Life events, emotional support, and health of older people

What are the contents of patient engagement interventions for older adults? A systematic review of randomized controlled trials

OBJECTIVE

To describe the contents of interventions reported in RCTs focusing on patient engagement of older adults.

METHODS

A systematic literature review based on a search for "patient engagement/activation/empowerment/involvement/participation". Interventions were classified according to: (i) specific components (micro level), (ii) single/multiple dimensions (educational, behavioral, affective) (meso level), and (iii) the studies' main educational, behavioral or affective dimension (macro level).

RESULTS

After screening 2749 articles, 35 were included. 20 unique components were identified, mostly behavioral or educational (45.5% each) (e.g., goal setting or written informational materials). Most interventions with a single-focus were classified as educational (31%), one was solely affective (3%). Half of the interventions covered more than one dimension, with four (11%) combining all three dimensions. Studies mainly focusing on the affective dimension included older participants (72 vs. 67 years), had a higher proportion of females (71% vs. 44%), and included other dimensions more frequently (67% vs. 31%) than did studies with a main focus on the educational dimension.

CONCLUSION

The contents of the interventions that focused on patient engagement of older adults tend to focus more on behavioral and educational dimensions than the affective dimension.

PRACTICE IMPLICATIONS

The possibility of adding the affective dimension into behavioral and/or educational interventions should be explored.

Sex Differences in Stress, Coping Resources, and Illness among the Elderly

Since studies have found only a modest relationship between life change and illness, researchers have begun to study "coping resources" that facilitate adjustment to life events. Only two studies have examined their effects on the elderly, and these suggest that coping resources for younger age groups may not serve this function for the elderly. Using a sample of 299 elderly, this study examines the relationship between life change and illness for each sex to determine if elderly men and women differ in their vulnerability to life change stress and to identify differences in what serves as a coping resource. The results suggest that elderly women are more responsive to life changes. For women, marriage and self-efficacy were exacerbators; for men, having a confidant exacerbated illness. Resources functioning as coping facilitators for young age groups potentially function as coping inhibitors when related to the largely negative/uncontrollable events of old age. In addition, the sexes may differ in the factors that serve as coping resources.

Transition from the spouse dementia caregiver role: A change for the better?

One in 15 Australians over 65 experience dementia, and are commonly supported by spouses. Evidence demonstrates declining wellbeing for these caregivers as their role continues. There are indications of improvement once caregivers transition out of the role (recovery) but alternate suggestions that caregiving stress may be too damaging to be appeased (wear and tear). It seems plausible that reason for transition (care recipient's move into residential care or death) will affect caregivers' outcomes. A synthetic cohort method compared caregivers' stress and wellbeing prior to, and one and two years post-transition. There was evidence of wear and tear for physical wellbeing but recovery for psychological wellbeing over time; with little difference based on reason for transition. Caregiver outcomes seem to be a function of the action rather than the reason for transition, but factors such as age must be considered when designing methods to support post-transition wellbeing.

Catastrophic interpretations and anxiety sensitivity as predictors of panic-spectrum psychopathology in chronic obstructive pulmonary disease

OBJECTIVE

Panic-spectrum psychopathology (denoting panic attacks and panic disorder) is highly prevalent in chronic obstructive pulmonary disease (COPD), and the cognitive model of panic has been proposed as an explanation of this high prevalence. In the current cross-sectional study we investigated factors predicting panic-spectrum psychopathology in COPD, and hypothesized that, consistent with the cognitive model, both the catastrophic interpretation of shortness of breath and elevated anxiety sensitivity would be significant predictors when variance shared with confounding variables was controlled.

METHODS

Sixty-two participants with COPD were interviewed with the Anxiety Disorders Interview Schedule for DSM-IV, Panic Disorder section, and completed measures of interpretation of breathing difficulty, anxiety sensitivity, anxiety, depression, disease-specific quality of life, and stressful life events. Objective disease severity was measured using forced expiratory volume in the first second.

RESULTS

Direct logistic regression was performed, and worse depressive symptoms, more catastrophic interpretations of shortness of breath, higher anxiety sensitivity, higher magnitude of recent stressful life events, and worse disease severity were each found to be significant unique predictors of panic-spectrum psychopathology in COPD after shared variance was controlled.

CONCLUSIONS

The results of the study provide support for the cognitive model of panic, and also suggest a diathesis-stress explanation of the development of panic-spectrum psychopathology in COPD. The findings have implications for future preventative psychological interventions.

Social support at age 33: the influence of gender, employment status and social class

This paper investigates the conceptualisation and operationalisation of social support and it's relationship to gender, employment status and social class. Clarification of these relationships is sought in order to better understand associations between social support and health. We used data from the 33-year survey of the 1958 British birth cohort study. Individual items and subscales of practical and emotional support were examined. In general, men had lower support than women and social classes IV and V had lower support than classes I and II. Emotional support, either from personal (for example, from friends or family), or combined with organisational sources of support (such as from a church or a financial institution), showed consistent gender and social class patterns. This suggests that emotional support is a robust concept across socio-demographic groups. Less consistent trends were found for practical support, in that socio-demographic trends depended on how practical support was measured. In particular, it depended on whether both personal and organisational sources of support were examined. Gender differences in social support were large and might therefore be expected to contribute to gender differences in health, whereas social class differences in social support were modest, suggesting a minor explanatory role for this factor in accounting for inequalities in health.

