The lived experience of health in the oldest old: a phenomenological study

Understanding the experience of living well, beyond the age of 85 years: a qualitative analysis using themes from a meta-ethnography

BACKGROUND

Increase in life-expectancy is not necessarily matched by an increase in quality of life.

OBJECTIVE

(1) To explore the quality of life of patients over the age of 85 in the second decade following unicompartmental knee replacement surgery (2) To understand the usefulness of a priori themes from an evidence synthesis as a framework for primary qualitative analysis.

DESIGN

Qualitative Research. A hermeneutic phenomenological approach, using a priori themes as sensitising concepts.

PARTICIPANTS

Adults over the age of 85 who were part of an outcomes study in the second decade following unicompartmental knee joint replacement.

METHODS

Semi-structured interviews in people's homes. Transcripts were coded and data sorted using a priori themes as sensitising concepts. Data that did not fit these themes, or that added nuance, were analysed thematically through constant comparison.

RESULTS

We interviewed seven white women and five white men, aged 85-100. Data resonated with a priori themes and supported additional themes that help us to understand older peoples' experience: (1) losing our autonomy can be challenging, so be kind; (2) we must take care of our own bodies and the NHS; (3) I am more afraid of not dying.

CONCLUSIONS

Findings indicate that health outcomes for older people should incorporate measures of participation and well-being; they highlight the importance of kindness in healthcare; they indicate that older people do not want to place additional burden on the NHS, and this can act as a barrier to care; they support the need for open conversations about dying well.

The Experience of Living to an Extreme Age: A Meta-Ethnography

Advances in health care mean that we can now treat diseases that once cut lives short. However, the increase in life expectancy has not been matched by improvements in quality of life. The World Health Organization warns us that all countries should prepare to meet the challenges of an aging population and this is integral to the United Nations 2030 Agenda for Sustainable Development. This may require a shift in attitude toward aging. We aimed to use meta-ethnography to explore the experience of adults living beyond the age of 80. Our conceptual model illuminates the phenomenon of connection in older age and reflects on the paradox of time: ephemeral, yet interminable. Our findings encourage us to reflect on the influence of enlightenment philosophies that underpin the desire for autonomy at all costs. Our study challenges the stereotypes of old age and has the potential to influence people's perspectives toward aging.

Older adults' definitions of health: A metasynthesis

BACKGROUND

Despite many gerontological studies focusing on the health of older adults, little attention has been paid to their perceptions of health. Understanding older adults' health perceptions is important because their self-perceptions are important predictors of and strongly related to survival and mortality. Older adults have different perceptions of health compared with younger adults because of their age-related changes, diseases, and limitations. There are also differences between older adults' and health professionals' perceptions of health.

OBJECTIVES

The purpose of this systematic review was to analyze and synthesize qualitative studies that have explored older adults' perceptions of health.

METHODS

Four electronic databases were searched for qualitative studies published from the earliest year to 2013, revealing 12 studies for inclusion. The systematic review employed three components of the meta-study including meta-data-analysis, meta-method, and meta-theory.

RESULTS

Five health themes are identified from the included studies: ability to do something independently, absence or management of symptoms, acceptance and adjustment with optimism, connectedness with others, and feeling enough energy.

CONCLUSION

Future gerontological research should use appropriate existing health theories and develop new health theories specific to older adults. Healthcare providers should evaluate and revise their health definitions according to older adults' health perceptions and provide appropriate health interventions. Policymakers should have an in-depth understanding of older adults' health perceptions to establish effective older-adult-centered health policies.

Research protocol: a synthesis of qualitative studies on the process of adaptation to dependency in elderly persons and their families

Background

Dealing with dependency in the elderly and their families leads us to explore the life experience of those involved together with the processes of adaptation to this condition. A number of original studies have been published which, following a qualitative methodology, have dealt with both dimensions.

Methods/Design

Objectives: 1) To present a synthesis of the qualitative evidence available on the process of adaptation to dependency in elderly persons and their families; 2) to conduct an in-depth study into the experiences and strategies developed by both to optimise their living conditions; 3) to enable standards of action/intervention to be developed in the caregiving environment.

A synthesis of qualitative studies is projected with an extensive and inclusive bibliography search strategy. The primary search will focus on the major databases (CINAHL, MEDLINE, EMBASE, PsycInfo, PSICODOC, Cochrane Library, JBI, EMBASE, LILACS, CUIDEN, CUIDEN qualitative, CUIDATGE, British Nursing Index, SSCI). The secondary search will be conducted in articles taken from the references to studies identified in the articles and reports and the manual search in congresses and foundation papers. Article quality will be assessed by the guide proposed by Sandelowski & Barroso and data extraction done using the QARI data extraction form proposed by the Joanna Briggs Institute for Evidence-Based Practice.

The synthesis of the findings will be based on the principles and procedures of grounded theory: coding, identification and relationship between categories, and synthesis using constant comparison as a strategy.

Discussion

This synthesis of qualitative evidence will enable us to detect health needs as perceived by the receivers in their own interaction contexts.

