Sense of coherence and illness appraisal in older women's quality of life

Does coping with pain help the elderly with cardiovascular disease? The association of sense of coherence, spiritual well-being and self-compassion with quality of life through the mediating role of pain self-efficacy

BACKGROUND

Population ageing is considered one of the biggest challenges facing the world, and the status of the elderly in society and their quality of life (QOL) have proved to be a concern in professional and scientific research circles. As a result, the current study sought to investigate the role of pain self-efficacy (PSE) as a moderator in the relationship between sense of coherence (SOC), spiritual well-being, and self-compassion with QOL in Iranian elderly with cardiovascular disease (CVD).

METHOD

This was a correlational study of the path analysis type. The statistical population included all elderly people with CVD who were at least 60 years of age in Kermanshah Province, Iran, in 2022, of whom 298 (181 men and 117 women) were selected using convenience sampling and according to the inclusion and exclusion criteria. The participants answered questionnaires from the World Health Organization on QOL, Paloutzian and Ellison's spiritual well-being, Nicholas's PSE, Antonovsky's SOC, and Raes et al.'s self-compassion.

RESULTS

The results of path analysis demonstrated that the hypothesized model of this study has a good fit in the studied sample. There were significant paths between SOC (β = 0.39), spiritual well-being (β = 0.13) and self-compassion (β = 0.44) with PSE. Although there were significant paths between SOC (β = 0.16) and self-compassion (β = 0.31) with QOL, there was no significant path between spiritual well-being and QOL (β = 0.06). Besides, there was a significant path between PSE and QOL (β = 0.35). Finally, PSE was found to mediate the relationship of SOC, spiritual well-being and self-compassion with QOL.

CONCLUSION

The results may provide psychotherapists and counselors working in this field of inquiry with advantageous information to choose or create a useful therapeutic method to work with the elderly with CVD. Meanwhile, other researchers are suggested to examine other variables which may serve a mediating role in the mentioned model.

Personality traits and income inequalities in self-rated oral and general health

The association of low income with poor health is widely recognized, but why some low-income individuals do not experience poor health remains unclear. The aim of this study was to determine whether greater positive personality trait scores modify the association between income and oral and general health-related quality of life (OHRQoL and HRQoL) among a representative sample of the South Australian population. Cross-sectional self-rated questionnaire data from a sample of 3645 adults in 2015-2016 were used for secondary analysis. In four factorial ANOVA models, the main effects, interaction, and effect modification of personality traits [measured using the Ten-Item Personality Inventory (TIPI)] on the association between income and OHRQoL [measured using the Oral Health Impact Profile (OHIP-14)] and HRQoL [measured using the European Quality of Life indicator (EQ-5D-3L)] were assessed. In the low-income group, participants with greater TIPI scale scores had lower means for the OHIP-14 and the EQ-5D-3L (better OHRQoL and HRQoL). Greater emotional stability scores modified the association between low income and HRQoL and OHRQoL. Stronger positive personality traits, such as emotional stability, appear to ameliorate the adverse effect of income inequalities in health.

Sense of coherence and adjustment to divorce among Muslim Arab citizens of Israel

This study examined the distinctiveness and causal relationships of Antonovsky's (1979) Sense of Coherence Scale and the Mental Health Index of Veit and Ware (1983) in a sample of 306 divorced Muslim Arab men and women in Israel. The findings, based on confirmatory factor analysis and latent‐variable structural modelling, suggest that in the present sample sense of coherence (SOC) and mental health are two independent but correlated constructs. They also suggest that, consistent with Antonovsky's theory, SOC may be better viewed as a mediator between stress and mental health than as a concurrent outcome of stress, although the latter possibility is not ruled out. Finally, the findings indicate that the SOC of the sample was relatively low in comparison with other groups. Copyright © 2003 John Wiley & Sons, Ltd.

Antonovsky's sense of coherence and resistance resources reduce perception of burden in family carers of people with Alzheimer's disease

Objectives: Taking care of people with dementia (PWD) has been associated with some degree of burden. The variability of the carer's burden can be partially explained by their personal characteristics. Antonovsky's model of health defined the resistance resources (RRs) as essential mechanisms to cope with stressors, and to shape the personal sense of coherence (SOC). This study identifies the RRs related with carer's SOC, and their implications in the perception of burden in family dementia carers.Methods: A sample of 308 participants from the 'SOC & DEM study' (154 carers and 154 PWD) was recruited from two memory clinics. Carer's personal characteristics of burden, SOC, self-efficacy, coping strategies, perceived social support, and depression were evaluated using standardized instruments. PWD's degree of dependence and behaviour and psychological symptoms of dementia (BPSD) were assessed too. A path analysis was used to test the relationship between caregiver burden and SOC including the personal RRs of the carers and clinical data of PWD.Results: The path model identified SOC as a major factor related to carer's burden perception (r = -.327). Self-efficacy (r = .285), two coping strategies, 'use instrumental support' (r = -.235) and 'behavioural disengagement' (r = -.219), and social support perceived (r = .304) were the main carer's personal characteristics directly related with SOC. Caring experience (r = -.281) was the main carer factor related with burden while dependence (r = .156) and BPSD (r = .157) were the dementia factors.Conclusion: The SOC has previously related with carer's burden. The results contributed to identify relevant and modifiable personal characteristics as RRs that could reduce this burden.

"Take good care of yourself" An integrative review of older widows' self-care for health and well-being

Take good care of yourself is a regard often said to older bereaved women. However, what does it mean? Though self-care is a well-known phenomenon within health, it is not well understood in the context of late life spousal bereavement and widowhood. We undertook an integrative review to synthesize knowledge of older women's self-care challenges, resources and activities when bereaved and in a healthy transition to widowhood. Good care refers to health-promoting self-care and can be explained as the older widows' ability to access and mobilize resources and activities that are significant for a healthy transition to widowhood.

