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Older women's experiences of living alone PDF

169 Pages·2009·0.54 MB·English
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Volume I: Research Component Older women’s experiences of living alone with Dementia By Soraya Michelle Frazer A thesis submitted to: The University of Birmingham For the partial fulfilment of the degree of Doctorate in Clinical Psychology Department of Clinical Psychology School of Psychology The University of Birmingham June 2009 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. Acknowledgements I would like to thank my supervisors, Drs Jan Oyebode, and Adam Cleary for all their enthusiasm, knowledge and wisdom. I would like to thank the staff at the Older Adult Service of Birmingham and Solihull Mental Health Foundation Trust for helping me recruit participants. Above all, I would like to thank the eight women who form the basis of this study, for giving of themselves freely and honestly. Thanks to my friends, family and fellow trainees. Finally thank you to my partner Marco, for your love, patience and encouragement, and also to my grandmothers, to whom I dedicate this thesis. 2 Overview Volume I The research volume comprises two papers which focus on the experience of living alone in older adults, the aim being to highlight them as a group of people, and encourage further important research. The literature review synthesises current research on the well-being of older adults living alone. Fifteen papers were identified, which include comparing well-being and loneliness in older adults living alone with those living with others, exploring the experiences of older women living alone, looking at predictors of quality of life in those living alone, looking at the impact of social networks and illness on well-being, and the impact of being house-bound on sense of self. The articles are heterogeneous in nature, reflecting the confusion in the literature surrounding the concepts of well-being, quality of life and life satisfaction. From the papers one can conclude that in general, living alone appears to have a negative impact on well-being, though not exclusively. Further research is suggested to explore the personal experiences and meanings of their lives to individuals who live alone. The empirical paper explores how women with dementia who live alone manage their sense of self and cope with the illness. Eight women were interviewed to explore how they managed their identities and coped in the absence of a significant co-resident other who might reflect them back to themselves. Interpretative Phenomenological Analysis was used to analyse the 3 transcripts. From the individual themes, master themes emerged about loss, embodiment, adapting, awareness, safety, relationships, exclusion and loneliness. The women appeared to be actively engaged in re-constructing their sense of self using a variety of coping strategies. Their relationships with others, particularly friends, neighbours and attendance at memory clubs were important in enabling connection and safety. Memory loss was mostly significant through loss of independence along with a desire for meaningful relationships. Volume II This volume presents five clinical practice reports (CPRs). CPR 1 discusses work with a man with depression and anxiety about taking antidepressants, formulating his problems from two different theoretical perspectives. CPR 2 presents findings of a small scale service project of a focus group exploring the experiences of service users’ of an assertive outreach service. CPR 3 is a single case experimental design of an assessment, formulation and intervention of a four year old girl with encopresis and enuresis. CPR 4 is a case study of an older man with depression using a systemic (narrative) framework. CPR 5 is a case study of psychodynamic work with a young woman. This was an oral presentation, with the abstract provided. 4 Contents Volume I Page Literature Review The impact of living alone on older adults: a systematic review Abstract 13 Introduction 14 Methodology 17 Results 18 Discussion 55 References 61 Empirical Paper How older women who live alone with dementia make sense of their experiences: An Interpretative Phenomenological Analysis Abstract 67 Introduction 68 Methodology 71 Results & Discusion 76 Conclusion 103 References 108 Public Domain Briefing Paper 16 Apendices 12 5 Appendix 1. Ethical Approval Appendix 2. GP Letter Appendix 3. Participant Information Sheet Appendix 4. Consent Form Appendix 5. Interview Guide Appendix 6. Paper Trail Appendix 7. Reflexivity Appendix 8. Notes to Contributors to ‘Dementia’ 6 Volume II CPR I: Psychological Models Title: The case of a 51 year old man with recurrent episodes of depression who is afraid to stop taking antidepressants Page Abstract 14 Case Outline 15 Cognitive Formulation 19 Psychodynamic Formulation 25 Critique 33 References 36 CPR II: Small Scale Service Related Project Title: Findings from a focus group exploring the experiences of service users from an assertive outreach team Abstract 46 Introduction 47 Methodology 49 Results 52 Discussion 60 Personal Reflections 67 References 69 7 CPR III: Single Case Experimental Design Title: Assessment, Formulation and Intervention with a four year old girl with encopresis and enuresis Abstract 95 Case summary and Asesment 96 Literature Review and Formulation 102 Intervention 109 Results 12 Discusion 13 Folow up and Conclusion 16 References 18 CPR IV: Case Study Title: ‘When the Green Slimy Bugger entered my life’ Abstract 128 Case Summary and asesment 129 Formulation 135 Intervention 141 Evaluation 147 Reflections 148 References 150 8 CPR V: Oral Presentation Title: Working in the Transferences: Assessment, Formulation and Intervention with Suzie Abstract 158 9

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