SEX DIFFERENCES IN STRESS, ILLNESS AND COPING RESOURCES AMONG THE NIGERIAN ELDERLY

Since studies have found only a moderate relationship between life change and illness, researchers have begun to study “coping resources” that facilitate adjustment to life events. Using a sample of 115 elderly residing in the small city of Awe in the Southwestern part of Nigeria, this study examines the relationship between life change and illness for each sex to determine if elderly men and women differ in their vulnerability to life change stress and to identify differences in what serves as a coping resource. The results suggest that elderly women are more responsive to life changes. For women, marriage and self-efficacy were exacerbators; for men, having a confidant exacerbated illness. Resources functioning as coping facilitators for young age groups potentially function as coping inhibitors when related to the largely negative/uncontrollable events of old age. In addition, the sexes may differ in the factors that serve as coping resources.

Correlates of self-care among the independent elderly: self-concept affects well-being

There was a significant positive correlation between self-care and self-concept, suggesting that psychosocial interventions that enhance an older person's self-concept may be expected to improve self-care and, conversely, that participation in self-care activities may be expected to strengthen self-concept. Although functional health status was not significantly correlated with self-care, it was related to self-concept, suggesting either that functional health has a role in maintaining self-concept among older persons or that self-concept positively contributes to functional health status. Self-concept and self-care can be enhanced in older persons by communicating respect and demonstrating caring behaviors, reinforcing health-promoting behaviors, encouraging activities of daily living that contribute to independence, and by avoiding a focus on self-care deficits.

Social support and stressful life events: age differences in their effects on health-related quality of life among the chronically ill

There is substantial evidence of individual variation in health-related quality of life measures that is not accounted for by age or disease condition. An understanding of factors that determine good health is necessary for maintained function and improved quality of life. This study examines the extent to which social support and stressful life events were more or less beneficial for the long-term physical functioning and emotional well-being of 1,402 chronically ill patients. Analyses, conducted separately in three age groups, showed that social support was beneficial for health over time regardless of age. In addition, low levels of support were particularly damaging for the physical functioning of older patients. Stressful life events impacted differentially on health-related quality of life; relationship events had an immediate effect on well-being which diminished with time; financial events had an immediate negative effect on functioning and well-being which persisted over time for middle-aged patients; bereavement had a delayed impact on quality of life, with the youngest patients especially vulnerable to its negative effects; work-related events had both negative and positive effects, depending on age group. Results reinforce the importance of identifying and dealing with psychosocial problems among patients with chronic disease.

Promoting health among the institutionalized elderly

1. Although health promotion is a current focus of nursing practice, the institutionalized elderly have not been a target of health promotion research by nurses. 2. Health promotion research in nursing home settings by other disciplines has shown that institutionalized elderly benefit from humanistic approaches and that lifestyle enhancement is possible in nursing home settings. 3. Long-term care nurses are in a unique position to empirically investigate the benefits and efficacy of health promotion interventions in institutionalized settings.

Nursing research in geriatric mental health

As the population of older people in the world increases, concerns about the health and delivery of health care to these elderly people become increasingly more important. Geriatric mental health arose as a nursing specialty in response to this concern over the health of older adults. This paper focuses on a review of nursing literature relevant to the mental and cognitive health of older adults. Implications for current practice and future research are explored.

Target populations of nursing research on social support

Nurses contribute to the social support field primarily through study of clinical and community populations. A review of the target populations identified in 63 empirical studies of social support conducted in the past decade revealed that nurses have, to date, studied populations central to their profession's activities and concerns. They have uniquely focused on surgical patients, the chronically ill, expectant couples and parents of infants, the bereaved, and lay caregivers. These target groups have suffered from maturational (transitional) and/or situational stressors. However, some at-risk groups have been overlooked; in particular, children, males only, native peoples, the poor, the unemployed, and the victims of child and elder abuse. Nurses practice in diverse institutional and community-based sites, and hence have direct contact with all these population groups. Once the features of a population that make it a fruitful focus of study by nurse investigators are identified, pertinent interventions can be tested.

Assessment of a short scale to measure social support

A wide variety of measures have been used to assess the effects of social support on both physical and psychological status. Information on the reliability and validity of many of these instruments is unavailable; other instruments appear to be reasonably valid but involve large numbers of questions and require considerable time for completion. This study examines the properties of a short, self-administered social support scale (SSS). Data are available from 3 samples: HMO clients in a weight loss program (N = 268); chronic facial pain patients (N = 92); and colorectal cancer patients (N = 318). Three scoring strategies measuring two dimensions (structural and perceptual) of social support are compared with respect to internal consistency and criterion and construct validity. One of these strategies results in a measure that behaves in a way consistent with other, longer instruments and appears to possess acceptable reliability and validity. Scores can be broken down by source (e.g. spouse, friends), and wording can be modified to measure either general support or support for a specific situation.

Social networks, stress, adaptation, and health. A longitudinal study of an inner-city elderly population

In this study, utilizing 19 social network variables and 3 outcome measures (need fulfillment, psychological symptoms, and physical symptoms), we follow 133 elderly residents of mid-Manhatten hotels for one year. The findings indicate that social networks exert a direct effect on reducing subsequent symptoms and enhancing ability to meet needs. Moreover, social networks trigger a buffering response to stressors in that their ability to reduce symptoms and to promote need fulfillment was greatest among high-stress individuals.