Older women's lives through time

Evaluating the Impact of Community Gardening on Sense of Purpose for Persons Living with Dementia: A Cluster-Randomized Mixed Methods Pilot Study

Background:

Gardening has been shown to have positive effects on persons living with dementia, but no studies have explored the effects of gardening on sense of purpose.

Objective:

Explore how gardening may influence sense of purpose for people with dementia.

Methods:

Ten residents with dementia diagnoses living in a skilled care facility participated in hour-long gardening sessions twice weekly at outdoor raised beds over a two-month duration. One group (n = 5) donated vegetables to a food pantry while the other (n = 5) harvested produce for personal use. Semi-structured interviews with participants and their caregivers conducted post-intervention were analyzed for themes.

Results:

Participants and caregivers reported biopsychosocial benefits of gardening, identifying four main themes: 1) Gardening outdoors provided specific physical benefits that improved quality of life; 2) Working on a project in a group setting improved mood and fostered a sense of community; 3) Gardening promoted reminiscence and reinforced a sense of self; 4) Gardening provided participants with a sense of purpose and pride.

Conclusion:

Gardening has biopsychosocial benefits for persons living with dementia, and there appears to be additive benefit linked to improved sense of purpose via charitable giving.

Health Conception and Health Promotion in Blue Collar Workers: Program Planning Issues

Health conception and health promotion behaviors were measured in 160 blue collar workers ages 18 to 65, focusing on factors influencing blue collar workers' participation in health promotion programs. Results of Laffrey's Health Conception Scale (LHCS) and Pender's Health Promoting Lifestyle Profile (HPLP) indicated:

• Health responsibility and interpersonal support were significantly greater for women than for men.

• Exercise was significantly greater for younger workers than for older workers.

• Nutrition was significantly greater for older workers than for younger workers.

• Health conception was significantly greater for younger women and for older men.

• A significant relationship exists between health conception and health promoting lifestyle.

• Role and self actualization were significantly greater for older workers than for younger workers.

Results suggest gender, age, and concept of health are important when planning health promotion programs at an industrial site.

Lifelong significance of disempowering experiences in prenatal and maternity care: interviews with elderly Swedish women

In this article I show how the effects of harsh and humiliating treatment, experienced by a number of Swedish women in antenatal care and childbirth in the mid-20th Century, endured for the rest of their lives. This treatment was carried out by medical staff in conformity with a view of expectant mothers as irresponsible and ignorant and with the prevalent idea of "natural birth." These effects were findings in an interview investigation that, with a colleague, I conducted into paid and unpaid work and health of 20 women, seen in a lifetime perspective. Our biomedical way of understanding risks and complications during pregnancy and birthing was confronted with many participants' feelings of distress, guilt, and grief linked to their childbearing experience. I interpret the treatments as "violations of dignity" and as abuse. The consequences are similar to those following traumatic birth experiences described in today's literature.

Symptom clusters and quality of life in older adult breast cancer survivors

PURPOSE/OBJECTIVES

To identify symptom clusters in older adult breast cancer survivors (ages 65-97 years) and examine whether symptom clusters are related to demographic, health, and quality-of-life variables.

DESIGN

Factor analysis to identify possible symptom clusters. The resulting clusters then were correlated with quality-of-life measures.

SETTING

Phone interviews between the participants and a trained research nurse.

SAMPLE

192 breast cancer survivors (X age = 70).

METHODS

This was a secondary data analysis of the baseline measures of demographics, health history, symptom bother, and physical, mental, and existential dimensions of quality of life. Exploratory and confirmatory factor analyses were conducted as well as multiple indicator multiple cause modeling and partial correlation analyses to assess the relationships among clusters and demographic, health history, and quality-of-life measures.

MAIN RESEARCH VARIABLES

Self-reported symptom bother, demographics such as age and education level, health history, and quality of life.

FINDINGS

Seven clinically distinct symptom clusters tapping 36 different symptoms in older adult breast cancer survivors were found. These symptom clusters were significantly related to multiple dimensions of quality of life.

