Sense of security among people aged 65 and 75: external and inner sources of security

Feeling safe in the context of digitalization in healthcare: a scoping review

BACKGROUND

Digitalization in healthcare and society can be challenging, particularly for people who have limited digital experiences. New digital technologies can influence individuals' perceived safety and well-being. In this study, we aimed to identify and analyze the literature on needs and influencing factors in the context of emotional and psychological safety and digitalization in healthcare.

METHODS

A scoping review was conducted based on the PRISMA-ScR standard. The literature was searched based on the databases Medline via PubMed, PsycINFO via Ovid, and CINAHL via EBSCO. Literature was included after a review of the titles, abstracts, and full texts published in English or German in the last 5 years (October 2017-September 2022). Eligible literature included definitions and descriptions of emotional and/or psychological safety and was related to digitalization in healthcare and was analyzed qualitatively via inductive content analysis. The findings were analyzed from ethical, psychosocial, legal, economic, and political perspectives.

RESULTS

A total of 32 publications were finally included thereof qualitative (n = 20), quantitative (n = 3), and mixed methods (n = 2) studies. Other included publications were systematic integrative reviews, scoping reviews, narrative reviews, white papers, and ethical statements. Of these publications, four qualitative studies focused on emotional or psychological safety in the context of digital technology use in healthcare as a primary research aim. Most literature has shown that perceived safety is influenced by perceived changes in healthcare, digital (health) literacy, the design of digital technology, and need orientation. The needs identified in this context overlap strongly with the influencing factors. A low or high perceived safety has an impact on users' thoughts and actions.

CONCLUSION

The importance of emotional safety in the context of digital technologies in healthcare is growing, while psychological safety seems to be underrepresented. The interaction between the influencing factors and the need to feel safe leads to considerations that can affect user behavior and have far-reaching outcomes for the implementation of digital technology in healthcare.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Registries on 16 December 2022 https://doi.org/10.17605/OSF.IO/HVYPT .

Determinants of a sense of insecurity among home-dwelling older people

Aims: A sense of insecurity may have an impact on older people's well-being and their courage to engage actively in meaningful activities. Studies on a sense of insecurity among older people are scarce. The aim of this study was to determine the extent to which home-dwelling older adults perceive their life as being insecure and how a sense of insecurity is associated with their health, functional status, active social engagement, well-being and perceptions of the societal treatment of older people. Methods: This study is part of the Helsinki Aging Study, a cohort study ongoing since 1989. Data were collected using a postal questionnaire that was mailed in 2019 to a random sample of home-dwelling older people ⩾75 years of age living in Helsinki (N=2917; response rate 74%). The questionnaire inquired about the respondents' sense of security/insecurity, and they were subcategorised into those feeling secure and those feeling insecure based on their answers. Results: Seven per cent of respondents felt insecure in their lives. In a stepwise logistic regression analysis, loneliness, living alone and perceived poor societal treatment of older people were associated with a sense of insecurity, while having good self-rated health, having children and meeting friends at least weekly were associated with lower odds of insecurity. Conclusions: Our findings highlight the importance of recognising and combating loneliness, social isolation and societal ageism in order to reduce insecurity among older people and to support their active engagement in life.

Users' ambivalent sense of security with humanoid robots in healthcare

Humanoid robots have already been shown to be useful in healthcare. To ensure successful interactions with humanoid robots, is it essential that the factors that influence users' sense of security be understood. Ensuring patients' sense of security is considered a key principle of good caring. The aim of this study was to illuminate users' sense of security with humanoid robots in healthcare. Twelve semi-structured interviews were conducted. The participants consisted of five women and seven men aged 24-77. Before being interviewed, the participants were shown a video vignette with Pepper, a fully developed humanoid robot, used in the daily care of patients. The data material was analyzed using qualitative content analysis. Most participants perceived the use of humanoid robots in healthcare to be both positive and negative. The overarching theme was: Ambivalent sense of security with humanoid robots in healthcare. The four categories revealed were: Humanoid robots are both reliable and unreliable, Humanoid robots are both safe and unsafe, Humanoid robots are both likable and scary, and Humanoid robots are both caring and uncaring. Here we increased knowledge of whether patients perceive a sense of security with humanoid robots in healthcare, including which fears users have. This is vital information that should be taken into consideration when further developing and introducing humanoid robots into the healthcare setting.

