The meaning of home for ageing women living alone: An evolutionary concept analysis

Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study

INTRODUCTION

Studies of older women's life transitions is rare but gains relevance as the aging population, with older women as the majority, expands.

PURPOSE

To explore the meaning of a good life for older widows with extensive home care needs.

MATERIALS AND METHODS

Semi-structured interviews were carried out with eleven women, aged 80 and over (82-95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5-6 hours, mean 3). Data were analysed by reflexive thematic analysis.

RESULTS

The theme "This Day in My Home, the frame of my life" reflects the women's experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely.

CONCLUSION

A day at home may seem static, yet it mirrors life's dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.

Relationship of widowhood with pulse pressure, fasting blood glucose, and mental health in older adults: a propensity matching score analysis

Background

Transitioning from marriage to widowhood presents inevitable and significant challenges for many older adults. This study explored the impact of widowhood on a range of mental health outcomes, including pulse pressure and fasting blood glucose levels, among older adults in nursing homes.

Methods

This cross-sectional study utilized cluster random sampling to recruit participants, with data analyzed from 388 older Chinese adults. Psychosocial traits were assessed using the Perceived Social Support from Family scale (PSS-Fa) for family support, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms, and the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms and suicidal ideation. Propensity score matching (PSM) was employed to control for confounding factors. A multivariate linear regression analysis was performed to explore the relationship between widowhood, mental health outcomes, pulse pressure, and fasting blood glucose levels.

Results

After applying PSM, the sample size was refined to 268 (N = 134 for both married and widowed groups) from the initial 388, excluding 120 unmatched cases. Widowed older adults were found to have notably lower family support (β = -0.81, p = 0.002), increased depressive symptoms (β = 1.04, p = 0.043), elevated pulse pressure (β = 8.90, p < 0.001), and higher fasting blood glucose levels (β = 3.22, p = 0.027). These associations exhibited greater beta values compared to pre-matching analysis.

Conclusion

Our findings revealed that widowed participants had reduced family support, an increased risk of depressive symptoms, heightened pulse pressure, and elevated fasting blood glucose in comparison to their married counterparts. Interventions focusing on social support, mental health, and cardiovascular well-being could be advantageous for this at-risk group.

Exploring the place attachments of older migrants in Aotearoa: A life course history approach

Migrants are faced with the task of creating a sense of home in a new context. As migrants grow older in their host countries, they are also making important decisions on where to live out the rest of their lives, making salient the places they attach themselves to. Place attachment, and its subcomponents of place identity and place dependence, are concepts that have been explored in the ageing and migration literature, demonstrating that positive, emotional attachments to places are positively correlated with better health outcomes. Although it has been established that individuals' attachments to places are dynamic, multidimensional and change over the life course, there is a paucity of research exploring the place attachments of migrants as they age using a life course approach. This study adopted a life course approach to investigate how the components of place attachment shifted over time for migrant people in Aotearoa New Zealand as they aged, and to better understand the mechanisms and barriers to establishing a sense of home in a foreign land. We examined the narratives of ten older migrants (65 years or older) who migrated to Aotearoa before the age of 50. Key findings illustrated that all participants had strong place identities (i.e., explicit self-identification and sense of belonging) to their countries of origin before migrating to Aotearoa, all participants developed strong place dependence (i.e., fulfilment of functional needs) to Aotearoa over their life course, but not everyone was able to develop place identity to Aotearoa. Mechanisms such as language, cultural attitudes, and values can both facilitate and prevent attachments to either home or host country. These results uncover how Aotearoa's ageing migrants negotiate their attachments to places over the life course.

The experience of living alone as an older woman in the UK during the Covid pandemic: an interpretative phenomenological analysis

BACKGROUND AND OBJECTIVES

More people are living alone across the life course: in later life this can have implications for practical and psychosocial support. The Covid pandemic emphasised the importance of this when the UK government restricted movement outside of households to limit the spread of disease. This had important ramifications regarding social contact and practical support. The objectives of this study were to explore the experience of older women living alone during this time, with a focus on health and wellbeing.