Does personality affect health-related quality of life? A systematic review

Background

Health-related quality of life (HRQOL) is increasingly measured as an outcome for clinical and health services research. However, relatively little is known about how non-health factors affect HRQOL. Personality is a potentially important factor, yet evidence regarding the effects of personality on HRQOL measures is unclear.

Methods

This systematic review examined the relationships among aspects of personality and HRQOL. Eligible studies were identified from Medline and PsycINFO. The review included 76 English-language studies with HRQOL as a primary outcome and that assessed personality from the psychological perspective. Individuals with various health states, including ill (e.g., cancer, cardiovascular disorders), aging, and healthy, were included in this review study.

Results

Some personality characteristics were consistently related to psychosocial aspects more often than physical aspects of HRQOL. Personality characteristics, especially neuroticism, mastery, optimism, and sense of coherence were most likely to be associated with psychosocial HRQOL. Personality explained varying proportions of variance in different domains of HRQOL. The range of variance explained in psychosocial HRQOL was 0 to 45% and the range of explained variance in physical HRQOL was 0 to 39%.

Conclusions

Personality characteristics are related to HRQOL. Systematic collection and analysis of personality data alongside HRQOL measures may be helpful in medical research, clinical practice, and health policy evaluation.

Correlates of Quality of Life in Older Adult Veterans

The purpose of this correlational study was to test theoretical propositions describing positive relationships between health promotion, sense of coherence, personal autonomy, and quality of life in older adult veterans and to explore their overall contribution to the prediction of quality of life. The sample consisted of 135 veterans aged 65 to 85 years who completed the Health-Promoting Lifestyle Profile, the Sense of Coherence-13 Scale, the Perceived Enactment of Autonomy Scale, and the Quality of Life Profile: Seniors Version, Short Scale. Health-promoting lifestyle, sense of coherence, and autonomy were positively correlated to quality of life. When the independent variables were subjected to a regression analysis, health-promoting lifestyle and autonomy explained 38% of the variance in quality of life.

Sense of Coherence and Health-Related Quality of Life among Patients Undergoing Coronary Artery Bypass Grafting or Angioplasty

BACKGROUND

Every year, 4 million people die from cardiovascular disease (CAD) in Europe. As many as 800,000 of them die before they reach the age of 65. The ischemic heart disease is also the most common cause of death in Finland. The invasive treatments of the CAD, coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) relieve symptoms and increase patient's health-related quality of life (HRQoL) in most of the cases. In this paper sense of coherence is discussed as related to health-related quality of life among CABG and PTCA patients in a one-year follow-up.

SAMPLE

The study sample consisted of consecutive male (N=439) and female (N=176) patients who were treated with the elective CABG or PTCA. The baseline data before the interventions were collected by structured interviews, the follow-up data by mailed self-administered questionnaires six and twelve months afterwards.

MEASURES

The sense of coherence was studied by using a 13-item SOC scale. HRQoL was measured by the 15D. It is a generic, multidimensional, standardized, self-administered instrument, which has both a profile and single index score property. The differences in both groups were defined by using T-tests. Follow-up outcomes were analysed by using analyses of variance for repeated measures.

RESULTS

Health-related quality of life increased in both groups during the follow-up. There was a correlation between health-related quality of life and sense of coherence in CABG and PTCA patients' group at baseline. The mean score of the 15D was lower in moderate sense of coherence tertile than in strong sense of coherence tertile in both groups. After six and twelve months the similar tendency existed in health-related quality of life and sense of coherence; patients who had poor or moderate sense of coherence had lower health-related quality of life than the patients with strong sense of coherence.

CONCLUSIONS

Sense of coherence was more stable among CABG patients than PTCA patients. In PTCA patients' group sense of coherence decreased during the follow-up time. In both patients' group the health-related quality of life increased statistically significant by 6 months. No significant change in health-related quality of life took place in either group from 6 to 12 months.

Internal and External Resources as Determinants of Health and Quality of Life

BACKGROUND

The salutogenic model has been established as a health promoting resource that is related to a strong sense of coherence (SOC), positive subjective health and quality of life (QoL). The aim of the study was to compare internal and external resources, life style factors, perceived health and QoL in Japan and Austria and to determine associations among these factors.

METHODOLOGY AND PRINCIPAL FINDINGS

A survey was conducted in a Japanese (N = 460) and an Austrian (N = 421) student sample using the following self-report health questionnaires: Sense of Coherence Scale (SOC-13), Social and Gender Role Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Dutch Eating Behaviour Questionnaire (DEBQ), SF-12 Health Survey, and the Cross-cultural Health Survey. Analyses of data showed that age (ß -0.12), and stress (ß -0.21) were negatively related and SOC (ß 0.47), family support are (ß -0.35) positively related to mental QoL. Significant predictors for emotional strain, were female gender (ß -0.24), older age (ß-0.14), lower SOC (ß 0.28), less traditional gender and social role patterns (ß 0.10), more restrained eating (ß -0.20), more alcohol intake (ß -0.16), and more stress (ß -0.25) explaining 42% of the variance in Austrian students. In Japan stress (ß -0.38) was negatively related and SOC (ß 0.37) positively related to mental QoL. Older age (ß -0.20), lower SOC (ß 0.29) and more stress (ß -0.33) were identified as significant predictors explaining 35% of the variance in Japanese students.

CONCLUSIONS AND SIGNIFICANCE

SOC and stress are strongly associated with QoL and perceived health in Austria as well as in Japan. SOC seems to be a crucial predictor for stress, and emotional health independent of the cultural context. A major challenge of cross-cultural research is to understand perceived health and QoL and the extent in which it is individually, socially, or culturally determined.

