African American older adults coping with chronic health conditions

Managing Complexity: Black Older Adults With Multimorbidity

BACKGROUND AND OBJECTIVES

Black older adults have higher rates of multimorbidity and receive less effective multimorbidity support than their white counterparts. Yet little is known about the experiences of Black older adults with multimorbidity that may be at the heart of those disparities and which are central to interventions and improving care for this population. In this study, we aimed to conceptualize the multimorbidity management (MM) experience for Black older adults.

RESEARCH DESIGN AND METHODS

As part of a larger study on Black older adults' multimorbidity and physician empathy, we conducted in-depth qualitative interviews with 30 Black older adults living in a large midwestern city in the United States aged 65 years and older with self-reported multimorbidity. We used grounded theory analysis to distill findings into a core conceptual category as well as component domains and dimensions.

RESULTS

"Managing complexity" emerged as the core category to describe MM in our sample. Managing complexity included domains of "social context," "daily logistics," "care time," and "care roles."

DISCUSSION AND IMPLICATIONS

We discuss how managing complexity is distinct from patient complexity and how it is related to cumulative inequality and precarity. Study findings have potential implications for intervention around provider education and empathy as well as for enabling agency of Black older adults with MM.

"Be Strong My Sista'": Sentiments of Strength From Black Women With Chronic Pain Living in the Deep South

The experience of chronic pain is influenced by gender, race, and age but is understudied in older Black women. Society and family alike expect Black older women to display superhuman strength and unwavering resilience. This qualitative study examined the narratives of 9 rural- and urban-dwelling Black older women to identify the ways in which they displayed strength while living with chronic osteoarthritis pain. Their "herstories" parallel the 5 characteristics of the Superwoman Schema/Strong Black Woman. Two additional characterizations emerged: spiritual submission for strength and code switching to suffering Black woman; these may be unique to Black Americans with pain.

The Lived Experiences of African American Centenarians: Narrative Exploration from a Life Course Theory Perspective

BACKGROUND AND OBJECTIVES

The purpose of this study was to examine examples of inequality experienced by African American centenarians throughout the life course.

RESEARCH DESIGN AND METHODS

Data were derived from 111 oral history transcripts from the Oklahoma Oral History Project. A sub-sample of all centenarians who identified as African American (n = 12) was utilized. An interpretive phenomenological approach and thematic analysis were used to review and code each narrative.

RESULTS

Findings revealed two themes: 1) Historical Time and Place with subthemes on Family Lineage, Segregation, Discrimination, and Racism, and Societal Changes. 2) Resource Buffers against Inequality with subthemes on multigenerational transmission, support and cultural connectedness, religion and spirituality, and self-reliance. Several centenarians acknowledged having grandparents who were slaves and others reported hidden family lineage due to complicated mixed-race dynamics. Work histories were impacted by the historical era, with limited "domestic" positions for women. Experiences with education varied, with one centenarian commenting on his legacy of teaching at Historically Black Schools whereas others expressed difficulty in keeping up with school and regret for not finishing.

DISCUSSION AND IMPLICATIONS

This is one of the first studies to explore life course experiences specific to African American centenarians. Centenarians in this study possessed survival skills, and various support systems including community and religious/spiritual support; perhaps buffering against the impact of cumulative racial inequality.

A mixed analysis approach to elucidate the multiple chronic condition experience of English- and Spanish-speaking older adults

Background

Having multiple chronic conditions (MCCs) is the most common health condition in older adults. The management of each condition presents many challenges. A key factor in patients’ ability to manage their own health care is their level of health literacy.

Purpose

The purpose of this mixed analysis study was to elucidate the experience of older adults living with MCCs and identify associations among the experiences to determine targets for future mobile health (mHealth) interventions focused on MCCs and health literacy.

Participants and methods

Using the Abilities, Skills, and Knowledge Model as a framework, semi-structured interviews were completed with 25 older adults in English and Spanish. Interviews were analyzed using inductive thematic analysis and hierarchical cluster analysis.

Results

The main themes from these results included 1) Reflections of chronic disease; 2) Emotional aspects of chronic disease; 3) Physical barriers to well-being; 4) Quality-of-care factors; and 5) Cognitive strategies for self-management. Qualitative results highlighted the importance of a multi-targeted approach to chronic disease self-management (CDSM). Cluster analysis identified associations within the qualitative data, revealing the importance of the subthemes related to coping with pain and the impact of the patient–provider relationship on treatment adherence.

Conclusion

Results support the utility of mHealth interventions to improve health literacy and promote CDSM.

