‘It can be difficult to help them’
Colliding logics of care and choice in Danish elder care for older citizens with substance use
DOI:
https://doi.org/10.7146/qs.v9i1.143671Keywords:
Aging, Substance use, Elder care, Marginalization, Inequality in health, logic of careAbstract
Older marginalized citizens with severe substance use are presently a growing population in Denmark. They struggle with comprehensive and complex needs for care and treatment, which put high demands on health and care professionals working with them. Yet, the complexity of their needs for care and the care provided to them is highly understudied. We take our empirical point of departure in an anthropological pilot study of care work in private homes and retirement homes in two municipalities, where we followed care professionals on their shifts and interviewed them in order to identify challenging situations in daily care. Building on Mol’s concept of logic of care (Mol 2008), we examine how the care professionals in their everyday work with substance using older citizens faced dilemmas in the provision of care within the logics of on the one hand Danish standards for “correct” care and on the other respecting the autonomy of substance using citizens.
References
Ahlmark, N, Sørensen, I. Davidsen, M. & O. Ekholm (2018). Sundhedsprofil for socialt udsatte i Danmark [SUSY marginalized 2017. Health profile for socially marginalized people in Denmark]. Statens Institut for Folkesundhed og Rådet for Socialt Udsatte
Bach, J. S. & Bjerge, B. (2021). Skål i skuret – Sundhed og omsorg blandt ældre udsatte rusmiddelbrugere [Cheers in the shed – Health and care among older marginalized substance users]. Tidsskrift for Sygdom og Samfund, 35: 139-158
Baumbusch, J.L. (2011). Conducting critical ethnography in long-term residential care: experiences of a novice researcher in the field. In: Journal of Advanced Nursing, 67(1): 184-192
Benjaminsen, L. (2019). Hjemløshed i Danmark 2019: National kortlægning [Homelessness in Denmark 2019: National mapping]. Det nationale forsknings- og analysecenter for velfærd
Birkedal, N. B., Højlund, S. & J.K. Sørensen (2021). Mange hjem under samme tag: en antropologisk undersøgelse af duftmiljøerne på seks plejehjem i Aarhus Kommune. Many homes under the same roof: An anthropological study of scent environments in six nursing homes in Aarhus Municipality. Report. Aarhus, MANTRA Aarhus University.
Bjerge, B, Bach, J. S. & J. K. Sørensen (2024). Caring for elderly substance users – challenges, dilemmas and recommendations. NAD Nordic Studies on Alcohol and Drugs
Bjerge, B. Oute, J. Christensen, L. & M. Nygaard-Christensen (2019). Om at ”strikke” et social tilbud sammen til borgere med komplekse problemstillinger [On “knitting” social efforts for citizens with complex problems]. In Bjerge, B. & E. Houborg (eds). Rusmiddelbrugere i krydsfeltet mellem sektorer og fagligheder. Aarhus, Aarhus University Press
Bjerge, B, Bach, J. S. & J. Sørensen (2023). Der mangler viden og efteruddannelse om ældre udsatte rusmiddelbrugere med behov for pleje [There is a lack of knowledge and training on marginalized substance users in need of care]. STOF – Viden om rusmidler og samfund: 45: 14-19
Bjerge, B, Nielsen, B. & V.A. Frank (2014). Rationalities of Choice and Practicalities of Care. Contemporary Drug Problems, 41. 57-90
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2018). Trendspotter manual: a handbook for the rapid assessment of emerging drug-related trends. Publications Office of the European Union, Luxembourg.
Flesland, L. (2014). Sykepleiere i pleie-og omsorgssektorens erfaringer med eldre, rusmidler og hjelpebehov. Nordisk sygeplejeforskning, 4(1). 43-58.
Han, B, H., Termine, D.J., Moore, A. A., Sherman, S.E. & J.J. Paramar (2018). Medical multimorbidity and drug use among adults in the United State, Preventive Medicine Reports. 214–219.
