Social integration following a stroke: understanding meaning and process in older people.

Abstract

This study focused on understanding the meaning and process of social integration in older people who had experienced a stroke. Straussian grounded theory guided the study design. Older people living in their own homes in three counties in southern England were included in the sample. A total of 30 people were purposively selected and semi-structured interviews were conducted with older people (mean age 76) between four and eight years after their stroke. The substantive theory from indecision to volition was generated and conceptualised as the core category and comprised of four related categories: Gaps in identity, internal conflict, negotiating and exploring and renegotiating and reconciling. It was found that people did not feel they had managed to attain social integration; instead they described a more restricted but evolving social world and a process within the context of a personal journey to establish meaningful relationships. After people’s strokes an empty social space unfolded from the loss of social groups. Within this space, feelings of fear emerged and people experienced increasing self-consciousness and an erosion of self-confidence. The journey described was encompassed within a complex framework shrouded in effort and hard work that required many people to make a conscious decision to act in order to forge new relationships outside of their homes and families. This study identified variation in the process with people describing differing social progression. Those people that were able to make progress needed to access and utilise resources, but only at the right time for them, which for some took many years. Only a few people had returned to previous social groups. The majority slowly built new friendships and a new social world began to emerge; one that was often fraught with setbacks or pauses. Targeted and effective interventions that support people’s individual social needs have been suggested. These and opportunities for further research will continue to build a greater understanding, enabling people to move from uncertainty and indecision to an active volitional choice in order to form new and personally meaningful social worlds.