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Aim. To explore the experience and strategies of mental health well-being through resilience in older people across the four participating countries. Background. While there is increasing evidence of the way older people maintain physical well-being, there has not been the same emphasis when examining the ways in which older people enhance their resilience and so promote mental health well-being. Design. An Appreciative Inquiry approach was used. Method. A convenience sample of 58 people over the age of 65 years from Australia, UK, Germany, and South Africa were interviewed. Data were analysed using thematic analysis. Results. Participants described their experiences of mental health well-being in relation to: social isolation and loneliness; social worth; self-determination; and security. Strategies utilised include promoting resilience by maintaining community connections and relationships, keeping active, and emotional, practical and spiritual coping. Conclusion. The findings highlight the importance of maintaining mental health well-being through resilience. Although there were some variations between countries, these strategies for maintaining well-being transcended culture and nation. Relevance to clinical practice. Listening to older people through research such as the current study will help to determine what help is needed and how healthcare and policy makers can assist.

Despite a widely accepted view of the importance of understanding experience from the point of view of the individual using services in modern western society, there are relatively few studies that have explored day-to-day living in a care home from the older person's perspective. This study aimed to present the voice of the untold stories of care home residents through an interpretative study that was informed by a biographical approach and narrative method. Eight older people who lived in four different care homes in England participated in a sequence of up to eight narrative interviews over a six month period. Through the process of listening to, retelling and interpreting the residents' stories the resident world was explored. There were three stages to the interpretative process that focused on:- developing a naïve or surface understanding to acquire a sense of the whole sequence of a participant's interviews; a structural analysis that examined the interviews to investigate what the text said and how it was said; and a critical in-depth examination of the interpretation within the wider social context. The interpretation revealed the unique way that each participant lived in a care home. These older people worked hard to reconstruct their life following the move to a care home and as they lived there. Though the residents were limited by physical, functional and cognitive problems, they developed strategies with the aim of influencing the life that they lived within a care home. Where they were able to implement those strategies they reconstructed their life in ways whereby they 'lived with care.' In this sense they were active biographical agents shaping this phase of their life. This is an alternative biography, to that of older people 'existing in care' as an outcome of care received. This thesis provides new insights into the residents' world. The overriding conclusion that can be drawn from these stories is that these older people were trying to live as active biographical agents who were instrumental in shaping their own life. They were able to do this to a greater or lesser extent and the conceptual model of biographical living that has been developed from the resident stories provides a framework to depict the complex interactions that shape an individual's experience in this environment. An inherent feature of this model is recognition that residents can be active agents throughout their lives in care homes. In summary, residents' desire to 'live with care' and this is not only possible, it is achievable.

Social care is currently undergoing a transformation, driven by Government policy, and key to this transformation is giving greater choice to service users. This vision of choice is based on a market model of competing service providers; such a model can be difficult to implement in rural areas where problems of space, time and access hamper service delivery. This raises the question of whether policy is biased towards urban areas and highlights the important role that geographical gerontology can play in developing more person-centred social care policy and practice. This consumerist vision of social care has also fuelled a theoretical debate which underpins this research. The market model of choice has been located within a wider discourse which regards the self as a rational, self-sufficient individual. An alternative discourse has been posited from a feminist ontology in which interdependence and co-responsibility come to the fore; such a discourse emphasises the personal dimension to social care practice. This project forms the research component of a professional doctorate in occupational therapy and is concerned with the self-expressed views of rural older people in relation to the above social care theory and policy. Taking a phenomenological approach, a narrative methodology was used to interview 11 older people who live in rural West Northumberland. Participants? narratives concerning social care re-affirm findings from previous gerontological research which assert low expectations, self-sufficiency and the crucial role of human relationships. Although at a superficial level, „choice? is not a term participants relate to social care, it is revealed that they do make choices on a daily basis both in relation to social care and their home situation, but choice is a complex and ongoing process rather than a one off event. It is suggested that the way participants situate themselves within their network of care and their geographic location helps them to maintain coherence in their personal identity. The concepts identified above are used to develop theory from a postmodern and feminist perspective in the areas of social care and geographical gerontology, forming an original contribution at the interface of these two domains.

This study evaluates the use of the Roper, Logan and Tierney model in an orthopaedic setting using a practitioner research approach. The aims of the study are to explore how the model influences the patients' needs, what staff are doing when giving care and how they plan and evaluate care. A qualitative phenomenological methodology was used, with inductive code development. Thirty-six patients participated in the study. The data was gathered by observing twelve patients, interviewing another twelve patients and analysing twelve care plans. Initial analysis was carried out by using the twelve activities of living as a framework to code the accumulated textual data. Comparison of this indicated where the model and practice differed. Exploratory diagramming was used in the analysis, resulting in the creation of frequency hierarchies. These were used to analyse the codes. They were presented in three areas, the data as a whole, the staff and patients' perspective and the long and short stay patients. The results support four themes emerging from the data, a hierarchical element exists in care, a common core of needs is found between the long and short stay patients, patients and staff perceive care differently and the identification of partnership as a key theme for effective care. The partnership theme has been explored by developing further themes from the data. The formation of partnerships between patients and staff are shown to be important in negotiating care. Frequency hierarchies in this study are found to be a powerful method of identifying themes, and an excellent tool for the exploration of qualitative data. The unique role of the research practitioner is also discussed and recognized as a valuable perspective for the critical evaluation of nursing models.

The study aim was to explore the information behaviour of older people living in a rural location in order to understand how they exchanged information through their social networks and social activities. The study provides a unique contribution to research with its emphasis on information exchange in a remote rural context based on the perspectives of older people. The approach was interpretative, using a phenomenological, interactionist methodological framework, taking account of social constructionist and critical realist philosophical perspectives and grounded in information behaviour theories and models. The ethnographic methodology, combining qualitative data collection methods, emphasized the lifestyle, the participants, the information and the contexts. Data were summarized thematically within the four global headings, "Lifestyle", "People", "Information" and "Place" and further themes and sub-themes reflected both the common and individual viewpoints of the participants. The key findings were that older people relied on family and close friends (strong ties) for support, advice and personal information. They preferred to exchange practical, local information about regular activities and local services interpersonally within their close social network groups and during social activity. This information was often available through more casual contacts (weak ties) facilitating information flow through social networks and social activities in both formal and informal information grounds. Informal information grounds, such as the Age Concern coffee morning, proved to be the most successful, where all the positive elements, including an informal atmosphere, the presence of close friends, casual contacts and a variety of information resources were present in one place. The „Model of Information Behaviour amongst Older People in a Rural Setting?, highlights the contextual and social influences affecting information behaviour, the means by which information is exchanged, the types of information exchanged, and the way in which social information grounds are successful for older people.