Abstracts & Presentation Summaries - Department of Health

community. We also need to understand how and why older adults and people with
disabilities use these services and something of the impact upon their lives.
Are PAG part of a service delivery package where users are simply in receipt of a set
of services or benefits (daily living skills, an enhanced capacity to remain living at
home and a constructed social experience)? Or do PAG actually generate what
Kevin McDonald calls a ‘capacity for action’ 5 for older adults and people with
disabilities where service users engage in meaningful experiences. Here a tension
emerges around the identity of service users as people needing social interaction,
daily living skills and independence demonstrated by living at home, and service
users as people with hopes and dreams and cultural, spiritual and/or material
reasons for living. It is a fundamental tension which confronts many human service
workers and it begs the question of what guiding principles frame practice, the best
interests of service users or the client wishes.
In thinking about how services are delivered the work of Antonovsky, a medical
sociologist provides some useful insights 6 . Antonovsky was puzzled by how it is
possible for highly traumatised individuals to manage stress and stay well. His work
initially focused upon Holocaust survivors and his explanation was that it was those
individuals with a strong sense of coherence who were better able to manage life’s
challenges. I think that the idea of coherence offers a way to both explain and
understand the issues and experiences of PAG users in terms of helping us to
understand how people manage and the supports which assist people to manage and
stay well. A sense of coherence has three dimensions; comprehensibility;
manageability; and meaningfulness.
Comprehensibility refers to a person’s world view or ways of seeing the world. How
older adults and people with disabilities see the world is in part a reflection of the
social construction of ageing and disability; if people are named and treated as
dependent, different or other then this will feature in their identity construction. If
people are given the freedom to develop their own sense of identity and identities, of
who they are, of what they can be then the world is less limiting and restrictive.
Manageability encompasses the mix of material, social, cultural and spiritual
resources to which an individual has access. Here the availability of responsive
health care, caring support services and friendship networks assist people to develop
a sense of control and empowerment rather adopt a victim mentality.
The final dimension of Antonovsky’s model is meaningfulness. This means having
areas of daily life (people, places, events and experiences) that people care about, that
are worthy of emotional, physical and intellectual investment. It may by the passion
of a punter, painter or pianist and is highly individualised. Meaningfulness is that
which moves us; a relationship; fragments from a rich and full life; religious
devotion. What is meaningful emerges from people’s lived experience and can be
shared through narrative, discourse and being.
5 McDonald, K. ‘Social Welfare: Reconstituting the Political?’ Proceedings of National Social Conference, Sydney, 1989, SPRC
Reports and Proceedings, No. 81
6 Antonovsky, A. (1987) Unravelling the mystery of health; how people manage stress and stay well, San Francisco, Jossey-
Bass
Antonovsky, A. (1979) Health, stress and coping, San Francisco, Jossey-Bass
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