A Review of Instruments on Cognitive Appraisal of Stress

PURPOSE

The purpose of this paper is to present a review of theoretically based measures of cognitive appraisal, and discuss psychometric strengths and limitations.

BACKGROUND

Understanding how an individual appraises stressful events becomes important when faced with alterations in mental health. Cognitive appraisals influence how an individual copes with stressful events and life crises that leads to changes in mental health. Measures on how an individual appraises a stressful event lack conceptual soundness and are limited by weak psychometric properties.

DATA SOURCES

Health and Psychosocial Instruments (HAPI) electronic database was searched using combinations of the key words cognitive appraisal, primary appraisal, secondary appraisal, appraisal of illness, appraisal of health, and stress appraisal. The quality of these instrument sources was assessed by published psychometric data in the primary source.

RESULTS

Five instruments were found that measure cognitive appraisal as theoretically described: the Meaning of Illness Questionnaire, the Stress Appraisal Measure, the Appraisal of Illness Scale, the Cognitive Appraisal of Health Scale, and the Primary Appraisal/Secondary Appraisal scale. A description of each tool, including purpose, scoring, and psychometric support, is provided.

CONCLUSION

There are a limited number of instruments that measure cognitive appraisal as theoretically described. Theoretically sound instruments with established psychometric support are needed to make accurate inferences about the role of cognitive appraisal in the mental and physical health of individuals experiencing stress.

A salutogenic program to enhance sense of coherence and quality of life for older people in the community: A feasibility randomized controlled trial and process evaluation

OBJECTIVE

To determine the feasibility of a salutogenesis-based self-care program on quality of life, sense of coherence, activation and resilience among older community dwellers.

METHODS

This is a feasibility randomized controlled trial. Sixty-four older community-dwellers were recruited from a Singapore senior activity center and randomly assigned to intervention and control groups. The intervention group attended a 12-week Resource Enhancement and Activation Program. The outcomes were assessed with the Chinese versions of World Health Organization Quality of Life Scale, Sense of Coherence, Patient Activation Measure, and Connor-Davidson Resilience Scale. Process evaluation was conducted using focus groups with the intervention group.

RESULTS

At the end of the program, the intervention group showed significant improvement in the Sense of Coherence scale and the psychological subscale of the WHO Quality of Life scale compared with the control group. Three themes emerged from the process evaluation: participation in the program, reflection on the experience, and improving the experience.

CONCLUSION

A salutogenic self-care approach could be a potential health promotion strategy for older people.

PRACTICE IMPLICATIONS

With improved sense of coherence and psychological aspect of quality of life, older people's self-care ability may improve, leading to better health and better quality of life.

Sense of Coherence as a Predictor of Quality of Life Among Iranian Students Living in Ahvaz

OBJECTIVES

There is evidence to support the correlation between a stronger sense of coherence (SOC) and better perceived quality of life (QOL). However, this association has not been described among Iranian students.

METHODS

Students were selected by stratified randomization and demographic data including age, gender, and employment status were collected. SOC was measured using the short-form of the Sense of Coherence Scale (SOC-13). The World Health Organization Quality of Life (WHOQOL)-BREF questionnaire was used to assess the QOL. Data was collected over one year between 2014 and 2015.

RESULTS

A total of 459 students participated in the study. The Cronbach's alpha score in domains of physical health, psychological health, environmental health, social relationships, and WHOQOL-BREF total score were 0.84, 0.83, 0.84, 0.78, and 0.94, respectively. Measured Cronbach's alpha for domains of meaningfulness, manageability, comprehensibility, and SOC-13 total score were 0.68, 0.67, 0.76, and 0.87, respectively. Marital status was not related to SOC whereas married students had significantly higher scores of QOL in the domains of psychological health, social relationships, and environment health (p=0.006, p<0.0001 and p=0.043, respectively). There were significant strong positive relationships between all components of SOC (meaningfulness, manageability, and comprehensibility) and all domains of WHOQOF-BREF (p<0.0001 for all).

CONCLUSION

This study shows that SOC and marital status are significant predictors of QOL among Iranian students.

Sense of coherence as a mediator of health-related quality of life dimensions in patients with breast cancer: a longitudinal study with prospective design

BACKGROUND

In our previous study, we found that the degree of sense of coherence (SOC) and baseline ratings of several dimensions of health-related quality of life (HRQoL) were the most important predictors of HRQoL changes 6 months after the pre-diagnosis period of breast cancer. To find a way to explain these findings, the aim of this study was to explore the mediating effect of the SOC between ratings of HRQoL dimensions before final diagnosis, and ratings of the same dimensions at the 6 months follow up, within a sample of women with breast cancer.

METHODS

A longitudinal study with a prospective design at baseline (T1) and 6 months later (T2) was conducted on 162 women with breast cancer. To measure HRQoL dimensions three different questionnaires, the European Organization for Research and Treatment of Cancer QLQ-30, the SF-12 Health Survey version 2 and the Health Index were applied at T1 and T2 to cover both diagnostic-specific and generic dimensions. Measurement of the SOC as a mediator was done by the SOC-13 scale.

RESULTS

Mediational analyses on eight significant pairs of HRQoL dimensions showed that the degree of SOC totally mediated variations of global quality of life (p < 0.001) as well as cognitive and social functioning (p <0.05) scores between T1 to T2. Changes in the scores of emotional functioning (p < 0.01), fatigue (p < 0.05), financial difficulties (p < 0.05), well-being (p < 0.001), and mental health component (p < 0.001) were partially mediated. The degree of SOC explained 16% to 45% of the variances in HRQoL dimensions at T2.

