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.

Self-control and autonomy are not guaranteed when people age and are in need of help from others, especially in institution-based housing. This occurs despite the fact that it is a generally accepted belief that care should be delivered with the greatest possible degree of independence and autonomy. This article discusses older people's experiences with and the opportunities for autonomy in institution-based housing. Through focus group interviews and observations, the daily lives of residents at two nursing homes in Sweden were studied through a comparative approach using the theoretical framework of organizational culture. Three themes emerged showing how autonomy was not a reality for the residents. The first theme revealed an ambivalent mission, indicating ambiguity as to whether the nursing home was a place to live in or a place in which to be cared for. The second theme was symbolic power, which encompassed the staff's power embedded in the organization. The third theme was the ageist approach to care, which was noted in the way staff considered the residents to be old people who were unable and unwilling to strive for autonomy. The three themes were embedded in the organizational culture and were created and recreated in the interaction between residents and staff. A key question for further research is how to change the culture to strengthen the residents’ autonomy.

The aim of this article is to reveal how care managers handle the process when older people consider relocation to a residential home in a Swedish context. The article is based on vignette-based interviews with seven care managers. The main findings in the article are that the care managers assist older people in their decisions by turning ageing in place and relocation, respectively, into seemingly natural choices. In both approaches, they use warrants related partly to ‘the best for older people’, partly to ‘the common good of economizing’. The conclusions drawn are that the care managers, by applying risk management and extensive alliance strategies, are not really able to question their own work situation and that they perform their work in a context of different parties restraining themselves. The implications for social work policy and practice are that the approach referring to older people's self-determination while actually dealing in risk assessment must be thoroughly reconsidered. Other practical implications are that the idea of the purchaser/provider model must be clarified, beyond the assessment of resources.