Caring to achieve the maximum independence possible: a synthesis of qualitative evidence on older adults' adaptation to dependency

Negative Aging Stereotypes: Fear of Dependency Impact on Anxiety and Depression in Middle and Older Adults, Examined by Gender

Negative stereotypes of aging, such as dependency, tend to paint a picture of older adults as frail or a burden on society. This study aimed to explore the relationship between the Fear of Dependency Scale and anxiety and depression, evaluating gender, age, and physical health as moderators. Findings suggest that age moderated the relationship between fear of dependency and depression and anxiety in women, with middle-aged women reporting the highest levels of depression and anxiety. Similarly, poor physical health in women with high fear of dependency was related to higher levels of depression and anxiety. Fear of dependency was related to higher levels of depression, but not anxiety in men. Age did not moderate the relationship between fear of dependency and mental health measures, but physical health did moderate the relationship. Men with poor perceived health and a high fear of dependency reported higher levels of depression.

What Makes Dependency on Homecare Bearable? A Phenomenological Study

Becoming dependent on homecare in old age is a radical life change that requires complex adaption. The purpose of this study was to explore the existential dimension of being dependent on homecare with a particular focus on what makes dependency bearable. In total, 15 older people living in Denmark or Norway were interviewed using a phenomenological approach. The material was analyzed employing Max van Manen’s meaning-giving approach coined “Phenomenology of practice.” During the analysis, four themes emerged: pure acceptance of an inevitable situation, acting independently as much as possible, negotiating to receive good care, and gratitude toward caring caregivers. The results point to a need for respectful and individualized homecare leveling out the subordinate position in which dependency on homecare tends to place older people.

The experience of dependence on homecare among people ageing at home

Being dependent on homecare potentially threatens a person's integrity and autonomy, particularly when people are dependent on help to manage basic bodily functions that involve intimacy and nudity, making the person vulnerable despite being in his or her own home. As the population continues to age and live longer, more people are expected to be dependent on homecare. The aim of this study was to investigate the phenomenon of dependence on homecare among people ageing at home. Individual in-depth interviews were used to explore 15 Danish and Norwegian homecare receivers’ experiences of dependence on homecare. Interview records were transcribed and analysed in a hermeneutical phenomenological process described by van Manen. First and foremost, the experience of dependence on homecare is a question of adaption. The older people in this study struggled to get used to their deteriorating body and at the same time they continuously had to negotiate to get care in accordance with their values. Being dependent on care could be experienced as being reduced to a task or a problem to be solved though the participants had a significant need for undivided mental attention. The presence of homecare staff in the participants’ homes could entail a change where the participants experienced that they lost control over the surroundings. According to the voices of the older people in this study, future homecare should be accommodated in an organisational set-up that gives priority to stability and continuity in the relation between the homecare receiver and the homecare staff. Also it is significant that homecare staff do not have a task-oriented approach to their job and are sensitive to the values of the homecare receivers.

What are the self-management experiences of the elderly with diabetes? A systematic review of qualitative research

BACKGROUND

The number of elderly individuals with diabetes is dramatically increasing. Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management. Understanding of self-management from the patients’ perspectives is important to nurses, healthcare providers, and researchers and benefits people by improving their self-management skills.

AIM

To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.

METHODS

Electronic databases were searched, including MEDLINE, CINAH, PsycINFO, PubMed, CNKI, and WANFADATA. Relevant research was identified by manually searching reference lists and gray literature. Only English and Chinese publications were included. The Critical Appraisal Skills Program was used to assess the quality of the research. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.

RESULTS

A total of 10 qualitative studies were included, and content analysis was performed. Five themes were identified: The need for knowledge about diabetes care, support systems, functional decline, attitudes toward diabetes, and healthy lifestyle challenges.

CONCLUSION

This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.

[The care in the prevention of falls in elderly people: Meta-summary of qualitative articles]

OBJECTIVE

To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community.

DESIGN

Meta-summary of qualitative evidence following the aggregation method.

DATA SOURCES

Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global and Ibecs), in English, French, Spanish and Portuguese; no time limit.

SELECTION OF STUDIES

Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected.

DATA EXTRACTION

Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted.

RESULTS

The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation.