CONCLUSIONS

The mediating pathway of the SOC in the context of this study appears to be the key to understanding how a higher sense of coherence as an inner resource may serve as a protective psychological factor in the adaptation process of the patients. Clinicians might consider coherence-oriented structure of the SOC and the connection between the SOC and HRQoL data in intervention plans from the first visit onwards. It may assist the identification of women who are at greater risk for maladaptation to the breast cancer trajectory.

Evaluation of the Criteria for Quality of Life of Elderly Health Care Centers in Tehran Province, Iran

Background and Objectives:

The objective of this study was to evaluate the elderly quality of life of people covered by the healthcare centers in Tehran and its influencing demographic and background factors.

Method:

This is a cross-sectional study of quality of life of the elderly population covered by healthcare centers and bases in Tehran, as well as the influential background and demographic factors. Sampling was performed using simple random stratified sampling proportionate to the size of strata. Data were collected using the Iranian version of the standard questionnaire Short Form Health Survey (SF-36).

Results:

According to the findings, 240 (60%) of the cases were men and 160 (40%) were women. Regarding age distribution, 76.3% fell in the 60-69 age range and 87.2% were illiterate. 18% of the elderly stated that they have financial problems and 19.5% did not express any financial problems. While studying the relationship between financial status and health status with the mean scores of quality of life, statistically significant differences were observed in all domains (p=0.032<0.001). The mean quality of life was lower in women compared to men.

Conclusions:

The findings of the present study indicate that the health-related quality of life in the elderly population is influenced by their health status and demographic and background variables.

Stress, sense of coherence and quality of life among Norwegian nurse students after a period of clinical practice

Background. Previous research has found that sense of coherence is significantly related to aspects of health, but studies on nurse students with a salutogenic approach are limited. Objectives. To investigate (1) if nurse students' experience of stress differs among clinical practice in nursing homes and medical/surgical wards. (2) Whether sense of coherence and stress are associated with quality of life. (3) If sense of coherence acts as a moderator in the relationship between stress and quality of life. Participants. Data were collected from 227 nurse students between January and April 2014. Methods. Questionnaires measuring stress, sense of coherence and quality of life were completed after a period of clinical practice. Linear regression analyses were used to measure associations between stress, and sense of coherence respectively, and quality of life. Results. The results showed that 33.92% of the students experienced moderate or high levels of stress, and there was significantly more stress in hospital wards compared to nursing homes (p = 0.027). Sense of coherence was positively associated with quality of life in the simple and multiple regression analyses (p < 0.01). Stress was negatively associated with quality of life in the simple regression analysis (p < 0.01), but not in the multiple analyses when sense of coherence was included. However, when we included an interaction term, stress was no longer associated with quality of life and sense of coherence appeared to be a significant moderator in the relationship between stress and quality of life (p = 0.015). Thus, a negative association was seen among students with the lowest levels of sense of coherence. Conclusion. These findings suggest that sense of coherence could be seen as a resource that nurse educators can build upon when supporting students in coping with stress.

Sense of coherence and health of community-dwelling older adults in Spain

BACKGROUND

In light of the demographic aging trend in Europe, investigation into successful aging is a public health priority. This paper describes the sense of coherence (SOC) of a sample of community-dwelling older adults in Spain and analyzes the relationship between SOC and both health and sociodemographic variables. SOC measures the extent to which an individual conceptualizes the world as comprehensible, manageable, and meaningful. Strong SOC may promote good health.

METHODS

The study followed a cross-sectional design involving a nationally representative sample of 1,106 community-dwelling adults aged 60 years and older in Spain. The sample was collected by geographically based proportional stratified sampling. RESULTS are based on responses to a questionnaire requesting sociodemographic information and including the following validated scales: SOC, Barthel index (BI), functional independence scale (FIS), personal wellbeing index (PWI), EQ-5D dimensions (mobility, personal care, daily activities, pain/discomfort, anxiety/depression), and the depression subscale of the hospital anxiety and depression scale (HADS-D). A multivariate linear regression model analyzed determinants of SOC.

RESULTS

Personal wellbeing (b = -0.32), depression (b = 0.26), and educational level (b = -0.06) were significant determinants of SOC. Lower SOC was associated with problems in all EQ-5D dimensions and moderate/severe disability as measured by the BI.

CONCLUSIONS

SOC in older adults is related to functional status, mental health status, personal wellbeing, and educational level. Public health initiatives should work to reduce the psychological and physiological impact of aging by focusing on the conditions that facilitate the coping of older adults.

Health capital in everyday life of the oldest old living in their own homes

As more people experience old age as a time of growth and productivity, more research is needed that explores how they master everyday life. This paper reports on a qualitative study that explored how ten older women age 90 years or more experience and cope with the challenges of everyday life with a salutogenic perspective. The findings suggest that health resources such as positive expectation, reflection and adaptation, function and active contribution, relations and home, contribute to the health capital of women. These health resources were of importance for the women's experience of comprehensibility, manageability and meaningfulness in daily life. Health capital is a meaningful concept for understanding coping in everyday life by older people.

Relationships between flow experience, IKIGAI, and sense of coherence in Tai chi practitioners

The purpose of this study was to examine the mental health effects of Tai chi on regular practitioners by investigating the relationships between flow experience, IKIGAI (Japanese: "Life worth living"), and sense of coherence. The results indicated that flow experience may influence IKIGAI and IKIGAI may influence sense of coherence; this suggests that IKIGAI may act as an intermediary between flow experience and sense of coherence. The results also indicated that the longer the Tai chi experience, the higher was the flow experience.

