Humpty Dumpty often comes up trumps. By this I mean that the character in Lewis Carroll’s Through the Looking Glass, and What Alice Found There observes that when using a word, ‘it means just what I choose it to mean — neither more nor less’. Such comments help in the reading of a literature review for the key to unlocking these often lies in knowing what words are in and what’s out. As readers of this Elf summary will likely recall these are often termed inclusion and exclusion criteria.
So in getting to grips with this review article the definition of social care needs to be shared. The authors choose, as is their privilege, to define social care as actions meeting basic daily living needs and socio-emotional needs (summarised). However they include care provided by paid people and volunteers, family and friends (at times all these are called carers). They also restrict their review to care in the ‘community’ (excluding care homes and apparently other settings).
With this in mind, the authors undertook a systematic review (Elf readers will know these are currently fashionable and considered to be very reliable) of older people’s experiences and opinions about the social care they receive. I use the word opinion here as I like its directness.
They read the qualitative literature, not survey findings, and used this to answer questions about how older people experience receiving social care. What’s good and bad about these experiences and what seems to affect people’s opinions? So while the different articles and chapters they read didn’t all ask these questions, the review authors thought about the findings from separate studies as a collection of responses where possible.
This all sounds simple. However, qualitative studies make this a hard process. They don’t always make it clear how people interviewed (the most common method) were recruited, who they were and what social care they actually experienced. Some studies have very few participants (numbers like 7, 9, 12 were found, and one study was of 3 people (one of whom lived in a care home so in reality the sample boils down to 2), and in some studies people were interviewed with their carers.
As an aside this matter of numbers is interesting when supervising Masters’ students doing their research dissertation. They are often very anxious about ‘having enough’ participants.
But back to this article. The authors present this review in a clear way which will be helpful to readers struggling to make some coherence from very disparate studies. They set out how and why they grade the studies as high, medium or low in quality.
They provide as a supplement (electronic link) a Table summarising all the papers included. This is an electronic document so might be easy to miss. Call me old-fashioned but I found it very helpful to print it off and to keep it beside me while I read the main paper as I kept forgetting what paper was being talked about.
The main conclusion is that older people receiving social care see this as a matter of relationships. These enhance the positive features of receiving care or can lie behind negative experiences.
If one was to design a system that would exacerbate the negative then one could probably do this by inventing rushed, pressurised, anxious, low paid staff who can provide little continuity of care and trust that their emotional and personal investment in relationship based care would keep a system going… but I digress.
Conclusions and summing up
What does the finding about relationship as being central to care mean? This review is a bit short on its implications for policy and practice.
It could perhaps have debated whether the priorities for person-centred care and relationship based care are compatible. It could have considered the challenges of relationship-based care for people who have dementia and whose distressing symptoms impact on relationships. It could have raised the question of how care technology undermines or supports relationship focussed care. And it needs to be said that not all relationships are positive.
The aim of reading such a paper (not the aim of necessarily writing about it) is to set thought processes in action. So in this way this systematic review does precisely that.
Most of its findings won’t come as a surprise and the shortage of papers they found to review probably reflects their inclusion criteria, especially their rejection of reports and other ‘grey’ literature. This is ironic as research in the UK from older people themselves and from voluntary groups is vibrant at the moment and seems often to have policy impact above that of other types of research.
de São José, J., Barros, R., Samitca, S. and Teixeira, A. (2015), Older persons’ experiences and perspectives of receiving social care: a systematic review of the qualitative literature. Health & Social Care in the Community. doi: 10.1111/hsc.12186 [Abstract]