CONCLUSIONS

The findings show the complexity of fall prevention and the need to incorporate care providers' opinions in preventive models.

Perspectives of older adults with a chronic condition on functioning, social participation and health: a qualitative study

Background

Problems with mobility, functioning and social participation make living independently difficult for frail older adults. To continue living independently, therapy adherence is a prerequisite. The causes for non-adherence among older adults are multiple and complex, which is why insight into older adults’ perspectives regarding their functioning is an essential factor to increase therapy adherence.

This study investigates the perspectives of older adults on their functioning, social participation and health, and the factors influencing these elements.

Methods

We conducted a qualitative study on the older adult’s perceived functioning, social participation and health. Fourteen home-dwelling older adults suffering from chronic health issues were purposively selected.

Semi-structured interviews were conducted with open-ended questions.

Data were analysed following the Basic Logical Model of Abduction and Creswell’s coding method.

Results

Assistive devices, the older adult’s dwelling and living environment, professional and informal support, and medication are perceived as important determinants for retaining functioning and social participation.

Attitude, social influence and personal effectiveness were found to influence whether a person performs or participates in an activity. A person’s attitude is related to the significance the activity has to that person, the activity’s importance, personal wellbeing, the person’s values, and their desire for autonomy. Peers and children have a social influence on the level of activity of the older person. Traditions, in particular religious activities, along with personal effectiveness are motivating factors determining whether a person performs or participates in an activity. Personal effectiveness is linked to the person’s belief in their personal competencies and to the relationship between effort and result.

Finally, it appears that the type of coping strategy the older adult adopts, has an influence on their behavior. The participating older adults often used remarkable problem-focused strategies, which had a positive effect on their level of autonomy.

Conclusions

Older adults have identified barriers and facilitators that influence their level of functioning and social participation. These findings help to create a framework for maintaining and increasing therapy adherence, which may be helpful in facilitating occupational therapists and other healthcare professionals to detect determinants of therapy adherence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02365-w.

More than just a task: intimate care delivery in the nursing home

Purpose: Intimate care procedures, such as bathing and toileting, are often regarded as simple, humble tasks. However, the provision of such care transforms a very private, personal activity into a social process. Understanding this complex process and the psychological impact it has on those providing and receiving care is critical in order to mitigate potential distress. The purpose of this study to examine the experience of delivering and receiving intimate personal care in the NH.

Methods: A focused ethnographic approach with participant observation, semi-structured interviews, focus groups and drop-in sessions, document review, and field notes. Data were analysed using constant comparative analysis.

Results: Quality care in this context is predicated on the care provider recognition of the emotional impact of care delivery on the care recipient. Our analysis identified that the overarching theme, of providing quality person-centred intimate care, requires creating and maintaining a relational space that promotes integrity.

Conclusions: The provision of intimate personal care consists of a complex interplay at the level of resident/care provider interaction (micro level); health care organization (meso level); and policy (macro level). Each of these levels interacts with and influences the other two. The components identified in our model may provide the basis from which to further examine resident experiences of quality intimate personal care.

Managing and keeping control: A qualitative synthesis of nursing and care staff strategies to prevent older people from falling

AIM

To better understand formal care providers' role in fall prevention.

DESIGN

Qualitative synthesis as part of an integrative review.

DATA SOURCES

Fifteen electronic databases were consulted with the time limit being December 2017. Studies included were qualitative primary studies on formal care providers and fall prevention of people over 65 years of age in health care facilities. 17 studies were included.

REVIEW METHODS

Qualitative researchers carried out a critical appraisal and abstraction of the studies retained. Primary studies were imported into Nvivo 12 software; grounded theory procedures of constant comparison, microanalysis, coding, development of memos and diagrams were completed concurrently in a continuous growing process of data conceptualization. Analysis was iterative; it started with open coding and ended with the development of an integrative memo.

FINDINGS

Primary studies were synthesized with the emerging core category of "Managing and keeping control" and described by the emerging strategies of risk management, risk control and articulation work. These three categories account for the formal care providers' role in fall prevention in health care facilities.

CONCLUSION

Fall prevention is not given by a series of means and instruments; it is rather built in the interactions between formal care providers and the material and social world. The interactive character of prevention implies that outcomes cannot always be anticipated.

