Ability for self-care in urban living older people in southern Norway

Published version of an article in the journal: Journal of Multidisciplinary Healthcare. Also available from the publisher at: http://dx.doi.org/10.2147/JMDH.S29388 Open AccessBackground: The number of older people living in urban environments throughout the world will increase in the coming years. There is a trend in most European countries towards improved health among older people, and increased life expectancy for both women and men. Norway has experienced less increase in life expectancy than some other European countries, and it is therefore important to investigate older urban Norwegian people's health and ways of living in a self-care environment, with special regard to health promotion. Aim: The aim of this study was to describe self-care ability among home-dwelling older (65+ years) individuals living in urban areas in southern Norway in relation to general living conditions, sense of coherence (SOC), screened nutritional state, physical activity, perceived self-reported health, mental health, and perceived life situation. Methods: In 2010, a randomized sample of 1044 men and women aged 65+ years who were living in urban areas in southern Norway answered a postal questionnaire consisting of five instruments, some background variables, and 17 health-related questions. Univariate and multivariate statistical methods were used in the analyses of the data. Results: The mean age of the participants was 74.8 years (SD = 7.1). Eighty-three percent of the participants had higher abilities to care for themselves. Self-care agency, perceived good health, being active, being frequently active, good mental health, not being at risk of undernutrition, and satisfaction with life were all positively related to self-care ability. Negative factors were perceived helplessness, receiving home nursing, being anxious, and being at a more advanced age. People aged 85+ years had worse mental health, were less physically active, and more at risk of undernutrition. Conclusion: Health professionals should focus on the health-promoting factors that reinforce older people's ability to care for themselves, and be aware of important symptoms and signs associated with a reduction in a person's self-care ability. Politicians should assume responsibility for health care with a special regard to senior citizens

Self-care telephone talks as a health-promotion intervention in urban home-living persons 75+ years of age : a randomized controlled study

Aim: The aim of this study was to evaluate the effects of a telephone-based self-care intervention among urban living individuals 75+ years of age by comparing self-reported perceived health, mental health, sense of coherence, self-care ability, and self-care agency before and after the intervention. Materials and methods: In a randomized controlled study, 15 persons answered a questionnaire about perceived health, mental health, sense of coherence, self-care ability, and self-care agency. In a sex- and age-matched control group (n=15), the same questions were answered. Data were collected before and after intervention. An open-ended question about experiences of the intervention was included in the last questionnaire. The intervention consisted of a first meeting with health professionals and additional five self-care telephone calls. The control group did not receive any intervention or attention except for the questionnaires. Descriptive statistics were used to describe the study group. To compare the intervention group and control group on nominal and ordinal levels, the McNemar test and the Wilcoxon signed-rank test, respectively, were chosen. Results: Thirty individuals (14 females and 16 males) participated in the study, ranging in age between 75 and 93 years. A significant difference was obtained in the intervention group regarding mental health. Mental health improved significantly in the intervention group (P=0.037). In the control group, mental health, sense of coherence, self-care ability, and self-care agency showed worse outcome results after the intervention (19 weeks). Conclusion: Self-care telephone talks improved mental health significantly in our sample, and mental health focus could be understood as a possible condition for health promotion to take place. Structured self-care telephone talks have proved to be successful and a relevant method to use in practice

Lived experiences of self-care among older physically active urban-living individuals