Effects of 'participatory group-based care management' on wellbeing of older people living alone: a randomized controlled trial

BACKGROUND AND OBJECTIVES

More knowledge is needed of the effectiveness of complex interventions that aim to promote the wellbeing of older people. This study examines the effects of 'participatory group-based care management' conducted among community-dwelling older adults living alone in Central and Eastern Finland. The intervention aimed to promote wellbeing and quality of life (QoL) using a needs-based and participatory approach.

METHODS

The study was carried out as a randomized control trial (intervention group n = 185, control group n = 207). In this article, baseline and 6-month follow-up surveys were used. QoL (WHOQOL-Bref instrument), loneliness (Revised UCLA Loneliness Scale; single-item question), and trust (two items of generalized trust and six items of institutional trust) were used as outcome measurements, and generalized estimating equations (GEE) modeling as the analysis method. Both per-protocol and intention-to-treat analyses were applied.

RESULTS

According to the per-protocol analysis, the intervention had no effects on QoL. Loneliness decreased among older people with poor QoL at the baseline. Additionally, the intervention enhanced trust in other people and some dimensions of institutional trust. The intention-to-treat analysis did not result in any significant effects on QoL or loneliness, but some small positive changes in institutional trust were found.

CONCLUSIONS

Based on some evidence of small positive effects, the intervention may be beneficial in alleviating loneliness and enhancing trust among older people living alone. Because of the contradictory results, more research is needed to examine the complexity of 'participatory group-based care management´ from the perspective of process evaluation.

Self-care ability and sense of security among older persons when using an app as a tool for support

THE STUDY'S RATIONALE

The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences.

AIMS AND OBJECTIVES

To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns.

METHODOLOGICAL DESIGN AND JUSTIFICATION

The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding.

ETHICAL ISSUES AND APPROVAL

Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent.

RESEARCH METHODS

Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach.

MEASUREMENTS AND INTERVENTION

The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses.

RESULTS

The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards.

STUDY LIMITATIONS

The small sample size for statistical analysis.

CONCLUSIONS

This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.

An exploration of factors associated with older persons' perceptions of the benefits of and satisfaction with a preventive home visit service

BACKGROUND

Preventive home visits (PHVs) are healthcare services aimed at promoting the health of home-dwelling older people and to support their abilities to live independently. To enhance effectiveness, studies that explore older persons' experiences of PHVs are needed.

OBJECTIVE

To assess older persons' perceived benefits and opinions of a PHV service and explore associations between perceived benefits from PHV and relevant sociodemographic/health-related factors.

THEORY

The study was based on a comprehensive understanding of health, as including objective health/disease, subjective health/well-being and coping ability.

METHODS

A cross-sectional survey was administered during spring 2013 in a Norwegian municipality where nurses had offered annual PHVs to residents aged 75 years and older since 1999. We invited a stratified random sample of 393 PHV users to participate; of these, 161 volunteered. The main outcome variables in the questionnaire were perceived benefits from PHV. Logistic regression models were used to analyse the associations between each benefit and sociodemographic/health-related background variables.

RESULTS

Approximately 39% of the respondents reported that PHVs added to their feelings of safety; 66% reported support for ability to live at home; 72% reported support for having a good life, 83% were satisfied with the service, and 90% stated that PHVs are important for older people. Each benefit was associated with different sociodemographic/health-related factors. Support for feelings of safety increased with age. More support for living at home was associated with poor physical health and not living alone. Those without children perceived more support for a good life. Satisfaction with PHV increased with increasing scores on the Life Orientation Scale. Persons with poor mental health and those not living alone more often perceived PHV as important.

CONCLUSIONS

Annual, comprehensive PHVs to a general older population may support older persons' health and independence. Low response rate restricts the possibility to generalise the results.

Adaptation to care dependency in community care

Purpose

The purpose of this paper is to explore the lived experiences of adapting to care dependency among adults receiving health and social care in ordinary housing.