Sense of coherence as a predictor of health-related behaviours among patients with coronary heart disease

AIMS

A high sense of coherence (SOC) has been found to be associated with favourable health-related behaviours. However, evidence is for the most part lacking on the influence of SOC on health-related behaviours among coronary heart disease patients. The aim of this study was to explore the association between SOC at baseline and smoking status, nutrition behaviour, physical exercise and alcohol consumption of coronary heart disease patients 12-28 months after they had undergone different cardiac treatments.

METHODS

A total of 179 coronary heart disease patients (mean age 58.32±6.54 years, 19% female) were interviewed before coronary angiography and 12-28 months after. Self-report data about health-related behaviours were obtained via a structured interview. SOC was measured using the 13-item Orientation to Life Questionnaire. The relationship between SOC and health-related behaviours was examined using regression and cross-lagged path analyses.

RESULTS

SOC at baseline predicted non-smoking and quitting smoking: odds ratio (OR) (95% confidence interval (CI)) per unit increase (over range 38-91) was 1.11 (1.03-1.19) and 1.09 (1.01-1.17), respectively. Moreover, baseline SOC predicted healthy nutrition behaviour among percutaneous coronary intervention patients: the OR per unit increase was 1.08 (95% CI: 1.01-1.15). Lastly, SOC at baseline predicted improvement in alcohol consumption at follow-up among coronary artery bypass grafting patients (standard score result: -0.15, p<0.05).

CONCLUSION

Coronary heart disease patients with a low SOC before treatment are less likely to improve health behaviours after cardiac treatment and should thus get additional attention in health promotion.

Sense of coherence: effect on adherence and response to resistance training in older people with hip fracture history

Our aim was to study the effects of sense of coherence (SOC) on training adherence and interindividual changes in muscle strength, mobility, and balance after resistance training in older people with hip fracture history. These are secondary analyses of a 12-week randomized controlled trial of progressive resistance training in 60- to 85-year-old community-dwelling people 0.5-7 years after hip fracture (n = 45; ISRCTN34271567). Pre- and posttrial assessments included SOC, knee extension strength, walking speed, timed up-and-go (TUG), and Berg Balance Scale (BBS). Group-by-SOC interaction effects (repeated-measures ANOVA) were statistically significant for TUG (p = .005) and BBS (p = .040), but not for knee extension strength or walking speed. Weaker SOC was associated with poorer training adherence (mixed model; p = .009). Thus, more complicated physical tasks did not improve in those with weaker SOC, independently of training adherence. Older people with weaker SOC may need additional psychosocial support in physical rehabilitation programs to optimize training response.

Components and determinants of quality of life in community-dwelling older adults

The objectives of this study are to detect the main components of global quality of life (QoL) of community-dwelling older adults from their own perspective and to identify determinants of health-related and global QoL in the same population. This is a cross-sectional study covering a representative sample of 1,106 community-dwelling adults aged 60 years and older residing in Spain. The survey collected information on QoL through a face-to-face interview asking for QoL components in free-format, as well as the completion of two QoL measures, the EQ-5D and the Personal Wellbeing Index. The most important QoL dimensions, according to the participants of this study, were health, family, and finances. Depression was the main determinant of both QoL indices, while functional independence and social support specifically influenced health-related and global QoL, respectively. Based on the perspective of the older adults as well as on statistical analysis, this work emphasizes the importance of health, family, and social support as areas of special interest in aging. There was a discrepancy when comparing findings related to the importance of financial status. Results also support that global and health-related QoL share some common determinants, but with different weights for functional independence and social support.

Effects of intensive strength-power training on sense of coherence among 60-85-year-old people with hip fracture: a randomized controlled trial

BACKGROUND AND AIMS

Older people with disabilities are at increased risk of psychological health decline. There are no earlier studies on the effects of resistance training on sense of coherence (SOC) among older people with a history of hip fracture. The aim of this study is to test the effects of intensive 12-week strength-power training on SOC among older adults after hip fracture.

METHODS

A clinical sample of 60-85-year-old community-dwelling men and women was studied, 0.5. to 7.0 years after hip fracture. Forty-six had no contraindications for participation and were randomized into training (n=24) and control groups (n=22). The training group participated in a 12-week, individually tailored, strength-power training program, twice a week in a senior gym and supervised by an experienced physiotherapist. SOC was assessed with Antonovsky's short 13-item scale. Data were collected at baseline and after intervention.

RESULTS

Intensive 12-week strength-power training had no effect on participants' SOC level.

CONCLUSIONS

Results indicated no change in SOC after 12-week physical exercise training among participants after hip fracture. Further studies on SOC among older people with disabilities and potential ways of increasing it are needed.

Sense of coherence as an independent predictor of health-related quality of life among coronary heart disease patients

PURPOSE

The aim of this study was to determine whether sense of coherence (SOC) at baseline predicts health-related quality of life (HRQoL) at 12-28-month follow-up among patients with coronary heart disease when controlled for sociodemographic and medical variables.

METHODS

A total of 179 consecutive patients (58.28 ± 6.52 years, 16.8% women) scheduled for coronary angiography (CAG) were interviewed before CAG and 12-28 months after. SOC was measured with the 13-item Orientation to Life Questionnaire. HRQoL was measured using the Short Form Health Survey 36 (SF-36), from which the mental and physical component summaries (MCS, PCS) were calculated. The relationship between SOC and HRQoL was examined using regression analyses.

RESULTS

SOC proved to be a significant predictor of the MCS-score (B = 0.29; 95% CI = 0.17-0.41) and PCS-score (B = 0.18; 95% CI = 0.06-0.31) when not adjusted for possible confounding sociodemographic and medical variables. After adjustment for sociodemographic and medical variables, SOC remained a predictor of the MCS-score (B = 0.26; 95% CI = 0.14-0.39). SOC also remained a predictor of the PCS-score when controlled for gender, age and family income; however, the association disappeared after adjustment for functional status (B = 0.07; 95% CI = -0.05 to 0.19).

