Older women's experiences of living alone

169 Pages·2009·0.54 MB·English

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

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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.

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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
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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.
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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

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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’

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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

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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

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CPR V: Oral Presentation

Title: Working in the Transferences: Assessment, Formulation and
Intervention with Suzie

Abstract 158

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