Chronic Kidney Disease and Older African American Adults: How Embodiment Influences Self-Management

Patients living with chronic kidney disease (CKD) must balance the medical management of their kidney disease and other chronic conditions with their daily lives, including managing the emotional and psychosocial consequences of living with a chronic disease. Self-management is critical to managing chronic kidney disease, as treatment consists of a complex regimen of medications, dosages, and treatments. This is a particularly important issue for older African American adults who will comprise a significant portion of the older adult population in the coming years. Yet current conceptualizations of self-management behaviors cannot adequately address the needs of this population. Embodiment theory provides a novel perspective that considers how social factors and experiences are embodied within decision-making processes regarding self-management care among older African Americans. This paper will explore how embodiment theory can aid in shifting the conceptualization of self-management from a model of individual choice, to a framework that cannot separate lived experiences of social, political, and racial factors from clinical understandings of self-management behaviors. This shift in the conceptualization of self-management is particularly important to consider for CKD management because the profound illness burdens require significant self-management and care coordination skills.

Perspectives of health and self-care among older persons-To be implemented in an interactive information and communication technology-platform

AIM AND OBJECTIVES

To acquire knowledge regarding the contents to be implemented in an interactive information and communication technology-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves.

BACKGROUND

The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals.

DESIGN

Descriptive qualitative design.

METHODS

This study was based on three samplings: a scoping review of the literature (n = 20 articles), interviews with healthcare professionals (n = 5) and a secondary analysis of interviews with older persons (n = 8) and nursing assistants (n = 7). The data were analysed using qualitative content analysis.

RESULTS

Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons.

CONCLUSIONS

The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive information and communication technology-platform for use in regular daily care assessments. Descriptions of self-care were limited indicating a possible gap in knowledge that requires further research.

RELEVANCE TO CLINICAL PRACTICE

Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.

African American elders' psychological-social-spiritual cultural experiences across serious illness: an integrative literature review through a palliative care lens

Disparities in palliative care for seriously ill African American elders exist because of gaps in knowledge around culturally sensitive psychological, social, and spiritual care. The purpose of this integrative literature review is to summarize the research examining African American elders' psychological, social, and spiritual illness experiences. Of 108 articles, 60 quantitative, 42 qualitative, and 6 mixed methods studies were reviewed. Negative and positive psychological, social, and spiritual experiences were noted. These experiences impacted both the African American elders' quality of life and satisfaction with care. Due to the gaps noted around psychological, social, and spiritual healing and suffering for African American elders, palliative care science should continue exploration of seriously ill African American elders' psychological, social, and spiritual care needs.

Living with complexity; marshalling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity

BACKGROUND

Multimorbidity poses a major health burden worldwide yet most healthcare is still orientated towards the management of single diseases. Literature on the experience of living with multimorbidity is accumulating but has not yet been synthesised in a manner conducive to informing the design of self-management interventions for this population. This study aimed to systematically review and synthesise findings from published, in-depth qualitative studies about the experience of multimorbidity, with a view to identifying the components and motivation for successful self-management in this population.

METHODS

Systematic review of and meta-synthesis of qualitative studies that evaluated patient experience of living with and/or self-managing mental and/or physical multimorbidity. MEDLINE, Embase, PsycINFO, CINAHL, and ASSIA along with reference lists of existing reviews and content pages of non-indexed specialists comorbidity journals were searched.

RESULTS

Nineteen studies from 23 papers were included. A line of argument synthesis was articulated around three third-order constructs: 1) Encounters with complexity; 2) Marshalling medicines, emotions, and resources; and 3) Self-preservation and prevention. Our interpretation revealed how mental and physical multimorbidity is experienced as moments of complexity rather than mere counts of illnesses. Successful self-management of physical symptoms was contingent upon the tactical use of medicines, whilst emotional health was more commonly managed by engaging in behavioural strategies, commonly with a social or spiritual component. Motivations for self-management were underpinned by a sense of moral purpose to take responsibility for their health, but also by a desire to live a purposeful life beyond an immediate context of multimorbidity.

CONCLUSIONS

Understanding how people experience the complexities of mental and physical multimorbidity may be crucial to designing and delivering interventions to support successful self-management in this population. Future self-management interventions should aim to support patients to exert responsibility and autonomy for medical self-management and promote agency and self-determination to lead purposeful lives via improved access to appropriate social and psychological support.