RESEARCH DESIGN AND METHODS

This study used an Interpretative Phenomenological approach. Semi-structured interviews were undertaken with seven women (aged 65 +), living alone in the UK. Interviews were carried out between May and October 2020. Interpretative Phenomenological Analysis was used to analyse the transcripts.

RESULTS

Findings show that life course events shaped how living alone was experienced in later life. Convergences and divergences in lived experience were identified. Three superordinate themes emerged from the Interpretative Phenomenological Analysis: Productivity, Ownership, and Interconnectedness.

DISCUSSION AND IMPLICATIONS

Findings highlight the importance of life course events in shaping the experience of later life. They also provide a better understanding of the lived experience of living alone as an older woman, increasing knowledge of this group and how living alone can affect health and wellbeing. Implications for research and practice are discussed, such as the importance of recognising the specific support needs for this group in later life, and the need for further knowledge about groups whose needs are not met by standard practice.

Professional home care providers' conceptualisations of frailty in the context of home care: A focus group study

BACKGROUND

In Norway, as in many other countries, more people receive health and care services in their homes than before. Home care professionals provide care and support to people with a range of health and care needs. Older home care service users are sometimes referred to as 'frail', but the terms 'frail' and 'frailty' have different meanings in different contexts, and little is known about the meaning ascribed to the terms in the context of home care services. Home care services are crucial for many older persons who have health challenges, and how home care professionals conceptualise frailty might shape clinical encounters.

OBJECTIVES

The purpose of this study is to explore how home care professionals conceptualised frailty in the context of home care.

METHODS

We conducted four focus group discussions with 14 home care professionals who worked in municipal home care in northern Norway and analysed the data using thematic analysis.

RESULTS

Our analysis resulted in five themes: '"Frail" - a term which is too imprecise to be useful', 'Frailty as a consequence of ageing', 'Frailty as lack of engagement and possibilities for engagement', 'Frailty as a contextual phenomenon' and 'Frailty as potentially affected by care'. The home care professionals conceptualised frailty as an individual trait but also as resulting from the interplay between individual and environmental factors. Moreover, their conceptualisations of frailty represented a continuum between frailty as related to prevention and management ('cure') and frailty as related to ageing as natural decline ('care').

CONCLUSION

The home care professionals conceptualised frailty diversely, as moving along a continuum between cure and care. Diverse conceptualisations of frailty might be necessary if nurses are to meet the changing and varying care needs of older persons who live in their own homes and need health and care services.

Measuring the quality of life of long-term care service users in Japan: a cross-sectional questionnaire study

BACKGROUND

In Japan's super-aging society, the number of long-term care service providers is increasing, and the quality of care is a matter of concern. One aspect of the quality of care is the user's quality of life. The questionnaires EQ-5D and WHO-5 are representative indicators of quality of life. Herein, we aimed to measure the quality of life in long-term care service users in Japan and to clarify the relationship between quality of life and the level of care required.

METHODS

A questionnaire study was conducted in 106 facilities of 22 corporations. In addition to the EQ-5D and WHO-5, sex, age, and the level of care required were assessed by descriptive statistics. Bonferroni's multiple comparison test was used to analyze each quality of life score, and the differences by sex and age were analyzed multiple regression analyses, with each quality of life score as the objective variable.

RESULTS

Of 4647 cases collected, 2830 were analyzed, with no missing data. Both indicators tended to be lower than the general older population. Those scores tended to be higher in females than males (EQ-5D: males, 0.58 ± 0.26; females, 0.60 ± 0.24; P = 0.06 and WHO-5: males, 13.8 ± 5.92; females 14.9 ± 5.70; P < 0.001). In terms of age, those under 65 years old with specific diseases had lower EQ-5D scores than those in other age groups (P < 0.001); however, WHO-5 scores did not differ by age. Multiple regression analysis showed a significant association between the EQ-5D score and level of care required, except for support-required level 1, which tended to worsen as the level of care required increased. Conversely, the WHO-5 score was significantly lower for care need levels 2, 4, and 5.

