Aging, Chronic Illness and Self-Concept, a Study of Older Women with Osteoporosis

grantor: University of TorontoThe increasing likelihood of chronic illness with aging requires that attention be given to the social aspects of aging and chronic illness. A focus on women's aging and health is essential because in later years women outnumber men, women have higher rates of nonfatal chronic illnesses and live longer with these conditions than men, and women have more chronic health problems than men. The overall purpose of this dissertation is to consider the relationships between the meanings of aging and chronic illness and the self-concept of women using an interpretive sociological approach. The self is regarded as a basic concept for the understanding of the dynamic relationship between the individual and society. How individuals negotiate experiences and events in their lives depends on the content, organization and functioning of their self-concepts. The self-concept integrates individuals' experiences across time providing continuity and meaning to these experiences. While the meanings of either aging or chronic illness may be related to one's self-concept, the coming together or coalescence of these two events may alter the relationships among the conceptions of aging. and chronic illness and the sense of self. Using Rosenberg's conceptualization of self-concept (1979), an in-depth interview and a self-administered questionnaire were designed and data collected from twenty-eight women with osteoporosis. Three types of self-concepts emerged from the data: the competent self, the contradictory self and the ineffectual self. When the meanings of aging and chronic illness were examined, five themes emerged in each area. Through analysis of the self-concept processes of self-esteem and self-consistency, a reciprocal relationship was found between self-concept and the meanings of aging and chronic illness. A comprehensive description of the three types of self-concept is presented highlighting this reciprocal relationship and including discussion of the strategies used to enhance, protect and maintain self-concept despite the changes brought on by aging and chronic illness.Ph.D

Aging with HIV and Disability: The Role of Uncertainty

Due to advances in treatment, people with HIV are living longer and developing disabilities related to the virus, adverse side effects of medications, and aging. Illness-related uncertainty has been shown to contribute to disablement; however, there is little understanding of the uncertainties related to aging with HIV. The purpose of this research was to describe the contribution of uncertainty to the disability experienced by older adults living with HIV. Forty-nine men and women living with HIV and 50 years or older participated in in-depth qualitative interviews exploring various aspects of social participation and disability. Transcriptions of the interviews were analyzed using a grounded theory approach. Age-related uncertainties were described in the following themes: source of health challenge; health providers' age-related knowledge and skills; financial uncertainty; transition to retirement; appropriate long-term housing, and uncertainty over who would care for them. While not directly attributable to aging, the episodic nature of HIV left many with uncertainties related to when their next episode of illness would occur and often resulted in an inability to plan in advance. Results highlight the need to focus on the notion of successful and positive aging with the view to identifying effective interventions that reduce disability and enhance the overall health of older adults with HIV. This work builds on previous studies highlighting the role of uncertainty in the disability experience by identifying age-related components specific to older adults aging with HIV

Experiences of women living with fibromyalgia: an exploratory study of their information needs and preferences

Women living with fibromyalgia consistently report experiencing a change in their lives in terms of stigma, inability to work, isolation from society and difficulty in managing their illness. Lack of understanding and knowledge about their disease has been linked to compromised health and quality of life. The aim of this study was to explore the experiences of information use of women living with fibromyalgia. A descriptive phenomenology was used for this study. Participants were identified through gatekeepers for women living with fibromyalgia across Canada. Data was collected via taperecorded interviews. The study was conducted in Canada between 2009-2010. Ten women (18 or older) participated in the research. Three essential themes emerged from the analysis that were vital to understand the unique experiences of women: i) understanding the need for information required to live with fibromyalgia, ii) struggling to meet vital and fundamental information needs and iii) transforming themselves to improve health and quality of life. Women living with fibromyalgia have vital and specific information needs and struggle to find and access appropriate information. They use diverse strategies in overcoming some of the challenges in accessing information. Most significantly, women draw on the information to make changes and to begin to coordinate their lives to live with fibromyalgia. For women living with fibromyalgia, the phenomenon of information use has a significant effect on their lives. Healthcare providers are perceived as an important source of information and need to be better informed, more prepared and dedicated to assisting women with their information needs