IMPACT

Although falls are one of the most researched clinical problems in nursing, the role played by nursing and care staff is dispersed and scantily documented. Formal care providers alternate risk management with risk control strategies to prevent older people from falling in health care facilities, they also resort to the articulation of the health care team as a complementary strategy. This review shows the dynamic character of fall prevention, which is something that has tended to go unnoticed in the literature and in policy.

[Fall prevention in older people and their families: a qualitative synthesis]

OBJECTIVE

To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers METHOD: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis.

RESULTS

Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions.

CONCLUSIONS

Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.

Decision-making on the location of care of the elderly: protocol for a systematic review of qualitative studies

INTRODUCTION

The elderly must take part in the management of their own health. One of the aspects they should be able to decide on is the place where they want to live. The aim of this review is to synthetise qualitative evidence in order to understand how decisions are made on the location of care of the elderly.

METHODS AND ANALYSIS

Systematic review of qualitative studies. Six databases have been consulted: Web of Science, PubMed, Scopus, CINAHL Complete, PsycINFO and SciELO Citation Index (from the beginning to 29 November 2017). The inclusion criteria will be: studies that deal with the decision-making process on the location of care of the elderly (already experienced by the participants), original studies, qualitative or mixed-method studies and studies written in English or Spanish. The obtained results will be exported to the Zotero bibliography manager. The references will be reviewed by title and abstract and, later, the complete texts will be reviewed for their inclusion. A tool created for this study will be used to extract the data. The quality will be assessed with Critical Appraisal Skills Programme Español. The data synthesis will be carried out using the constant comparative method. All this process will be performed independently by two reviewers. Enhancing transparency in reporting the synthesis of qualitative research has been used to draw up this protocol.

ETHICS AND DISSEMINATION

This protocol did not require ethical approval, since it is a protocol for a systematic review. The plans to disseminate our results include publishing a research paper in a high-impact journal in our study area. Also, if possible, our results will be presented in scientific conferences. Besides, the obtained results will complement and discuss the doctoral thesis of one of the authors of the review.

PROSPERO REGISTRATION NUMBER

CRD42018084826.

Considering axiological integrity: a methodological analysis of qualitative evidence syntheses, and its implications for health professions education

Qualitative evidence synthesis (QES) is a suite of methodologies that combine qualitative techniques with the synthesis of qualitative knowledge. They are particularly suited to medical education as these approaches pool findings from original qualitative studies, whilst paying attention to context and theoretical development. Although increasingly sophisticated use is being made of qualitative primary research methodologies in health professions education (HPE) the use of secondary qualitative reviews in HPE remains underdeveloped. This study examined QES methods applied to clinical humanism in healthcare as a way of advancing thinking around the use of QES in HPE in general. A systematic search strategy identified 49 reviews that fulfilled the inclusion criteria. Meta-study was used to develop an analytic summary of methodological characteristics, the role of theory, and the synthetic processes used in QES reviews. Fifteen reviews used a defined methodology, and 17 clearly explained the processes that led from data extraction to synthesis. Eight reviews adopted a specific theoretical perspective. Authors rarely described their reflexive relationship with their data. Epistemological positions tended to be implied rather than explicit. Twenty-five reviews included some form of quality appraisal, although it was often unclear how authors acted on its results. Reviewers under-reported qualitative approaches in their review methodologies, and tended to focus on elements such as systematicity and checklist quality appraisal that were more germane to quantitative evidence synthesis. A core concern was that the axiological (value) dimensions of the source materials were rarely considered let alone accommodated in the synthesis techniques used. QES can be used in HPE research but only with careful attention to maintaining axiological integrity.

The start of caring for an elderly dependent family member: a qualitative metasynthesis

BACKGROUND

The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers' lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives.

METHODS

A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles.

RESULTS

Three categories were developed to explain the process of becoming a caregiver 'taking on the role' (life changes, uncertainty and confusion, and acceptance or resistance); 'beginning to realise' (new needs, impact, and appraisal); and 'implementing strategies' (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress).

CONCLUSIONS

The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.

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.”