CONCLUSIONS

Older adult breast cancer survivors experience multiple concurrent symptoms that appear to cluster. Identifying symptom clusters helps to elucidate possible intersymptom relationships which may lead to the design of more effective symptom management interventions for older adult breast cancer survivors.

IMPLICATIONS FOR NURSING

Older adult breast cancer survivors should be assessed for a wide variety of symptoms if clinicians hope to identify and understand intersymptom relationships. Such assessment would enable more comprehensive symptom management.

Proactive coping in community-dwelling older Australians

This article reports on a study of older community-dwelling Australian adults which aimed to test whether a relatively unexplored construct, proactive coping, could have a role in purpose in life, personal growth, and life satisfaction. A total of 109 women and 115 men (Mean age = 75.04 yrs, SD = 6.66) completed a questionnaire containing Greenglass et al.'s (1999) Proactive Coping Inventory, the Purpose in Life and Personal Growth subscales of Ryff's (1989) Psychological Well-being Scales, and the Satisfaction with Life Scale (Diener et al., 1985). The results of hierarchical multiple regression analyses indicated that proactive coping was a highly significant predictor of all three measures of well-being, after controlling for age and health. The effect on personal growth and purpose in life was particularly strong. Proactive coping does seem to be an important variable in the psychological well-being of older adults. However, the correlational nature of the design, and the likelihood of some conceptual overlap between the well-being variables, suggest that these inferences can only be tentative. Designing psychological interventions to improve proactive coping may help to improve quality of life at older ages. There is a need for experimental research to further explore the causal influence of proactive coping and for further theoretical work to determine the exact nature of proactive coping.

Effect of perceived barriers to symptom management on quality of life in older breast cancer survivors

Negative attitudes of both older adults and healthcare providers about aging can be barriers to self-care in old age. The aims of this study were to (1) examine the extent to which older breast cancer survivors experience barriers to symptom management and (2) explore whether barriers influence quality of life. Three possible barriers to symptom management were examined: negative beliefs about managing symptoms, perceived negative attitudes of healthcare providers, and difficulties in communicating about symptoms. This study was a secondary analysis of pooled baseline data from 61 older (age >64 years) women who participated in 2 pilot studies that tested a symptom management intervention for older breast cancer survivors. The most frequent barrier reported was difficulties in communicating about symptoms with healthcare providers. Each of the barriers affected psychosocial, but not physical, quality of life. Barriers to symptom management may lead to poorer self-care of symptoms that can result in lower levels of psychosocial quality of life. Healthcare providers need to encourage older cancer survivors to report symptoms and worries related to their cancer diagnosis and should be cautious in expressing attitudes that could reinforce older adults' negative perceptions about aging.

The essence of life purpose

Life purpose is an important thread of critical care nursing. However, no consensus exists for a definition of life purpose. In addition, ambiguity prevails regarding the manner in which life purpose is incorporated into nursing practice and research. Therefore, through a conceptual synthesis process, this article aims to clarify the essence of life purpose with relevance to health and critical care nursing today. The outcome of the conceptual synthesis is an operational definition to be used in future nursing research. Information was obtained from a literature search of scholarly articles using (1) searches of electronic databases of literature about life purpose and (2) research studies addressing conceptual, substantive, and methodological domains. Topics consisted of the philosophical underpinnings of life purpose, its attributes, definitions, and theoretical frameworks, along with differences in theories and empirical support. Finally, emerging from this process, the article culminates with a proposed conceptual definition of life purpose, which may be applied broadly to older adults in various critical care settings.

Symptoms, symptom beliefs, and quality of life of older breast cancer survivors: a comparative study

PURPOSE/OBJECTIVES

To compare symptoms, symptom beliefs, and quality of life (QOL) of older breast cancer survivors to those of older women without breast cancer.

DESIGN

Descriptive, correlational study.

SETTING

Urban and rural communities in the Midwest United States.

SAMPLE

18 breast cancer survivors and 24 women without breast cancer, older than age 64 (X age = 76 years).

METHODS

In-home interviews using structured instruments.

