Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity

Åke Grundberg,1 Britt Ebbeskog,2 Sanna Aila Gustafsson,3 Dorota Religa11Division of Neurogeriatrics, 2Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, 3Psychiatric Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, SwedenAbstract: Mental health promotion needs to be studied more deeply within the context of primary care, because persons with multiple chronic conditions are at risk of developing poor mental health. In order to make progress in the understanding of mental health promotion, the aim of this study was to describe the experiences of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity – what these seniors believe is important for achieving a dialogue that may promote their mental health. Seven interviews with six women and one man, aged 83–96 years, were analyzed using qualitative content analysis. The results were summarized into nine subcategories and three categories. The underlying meaning of the text was formulated into an overarching theme that embraced every category, “perceived and well-managed as a unique individual”. These seniors with multimorbidity missed someone to talk to about their mental health, and needed partners that were accessible for health dialogues that could promote mental health. The participants missed friends and relatives to talk to and they (crucially) lacked health care or social service providers for health-promoting dialogues that may promote mental health. An optimal level of care can be achieved through involvement, continuity, and by providing a health-promoting dialogue based on seniors’ needs and wishes, with the remembrance that general health promotion also may promote mental health. Implications for clinical practice and further research are discussed.Keywords: aged, care of older people, mental health-promotion, municipal car

Painful leg ulceration: a prospective, longitudinal cohort study

Objective To explore the relationship between pain mechanism, pain intensity and leg ulcer characteristics. Design A six month longitudinal cohort study in a community setting in the north of England. Participants 95 patients with leg ulceration referred consecutively to district nurses. Main outcome measures Pain intensity using daily visual analogue scores, leg ulcer characteristics (aetiology, size, location, duration) and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs). Results Type, duration, position and size of the leg ulcer had no effect on average daily pain scores. Using the LANSS questionnaire, 43.5% of respondents reported symptoms suggestive of a neuropathic mechanism to their pain. Patients with neuropathic symptoms had higher average daily pain scores (p<0.001). Fewer people healed with neuropathic symptoms compared to those with no neuropathic symptoms (30.8% versus 52.1%). Conclusion Severity of pain can not be predicted by the type, size, position or duration of ulceration. Patients who scored positively for neuropathic symptoms had higher average daily pain scores and fewer had healed leg ulcers at 6 months compared to those who did not experience neuropathic sign and symptoms. This is an interesting future avenue for research

The impact of chronic venous leg ulcers: a systematic review.

OBJECTIVE: Chronic venous leg ulcers are common, intractable and often recurrent, but care tends to be wound focused, potentially overlooking the significant impact the condition has on patients' lives. A systematic review was undertaken to explore the factors that impact on the quality of life of patients with chronic venous leg ulceration. METHOD: Eligible articles published between 1990 and 2013 were identified via electronic searches of research databases (MEDLINE, CINAHL, BNI, EMBASE, PsycINFO, AMED and HMIC, Cochrane Collaboration database and Google Scholar). RESULTS: There were 23 studies (11 qualitative and 12 quantitative) that met the inclusion criteria. There were then the subject of a full review. The qualitative studies were collapsed into four core themes: physical, psychological, social implications and the nurse-patient relationship. The quantitative studies were grouped according to the tool applied. The review demonstrated that chronic venous leg ulcers impact negatively upon all areas of daily living. Pain, exudate, odour and the impact on mobility were daily challenges. The ability to engage with everyday functioning was restricted either owing to the ulcer, the dressing or to a self-imposed isolation in response to the impact of symptoms. Depression and low mood were common and yet, despite this, some studies reported that participants remained hopeful. CONCLUSION: Studies suggest that chronic venous leg ulceration negatively affects the quality of life of the patient and that such issues receive inadequate attention during current consultations. If such negative implications are to be effectively addressed, key issues need to be considered during every consultation. DECLARATION OF INTEREST: This study was funded by West Midlands Strategic Health Authority. The authors have no conflicts of interest to declare