Houborg, E, Kronbæk, M, Kappel, N, Fahnøe, K. R. & S. M. Pedersen (2022). Marginaliserede stofbrugeres hverdagsliv i København. Stofmiljøer og velfærdstilbud [The everyday lives of marginalized drug user in Copenhagen]. Center for Rusmiddelforskning
INCB (2020). Report of the International Narcotics Control Board for (2020). I. A hidden epidemic: The use of drugs among older people. Vienna: United Nations
Kappel, N. & K. S. Johansen (2022). Sundhed og Sundhedsvæsenet [Health and healthcare services]. PP.209-232 In Houborg, E., Kronbæk, M., Kappel, N., Fahnøe, K. R., Pedersen, S. m: & K. S. Johansen (eds.) Marginaliserede stofbrugeres hverdagsliv i København – stofmiljøer og velfærdstilbud. Aarhus Universitetsforlag
Karlsson, L. & Gunnarsson, E. (2018). “Squalor, chaos and feelings of disgust: care workers talk about older people with alcohol problems”. Ageing and Society, 38 (8). 1624-1644
Klausen, S. H., Christiansen, R., Emiliussen, J., Nielsen, A.S. & S. Engelsen (2023). Ældrevelfærd og alkohol – en vanskelig cocktail [The welfare of older people and alcohol – a difficult cocktail]. In Thomsen, K. R., Bjerge, B., Holbech-Vallentin, L. & K. Bloomfield. Alkohol - en del af dansk kultur på godt og på ondt. Aarhus Univerisity Press. 71-94
Koivula, R., Tigerstedt, C., Vilkko, A., Kuussasaari, K. & Pajala, S. (2016). How does older people’s drinking appear in the daily work of home care professionals?. Nordic Studies on Alcohol and Drugs, 33. 537-550
Kusenbach, M. (2003). Street Phenomenology. Ethnography, 4 (3). 455–485. doi.org/10.1177/146613810343007.
Kvale, S. & Brinkmann, S. (2015). Interview. Det kvalitative interview som håndværk [Interview. The qualitative interview as craft]. (3. edition.). København: Hans Reitzels Forlag.
Madison, D.S. (2005). Critical Ethnography: Method, Ethics, and Performance. Sage, Thousand Oaks, California
Mammen, D. (2018). Ulighed i sundhed rammer de socialt udsatte [Inequality in health hits the socially marginalized]. Sygeplejersken 2018 (7). 22-25
Mejnertz, L. (2012) En karruseltur rundt om patienten. Tværsektoriel Kommunikation. En etnografisk undersøgelse af den tværsektorielle kommunikation imellem hospital, kommune, praktiserende læge og borger/ patient [A carousel trip around the patient. Cross sectoral communication. An ethnographic examination of the cross sectoral communication between hospital, municipality, GP and citizen/patient]. Report. København: Caretech Innovation
Mol, A. (2008). The logic of care: Health and the problem of patient choice. New York: Routledge.
Mol, A., Moser, I., & Pols, J. (2010). Care: Putting practice into theory. In A. Mol, I. Moser, & J. Pols (Eds.), Care in practice: On tinkering in clinics, homes and farms (7-26). Bielefield: Transcript-Verlag.
Moore, D., & Fraser, S. (2006). Putting at risk what we know: Reflecting on the drug-using subject in harm reduction and its political implications. Social Science & Medicine, 62. 3035–3047.