MAIN RESEARCH VARIABLES

Symptom distress (number of and distress from symptoms), symptom beliefs, chronic health problems, and QOL.

FINDINGS

No group differences existed in demographic characteristics, symptom number, symptom bother, chronic health conditions, or QOL. Women in both groups most often attributed the cause of their symptoms to aging, chronic illness, or unknown, but rarely to breast cancer. Attributing symptoms to chronic illness or breast cancer was significantly related to more pain, depression, role impairment, and poorer mental health. Not knowing the cause of symptoms was significantly related to poorer social functioning, mental health, and purpose in life; less energy; and higher levels of depression and anxiety.

CONCLUSIONS

The symptom experience and QOL of older breast cancer survivors are similar to those of older women with other chronic health problems. Beliefs about symptoms influence QOL in older women.

IMPLICATIONS FOR NURSING

A broader assessment of symptoms is needed to assist older breast cancer survivors with symptom management. Symptom interventions in older women should address patients' beliefs about symptoms if QOL is to be enhanced.

Relationship of social role quality to psychological well-being in women with rheumatoid arthritis

The purpose of this study was to examine the mediating and moderating effects of women's social role quality on the psychological well-being of women with rheumatoid arthritis (RA). One hundred and fifty-six women with a diagnosis of RA (M age = 59, SD = 11) completed self-report measures of arthritis history, physical health, psychological well-being, and role quality. Hierarchical multiple regression analyses indicated that role quality mediated the effects of physical health on depression and purpose in life, moderated the effects of health on depression, and moderated the effects of pain on purpose in life. Women in poor health with high role quality were significantly less depressed than women in poor health with poor role quality. Women with high levels of pain and high role quality had more purpose in life than women with high levels of pain and low role quality. Despite difficulties with their physical health, women who had high role quality had higher levels of psychological well-being. Findings from this study may aid in the development of meaningful interventions to help women with RA manage their daily lives to optimize well-being.

Social role quality, physical health, and psychological well-being in women after heart surgery

Women's social role quality may be an important factor in their adaptation after heart surgery. Relationships among different dimensions of role quality, physical health, and psychological well-being were examined in 157 midlife and older women who had undergone heart surgery. Overall, older women (n = 89) were similar to younger women (n=68) in physical recovery from heart surgery. Poorer health outcomes were associated with number of health problems, not age. Women with more health problems and lower subjective health perceptions had lower role quality. Multiple regression analyses indicated that, in general, role quality mediated the effects of physical health on psychological well-being. Regardless of the extent of physical health problems, women with higher role quality had higher levels of psychological well-being.

Conceptualizing resilience in women older than 85: overcoming adversity from illness or loss

Resilience in women older than 85 is defined as the ability to achieve, retain, or regain a level of physical or emotional health after devastating illness or loss. This concept analysis of resilience in women older than 85 is based on the strategy suggested by Meleis. Resilience in women older than 85 is symbolized by a coiled wire, enclosed within a box similar to a jack-in-the-box. Environmental factors within the jack-in-the-box include frailty, determination, previous experience with hardship in learning how to cope, access to care, culturally based health beliefs, family support, self-care activities, caring for others, and functioning like efficiently working machines. External factors that influence the ability of the wire to recoil include the structure of the box itself and stress. More study is needed regarding diverse older women's experiences of resilience to develop a workable, clinically focused theory.

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

The purpose of this descriptive, correlational study was to test a conceptual model of proposed relationships between physical health limitation, the sense of coherence, illness appraisal, and quality of life in a sample of 137 older women. The typical respondent was 76, widowed, with an income less than $12,000, and several health problems. Hierarchical multiple regression analysis indicated that physical health limitation, particularly symptom bother and functional health, had a significant negative influence on quality of life. However this effect was mediated by sense of coherence and illness appraisal. Regardless of the level of symptoms or functional health, women with higher sense of coherence and more positive illness appraisals had higher levels of quality of life. The findings support the proposed model and further our understandings regarding the protective role of personality resources in perceived quality of life in older women with chronic illnesses.