CONCLUSIONS

SOC is a predictor of mental and physical HRQoL at 12-28-month follow-up, crude and also after adjustment. Patients undergoing CAG with low SOC thus deserve particular attention in regard to the maintenance and improvement of their HRQoL.

An exercise trial for wheelchair users: project workout on wheels

There is growing interest in promoting health for people with disabilities, yet evidence regarding community-based interventions is sparse. This paper describes the design details of a randomized controlled trial (RCT) that will test the effectiveness of a multi-component behaviorally based, intervention to promote exercise adoption (over 6 months) and maintenance (up to one year) among wheelchair users and includes descriptive data on participant characteristics at baseline. Participants were randomly assigned to either a staff-supported intervention group or a self-guided comparison group. The primary study aim is to assess the effectiveness of the multi-component behaviorally based intervention for promoting physical activity adoption and maintenance. The RCT will also assess the physical and psychosocial effects of the intervention and the complex interplay of factors that influence the effectiveness of the intervention. Therefore, the primary outcome derives from participant reports of weekly exercise (type, frequency, duration) over 52 weeks. Secondary outcomes collected on four occasions (baseline, 3 months, 6 months, 12 months) included physiological outcomes (VO(2) peak, strength), disability-related outcomes (pain, fatigue, participation), and psychosocial outcomes (exercise self-efficacy, exercise barriers, quality of life, depression, mood). This study will provide evidence regarding the effectiveness of a multi-component behaviorally based intervention for promoting exercise adoption among people with mobility impairments that necessitate wheelchair use.

Psychosocial factors associated with the effects of physiotherapy in the acute hospital

PURPOSE

To examine the associations between psychosocial factors and physical functioning at admission, and functional recovery during an acute hospital admission.

METHOD

Included into this multi-centre cohort study were 642 patients with cardiopulmonary, musculoskeletal and neurological conditions recruited from 32 Swiss hospitals. Functional status was measured at admission and discharge using the Barthel Index (BI); BI change was used as an indicator for functional recovery. Sense of coherence (SOC) and depression were assessed at admission using the SOC questionnaire and the Hospital Anxiety and Depression Scale (HADS); patient motivation was judged at discharge by physiotherapists on a Visual Analogue Scale. Mixed effect regression was used to assess associations of SOC, depression and motivation with functional status at admission and functional recovery. Distinct models were built to control for sets of behavioural, socio-economic and disease-related variables.

RESULTS

Functional status at admission was significantly associated with SOC, depression and motivation. Functional recovery was significantly associated with motivation, but not with SOC. Significant associations between functional recovery and depression were found in some of the models.

CONCLUSIONS

As motivation showed strong associations with functional recovery, future studies should examine how functional recovery is influenced by motivation and how motivation can be improved.

Healthy ageing in a salutogenic way: building the HP 2.0 framework

Healthy ageing is influenced by a variety of interacting determinants. Because no one agency can tackle all these determinants, the promotion of healthy ageing requires an intersectoral approach. The aim of this article is to describe a theoretical basis, the development and possible applications of a framework within a municipality in the Netherlands. This framework supports intersectoral collaboration by guiding and stimulating the development, implementation and evaluation of health promotion activities for healthy ageing. It is based on the principles of health promotion and on the theory of salutogenesis and built upon three interrelated central concepts: (1) sense of coherence, (2) resources for health, and (3) health. The framework visualises the interrelationships of the three concepts within health promotion and salutogenesis. This visualisation makes explicit the value and the contribution with respect to content of intersectoral collaboration and the participation of older people in health promotion. The relationships between the concepts of the framework also indicate the need to undertake different types of research and gather different kinds of data to develop, implement and evaluate healthy ageing strategies.

Quality of life in older Norwegian adults living at home: a cross-sectional survey

The term quality of life (QoL) has been used in nursing for several years despite having neither a common conceptual model nor a common definition. The Wilson and Cleary Model (WCM), defined in 1995, is used as a conceptual model to identify suitable variables important in planning nursing care in a study among Norwegian older adults. The objective of this study was to investigate how the relationships among depressive symptoms, physical function, health satisfaction, age and environment may predict QoL in a model based on the WCM. The overall model provides empirical evidence for linkages in the WCM. Results showed that QoL is likely to be influenced by the direct effects of environmental conditions, health satisfaction and age. In addition, environmental conditions and age had indirect effects on QoL, in particular via depressive symptoms. Environment had both a significant direct and an indirect effect on QoL. An indirect effect of environment on QoL was shown with depressive symptoms, physical function and perceived health as mediators. There was only a small amount of evidence for age predicting QoL. This model may help nurses and other health care workers to collect and assess information, to suggest suitable interventions and to guide decision making.

Quality of life among Norwegian older adults: focus group results

Fundamental to the nursing profession is understanding what issues are important to quality of life (QoL) for older adults. The aim of this study was to explore issues of importance to older adults and to compare findings with Lawton's theoretical QoL conceptualization. Five focus groups were conducted with healthy and hospitalized adults and health professionals. Many valued aspects of human existence were found to affect QoL, and results lend empirical support to many of the themes appearing under Lawton's four sectors. Results indicate the need for multidimensional assessments of QoL among older adults related to health, psychological, personal competency, social, environmental, and spiritual indicators. Issues related to time use, happiness, cognitive functioning, self-concept, coping with change, social functioning, self-determination, altruistic activity, living conditions, security, and technological aids should also be considered in future assessments of QoL. Research is needed to explore the relevancy of these issues in future assessments of QoL among older adults.

Childhood psychopathology and sense of coherence at age 18: findings from the Finnish from a boy to a man study

OBJECTIVE

To examine associations between childhood psychopathology and family factors at age 8, and sense of coherence (SOC) at age 18.