CONCLUSIONS

The quality of life of long-term care service users was worse than that of the general older population, it tended to be low among males and those under 65 years old with specific diseases. Furthermore, it gradually decreased as the level of care required increased. It is important to monitor users' quality of life as a quality indicator of care, to improve and manage it.

Do You Feel Safe at Home? A Qualitative Study among Home-Dwelling Older Adults with Advanced Incurable Cancer

Many older adults with cancer prefer to live at home, and home treatment and outpatient care have been recommended for such patients. To improve their mental health, it is important to identify the challenges that are faced by home-dwelling older adults with cancer. This study aimed to examine the impact of the home on older adults with advanced cancer who were receiving treatment and follow-up care. In a cross-sectional design with criterion-based sampling, eight qualitative interviews were transcribed and interpreted thematically. We identified three themes of home-safety management: good home-safety management, uncertain home-safety management, and home-safety management collapse. Moreover, we revealed eight sub-themes important to the participants' home-safety experience. Ensuring that older adults feel safe at home will afford them the opportunity to enjoy living at home, which in turn may alleviate their symptom burden and enhance their mental health.

Shattered Voices: Daughters' Meaning Reconstruction in Loss of a Mother to Intimate Partner Homicide

Intimate partner homicide is a major public health concern around the world and the most lethal outcome of domestic violence. Its impact on the surviving bereaved offspring is immense, yet there is a significant gap in the literature regarding the long-term effects of this type of loss. The current qualitative study is aimed at filling this gap. The study used the constructivist paradigm of bereavement as a theoretical background to reveal the meanings constructed by bereaved Israeli daughters whose biological mothers were killed in acts of intimate partner homicide by their biological fathers. Three main themes of meaning emerged from 12 in-depth semi-structured interviews: "destruction of one's home"; "blast injury"; and "in doubt". An examination of the three themes in the current study reveals a deep shatter in participants' world of meaning to its very basic foundations. In light of intense psychological and social forces, the participants constructed and reconstructed such narratives of meaning in a continuous process of meaning making throughout their lives, years, and decades post loss. Derived from the findings are implications for practice. Mental healthcare professionals must attend to this basic shatter with an extreme level of caution, as they help homicide survivors reconstruct a world of meaning shattered by loss. Moreover, the long-lasting effects emphasize an appropriate legal and political involvement; specifically, policy regulations and rights should provide psychosocial care programs that are suited to the needs of offspring co-victims of intimate partner homicide in particular. In light of the strong social influence on participants' loss experience, further efforts are required to raise social awareness about this burning social concern and to fight the stigmatization of co-victims of homicide in general and co-victims of intimate partner homicide in particular.

Self-Esteem, Anxiety, and Depression in Older People in Nursing Homes

Background: Social environment and type of care may influence mental health in late life. The aim of this study was to assess the associations between depression, anxiety, and self-esteem in older people. Methods: The study evaluated mental health in people older than 65 years of age in Zadar County, Croatia. The participants were interviewed using the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Rosenberg Self-Esteem Scale. Multiple linear regressions were used to assess the correlations between depression, anxiety, and self-esteem. Results: Compared with elderly people living in their own homes, elderly people in nursing homes reported lower self-esteem, higher depression, and higher anxiety. The level of self-esteem decreased with increased levels of depression. Anxiety was significantly associated with depression, while depression strongly increased with an increase in anxiety. Older age was associated with depression, while widowhood was a negative predictor of self-esteem. Institutionalization was borderline significantly associated with anxiety, while gender was associated with anxiety. Conclusions: The study found associations between self-esteem, anxiety, and depression in the elderly. The strategy of humanization in nursing care for older people should be applied equally in nursing homes and in community-dwelling states. Public health programs aimed at maintaining the mental health of older people are needed.

