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Ongoing demographic, social, economic and cultural changes point to the dynamic and continually changing contexts of rural areas in Ireland and Northern Ireland. However, the influence of such changes on the lives of older people remains under-explored, particularly the question of how older people perceive, connect to and engage in their communities. Drawing on interviews and focus groups with indigenous and non-indigenous older people in three case-study sites in Ireland, Northern Ireland and a cross-border region, this article presents a comparative analysis of how changing community contexts have shaped the lives of rural-dwelling older people. The analysis focuses on four key areas: economic structure and service access; social relations and social cohesion; meanings and attachments; and community engagement. While the findings demonstrate that some dimensions of participants' lives were affected by complex economic and social changes, others dimensions were connected in a more significant way to life course and residential history and the desire to maintain community capacity. (Contains 1 table and 1 figure.)

Personhood has been a key influence on the development of person-centred care models in dementia. However, there is ambiguity around the concept and interpretation of personhood, and what it means in practical terms for the delivery of care to people with dementia. This study examines the conceptualisation of personhood within the formal care system for people with dementia in Ireland. A multiple perspective study design examines the experiences of personhood in dementia from the perspectives of people with dementia, family carers and a range of formal carers. Semi-structured interviews with participants were conducted in both community and long-term care settings. Interpretative phenomenological analysis is used to examine the data. A total of 31 participants were interviewed: eight people with dementia, eight family carers and 15 formal carers. There is general consensus on the core elements of personhood among all participants: interests and preferences; lifecourse experiences; social interaction; family; and place. However, there is ambiguity among family carers and formal carers in the interpretation of changes to personhood as the disease progresses. Interpersonal and structural barriers to supporting personhood are identified by all participants. The findings provide guidance on the traits of personhood-enhancing care, including effective communication skills, and the potential of health and social care reform to support the core elements of personhood among people with dementia. [ABSTRACT FROM AUTHOR]

People with dementia and their carers have a wide range of health and social care needs. People with dementia, carers and health and social care professionals (HSCPs) all have different perspectives on dementia care. Differences among these groups are important for commissioners of services and for front-line HSCPs. To compare the service recommendations of people with dementia and carers with those of HSCPs, under different budgetary conditions. A mixed-methods approach, which builds on the Balance of Care method, was used. Nine workshops were held with 41 participants from three groups: people with dementia, carers and HSCPs. Participants were asked to make decisions on a set of services for case types of dementia under two scenarios: a no budget constraint (NBC) scenario and a budget constraint (BC) scenario. While each group allocated resources in broadly similar overall proportions, important differences in emphasis emerged: (i) people with dementia and carers placed more emphasis on psychosocial supports than HSCPs; (ii) carers put more emphasis on respite opportunities for carers; and (iii) carers identified residential care as the most suitable setting for the person with dementia more frequently than health care professionals. Our findings suggest that the importance of psychosocial interventions, including counselling and peer support programmes, are currently underestimated by HSCPs. The provision of in-home respite is highly valued by carers. Even with unconstrained resources, some carers do not judge home care to be a viable option for dementia case types with high-level care needs. [ABSTRACT FROM AUTHOR]

The Senior Help Line in Ireland provides a confidential telephone listening service for socially-excluded older people and is operated by older volunteers. The service has grown rapidly in recent years and is highly regarded as an important service for older people in the country. This paper provides a systematic examination and assessment of the service, from the perspectives of costs, outcomes and best practice. The study uses personal interviews, focus groups and postal questionnaires to elicit information about the service and its impact on volunteers and callers. The Senior Help Line has made a significant contribution to the health and wellbeing of older people in Ireland at relatively low cost. The service demonstrates the positive effects of volunteering for older people, and the value and effectiveness of peer-to-peer communication for vulnerable callers. The helpline is a model project in terms of accountability and best practice, but requires additional resources, particularly for publicity and training. It needs to become a branded national service for vulnerable older people to meet the level of need for a service of this kind. The help-line also needs to be linked more formally to existing health and social care provision for older people, to become part of a holistic model of healthy ageing for older people. For the service to reach its manifest potential, the efforts of the volunteers need to be supported by higher and sustained levels of public spending, through more widespread and substantial public-voluntary partnership arrangements. KEY WORDS--evaluation, volunteers, senior help-line, best practice.