METHODS

The sample includes 2,314 Finnish boys born 1981 with information about psychopathology from parents and teachers using Rutter scales, and self-reports of depressive symptoms using Child Depression Inventory (CDI), and self-reports of SOC at age 18.

RESULTS

Low parental education level and living in other than two biological parent family at age 8 were associated with low SOC 10 years later. Boys with internalizing symptoms based on parent/teacher reports, and depressive symptoms based on self-reports at age 8 were at risk for lower SOC at follow-up. Comorbidity of internalizing and conduct problems had the strongest association with low SOC.

CONCLUSION

The study shows that internalizing symptoms, comorbid conduct and emotional problems, low parental education level and nonintact family at age 8 predict low SOC at age 18. Future research whether universal, selective or indicated early interventions targeted on risk factors of childhood mental health problems may result in promotion of well-being (including good SOC) in early adulthood is warranted.

Sense of coherence--a determinant of quality of life over time in older female acute myocardial infarction survivors

AIMS

To determine the relationships between different sense of coherence levels and quality of life, and in older female myocardial infarction survivors; to investigate how socio-demographic, clinical characteristics, sense of coherence self-reported symptoms and function affect quality of life; and to determine whether sense of coherence and quality of life are stable during a six-month follow-up.

BACKGROUND

Myocardial infraction confers new physical and mental challenges. However, research on sense of coherence and other factors involved in maintaining physical, psychosocial and environmental aspects of quality of life in older female myocardial infraction survivors is scant.

DESIGN

Survey.

METHODS

A postal survey was conducted of 145 women, aged 62-80 years, three months to five years after myocardial infarction (T1), with a follow-up after six months (T2). Self-reported socio-demographic and clinical data and hospital medical records data were collected. The sense of coherence scale (SOC-29) and the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) were used.

RESULTS

We found a significant difference in quality of life between weak, moderate, and strong sense of coherence groups (p<0.001). Sense of coherence contributed to the level of all quality of life domains (p<0.001). Several clinical characteristics contributed to quality of life: (1) physical domain: comorbidities (p<0.001), previous myocardial infarction (p = 0.013), ejection fraction (p<0.011), length of hospital stay (p = 0.005) symptoms and function (p<0.001); (2) psychological domain: previous myocardial infarction (p = 0.031) and symptoms and function (p<0.001); and (3) environmental domain: education (p = 0.033) and symptoms and function (p = 0.003). On group level, both sense of coherence and quality of life were stable. Experiencing specific health changes (p<0.001), not major life events, influenced quality of life during the six-month follow-up.

CONCLUSION

Sense of coherence was an important stable determinant of quality of life domains in female myocardial infarction survivors. Although other factors were identified, further research is needed to elucidate additional determinants of quality of life.

RELEVANCE TO CLINICAL PRACTICE

These specific factors could guide clinicians in making treatment decisions that optimize the quality of life of their patients. Applying a salutogenic perspective through patient education may be important.

Sense of coherence as a resource in relation to health-related quality of life among mentally intact nursing home residents - a questionnaire study

BACKGROUND

Sense of coherence (SOC) is a strong determinant of positive health and successful coping. For older people living in the community or staying in a hospital, SOC has been shown to be associated with health-related quality of life (HRQOL). Studies focusing on this aspect among nursing home (NH) residents have been limited. This study investigated the relationship between SOC and HRQOL among older people living in NHs in Bergen, Norway.

METHODS

Based on the salutogenic theoretical framework, we used a descriptive correlation design using personal interviews. We collected data from 227 mentally intact NH residents for 14 months in 2004-2005. The residents' HRQOL and coping ability were measured using the SF-36 Health Survey and the Sense of Coherence Scale (SOC-13), respectively. We analyzed possible relationships between the SOC-13 variables and SF-36 subdimensions, controlling for age, sex, marital status, education and comorbidity, and investigated interactions between the SOC and demographic variables by using multiple regression.

RESULTS

SOC scores were significantly correlated with all SF-36 subscales: the strongest with mental health (r = 0.61) and the weakest with bodily pain (r = 0.28). These did not change substantially after adjusting for the associations with demographic variables and comorbidity. SOC-13 did not interact significantly with the other covariates.

CONCLUSION

These findings suggest that more coping resources improve HRQOL. This may indicate the importance of strengthening the residents' SOC to improve the perceived HRQOL. Such knowledge may help the international community in developing nursing regimens to improve HRQOL for older people living in NHs.

Quality of life of older adults in Canada and Norway: examining the Iowa model

In this study, Glick and Tripp-Reimer's (1996) Iowa model for gerontological nursing serves as a guiding framework for a descriptive exploratory study of quality of life (QOL) of older adults. Using secondary data, the authors explored whether the effects of health appraisal, morbidities, social support transitions (SST), and the environment on QOL would be partly mediated by cognitive developmental transitions (CDT). Data sets were available from studies with random samples of community-dwelling older adults from Canada (n = 202) and Norway (n = 490). The partly and fully mediated effects found suggest positive CDT in older age might be significantly enhanced by the presence of intimate ties, positive perceptions of one's health limitations, and residence in a healthy, safe, and resource-rich physical environment. These findings represent a novel attempt at testing complex linkages between aspects of elder, environment, and nursing concepts within the Iowa model warranting further research.

