Abstract
Spain, in common with many other developed nations, is facing an increasing older adult population, many of whom are increasingly frail and medically complex. The authors of the reviewed study identify specific challenges stemming from cultural attitudes around the provision of care for older adults and a shift from family-centred provision to a greater reliance on professional models of care. In order to explore this further, the authors conducted a phenomenological case study including 15 cases of older adults experiencing transitions in their care.
The study interviewed older people, family carers and professional carers from day centres, home care and care home services. The data were analysed by looking for words and phrases that were considered revealing of the experience, and the authors formulated themes based on recurring concepts. This process resulted in seven themes, which they considered to portray the transition from home care to care in a professional care setting in Spain. Noteworthy among their findings were the pivotal role of caregivers and the level of dependency of the older person. More challenging issues over the role of income status in determining care transitions and the funding of long-term care are significant problems not limited to Spain (Wubker et al., 2015).
The scope of this study is vast and, despite framing it in a specific country, in attempting to evaluate transitions to all professional care settings – paid home care, day centre use and care home admission – the authors have amassed a heterogeneous range of experiences. Without disputing that there may be much in common among these experiences, it is difficult to compare use of a day centre with a permanent change of residency moving into a care home. Furthermore, the care services available in Spain, particularly the model of care in the care home setting, are not adequately described, which makes international comparisons more difficult (Sanford et al., 2015; Burton et al., 2017).
The authors report that they included adults with a diagnosis of dementia, a vital population whose views have often been under-represented in this area (Lord et al., 2016). Researchers from elsewhere may note with interest that there are no specific ethical restrictions on interviewing people with dementia in Spain; thus, the researchers followed guidance of international organisations in their approach. Interviews were conducted with a family member present, who provided consent on behalf of the person with dementia. The researchers directed questions to the family member, but allowed the participation of the person with dementia. How to fully involve people with dementia in relevant research such as this must be a priority (Kelly et al., 2015).
The final recommendation to highlight was the need to expand the qualified care workforce to meet the needs of older people. A workforce supported and able to embrace the complexity of care required by older adults in all care settings, particularly those with dementia, should be our goal. This necessitates a change in the emphasis and delivery of education to nurses, doctors, care staff and allied health professionals alike.