Design/methodology/approach

This was done by conducting a phenomenological study by interviewing ten adults, receiving home care services in ordinary housing.

Findings

Participants not only adapted by becoming a “good patient” but they had four strategies they used: sociability, distance, competence and compliance, contributing to a sense of dignity and personal safety.

Research limitations/implications

Further research is needed regarding how to preserve quality of care with adults with various ways of adapting to care dependency.

Practical implications

The relationship between professionals and adults in care dependency is a dynamic process where a need for understanding different modes of adaptation is vital. Good treatment and quality care may be different things to different adults, depending on what aspects of the process of adaptation concern them the most, and depending on their individual adaptation strategy.

Originality/value

This paper contributes to the understanding of modes of adaptation to care dependency from the perspective of adults indicating that working person centered may include respecting strategies not traditionally being associated with “the good patient.”

Who often feels lonely? A cross-sectional study about loneliness and its related factors among older home-dwelling people

AIM AND OBJECTIVES

To investigate the prevalence of individuals who often feel lonely among a sample of Norwegian older home-dwelling people aged ≥65 years old, as well as to identify any possible factors explaining their loneliness.

BACKGROUND

Loneliness is known to be common among older people. To identify those older adults who are lonely, and to acquire knowledge about the complexity of their loneliness, is important to provide them with adequate help and support.

DESIGN

This study employed a cross-sectional design.

METHOD

A questionnaire was mailed to a randomised sample of 6,033 older home-dwelling persons aged ≥65 years. A total of 2,052 persons returned the questionnaire and were included in the study. The questionnaire consisted of questions asking whether the subjects often felt lonely or not, as well as health-related and background questions and instruments to measure the participants' sense of coherence, mental problems, nutritional screening and self-care ability. The data were analysed using univariate and multivariate statistical methods.

RESULTS

A total of 11.6% of the participants reported often feeling lonely. Six factors emerged to be independently associated with often feeling lonely among the respondents: Living alone, not being satisfied with life, having mental problems, a weak sense of coherence, not having contact with neighbours and being at risk for undernutrition.

CONCLUSIONS

The study shows that often feeling lonely among older home-dwelling persons is a health-related problem that includes social, psychological and physical aspects. Moreover, these persons have limited resources to overcome feelings of loneliness.

IMPLICATIONS FOR PRACTICE

Lasting loneliness among older home-dwelling persons requires an overall, person-centred and time-consuming approach by nurses. Nurses with advanced knowledge on geriatric nursing may be required to offer appropriate care and support. Healthcare leaders and politicians should offer possibilities for adequate assessment, support and help.

Meaning in life and physical health: systematic review and meta-analysis

This systematic review and meta-analysis aimed to clarify the associations between meaning in life and physical health using random-effects models. Conceptualisation of meaning (order in world vs. purpose in life), type of health indicators, participants' health status, and age issues were investigated as moderators. Systematic searches of six databases resulted in inclusion of k = 66 studies (total N = 73,546). Findings indicated that meaning in life and physical health formed weak-to-moderate associations (the overall estimate of the average effect = 0.258). Conceptualisation of meaning, participants' health status, and their age did not moderate these associations. Operationalisation of health moderated the relationship between meaning in life and health. The strongest associations were found for subjective indicators of physical health. Significant albeit weak associations between meaning in life and objective indices of health were found. Furthermore, stronger effects were observed when the measures of meaning combined items referring to meaning in life and meaning-related sense of harmony, peace, and well-being, compared to measures focusing solely on meaning in life. Overall, the results point to the potential role of meaning in life in explaining physical health.