Møller, A. F. & A. Nørlyk (2017). Ældres patienters oplevelse af selvbestemmelse, når de modtager sygepleje i eget hjem: en fænomenologisk-hermeneutisk analyse undersøgelse [Older patients’ experiences of autonomy when receiving nursing services in their own home: a phenomenological-hermeneutical analysis]. Klinisk Sygepleje, 31(4). 257-272
Nilou, F.E., Christoffersen, N.B., Møller, S.R., Klitgaard, M.B, Pedersen, P.V., Davidsen, M, Ekholm, O. og Nanna Gram Ahlmark (2023). SUSY UDSAT 2022 Sundhedsprofil for socialt udsatte mennesker i Danmark og udviklingen siden 2007 [Health profile for socially marginalized people in Denmark and the development since 2007]. Statens Institut for Folkesundhed, SDU, København
Pedersen, P.V., Christoffersen, N.B., Møller, S.R. & Michael Davidsen (2023). Dødelighed og brug af sundhedsvæsnet blandt socialt udsatte mennesker i Danmark Registeropfølgning 2007-2021 [Mortality and use of health services among socially marginalized people in Denmark – Register follow up 2007-2021]. Report, Statens Institut for Folkesundhed, SDU
Poulsen, A.G. (2021). Babyboomers bliver pensionister med et glas vin i hånden [Baby boomers retire with a glass of wine in hand]. Ugeskrift for læger: https://ugeskriftet.dk/nyhed/babyboomere-bliver-pensionister-med-et-glas-i-handen [viewed on April 25th 2023]
Rasiah, S, Jaafar, S, Yusuf, S, Ponnudurai, G, Chung, K, P, Y & S. D. Amirtharlingam (2020). A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: a scoping review protocol. BMJ Open, 10, doi:10.1136/bmjopen-2018-028061
Rosen, D., Hunsaker, A., Albert, S. M.,Cornelius, J.R.,& C. F. Reynolds (2011). Characteristics and consequences of heroin use among older adults in the United States: a review of the literature, treatment implications, and recommendations for further research, Addictive Behaviour, 36 (4). 279–285.
Rosenthal, MM. (1994). Kolleger agerar ofta sent mot svenska problemläkare. Stor tolerans mot privata alkoholproblem. Läkartidningen. 91. 4651–4657.
Rostgaard, Tine (2006). Constructing the care consumer. Free choice of home care for the elderly in Denmark. European Societies 8 (3). 443-463.
Spradley, J.P. (1979). The Ethnographic Interview. Harcourt Brace Jovanovich College Publishers; Fort Worth
Sundhedsstyrelsen [Danish Board of Health](2015). Forebyggelse på ældreområdet: Håndbog til kommunerne [Prevention for elders. Handbook for the municipalities]. https://www.sst.dk/da/aeldre/forebyggelse/~/media/06270654E0FD44EFB919F2112ABF794D.ashx
Sundhedsstyrelsen [Danish Board of Health] (2020). Kortlægning af viden om grupper af ældre udsatte borgere med særlige behov. [Mapping of knowledge on older marginalized citizens with special needs - Report]. https://www.sst.dk/-/media/Udgivelser/2020/Kortl%C3%A6gning-af-viden-om-grupper-af-udsatte-%C3%A6ldre-borgere-med-s%C3%A6rlige-behov/Kortlaegning-af-viden-om-grupper-af-udsatte-aeldre-borgere-med-saerlige-behov
Sørensen J.K., Pedersen A.F., Bruun N.H., Vedsted P., Christensen B. (2016). Substance use disorders among Danish physicians. An explorative study of the professional socialization and management of colleagues with substance use disorders. Journal of Addiction Medicine, 10. 248–254
Sørensen, J.K (2019). How physicians’ professional socialisation and social technologies may affect colleagues in substance use disorders. Addiction Research & Theory, 27 (2). 104-113
Thomsen, K. R, Bjerge, B. Vallentin-Holbech, L. & K. Bloomfield (2023). Introduktion. Pp. 9-18 in Thomsen, Bjerge, Vallentin-Holbech & Bloomfield (eds.) Alkohol - en del af dansk kultur på godt og på ondt [Alcohol – a part of Danish culture for good and for bad], Aarhus: Aarhus University Press
Viftrup, D.T., Hvidt, N.C. & Boelsbjerg, H.B. (2022). Træt af at yde omsorg. Et aktionsforskningsstudie om, hvordan man forebygger omsorgstræthed blandt medarbejdere på hospice gennem relationsarbejde [Tired of providing care. An action research study on how to prevent compassion fatigue among staff at a hospice through relational practice]. In Klinisk Sygepleje, DOI: 10.18261/ks.36.3.4
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