two aspects of discretion, where ‘structural aspects’ refer to choices between permitted alternatives and ‘epistemic aspects’ to practical reasoning under conditions of indeterminacy. With this combination, a multitude of circumstances contributing to the restrictive approach is revealed. Thus, the theoretical model includes levels as well as discretionary powers where formulas constitute the foundation at each level, subsequently related to multidisciplinary references in order to get the practice into perspective. The findings show that the priority given to home-based care in contrast to residential care is repeated and confirmed at each level and besides in an interchange between structural and epistemic aspects.

Det övergripande syftet med artikeln är att med hjälp av en teoretisk utgångspunkt beskriva, analysera och försöka förstå varför biståndshandläggarna i sin dagliga yrkesutövning normaliserar en restriktiv hållning när äldre personer överväger en flytt till ett särskilt boende. Medan tidigare forskning i stor utsträckning har uppmärksammat på vilket sätt biståndshandläggarna tillämpar en restriktiv hållning, uppmärksammar den här artikeln omständigheter som möjliggör den. Fokus är på influenser från olika sociologiska nivåer, därigenom ‘stratifierade’, och från två aspekter av hur biståndshandläggarna går tillväga, där ‘strukturella aspekter’ avser val mellan tillåtna alternativ och ‘epistemiska aspekter’ ett praktiskt resonerande under betingelser av obestämdhet. Med denna kombination framträder ett flertal omständigheter som bidrar till den restriktiva hållningen. Därmed inkluderar den teoretiska modellen såväl nivåer som aspekter av biståndshandläggarnas handlingsutrymme och resonemang med formler som utgångspunkter på varje nivå, vilka i ett nästa steg relaterats till flervetenskapliga referenser för att ge praktiken perspektiv. Resultatet visar att den prioritet som ges den hembaserade omsorgen i motsats till omsorgen på särskilda boenden upprepas och bekräftas på varje nivå och dessutom i en växelverkan mellan strukturella och epistemiska aspekter.