Perception of risk for older people living with a mental illness: Balancing uncertainty

Risk is commonly defined as a negative threat which needs to be controlled and mitigated; as a concept, it takes high priority in contemporary mental health services. Health-care organizations and clinicians are now required to use levels of risk as a benchmark for clinical decision-making. However, perceptions of risk change according to the lens through which it is viewed. A qualitative, exploratory research study was undertaken in an aged persons' mental health programme in Victoria, Australia, to explore the notion of risk from the multiple perspectives of service providers and consumers. Data were obtained through in-depth interviews, and analysis was based on the framework of Ritchie and Spencer. Balancing uncertainty emerged as a major theme, and comprised two subthemes: (i) complexity of risk from the perspective of providers of services; and (ii) complexity of safety from the perspectives of recipients of services. These differences emphasize a significant disjuncture between perceptions of risk and the potential for the individual needs and concerns of consumers to be subsumed under broader organizational issues. The uncertainty this tension highlights suggests the need to reconceptualize risk, incorporating the views and experiences of all stakeholders, particularly consumers and carers, to enhance recovery-oriented services and facilitate consumer participation within mental health services.

The language of risk: common understanding or diverse perspectives?

Risk as a concept now takes high priority in contemporary mental health services, with increasing pressure on mental health services to develop risk assessment and management practices. This focus on risk has been criticised for its over-reliance on measurement and management at the expense of therapeutic care and is perpetuated by the language of risk which reinforces power differentials and limits capacity for consumers and carers to influence discussions and debates. Furthermore, to date, most work in this area reflects adult settings with limited consideration of the unique needs of older people and the impact of risk assessment on the care they receive. A qualitative, exploratory approach was undertaken using individual interviews and focus groups to enhance understanding of how risk is conceptualised within an older persons' setting. Managers, clinicians, consumers, and carers from a large metropolitan service participated (n = 57). The language of risk was a major theme emerging from this work. This language, so familiar to providers of services, was not familiar to consumers and carers. A reframing of risk is necessary to reflect consumers' and carers' experiences and understandings. This approach will be essential in promoting consumer and carer participation within recovery-based services, reflecting significant goals of government policy.

Ontological Security in Nursing Homes for Older Persons - Person-Centred Care is the Power of Balance

INTRODUCTION

The Swedish national guidelines for elderly care describe how older persons should be able to trust that their care is permeated with security. Different theoretical perspectives can be found that describe what creates security. Many studies have been done about security. However, few studies have explicitly asked older persons what security in nursing homes means to them.

AIM

The aim of the study was to describe how older persons in nursing homes talked and reflected about security in their daily lives.

METHOD

Nine older persons were interviewed in, in-depth interviews one to three times and the resulting data was analysed using content analysis.

RESULTS

The older persons adapted to having their own needs and those of the other older persons met and to the staff routines which created a sense of security. At the same time, they longed for security in which they could trust themselves and create their own daily life. Further to have a sense of belonging and of being liked for created an internal, interpersonal and external security. This can be linked to an ontological security which means having a sense of confidence in the continuity of self-identity and order in events, a being in the world.

CONCLUSION

Person-centred instead of institution- centred care can provide the balance of power that allows the older person to obtain ontological security in which the staff's ability to create a relationship with the older persons becomes crucial.

Assessment of ethical ideals and ethical manners in care of older people

The aim of this study is to establish structured clusters and well-defined ontological entities (nodes) describing ethical values as both ideal and opportunity for ethical manner as perceived by thecaregiver.In this study, we use Bayesian Belief Networks (BBNs) to analyse ethical values (ethos) and ethical manners in daily work with older people. Material is based on questionnaire data collected by the instrument for the self-assessment of individual ethos in the care of older people(ISAEC) in spring 2007 in a municipality in Western Finland. This study is unique in its kind, both concerning the selected approach and methodological questions. BBNs have not been used significantly in nursing research, nor are there any studies that examine the ethical possibilities with focus on the probable effects upon changing conditions.

Towards salutogenesis in the development of personalised and preventive healthcare

The purpose of this review is to discuss how a salutogenetic approach that takes into consideration the human being as physical, psychological and spiritual entity may provide some answers to the difficulties faced by healthcare systems. The choice of medical intervention needs to take into account the technological advances of biomedicine but tailor them to the physical, psychological and spiritual needs of the patient in the context of their biography. Such person-centred medicine aims to strengthen Antonovsky’s concepts of resilience and sense of coherence with each therapeutic intervention so that overcoming illness becomes the foundation for better future health. Appropriate evaluation parameters need to be developed and included in order to evaluate the success of interventions in a person-centred, salutogenetic system.