[The first moments of the carer: The process of becoming a caregiver of a dependent elderly relative]

Objetivo

Describir el proceso inicial por el que pasan las personas que se convierten inminentemente en cuidadores de algún familiar mayor en situación de dependencia.

Diseño

Estudio cualitativo cuyo análisis se ha regido por los principios de la teoría fundamentada.

Emplazamiento

El estudio se ha realizado en los distritos sanitarios de Jaén, durante 2015 y 2016, a nivel comunitario.

Participantes y/o contextos

La captación se realizó mediante los enfermeros gestores de casos de los Centros de Salud de cada distrito sanitario, los cuales localizaron participantes que cumpliesen los criterios de inclusión y los invitaban a participar en el estudio.

Método

Se han llevado a cabo 11 entrevistas en profundidad a personas que llevan cuidando menos de un año a un familiar mayor con dependencia hasta la saturación de la información.

Resultados

Tres fases han sido descritas durante este proceso. Una fase inicial de cambios, en los que la persona cuidadora asume nuevas actividades; una segunda fase atestada de emociones, en la que emergen necesidades y consecuencias en las personas cuidadoras; y una tercera fase donde destaca la aceptación como estrategia de afrontamiento y la incertidumbre como expectativa de futuro.

Discusión

La descripción de este proceso proporciona una mejor comprensión de la experiencia de convertirse en persona cuidadora familiar, con el fin de ayudar a los profesionales de la salud a adaptar los planes de atención a esta situación inicial.

Psychosocial adaptation: an evolutionary concept analysis exploring a common multidisciplinary language

AIMS

To provide the first known concept analysis of psychosocial adaptation, exploring its evolution from the concept adaptation. We also determine how psychosocial adaptation is conceptualized across nursing, health, sociobehavioural and education disciplines.

BACKGROUND

Psychosocial adaptation is an important conceptual term that is poorly defined in nursing and other health, sociobehavioural and education disciplines. A thorough understanding of the concept's application in nursing and across disciplines can help to clarify its meaning, facilitate a more effective common language between disciplines and inform future psychosocial adaptation research.

DESIGN

Rodger's evolutionary view guided this concept analysis.

DATA SOURCES

Peer-reviewed English and Spanish manuscripts published between 2011-2013 were retrieved from the following databases: CINAHL, Psych INFO, PubMed, Scopus and LILACS.

REVIEW METHODS

Eighty-nine articles related to psychosocial adaptation were included in the analysis. Findings identify key attributes, antecedents and consequences associated with the use of the concept. Findings were compared vis-a-vis reported characteristics of adaptation.

RESULTS

The attributes characterizing psychosocial adaptation are: change, process, continuity, interaction and influence. In psychosocial adaptation, new life conditions serve as antecedents, while consequences are good or bad outcomes. Important features of the evolution of this concept include its broad appropriation across the reviewed disciplines. The attributes of psychosocial adaptation, have some similarities to those of general adaptation. Both concepts include an aspect of change, but unlike adaptation, psychosocial adaptation has branched away from biological descriptors, such as homeostasis and tends to focus on relational characteristics, such as interaction and influences.

What value is the CINAHL database when searching for systematic reviews of qualitative studies?

BACKGROUND

The Cumulative Index to Nursing and Allied Health Literature (CINAHL) is generally thought to be a good source to search when conducting a review of qualitative evidence. Case studies have suggested that using CINAHL could be essential for reviews of qualitative studies covering topics in the nursing field, but it is unclear whether this can be extended more generally to reviews of qualitative studies in other topic areas.

METHODS

We carried out a retrospective analysis of a sample of systematic reviews of qualitative studies to investigate CINAHL's potential contribution to identifying the evidence. In particular, we planned to identify the percentage of included studies available in CINAHL and the percentage of the included studies unique to the CINAHL database. After screening 58 qualitative systematic reviews identified from the Database of Abstracts of Reviews of Effects (DARE), we created a sample set of 43 reviews covering a range of topics including patient experience of both illnesses and interventions.