Published version of an article in the journal: Clinical Interventions in Aging. Also available from the publisher at: http://dx.doi.org/10.2147/cia.s39689 Open accessBackground: Promoting physical activity is a public health priority in most industrial countries, and physical function is an important factor when taking into consideration older people's self-care and health. Despite the increasing challenges associated with urbanization and the aging population, urban life appears to be positive in many ways for urban dwellers. However, the manner in which older people live in urban settings and how this influences their ability to take care of themselves should be considered important knowledge for health professionals and politicians to acquire. The aim of this study was to describe the lived experiences of self-care and features that may influence health and self-care among older urban home-dwelling individuals who are physically active. Methods: Ten subjects, three women and seven men, who were aged 65-82 years and identified to be physically active, were interviewed. The interviews were recorded, transcribed verbatim, and analyzed according to the descriptive phenomenological method devised by Giorgi. Results: Our findings showed beneficial self-care. The participants lived active everyday lives and were frequently physically active. They were part of a supportive, inclusive, and promoting fellowship, and they had the opportunity to travel. They utilized their competence and experienced making themselves useful. It was a privilege to be part of a family life as a husband, wife, parent, and/or a grandparent. They acknowledged physical and mental limitations, yet they felt they were in good health. Conclusion: Health professionals and politicians should identify places where fellowship and relationships can be built, as well as encourage older people to use their competence by engagement in volunteering. These interventions are important to support older people's self-care and health. This may also be a way to reduce ageism in Western societies

Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people

Artikkelen rapporterer en studie hvor hensikten var å teste reliabilitet og validitet av den norske versjonen av Nutritional Form For Eldre (NUFFE-NO) blant hjemmeboende eldre, og å bruke kortformen av Mini Nutritional Assessment (MNA-SF) som en standard.Nutritional screening instruments need to be evaluated in terms of reliability and validity and being able to demonstrate sensitivity and specificity for use in clinical practice and research. The aims of this study were to test the reliability and validity of the Norwegian version of the Nutritional Form For the Elderly (NUFFE-NO) in a sample of older home-dwelling people, and to use the short form of the Mini Nutritional Assessment (MNA-SF) as a standard. A postal questionnaire, including the two instruments, background variables, and health-related questions, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. In total, 2106 persons responded and were included. Data were analyzed statistically regarding homogeneity, concurrent and construct validity, sensitivity, and specificity of NUFFE-NO. A Cronbach's alpha coefficient of 0.71 and significant item-to-total correlations were obtained as measures of homogeneity. Concurrent validity was assessed by a correlation coefficient of -0.37 (P < 0.001) between NUFFE-NO and MNA-SF. NUFFE-NO could separate known nutritional at-risk groups as a measure of construct validity. A cut-off point of ≥4 for identification of older people at nutritional risk was found for NUFFE-NO with MNA-SF as a standard. NUFFE-NO shows adequate psychometric properties regarding homogeneity and construct validity. MNA-SF was not found to be the most suitable standard to use, because a low correlation coefficient was obtained as a measure of concurrent validity and a lower cut-off point was found compared with another study using the Mini Nutritional Assessment (MNA(®)) as a standard for NUFFE-NO. The obtained cut-off point of ≥4 is not recommended for use in practice or research, because many false positive nutritional at-risk persons would then be identified. Further studies with suitable design have to be performed among older home-dwelling people using the MNA as a standard

Loneliness Among Older Home-Dwelling Persons: A Challenge for Home Care Nurses

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Engagement, knowledge and autonomy : facing a new generation older urban living people : studies on self-care and health

