The attendants who participated in this study were aged 56–61, [median ± semi-interquartile range (Md ± Q): 61.0 ± 2.0] and were all female (Table 1). The majority (4; 66.7%) of them were not part of a couple [two were single (33.3%), one was widowed (16.7%) and one was divorced (16.7%)]. Half of the attendants reported incomes of $25,000 or more, and most were satisfied with their incomes [one was satisfied (16.7%) and three were very satisfied (50.0%)]. The attendants had either a college or a vocational diploma (n = 3; 50.0%) or a Bachelor’s degree (n = 3; 50.0%). Four attendants (66.7%) had previous volunteer experience prior to the APIC, and most of them (n = 3; 75.0%) had volunteered for more than five years. Half of the attendants assisted more than one older person during the APIC.
Table 1. Socio-demographic characteristics of attendants (n=6)
Attendant #
|
Age (years)
|
Marital statusa
|
Incomeb
|
Income satisfactionc
|
Educationd
|
Volunteering involvement before the APICe
|
Volunteering involvement (years)
|
Assisted older adults in the APIC
|
A1
|
58
|
1
|
4
|
1
|
1
|
1
|
12
|
4
|
A2
|
61
|
3
|
3
|
2
|
2
|
2
|
-
|
1
|
A3
|
56
|
3
|
1
|
3
|
2
|
1
|
5
|
1
|
A4
|
61
|
2
|
3
|
3
|
1
|
1
|
8
|
2
|
A5
|
61
|
4
|
2
|
2
|
2
|
1
|
4
|
3
|
A6
|
61
|
1
|
2
|
2
|
1
|
2
|
-
|
1
|
a (1) Married / Common law; (2) Widowed; (3) Single; (4) Divorced / Separated
b (1) < $15.000; (2) $15.001-$25.000; (3) $25.001-$40.000; (4) > $40.001
c (1) Very satisfied; (2) Satisfied; (3) Dissatisfied
d (1) College / Vocational; (2) Bachelor
e (1) Yes; (2) No
Overall, all the attendants appreciated their experience during the APIC when assisting older adults in optimizing their social activities and life plan. The attendants’ assistance experience was described in terms of: 1) developing a meaningful relationship with older adults, 2) increasing their self-knowledge, 3) encountering challenges, and 4) performing roles. Firstly, the attendants developed meaningful relationships with the older adults they assisted. All attendants reported they were caring with older adults, such as being generous with their time and help, or worrying about the older adults’ health, as one attendant indicated: “I told her that I was really happy to see that she was much better and looked good [after an illness episode]. I felt she was much less anxious and leading a fuller life.” (Logbook of A3; LA3). The attendants said their relationships with their older adults were pleasant, based on trust, and allowed for the sharing of common interests: “I was so happy to share with him one of his passions, his love of books. A moment of pure happiness.” (LA1). The attendants reported being good listeners, which allowed the older adults to confide in them and express their emotions. Moreover, the attendants mentioned that their presence reassured the older adults, gave them energy, cheered them up, and helped them maintain social ties in the community.
Secondly, the APIC contributed to the attendants’ self-development, especially when they had to be assertive because of the older adults’ attitudes, such as when they refused to look at the social activities being carried out in the community (n = 7) or lacked interest in participating in them (n = 3). The attendants’ self-assertion helped develop an egalitarian relationship, in which the older adults understood more about the attendants’ role and acted more respectfully towards them, as illustrated in the following example:
“I found her very stiff, she did not want to make a connection and just saw me as an employee […]. At one point, I had to sit down with her and tell her: ‘I’m not comfortable with that’. I think that helped and eventually she realized that, it’s true, she’s not my employee.” (A5).
One third (n = 2) of the attendants reported that the APIC gave them an opportunity to increase their self-knowledge, their self-esteem, and their self-satisfaction. They recognized their own qualities and abilities. They realized that they could influence those close to them with their advice, including the assisted older adults, which increased their self-esteem. Through the APIC, the attendants (n = 4) initiated contemplation of the aging process for themselves as well as for the older adults around them, and adapted their vision of the aging process to the assisted older adults’ reality. More precisely, these adaptations related to life in a residence and the care services provided by the public health system. Their experiences also allowed half of the attendants to reflect on, and ask questions about, their responsibilities towards assisted older adults and the difficulties associated with unclear boundaries with them. To maintain a positive and appropriate relationship with older adults, four attendants needed to distance themselves from the older adults’ personal problems or important decisions to be made. Distancing themselves was not always easy for the attendants, as mentioned by one who assisted a blind older adult experiencing a couple crisis during the APIC: “The hardest thing was to be able to help him without interfering in decisions [to split up with his wife and move into another apartment], to keep myself at a distance from that.” (A1 in meeting; MA1). Such a situation was beyond the role of the attendants and required the care of a health professional, as explained by the same attendant: “I felt overwhelmed when the couple broke up [resulting in an interruption of the APIC with the attendant for two weeks]. I would have liked the social worker to act a little faster, come and support them during the crisis because there was violence.” (A1). A third (n = 2) of the attendants reported experiencing situations beyond their role.