African Americans’ Perceptions of Pain and Pain Management

Purpose: The purpose of this systematic review is to explore the perceptions of acute, persistent, and disease-specific pain and treatment options held by adult African Americans. Underassessment and undermanagement of pain in African Americans has been well documented; however, the cultural continuum of pain perceptions and their influence on pain assessment and management has not been synthesized. Design: Electronic database searches of the Cumulative Index for Nursing and Allied Health Literature and PubMed, Web-based searches of the pain-specific journals plus a manual search of reference lists identified 41 relevant articles addressing perceptions of pain and/or pain management. Findings: Analysis of the literature revealed six themes: (a) meaning of pain, (b) description of pain, (c) coping with pain, (d) impact of pain, (e) patient–provider relationship, and (f) treatment approaches. Conclusion: These findings warrant further research and indicate the need for more precise evaluation of pain in African Americans, highlighting an imperative to incorporate cultural patterns into pain management practice and education.

A sense of dignity in later life: a qualitative study on the views of older women migrants from minoritised backgrounds

Purpose

– Research evidence indicates the need for studies that explore the salience of dignity from the perspective of older people from a range of ethno-linguistic and cultural backgrounds. Drawing findings from a mixed-methods study on social-care expectations of community-dwelling older women from black and minority-ethnic backgrounds, the purpose of this paper is to explore the interrelationships between life-course events (such as migration) and the roles adopted by the women throughout their lives, which shaped their understanding of dignity.

Design/methodology/approach

– Face-to-face, semi-structured interviews with 32 older women in Wales were conducted in the participants’ first languages. The interview schedule was developed, piloted and peer-reviewed; it covered the themes of migration, perceptions of dignity, dignity in later life, perceptions of care and care with dignity. Transcripts were analysed using thematic analysis. This paper focuses on what dignity meant to older women and how a sense of dignity was fostered in later life.

Findings

– For the participants, a sense of dignity in later life was shaped by migration to the UK, and their shifting, transnational understanding of growing old in the UK and of the perceived worth and value of the roles they played. Although some women also saw other platforms (such as work and their status as professionals) as being of importance, a sense of purpose fostered in their roles as wives, mothers and grandmothers, and as mentors and guardians of cultural knowledge, underpinned their understanding of dignity, and reinforced their sense of acknowledgement and worth. Fostered from an early age through interactions with the family and close community (religious, cultural or ethnic), respect for older people was revealed to remain a key element of the participants’ personal and cultural value systems, as were the ways in which respect should be both earned and manifested. The sense of heightened vulnerability, because of advancing age, and the impact of cumulative negative encounters and racialised micro-aggressions, were real and pressing.

Practical implications

– Given the changing demographic of the older population throughout Europe and the world, there is a need to raise awareness among policy makers and practitioners of the importance of dignity from a range of perspectives – providing first-hand accounts that bring these to life, and data that can be used to help develop effective interventions.

Originality/value

– This paper adds to the understanding of dignity from a transnational, multi-ethnic perspective; the potential impact of multiple social positions (being old, being a woman, being a migrant and being from a minority-ethnic group) on the perception of being treated and regarded as important and valuable; and the need to raise awareness among policy makers and practitioners of the importance of dignity from a range of perspectives, providing first-hand accounts that bring these to life and that can be used to help develop effective social-care interventions.

Respect, compassion and dignity: the foundations of ethical and professional caring

Throughout 2011, and for much of this year, the national and professional press have been dominated by reports of failures in health and social care. Stories have focussed on the avoidable harm and disturbing cruelty suffered by individuals and the distress of distraught families seeking answers in the light of systemic organisational failure on an incredible scale (Francis 2010, CQC 2011a, CQC 2011b).

Synergy between molecular and contextual views of coping among four ethnic groups of older adults

The coping styles of four ethnic groups of older adults in response to negative life events were analyzed in a population-based study of 1118 residents of Brooklyn, New York. Using a molecular approach, data regarding the context of events and the corresponding coping responses was obtained. Open-ended semi-structured interviews allowed participants to describe recent negative life events and explain how they coped. An empirically derived coding system distinguished four major negative life events: Death, Illness/Injury, Empathic Response to Distress of Others, and Interpersonal Conflict. Nine major styles of coping emerged: Medicate, Active Coping, Passive Response, Prayer, Stoicism, Social Support, Positive Self-Talk, Acknowledgment of Emotions, and Distraction. Gender and ethnic differences in coping styles were found. Although ethnic specificity in coping emerged when context was considered, the few effects of ethnicity suggests that the major normative events of later life may pull for generic coping responses.

Exploring the role of spirituality in self-management practices among older African-American and non-Hispanic White women with chronic conditions

OBJECTIVE

The purpose of this study was to examine the role of spirituality in the self-management of chronic illness among older women with chronic conditions.

METHODS

A sample of 41 African-American and non-Hispanic White women, of age 66 and older, participated in the process of self-care study. Data were collected from semi-structured interviews and analysed for common themes using the Grounded Theory method.