[Health aspects in adults over 80 with independent community life: an Australian perspective]

This qualitative study describes the factors that influence the health care practices of 14 elderly persons living independently in Perth, Western Australia. Through in-depth interviews with the participants, the health care practices people were explored. Five distinct themes emerged from the data. These themes were the past time, an active life, nutrition, getting old, economical security and personal satisfaction. This study provides an insight into the life of older adults and the problems associated with ageing.

Resident and family perspectives. The first year in a long-term care facility

The purpose of this longitudinal study was to explore perspectives, needs, and expectations of residents (N = 6) and family members (N = 3) of the resident's first year in a long-term care facility. The narrative method and a semi-structured interview guide were used to obtain participants' views at 2 and 6 weeks, and 3, 6, 9, and 12 months after admission. During data analysis, six themes emerged, which suggest implications for gerontological nursing education and practice. The authors conclude that by listening to residents and family members, nurses can use this information to improve life for residents and dignify them as individuals.

The experience of caring for a family member with Alzheimer's disease

The purpose of this phenomenological study was to describe the experience of caring for a family member with Alzheimer's disease or related disorder (ADRD) living at home among a diverse sample of 103 family caregivers. The study involved secondary analysis of in-depth transcribed interview data using van Kaam's rigorous four phase, 12-step psychophenomenological method. A total of 2,115 descriptive expressions were categorized into 38 preliminary structural elements. Eight essential structural elements emerged from an analysis of the preliminary structural elements. The eight elements were then synthesized to form the following synthetic structural definition: Caring for a family member living at home with ADRD was experienced as "being immersed in caregiving; enduring stress and frustration; suffering through the losses; integrating ADRD into our lives and preserving integrity; gathering support; moving with continuous change; and finding meaning and joy."

The changing face of phenomenological research: traditional and American phenomenology in nursing

In recent years, phenomenological researchers in nursing have become concerned about the differences between traditional European phenomenology and the way phenomenology is frequently conducted in nursing. Indeed, Crotty asserts that much of the phenomenology conducted by nurses cannot be phenomenology because it does not espouse the constructionist epistemological position regarded by Husserl as essential to phenomenology. This article explores the differences between traditional European and American phenomenology and argues that the latter approach extends the phenomenological project in valuable and meaningful ways that are particularly appropriate for the health sciences.

Health concept of older Hispanic immigrants

The purpose of this study was to explore the health concept of older Hispanic immigrants. In tape-recorded home interviews, 54 respondents were asked to define health, describe the characteristics of a healthy older person, identify what contributes to good health, and report what they did to maintain their health. Responses were transcribed and then analyzed qualitatively for categories and themes. Based on the findings, a concept of health evolved that included six major themes: integrating physical, emotional, and spiritual aspects; possessing mental health; feeling well; enjoying independence; practicing self-care; and orienting toward family. These themes will be useful to nurses in planning and implementing health services for similar older Hispanic immigrants.

Phenomenology: its use in nursing research

As nurses begin to recognize the incongruities between their philosophy of nursing and their research methods, growing acceptance of phenomenology as an alternative research method is occurring. This trend is evidenced by the increase in publications of phenomenological research studies in nursing literature. The purpose of this article is to review (a) some philosophical and methodological issues of phenomenology and (b) the use of phenomenology in nursing research. The studies reviewed in this article illustrate the breadth of applicability of this qualitative method for nursing. Phenomenological research has been conducted with persons ranging from adolescents to the oldest old. Diverse clinical specialties of nursing have already proven fertile areas for phenomenological research such as medical-surgical, maternal-child, gerontological, and emergency room nursing.

Aging in the oldest old living in Scotland: a phenomenological study

The purpose of this phenomenological study was to uncover ways in which the oldest old living in a Scottish community view the experience of aging. The research was guided by Parse's theory and followed the van Kaam method to elicit a structural definition of the meaning of aging, as described by the oldest old. Through the processes of intuiting, analyzing, and describing, it was found that the experience of aging is intensifying engagements as transfigurations signify maturity tempering the unavoidable with buoyant serenity. Findings are discussed in light of meaning specified in other explorations of the aging experience. Conceptual expansion enhances understanding for practice and further research.

Health for people with a terminal diagnosis

A naturalistic study was designed to investigate how people with terminal diseases describe health. Three domains emerged. The mental/emotional domain included hope, love, and control. The spiritual domain contained belief in a higher power, recognition of mortality, and self-actualization. The physical domain consisted of health promotion activities, feeling good, and relationship with a physician. This investigation suggested many similarities with Newman's model. One area of agreement was in the informants' belief that their disease was a part of their health. The emergence of the disease pattern allowed health to unfold. Many informants believed they became healthier because of their diagnoses.

Human becoming: Parse's Theory of nursing

This article updates Parse's theory of human becoming (formerly man-living-health) and the congruent practice and research methodologies. The language of the assumptions and principles is revised to be in keeping with the change in name, from "man-living-health" to "human becoming." No other aspects of the theory are changed. Assumptions underpinning the Parse research method are specified for the first time. Specific examples are included to illustrate the practice methodology and references named to demonstrate the research methodologies. The practice and research methodologies are presently evolving, and it is anticipated that the evolution and use of these methodologies will enhance the theory. The ontology and the congruent methodologies are offered as a contribution to the evolution of nursing science.