Aim: The overall purpose of this thesis was to explore the phenomenon of self-care among older, urban homedwelling people in order to enhance health and well-being and be able to inform and improve policy and practise. Methods: A mixed methods design was chosen. A descriptive cross-sectional design was applied for Study I and 1,044 randomly chosen men and women aged 65+ years, living in urban areas in southern Norway answered a postal questionnaire consisting of five instruments measuring risk for undernutrition, self-care ability, self-care agency, sense of coherence, mental health, background variables, and 17 health related questions. Studies II and III, had a qualitative design with a descriptive phenomenological (II) and a phenomenological hermeneutical approach (III). Ten persons 65-82 years, identified to be physically active every day (Study II), and nine single living persons 70-82 years of age, identified to be in good health (Study III), were interviewed. A randomized controlled study, was performed (Study IV) for the purpose of evaluating the effects of a telephone-based selfcare intervention. Fifteen persons aged 75-93 answered a questionnaire about perceived health, self-care ability, self-care agency, sense of coherence and mental health before and after intervention. In an age and sex matched control group (n=15), the same questions were answered without any attention except for the questionnaires. Data in Study I were analysed with univariate and multivariate statistical methods and to compare the intervention group and control group in Study IV, the McNemar-test and the Wilcoxon signed-rank test were used. For analysing data in the interview studies, a descriptive phenomenological (II) and a phenomenologicalhermeneutical (III) method were used. Main results: A majority (83%) of the participants in Study I had higher self-care ability. Self-care agency, perceived good health, being active, being frequently physically active, good mental health, not being at risk for undernutrition, and satisfaction with life, all promoted self-care ability. Negative factors for self-care ability were perceived helplessness, receiving home nursing, being anxious and advanced age. For the oldest participants, 85+ years of age, frequency of physical activity was the strongest factor promoting self-care ability. Age was a negative factor for self-care ability among persons being 75-84 years of age. The participants in Study II lived active everyday lives and were frequently physically active, they were part of a supportive, inclusive, and promoting fellowship, and they had the opportunity to travel. They utilized their competence and experienced making themselves useful. It was a privilege to be part of a family life as a husband, wife, parent, and/or a grandparent. They acknowledged physical and mental limitations, yet they felt they were in good health. For the single living older persons in Study III, the meaning of self-care and health for the perception of life situation and identity was characterized as strength and a time dimension. As older persons, the participants were caring, autonomous, and robust characters who had experienced difficult times in life and in a resilient way moved towards a new future. They valued and were grateful for what they had learned in their lives and could go forward and still experience and explore. In Study IV, a significant difference was obtained in the intervention group showing improved mental health (p=0.037). In the control group, mental health, sense of coherence, selfcare ability, and self-care agency, all showed worse outcome results after the intervention time (19 weeks). Conclusions: Important factors promoting self-care and health in older persons living in urban areas in southern Norway are good mental health, being satisfied with life, perceiving good health, being active, not being at risk of undernutrition, and being physically active once a week or more. Self-care ability declines in participants 75+years of age. For the oldest people, 85+ years of age, physical activity is the most important factor promoting self-care ability. A telephone-based self-care intervention may improve mental health that is critical for establishing self-care ability and self-care actions in older home-dwelling people. Physically active older persons have valuable resources such as engagement, knowledge and involvement in their surroundings. The single living older persons seem to represent a new generation of older people living alone and are characterized by strength, temporality, gratitude, autonomy, and natality. Society needs to acknowledge older people to a greater extent, involving them in important and necessary work in different fields

Being old and living alone in urban areas. The meaning of self-care and health on the perception of life situation and identity

Background: Living alone in urban areas when getting old is an important and necessary field for research as the growth of the urban population worldwide increases, and due to the fact that people live longer. How older people manage their self-care and health, and how this might influence their identity and life situation may be very important to understand when planning for a new, upcoming older generation. The aim of this study was to elucidate the meaning of self-care and health for the perception of life situation and identity among single-living older individuals in urban areas in southern Norway. Methods: A phenomenological–hermeneutic approach inspired by Ricoeur was applied. Nine single-living older persons in urban areas, 70–82 years of age, and identified to be in good health were interviewed. The interviews were audiotaped, transcribed verbatim, and analyzed using a phenomenological–hermeneutic method. Results: Strength and a time dimension characterized the meaning of self-care and health for the perception of life situation and identity as narrated by the group of single-living older individuals in urban areas in southern Norway. The informants were, as older individuals, car- ing, autonomous, and robust characters, who had gone through difficult times in life, and in a resilient way moved towards a new future. They valued and were grateful for what they had learned in their lives and could go forward and still experience and explore. Conclusion: Self-care is significant in the perception of life situation and identity among single urban older people in this study, and characterized by strength, temporality, gratitude, autonomy, and natality. Society needs to acknowledge the strengths and capabilities of older people to a greater extent. Keywords: aged, health promotion, phenomenological–hermeneutic method, salutogenesis, tim

Being old and living alone in urban areas. The meaning of self-care and health on the perception of life situation and identity