RESULTS

Audiotaped and transcribed interviews identified four categories that emerged to suggest the influence of spirituality in behavioural change and disease management: (1) God's involvement in illness management; (2) prayer as a mediator; (3) spirituality as a coping mechanism; and (4) the combination of conventional and spiritual practices.

DISCUSSION

Older women with various chronic illnesses defined 'spirituality' in a broad, holistic way, and the findings suggest that spirituality played a part in documenting the self-management process. Knowledge of spirituality and the role it plays in illness management may assist public health gerontologists in designing effective and culturally appropriate self-management programmes.

Striving for control: cognitive, self-care, and faith strategies employed by vulnerable black and white older adults with multiple chronic conditions

The average older adult reaches age 65 with at least two chronic, co-occurring illnesses, or multiple morbidities (MM). We currently lack critical information about the specific strategies older adults use to attempt to control these MM. To increase our understanding of how older adults attempt to manage these MM and retain control of their health, in-depth interviews were conducted with 41 Black and White middle aged and older men and women with MM. We were particularly interested in representing the experience of those groups more vulnerable to adverse health outcomes due to greater disease prevalence and low income. During in-depth interviews, we asked open-ended questions on life and health history and open-ended and semi-structured questions about self-care for multiple morbidities. Participants expressed a strong desire to remain in control of their health; to do so they employed a wide range of strategies including cognitive structuring techniques (being health vigilant, normalizing, resignation/relinquishing control, and social comparison), self-care activities (emphasizing diet, exercise, medication taking, modifying existing activities, going to the doctor), and faith orientations (prayer as a constructive support strategy, gaining strength from God, church as a central part of life). With the exception of faith orientations, there were no race/ethnicity differences in the strategies participants use. Future studies should expand on this knowledge by exploring the contextual, cultural, and psychological backdrop and characteristics that shape the use of these coping strategies.

Low-income HIV-infected women and the process of engaging in healthy behavior

This cross-sectional multimethod study sought to examine the process of engaging in healthy behaviors, particularly related to stress management, in HIV-infected women with low incomes. Recruited from northeast Ohio, 42 women completed standardized research measures to assess healthy behaviors (via the Health-Promoting Lifestyle Profile II) and the processes of change espoused by the Transtheoretical Model of Behavior Change; 8 of those women participated in individual semistructured interviews conducted at a later point in time to gain additional insight into the phenomenon. Participants were 25 to 60 years of age (mean 38.44 +/- 8.08) and most of the frequently reported healthy behaviors related to spiritual growth and interpersonal relations. Self-reevaluation was the process of change most frequently reported. Qualitative analysis revealed several processes women use to enhance the adoption and maintenance of healthy behaviors; some themes were adequately reflected by the Transtheoretical Model's Processes of Change, whereas a few emerged as processes not usually associated with the Transtheoretical Model. This study yielded useful preliminary information to further explore the adoption and maintenance of health-promoting behavior for HIV-infected women.

The challenges of multimorbidity from the patient perspective

BACKGROUND

Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective.

OBJECTIVE

The aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients with single chronic illnesses.

DESIGN

This research is designed as a cross-sectional survey.

PARTICIPANTS

Based upon ICD-9 codes, patients from a single VHA healthcare system were stratified into multimorbidity clusters or groups with a single chronic illness from the corresponding cluster. Nonproportional sampling was used to randomly select 720 patients.

MEASUREMENTS

Demographic characteristics, functional status, number of contacts with healthcare providers, components of primary care, self-management learning needs, and willingness to see nonphysician providers.

RESULTS

Four hundred twenty-two patients returned surveys. A higher percentage of multimorbidity patients compared to single morbidity patients were "definitely" willing to learn all 22 self-management skills, of these only 2 were not significant. Compared to patients with single morbidity, a significantly higher percentage of patients with multimorbidity also reported that they were "definitely" willing to see 6 of 11 non-physician healthcare providers.

CONCLUSIONS

Self-management learning needs of multimorbidity patients are extensive, and their preferences are consistent with team-based primary care. Alternative methods of providing support and chronic illness care may be needed to meet the needs of these complex patients.

Health-related research on older inmates: An integrative review

The literature on older inmates' health is fragmented and insufficiently developed. In this integrative review, 21 research articles on health and older inmates were identified, critiqued, and synthesized to determine: the minimum age criterion most commonly used; health-related variables explored; health status; the health impact of incarceration; and aging-specific policies, programs, and facilities. Age 50 and older was used most often. The top three health variables were psychiatric conditions, physical illnesses, and substance abuse. Self-reports of health status varied across studies; however, inmates consistently reported health declines since incarceration. Older inmates' health needs appear often to be left unmet. Nursing investigations are needed leading to practice innovations to enhance prisoners' self-management to reduce disease burden and fiscal and societal costs.