Older adult mistreatment, dementia, and the family caregiver in the Northeastern Ontario home: the influence of context on professional agency

Abstract

This integrated-article thesis presents the findings of a qualitative critical inquiry with three related aims: to understand the experience of formal care practitioners who encounter mistreatment of an older adult with dementia by their family caregiver in the home; to explain the influences of the domestic, health care, geographical, and socio-political contexts upon that experience; and to facilitate empowerment and collective action to improve policy, practice and care outcomes. Viewing this experience through a Critical Social Theory lens, data collection methods consisted of interviews, reflective journals, and inquiry and action focus groups. Practitioners representing 23 organizations providing care to older adults in their homes in urban and rural Northeastern Ontario participated over the course of two phases of Understanding and Empowerment. In this thesis, Chapter 1 will review the literature, identifying gaps in knowledge and describing the critical theoretical underpinnings, methodology and theoretical thematic analysis which were instrumental to facilitate self-reflection of past cases, critique of socially dominant ideologies and structures, dialogue with other practitioners also encountering these cases, and dialectic reasoning, a process of examining contradictions of what is, versus what should be in cases of older adult mistreatment and dementia. Chapter 2 presents the findings on the experience of practitioners with these cases. More specifically, practitioners described a lack of professional agency defined as the ability to control outcomes and act in a meaningful way in their cases. Next, Chapter 3 examines the home, familial, health care, geographical and socio- political contexts and their influences on professional agency. Those findings describe the oppression of these contexts on practitioners who could not control the outcomes of older adult mistreatment [OAM] within them. Chapter 4 then presents the process of empowerment during which practitioners shared their concerns related to these oppressive contexts and collaborated towards collective action projects to improve policy, practice and outcomes. Chapter 5 situates the significance of the findings within the field of OAM and dementia and discusses cross- cutting themes linking the papers. Limitations of the study will be reviewed as well as recommendations for policy, practice and research.