Exploring Client-Centered Care Experiences in In-Patient Rehabilitation Settings

Patient or client-centered care has been widely accepted as an essential component of health care delivery in many countries. Few studies explore actual implementation of client-centered principles and clients’ and health care providers’ (HCPs) experiences with these approaches. Our objective was to explore current models of delivery of rehabilitation services from the perspectives of patients, families, and HCPs. We conducted semistructured interviews with patients, families, and HCPs of one of four rehabilitation facilities in South-Central Ontario, Canada. Being on common grounds/Working toward client set goals was the main category identified by both clients and HCPs. Although successful partnerships were created, the majority of clients assumed a passive position. Clients needed more information about the rehabilitation progression and alternative treatment options. The results of the study suggest that we need to encourage and educate clients to become motivated, well-informed, proactive participants in their care

Aging with HIV

The purpose of this qualitative study was to develop a theoretical model describing the disability experienced by older adults living with HIV. Forty nine HIV positive men and women over the age of 50 years participated in in-depth qualitative interviews. Transcribed interviews were analyzed using grounded theory techniques. Uncertainty or worrying about the future was at the core of the model. Components of disability including symptoms and impairments, difficulties with day to day activities and challenges to social participation were experienced in the context of extrinsic or environmental factors (social support, stigma) and intrinsic contextual factors (positive living strategies, age). Time was an overarching component of the model. The model suggests areas for interventions to prevent or reduce disability related to the consequences of aging with HIV and improve overall quality of life

A grounded theory of social participation among older women living with HIV

Background: As adults age with human immunodeficiency virus (HIV), the role for rehabilitation continues to emerge. Understanding how social participation is affected among women aging with HIV can inform occupational therapy assessment and treatment. Purpose: Our purpose was to develop a theoretical model that describes the experiences of social participation from the perspective of older women living with HIV. Method: A grounded theory methodological approach was utilized. We conducted interviews with 20 women living with HIV, age 50 or older, to explore various aspects of social participation, including self-care, relationships with others, and access to health and social services. Emergent themes informed the theoretical model. Findings: The theoretical model comprises four concepts related to social participation: social engagement, social isolation, contrasting perceptions about factors variably influencing participation, and contextual influences that may enhance or hinder social participation. Implications: Women aging with HIV experience social participation as a dynamic process involving social engagement and isolation. Contextual influences may promote and impede social participation

Home and community occupational therapy for children and youth: a before and after study

There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth.To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost.Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion.A statistically and clinically significant improvement in occupational performance was demonstrated (p < 0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome.Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services

Physical Function Assessment of a Mayan Population Living With Osteoarthritis: The Importance of Considering Different Aspects of Functioning

Objectives: To assess the physical function of people living with osteoarthritis in a Maya-Yucateco rural community from 3 perspectives and explore factors associated with the presence of disability. Design: Physical function and social, physical, psychological, and behavioral factors were evaluated in all adults detected with hand, hip, and/or knee osteoarthritis (n = 144) through a Community-Oriented Program for the Control of Rheumatic Diseases–based census in the Mayan community of Chankom, Yucatán. All cases fulfilled the American College of Rheumatology criteria. Physical function was assessed from 3 perspectives: hypothetical or “what people think they can do” (Health Assessment Questionnaire-Disability Index [HAQ-DI]), experimental or “what people could do in standardized conditions” (6-minute walk test [6MWT] + the Functional Dexterity Test) and enacted or “what people actually do” (personal care, work, and leisure activities’ self-report). Results: About 80% of participants reported “mild” disability (HAQ-DI ≤ 1) in the hypothetical function perspective, whereas average experimental function scores were low (6MWT: 206 m, Functional Dexterity Test: 64 seconds), and 78% of participants reported problems with enacted function (ie, work). Pain was significantly associated with disability in the hypothetical perspective (odds ratio [OR] = 3 [95% confidence interval [CI]: 1-4]); levels of wealth (β = 5 [95% CI: 1-9]) and muscle strength (β = 54 [95% CI: 20-87]) were significantly associated with functioning in the experimental perspective; and lower levels of self-efficacy (OR = 12 [95% CI: 6-27]) and physical activity (OR = 12 [95% CI: 6-27]) were significantly associated with work disability in the enacted function perspective. Conclusions: People living with osteoarthritis in Chankom show important issues when assessing physical function at the experimental and enacted perspectives, which could have been overlooked if only the hypothetical perspective was considered. Different factors were associated with different physical function perspectives and all should be addressed to decrease disability in this community