-Background: Living alone in urban areas when getting old is an important and necessary field for research as the growth of the urban population worldwide increases, and due to the fact that people live longer. How older people manage their self-care and health, and how this might influence their identity and life situation may be very important to understand when planning for a new, upcoming older generation. The aim of this study was to elucidate the meaning of self-care and health for the perception of life situation and identity among single-living older individuals in urban areas in southern Norway. Methods: A phenomenological–hermeneutic approach inspired by Ricoeur was applied. Nine single-living older persons in urban areas, 70–82 years of age, and identified to be in good health were interviewed. The interviews were audiotaped, transcribed verbatim, and analyzed using a phenomenological–hermeneutic method. Results: Strength and a time dimension characterized the meaning of self-care and health for the perception of life situation and identity as narrated by the group of single-living older individuals in urban areas in southern Norway. The informants were, as older individuals, car- ing, autonomous, and robust characters, who had gone through difficult times in life, and in a resilient way moved towards a new future. They valued and were grateful for what they had learned in their lives and could go forward and still experience and explore. Conclusion: Self-care is significant in the perception of life situation and identity among single urban older people in this study, and characterized by strength, temporality, gratitude, autonomy, and natality. Society needs to acknowledge the strengths and capabilities of older people to a greater extent. Keywords: aged, health promotion, phenomenological–hermeneutic method, salutogenesis, tim

Lived experiences of self-care among older physically active urban-living individuals

Background: Promoting physical activity is a public health priority in most industrial countries, and physical function is an important factor when taking into consideration older people’s self-care and health. Despite the increasing challenges associated with urbanization and the aging population, urban life appears to be positive in many ways for urban dwellers. However, the manner in which older people live in urban settings and how this influences their ability to take care of themselves should be considered important knowledge for health professionals and politicians to acquire. The aim of this study was to describe the lived experiences of self-care and features that may influence health and self-care among older urban home-dwelling individuals who are physically active. Methods: Ten subjects, three women and seven men, who were aged 65–82 years and identified to be physically active, were interviewed. The interviews were recorded, transcribed verbatim, and analyzed according to the descriptive phenomenological method devised by Giorgi. Results: Our findings showed beneficial self-care. The participants lived active everyday lives and were frequently physically active. They were part of a supportive, inclusive, and promoting fellowship, and they had the opportunity to travel. They utilized their competence and experienced making themselves useful. It was a privilege to be part of a family life as a husband, wife, parent, and/or a grandparent. They acknowledged physical and mental limitations, yet they felt they were in good health. Conclusion: Health professionals and politicians should identify places where fellowship and relationships can be built, as well as encourage older people to use their competence by engagement in volunteering. These interventions are important to support older people’s self-care and health. This may also be a way to reduce ageism in Western societies. Keywords: aged, health promotion, perceived health, phenomenolog

Lived experiences of self-care among older physically active urban-living individuals

- Published article -cc-by-ncBackground: Promoting physical activity is a public health priority in most industrial countries, and physical function is an important factor when taking into consideration older people’s self-care and health. Despite the increasing challenges associated with urbanization and the aging population, urban life appears to be positive in many ways for urban dwellers. However, the manner in which older people live in urban settings and how this influences their ability to take care of themselves should be considered important knowledge for health professionals and politicians to acquire. The aim of this study was to describe the lived experiences of self-care and features that may influence health and self-care among older urban home-dwelling individuals who are physically active. Methods: Ten subjects, three women and seven men, who were aged 65–82 years and identified to be physically active, were interviewed. The interviews were recorded, transcribed verbatim, and analyzed according to the descriptive phenomenological method devised by Giorgi. Results: Our findings showed beneficial self-care. The participants lived active everyday lives and were frequently physically active. They were part of a supportive, inclusive, and promoting fellowship, and they had the opportunity to travel. They utilized their competence and experienced making themselves useful. It was a privilege to be part of a family life as a husband, wife, parent, and/or a grandparent. They acknowledged physical and mental limitations, yet they felt they were in good health. Conclusion: Health professionals and politicians should identify places where fellowship and relationships can be built, as well as encourage older people to use their competence by engagement in volunteering. These interventions are important to support older people’s self-care and health. This may also be a way to reduce ageism in Western societies. Keywords: aged, health promotion, perceived health, phenomenologyThis work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.ph