The future of post-reproductive health: The role of the Internet, the Web, information provision and access

The World Wide Web celebrated its 25th birthday in 2014. In those 25 years, the Web has evolved from static websites (Web 1.0) to a highly complex dynamic system (Web 3.0) with health information processing one of the primary uses. Until now, the western biomedical paradigm has been effective in delivering healthcare, but this model is not positioned to tackle the complex challenges facing healthcare today. These challenges have arisen by increasing healthcare demands across the world, exacerbated by an ageing population, increased lifespan and chronic conditions. To meet these needs, a ‘biopsychosocial’ shift from reactive to proactive health is necessary with a patient-centric emphasis (personalised, preventative, participatory and predictive) that includes ‘gender-specific medicine’. The management of the menopause, part of post-reproductive health, requires a life-course approach as it provides a framework for achieving a women’s preferred health outcome. Surveys from www.menopausematters.co.uk have consistently shown that women do not feel informed enough to make decisions regarding Hormone Replacement Therapy and alternative therapies. Health professionals must meet this challenge. The recently published National Institute for Health and Care Excellence guidance on the diagnosis and management of the menopause highlights the need for tailored information provision. The Internet underpinned by the academic disciplines of Health Web Science and Medicine 2.0 has potential to facilitate this shift to biopsychosocial medicine and tailored information within a life-course framework. The concept of Health Web Observatories and their potential benefit to a life-course approach using tools such as www.managemymenopause.co.uk is discussed

Use of information and communication technologies improves healthy and unhealthy elderly people's quality of life – the key role of the training setting

The link between the use of ICT and QoL has only been recently theorized because ICT is not, per se, a correct and easy tool to improve elderly people's QoL. We conducted a research consisting of two studies: the first one involved healthy and unhealthy seniors and the second one was a pilot study inspired by Action Research. We aimed to investigate whether elderly people's QoL was influenced by higher beliefs, self-efficacy and positive attitudes towards ICT. Regarding the first study, most participants did not have any digital skills or only a very low level. Their perceived QoL was quite good. Their self-efficacy beliefs were very high. Their attitudes towards ICT were on the the mid-point scale. The QoL was affected by self-efficacy. In respect to the second study, data were collected before and after tests focused on improving the seniors' digital skills. The post-training data were significantly more positive than pre-training. Self-efficacy was significantly higher after training, as was perceived QoL. The results provide evidence that seniors perceive their own lives as better than other age cohorts attribute to them. The quality of the relationship between seniors and trainers represents a main point that positively affects the QoL.Keywords: Seniors, Information and Communication Technology, Quality of Life, Active Training, Relationshi

ACTIVITIES AND ADAPTIVE STRATEGIES IN LATE LIFE DEPRESSION: A QUALITATIVE STUDY

This study sought to understand activity choices of older adults when they were depressed and in the early stages of recovery. Qualitative analysis was used to identify themes of activities continued, stopped, resumed, and newly begun. Participants (n=27) were recruited from a randomized clinical trial (R37 MH43832) and were community dwelling, predominantly female, with a mean age of 73.3 years. One interview was conducted with each participant in recovery for at least 3 but no longer than 7 months, using a semi-structured interview. When depressed, participants continued some activities and stopped others. Activities were continued when they were part of an established habit or commitment, gratifying, a means of distraction or escape, and/or an attempt to hide depression from others. Participants continued activities when they were nudged by another person and/or felt a sense of pushing oneself to maintain normalcy. Participants stopped some activities when they were no longer meaningful and/ or were too physically painful to complete. Some activities were stopped when participants had insufficient physical/cognitive energy or did not wish to expend their limited reserve, avoided negativity, and/or constricted their social space.In recovery, the majority of activities in which participants engaged when they were depressed were continued spontaneously. Some, however, were stopped when no longer meaningful or necessary, and/or when participants' activity level increased substantially, limiting available time. Participants resumed most activities when activities were again meaningful, physical and/or cognitive energy returned, pain complaints diminished, health promotion was desired, and/or when participants were able to confront negative situations, and/or enlarge their social space. Some activities, however, were not resumed when participants actively weighed activity options and chose to divert time and energy to higher priorities. Some participants engaged in new activities not done prior to or during depression when positive self-change opened up opportunities for engagement or participants undertook efforts to reorganize their lives.In conclusion, adaptive strategies were brought into play at various time points as participants selected activities to continue, stop, resume, and newly begin as they strove to survive the depressive episode and, then, re-enter and participate in their former lives in recovery