RESULTS

For all 43 reviews (21 %) in our sample, we found that some of the included studies were available in CINAHL. For nine of these reviews, all the studies that had been included in the final synthesis were available in the CINAHL database, so it could have been possible to identify all the included studies using just this one database, while for an additional 21 reviews (49 %), 80 % or more of the included studies were available in CINAHL. Consequently, for a total of 30 reviews, or 70 % of our sample, 80 % or more of the studies could be identified using CINAHL alone. 11 reviews, where we were able to recheck all the databases used by the original review authors, had included a study that was uniquely identified from the CINAHL database. The median % of unique studies was 9.09%; while the range had a lowest value of 5.0% to the highest value of 33.0%. [corrected].

CONCLUSIONS

Assuming a rigorous search strategy was used and the records sought were accurately indexed, we could expect CINAHL to be a good source of primary studies for qualitative evidence syntheses. While we found some indication that CINAHL had the potential to provide unique studies for systematic reviews, we could only fully test this on a limited number of reviews, so we are less confident about this finding.

Caring for Residents of Eldercare Facilities: A Concept Analysis

PURPOSE

To report the results of an evolutionary concept analysis of caring in facilities that provide care for elders.

SOURCES

Cumulative indices for CINAHL, ERIC, Academic Search Complete, PsychINFO, Medline, and CEPTS.

RESULTS

Caring is an interactive process characterized by seeing, helping, and communicating, which are analogous to two wheels with one axle. Caring is preceded by individuality and followed by well-being.

CONCLUSION

The findings explicate the core components of caring in facilities that provide care for elders.

IMPLICATIONS

The metaphor of an axle and wheel can guide caregivers in delivering effective care as the demand for improved well-being of residents of eldercare facilities increases.

How older people cope with frailty within the context of transition care in Australia: implications for improving service delivery

Transition care is increasingly common for older people, yet little is known about the subjective experience of the transition care 'journey' from the perspective of clients themselves. This study examines how older people cope with frailty within the context of a dedicated transition care programme and discusses implications for improving service delivery. Qualitative in-depth interviews were carried out during 2011 in the homes of 20 older people who had recently been discharged from a transition care programme operating in Adelaide, South Australia (average age 80 years, 65% female). Thematic analysis identified three key themes: 'a new definition of recovery', 'complexities of control' and 'the disempowering system'. Despite describing many positive aspects of the programme, including meeting personal milestones and a renewed sense of independence, participants recognised that they were unlikely to regain their previous level of functioning. For some, this was exacerbated by lacking control over the transition care process while adapting to their new level of frailty. Overall, this research highlighted that benefits associated with transition care can be undermined by fragmentation in service delivery, loss of control and uncertainties around future support.

Who cares? Implications of care-giving and -receiving by HIV-infected or -affected older people on functional disability and emotional wellbeing

This paper examines how care-giving to adults and/or children and care-receiving is associated with the health and wellbeing of older people aged 50+ in rural South Africa. Data used are from a cross-sectional survey adapted from World Health Organization's Study on Global Ageing and Adult Health (SAGE) conducted in 2009/10 in rural South Africa. Bivariate statistics and multivariate logistical regression were used to assess the relationship between care-giving and/or care-receiving with functional disability, quality of life or emotional wellbeing, and self-rated health status, adjusted for socio-demographic factors. Sixty-three per cent of 422 older people were care-givers to at least one young adult or child; 27 per cent of older people were care-givers due to HIV-related reasons in young adults; 84 per cent of participants were care-recipients mainly from adult children, grandchildren and spouse. In logistic regressions adjusting for sex, age, marital status, education, receipt of grants, household headship, household wealth and HIV status, care-giving was statistically significantly associated with good functional ability as measured by ability to perform activities of daily living. This relationship was stronger for older people providing care-giving to adults than to children. In contrast, care-givers were less likely to report good emotional wellbeing; again the relationship was stronger for care-givers to adults than children. Simultaneous care-giving and -receiving was likewise associated with good functional ability, but about a 47 per cent lower chance of good emotional wellbeing. Participants who were HIV-infected were more likely to be in better health but less likely to be receiving care than those who were HIV-affected. Our findings suggest a strong relationship between care-giving and poor emotional wellbeing via an economic or psychological stressor pathway. Interventions that improve older people's socio-economic circumstances and reduce financial hardship as well as those that provide social support would go some way towards mitigating this relationship.