Older Women Living Alone in the UK: Does Their Health and Wellbeing Differ from Those Who Cohabit?

With an increased prevalence of people living alone in later life, understanding the health and wellbeing of older women living alone in the UK is an important area of research. Little is known about health and wellbeing in this population and whether they differ from those who cohabit. This paper fills this research gap. Analysis was undertaken of Wave 8 of the Understanding Society Household Panel Survey, including variables such as internet use and volunteering. Differences were found between those who live alone and cohabit. Volunteering was a predictor of better health outcomes for those who lived alone but not for those who cohabit, despite similar rates of volunteering. Internet use predicted some better health outcome for those who cohabit but poorer for those who live alone. This suggests lifestyle factors vary in how they affect the health and wellbeing of older women, depending on cohabitation status.

Domestic violence: a Rodger's evolutionist conceptual analysis

OBJECTIVE

to analyze the concept of domestic violence based on its use in health sciences, humanities, and exact sciences according to Rodgers' evolutionary model.

METHODS

this is a concept analysis based on Rodgers' evolutionary conceptual model. Ninety-six articles were included in Portuguese, English, Spanish, and French, which had a definition of domestic violence, having identified the antecedents, attributes and consequences and produced a model case.

RESULTS

twenty-two attributes, ten antecedents and eight consequences were identified.

FINAL CONSIDERATIONS

from antecedents, attributes and consequences, it was possible to identify the connection between domestic violence and gender issues, especially patriarchal, being seen in a normalized way by society and causing consequences to the victims' physical and psychological health.

The health and well-being of older women living alone in the United Kingdom and beyond: a scoping review

In the United Kingdom (UK), women are more likely to live alone in later life. Social factors such as household composition have been shown to affect health and wellbeing as we age. The health and well-being of older women who live alone are of interest to researchers, care providers, health organizations, and policymakers. This article contributes to the literature by detailing a scoping review, establishing the current evidence in this field. The purpose and context of the review are given. The methodology and resulting data are described. Gaps in the literature and implications for practice and research are given.

Meaning of home and health dynamics among younger older people in Sweden

Research has shown that positive evaluations of home are important for very old people’s health, well-being and independence in daily life. The rationale for the present study derives from our survey study findings, confirming such associations also in a younger cohort (N = 371). The purpose of this study was to further increase the understanding of the dynamics of meaning of home and health among community-living healthy younger older people, in the present and in a projected future. Data were collected through semi-structured interviews with 13 persons aged 67–70 years living in ordinary housing in Sweden, followed by a qualitative content analysis. Findings suggest that the home becomes progressively important after retirement. Not only the immediate home environment but also local neighbourhoods influence perceptions about home. Home brings emotional and social benefits but also worries about how to cope with complex home ambivalence when reflecting upon future housing arrangements. The findings suggest that it is important to consider the role of perceived aspects of home for health and well-being in early phases of the ageing process. The findings could be used to raise awareness among policymakers, housing authorities and professionals involved in housing-related counselling.

Exploring the Perspectives of Older People on the Concept of Home

Objectives

Continuing to live at home is arguably one of the most important challenges older persons face as they age. The aim of this study was to clarify how older adults conceptualise home through age-related lifestyle changes.

Methods

Principles from grounded theory were used to examine the perspectives of 21 older adults obtained from three focus group discussions and 10 in-depth semistructured interviews.

Results

Four major categories were developed: “anchoring self,” “enabling freedom,” “being comfortable,” and “staying in touch.” Discussion. For the participants in this study remaining at home enabled a sense of independence and freedom, self-worth and identity, comfort, and an ongoing active role in the community. However, some aspects of home could be renegotiated despite changes to living location, with new social connections able to be forged and personal comforts being transferrable. This holds important implications for supporting older persons to both sustain living at home and to adjust to changing circumstances, suggesting the importance of drawing on the experiences of older persons themselves in developing strategies to promote successful aging.