Antonovsky's sense of coherence scale and its relation with quality of life: a systematic review

The aim of this paper is to synthesise findings on the salutogenic concept, sense of coherence (SOC), and its correlation with quality of life (QoL). This study is descriptive and analytic, with a systematic integration of the contemporary knowledge base on the salutogenic research published in 1992-2003. This review includes 458 scientific publications and 13 doctoral theses on salutogenesis. In all, 32 papers had the main objective of investigating the relationship between SOC and QoL. This study is based on scientific publications in eight authorised databases, doctoral theses and available books. The SOC seems to have an impact on the QoL; the stronger the SOC, the better the QoL. Furthermore, longitudinal studies confirm the predictive validity of the SOC for a good QoL. The findings correspond to the core of the Ottawa Charter--that is, the process of enabling people to live a good life. Therefore, a certain possibility to modify and extend the health construct is becoming discernible, implicating a construct including salutogenesis and QoL. The SOC concept is a health resource, influencing QoL.

A salutogenic view on subjective well-being in active elderly persons

In this paper, subjective well-being as an indicator for successful aging is investigated from a salutogenic perspective that states that the sense of coherence plays a key role for psychological adaptation. It should be demonstrated that the sense of coherence mediates the relationship between generalized resistance resources and subjective well-being. One-hundred-and-seventy psychophysically active elderly persons (37 men) filled out a questionnaire assessing the sense of coherence, subjective well-being and resistance resources (such as age, education, physical health, activity level, social support and personality variables). It was found that resources co-varied with the sense of coherence and subjective well-being, accounting for 52 and 48% of the variance, respectively. The most important predictors were self-efficacy, self-esteem and education. After controlling for resources, the sense of coherence accounted for an additional 6% of the variance in well-being. The sense of coherence clearly mediated the relationship between resources and well-being. The findings corroborate the salutogenic idea that the sense of coherence creates, or maintains, a form of psychological integrity as represented by subjective well-being. The promotion of a strong sense of coherence should be a major aim of gerontological interventions.

The conceptualization and measurement of quality of life in older adults: a review of empirical studies published during 1994-2006

Instruments with acceptable measurement properties that support their application to older adults across a range of settings need to be identified. A narrative literature review of empirical studies investigating the conceptualization and measurement of quality of life (QoL) among older adults from 1994 to 2006 was performed. The review focused on evidence provided for conceptual frameworks, QoL definitions, types of measurements utilized and their psychometric properties. Two searches were conducted. The first search conducted in 2004 used Cinahl, Medline, PsycInfo, Embase and Cochrane databases. A supplemental search was conducted in December 2006, which included these bases from 2004 to 2006, and Sociological Abstracts and Anthropological literature base. The review included 47 papers. A total of 40 different measurements were applied in the studies, assessing most frequently functional status and symptoms. The most extensive psychometric evidence was documented for the SF-36. Although construct validity was reported in the majority of studies, minimal empirical evidence was given for other psychometric properties. Further, 87% of the studies lacked a conceptual framework and 55% did not report any methodological considerations related to older adults. Quality control standards, which can guide measurement assessment and subsequent data interpretation, are needed to enhance more consistent reporting of the psychometric properties of QoL instruments utilized. Future work on the development of common QoL assessment models that are both person-centered, causal and multidimensional based on collaborative efforts from professionals interested in QoL from the international gerontological research community are needed.

Nursing home residents' sense of coherence and functional status decline

Functional status decline places an enormous burden on health care services and strategies to identify at risk subgroups are needed. The purpose of this study was to examine the relationship between sense of coherence (SOC) and functional status to determine if SOC can be used to identify at-risk subgroups. In a convenience sample (N = 65) of nursing home residents measures of functional status and SOC were compared at 2 times. The mean functional status score of the weak SOC group (n = 28) at Time 1 was 16.14 and 17.32 at Time 2 indicating functional status decline. The mean functional status score of the strong SOC group (n = 37) at Time 1 was 12.38 and 11.76 at Time 2 indicating improved functional status. Although these changes were not statistically significant the trends suggest that a weak SOC may indicate increased risk for functional status decline.

Coping with recurrent breast cancer: predictors of distressing symptoms and health-related quality of life

Little is known about how postmenopausal women with recurrent breast cancer cope with distressing symptoms and which factors predict health-related quality of life (HRQOL). In the present study, 56 consecutively enrolled patients completed questionnaires measuring symptom occurrence, coping capacity, coping efforts, and HRQOL at the time of recurrence. Results from this study illustrate that women with recurrent breast cancer suffer from multiple, concurrent, and interrelated symptoms of illness, anxiety, depression, and fatigue. Highly prevalent symptoms are lack of energy, difficulty sleeping, pain, worrying, problems with sexual interest, feeling sad, and dry mouth. The most frequently occurring symptom is problem with sexual interest, and the most severe symptom is worrying. The most distressing symptom experienced is pain. The majority of the women report 10-23 symptoms. Women who experience multiple symptoms also report higher levels of symptom distress. The experience of distressing symptoms is predicted by coping capacity, and the coping efforts experienced predict HRQOL. Patients with lower coping capacity report higher prevalence of symptoms, experience higher levels of distress, and experience worse perceived health, which in turn may decrease their HRQOL. To help women manage recurrent breast cancer, it is important to use multidimensional measurement to identify, evaluate, and treat distressing symptoms, and not assess single symptoms only. Care must be based upon the awareness of critical factors that exacerbate vulnerability to distress, as well as the ability to adapt to a recurrent breast cancer disease.

Predictors of quality of life in old age: A cross-validation study

A replication study was undertaken to validate a model of quality of life (QOL) generated in an earlier study on a random sample of 202 older adults. Pathways found to be significant were retested using QOL data from a convenience sample of 420 older adults. Using path analysis, we found that financial resources, health, and meaning in life directly and positively influenced QOL. Health, emotional support, and the physical environment indirectly affected QOL through purpose in life. All but one pathway were replicated, explaining 50.5% of the variance in QOL. Further explorations of the influence of spirituality, emotionally close ties, and opportunities for active engagement on QOL in older age are warranted.