Many frail, older people living in care homes are not being given the chance to be, quite simply, themselves, says research funded by the Economic and Social Research Council (ESRC). The research has broken new ground in getting perspectives from people living in care homes, including many with dementia and/or communication difficulties.

The project identified that 'being oneself', and feeling positive about it, enabled older people who can no longer live at home to enjoy a better quality of life. Government guidance is that carers should listen more to people in homes as a step towards improving their quality of life. But the researchers found that carers mostly have "limited opportunities" to implement this guidance.

"People need to be able to express themselves", says Susan Tester, lead researcher. "Their quality of life is inhibited if they are not able to feel 'at home' and comfortable in expressing a sense of self positively." Paying attention to how they look, valuing their possessions, showing that they like to have some personal space, all add to how they see themselves.

This sense of one's self is important in the relationships that people sustain with other residents in the home and with their families. Some manage to have contact with other residents even when their speech is impaired and their hearing poor. But some residents were hostile to others.

Trips outside the care home are rare and this confinement increases the risk of being cut off from past associations with neighbours and friends and family. Ordinary activities, like window shopping or going for a pint were no longer possible. The quality of life of residents is determined almost wholly within the home. Relations with family, however, are important, particularly for the few in care who could keep up with their relatives and feel that they were still a part of the family. People with dementia, meanwhile, seemed to draw comfort in their relationships with family now dead.

The degree of control that people enjoyed in daily living was found to depend on the environment in which they lived and the sort of care they received as well as their own physical and mental aptitudes. The care staff had a key role in supporting people to help themselves. This was most notable in helping older people to be continent. Where people did not get this help, there was anger and distress on their part. Carers could also help enhance the quality of life by fostering caring personal relationships with residents. Likewise, they could inhibit it through lack of personal care and respect.

The research included focus groups, observations, carried out in four care home settings, guided conversations and individual observation of a sample of 52 residents from seven care homes. The participants included 41 women and 11 men, in age groups from 65-69 to 95-99, the majority in the 75-89 range. 24 had been diagnosed with dementia. Conversation methods included the use of Talking Mats, a visual framework using picture symbols to help people with communication difficulties.