Thirdly, the attendants faced some challenges related to the older adults. The physical condition of some older adults restricted opportunities for, or the duration of, social activities on several occasions. The health of some older adults (n = 6) deteriorated during the APIC and prevented them from participating in social activities in the community, leaving most of the attendants (n = 4) to run out of ideas about social activities that could be done with them, as expressed by one attendant: “[The older woman I assisted] fell in her apartment and, from that moment, she was not able to walk and had no energy. I did not know what to do with her [to help her carry out social activities].” (A4). Some older adults exhibited inappropriate behavior (n = 7) that at times compromised the interpersonal relationships with the attendants or participation in the social activities. On occasion, some attendants (n = 2) were yelled at, heard derogatory words, or felt impatience towards them from the older adults, as reported by one attendant who was faced with such a situation: “I have difficulty with screams, anger and explosive frustrations […]. It was natural for [the older woman I assisted] to use a very dry tone and it felt aggressive. ” (LA5). Some attendants (n = 3) reported that some older adults (n = 4) had rigid personalities, such as demonstrating a closed attitude or refusing to pay for activities, which limited social exchange opportunities. Some attendants (n = 2) were concerned about the older adults’ physical abilities because of their refusal to use appropriate technical assistance during the APIC, as illustrated by one attendant: “She had difficulty walking, but refused to use her walker.[…] I stayed close by, but it worried me the whole time.” (LA6).
The attendants (n = 5) reported that another challenge during the APIC was the older adults’ refusal to get involved in social activities in their community, whether for lack of interest in doing activities with peers or other needs deemed more meaningful for them, such as chatting with the attendants. Talking with the older adults about the goals of social activities then became difficult due to this lack of interest, as experienced by this attendant: “Joining [community] organizations was often discussed with her [older adult], but she really did not want to. She said: ‘No, I do not need that’.” (A6). On some occasions, seven older adults expressed needs other than doing social activities outside their homes (i.e. watching television). Likewise, three older adults did not want to maintain social relations with others in the neighborhood, especially because of their uncertainty about socializing with peers and fear of being rejected or denigrated when joining an existing social group. Furthermore, the attendants reported that some older adults (n = 3) refused to compromise on, for example, paying for some social activities or calling for adapted transportation to attend a community activity, making social integration difficult, as was the case for this older adult: “We could have gone out every week, but she knew there were fees if we ever went out. She didn't want to pay for taxis, she said it was too expensive, and she didn't want to take adapted transport because she said it was lousy, it wasn't made for her, so we stayed at home.” (LA5).
Fourthly, the attendants mentioned performing several roles during the APIC. All of the attendants reported having identified opportunities for the older adults to get involved in the community, which contributed to their social participation. Every attendant also reinforced empowerment in older adults by maintaining their functional independence, encouraging them to try new social activities, and accomplishing activities outside their home. This example illustrates how the attendants positively contributed to the older adults’ empowerment, including their ability to make choices independently, as described by one attendant: “Madam is increasingly gaining confidence regarding our sessions. She made her choice without waiting for my response [to undertake social activities].” (LA5). Although it fell outside their role, all attendants felt that they had contributed to daily tasks in the older adults’ lives, such as managing mail and phone calls, which were sometimes stressful and where assistance from attendants was precious and helpful: “She mentioned that the afternoon had passed too quickly but that she was very happy with the calls [to resolve a problem with the older adult’s unpaid bills] that I had made for her, because she felt reassured.” (LA6). Moreover, attendants (n = 3) reported having enhanced the older adults’ qualities and abilities, by emphasizing progress and congratulating them on initiatives, which subsequently encouraged the older adults to take action. One attendant observed changes in the assisted older adult’s attitude and motivation towards opportunities for social activities after pointing out her social and physical abilities: “[During the APIC] She really opened up to people, to the world, there were no more barriers. This project enabled her to take small outings, to chat, to say you can do it, to restore the person’s confidence, which made all the difference.” (MA1). Finally, some attendants (n = 4) said that they contributed to the older adults’ social participation by acting as an agent of change and encouraging them to integrate into the community, as expressed by one attendant: “I suggested that she sign up for creative workshops. Following this suggestion she informed me that she had just enrolled in Tai Chi at her community center.” (LA5). The attendants (n = 2) supported the older adults in making permanent changes with regard to their social participation that was better adapted to their needs and their abilities, and in making long-term commitments in their community. At the end of the APIC, all the attendants wanted to maintain the friendship bonds with the older adults. Half (n = 3; 50%) of the attendants continued contact and visits with the older adults for a few months after the end of the APIC, but no longer maintained relationships with them 12 months later. The other half of the attendants are still visiting or hearing from the older adults because they are attached to them and they still have a place in their lives, as reported by one attendant: “I have a lot in common with [the older woman I assisted], what she likes are things I like too. So, for sure, we continue to see each other.” (A1).