Presenter(s):
Carol-Ann Dixon; Vera Roos; Matthews Katjene; Jaco Hoffman, North-West University, South Africa
Abstract
This presentation is positioned within the context of the shift from service-oriented (‘medicalised’) care to more person and relationship-centered models of care. While the global drive is to promote ageing in place, ageing in the right place includes the choice to live in FRCE. However, little attention has been given to the relationships between older persons and paid care workers, which are critical to well-being and care quality. Although several care models (e.g. person-centred and relationship-centred) emphasise the importance of relationships, they do not sufficiently consider the interpersonal context, involving both older persons and care workers. Accordingly, this presentation approaches relationships from an interactional viewpoint as the continuous and circular processes of acting and reacting. A multi-phased qualitative study, conducted in Durban, South Africa, examined interactions within three FRCE settings, each employing different care models. Findings from Phase 1, a scoping review of 36 studies, highlighted four key insights: 1) Context matters. Older persons and care workers assign different meanings to the same physical environment. Care workers operate in a workplace guided by care protocols whereas older persons perceive it as their home. 2) Diversity within formal care settings. Older persons with varying degrees of functioning interact with diverse care workers, who are younger and often speak a different language or follow different sociocultural norms. 3) Interpersonal dynamics. Control in caregiving interactions manifests when care workers move for a one-up position and older persons take on a more submissive position. The nature of relational qualities varying along a continuum from effective to ineffective. 4) Relational outcomes. Depending on the interactional dynamics, relationships can be either effective or ineffective. Data collection utilised the Mmogo-method, a visual data-collection technique emphasising participant inclusivity to gather information from older persons and care workers. Phase 2 explored older persons’ experiences of the caregiving relationship, revealing that the interpersonal context informs interactions, elicits a care imprint and the presence of effective relational qualities which were associated with emotional closeness, confirmation, and collaboration, whereas ineffective relationships exhibited distance and conflict. Phase 3 analysed care workers’ perspectives, showing that adopted care models often fail to translate into relationally focused interactions. Perspectives on aging, sociocultural norms, and intergenerational dynamics inform interactions and ultimately relational and care outcomes as effective or ineffective. Additionally, findings related to Ubuntu could, in future research, be explored as a foundation for establishing kinship and may share commonalities with the concept of filial piety. In Phase 4, the Care and Relational Dynamics (CaRD) framework was developed which explains relational caregiving dynamics at individual, inter-individual, group, and intergenerational levels. The CaRD framework offers a novel, flexible approach for understanding and improving relational outcomes in FRCE, with potential applications in policy, training, and caregiving interventions. By integrating CaRD, FRCE can enhance care quality through constructive and authentic engagement, ultimately fostering a holistic and inclusive care environment.
Bio(s):
Carol-Ann Dixon is a seasoned Counselling Psychologist with over two decades of experience in private practice across South Africa and the UK. Currently, she serves as a Board Member for Imago Africa and Imago Relationships Worldwide (IRW). Carol-Ann is pursuing a PhD in Relational Dynamics and Development at North West University in South Africa, expected to be completed in 2025. Her academic journey includes her Master degree from the University of Johannesburg (1999), advanced clinical training in Imago Relationship Therapy and Encounter-Centered Couples Therapy, as well as certifications in Mediation, and Narrative Therapy. She is registered with the Health Professions Council of South Africa (HPCSA), the Psychological Society of South Africa (PsySSA), and the Health and Care Professional Council (HCPC) UK. She has contributed to the field through her academic research, including her recent publication Public Health Reviews (2024) which offers a critical examination of effective relationships between younger caregivers and older care recipients across formal residential care settings, reflecting her ongoing interest in relational quality and optimal care outcomes. Her practice and scholarship focus on intergenerational relational dynamics, with a commitment to helping individuals, couples, families and communities develop healthier and more meaningful connections.
Vera Roos is Professor in the Ageing and Generational Dynamics in Africa (AGenDA) programme in the Optentia Research Unit at North-West University, and an Affiliate Research Fellow of the Institute of Population Ageing at the University of Oxford. As a socio-gerontologist, she focuses on relational experiences and on the contributions of older individuals in challenged contexts. Vera presented her research on topics related to enabling interpersonal contexts, loneliness, friendship, and intergenerational relations at national and international conferences, and has published widely, including four edited books. Vera developed the Mmogo-method®, a projective visual data-collection tool to enable research participation despite age, language, or cultural barriers. Findings from this visual method informed the development of self-interactional group Theory (SIGT). Her commitment to promoting the well-being of older people prompted the development of an information and communication eDirectory system, Yabelana, with context-specific information for use on smart and older generation mobile phone devices.
Dr. Matthews Katjene holds an Master of Science in Clinical Psychology (MEDUNSA) and a Doctor of Philosophy in Industrial Psychology (NWU). He is a Registered Clinical Psychologist and Neuropsychologist in the Health Professions Council of South Africa (HPCSA). He is the Managing Director of PsychWell Consulting, an Extraordinary Researcher and Academic Supervisor in Optentia Research Unit at the North-West University. His research interests includes relationship dynamics in teams, groups, families, couples and individuals, reproductive health, adult and child psychopathology, medico-legal and forensic psychology, neuropsychology, organisational development and culture management, leadership and individual effectiveness and mental health. He has contributed to multiple research publications in local and international journals. He is a member of the International Neuropsychological Society in which he served as a Conference Program Committee member of the 2023 San Diego, 2024 New York and 2025 New Orleans Conferences. He is a member of the Psychological Society of South Africa (PsySSA), South African Society for Clinical Psychology and Neuro & Forensic Psychology Division of PsySSA. He is a former Board Member and Chairperson of the HR Committee of the Families South Africa (FAMSA) and serves on the Panel of Experts of the Road Accident Fund.
Jaco Hoffman (DPhil, Oxon) is professor of gerontology at the Optentia Research Unit, North-West University, South Africa, where he leads the Ageing and Generational Dynamics in Africa programme. He is also a professorial fellow at the Institute of Population Ageing, University of Oxford, UK. He is an honorary professor in the Institute of Ageing in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town; a past president of the South African Gerontological Association, and a founding member of the South African Older Persons Forum. Jaco co-directs the International Longevity Centre, South Africa, and is a director of the International Federation of Ageing Board. He was appointed as a Lancet Journal Commissioner for the Long-Term Care of Older Persons.
