The lived experience of oldest-old rural adults

Rural-urban differences in older adults' life satisfaction and its determining factors

Although determinants of life satisfaction in older adults have been well documented, research has to date failed to fully address the experience of older adults living in places with different levels of urbanization. Furthermore, there are conflictive findings regarding the type of residence environment that offers the greatest benefits for the wellbeing of older adults. Our study proposes an integrative research model to determine the nature of the relationships between loneliness, self-esteem and life satisfaction, with a particular focus on the living environment (rural-urban) of the older adults. Using a cross-sectional survey design volunteers (aged 60+) from rural (n = 198) and urban (n = 198) in Galicia (Spain) completed a questionnaire. Structural Equation Modelling (SEM) was used to test the relationships between loneliness, self-esteem and life satisfaction and multigroup analysis was performed to analyse the existence of differences in the relationships based on the area of residence of older adults. We found that higher levels of loneliness were a significant predictor of reduced life satisfaction and reduced self-esteem. Self-esteem not only increases life satisfaction, but also reduces the negative impact loneliness may have on it. Where the older adults lived had a significant effect on the relationships between loneliness, self-esteem and life satisfaction. The relationships were stronger for older adults living in urban areas. Differentiated policy initiatives should be considered, depending on the area of residence in order to increase the life satisfaction of older adults.

Everyday life experiences of Chinese community-dwelling oldest old who live alone at home

PURPOSE

Older adults aged ≥ 80 years living alone at home are more likely to experience challenges. Daily life experiences regarding living alone are still limited in the Asian context. This study explored the everyday life experiences of older Chinese residents living alone at home. Research questions included: (1) How do Chinese community-dwelling old people describe everyday life experiences related to living alone? (2) What kind of difficulties and needs do Chinese community-dwelling older people living alone face in everyday lives? (3) How do Chinese community-dwelling older people cope with challenges faced in their everyday lives related to living alone?

METHODS

This was qualitative descriptive research. Purposive sampling was adopted to recruit 13 participants aged 80-92 years of age from communities and one hospital. Semi-structured interviews were conducted to collect data which was analysed by conventional content analysis.

RESULTS

Three themes were identified: theme 1-difficulty in finding a sense of belonging, theme 2-striving to maintain independence, theme 3-hard to gain a sense of control.

CONCLUSIONS

This study provided novel insights into understanding the difficulties and needs of Chinese older people living alone at home. Three key challenges and associated strategies they used to cope with in daily lives were presented.

A Theoretical Framework of Home-Based Professional Nursing Practice

The purpose of this article is to introduce a descriptive middle-range theoretical framework unique to professional nursing practice provided in the patient's home. The variety of care models provided in the home, ranging from nonskilled home maintenance service to hospital-at-home programs, reinforces the need to clearly define and describe home-based professional nursing practice. This framework includes six concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy), and four relational statements of the concepts that describe the experience of patients in their homes and home-based providers. The four theoretical statements are: (1) The patient's beliefs, habits, and self-management actions in the home are shaped by the meaning of home and the physical home environment. (2) The patient has ultimate decision-making control and authority over his/her own health-related behaviors in the home. (3) Home-based care includes interprofessional teams to provide holistic care and maximize self-management ability. (4) The home-based nurse is autonomous when working in the home with the patient/caregiver and has primary responsibility for holistic assessment and intervention. Knowledge of this theoretical framework can help nurses maintain the integrity and purpose of the professional nurse's role in home-based care as well as provide guidance for nursing education and organizational structures. Recommendations for research to test and validate the framework are provided.

"Falling off the wagon": older adults' experiences of living with frailty in rural arctic communities

Most populations around the world are ageing. The proportion of older adults in the population is larger and is growing more rapidly in rural communities than in urban areas. Longevity increases the risk of frailty. Our aim was to explore how single-living frail older adults experience living with frailty in everyday life in rural Arctic areas. Over eight months, we conducted a series of three interviews with eight older adults identified as frail by home care services in two rural municipalities in northern Norway. We conducted a thematic analysis. We generated three themes. Frailty as a dynamic phenomenon indicated that the participants’ experiences of frailty varied over time. Frailty as part of old age referred to the findings that many participants tried to adapt to the changing circumstances, while others found it more challenging to accept the experienced limitations. Frailty in a rural Arctic context concerned the findings that the rural Arctic environment affected the participants’ experiences of frailty due to its long, snowy winters; long distances between communities and municipal centres; and out-migration. Our results demonstrate that frailty is a consequence of the interplay between ageing persons and their physical and social environments.

Rural Healthcare IoT Architecture Based on Low-Energy LoRa

Connected health is expected to introduce an improvement in providing healthcare and doctor-patient communication while at the same time reducing cost. Connected health would introduce an even more significant gap between healthcare quality for urban areas with physical proximity and better communication to providers and the portion of rural areas with numerous connectivity issues. We identify these challenges using user scenarios and propose LoRa based architecture for addressing these challenges. We focus on the energy management of battery-powered, affordable IoT devices for long-term operation, providing important information about the care receivers’ well-being. Using an external ultra-low-power timer, we extended the battery life in the order of tens of times, compared to relying on low power modes of the microcontroller.

Becoming and being an older adult: A mixed methods study of the lived experience of aging

PURPOSE

This phenomenological inquiry explored what it is like to become and to be old. The principal aims of this study were to first characterize participants' lived experience of becoming and being an older person, then to determine the extent to which they were aging in a conscious way that evidenced aspects of gerotranscendence, and finally, to contextualize participants' responses within existing research on the phenomenon.

DESIGN AND METHODS

In a concurrent embedded mixed-methods design using an interpretive inquiry strategy, 17 men and women living independently in their communities responded to questions about their experience of aging and completed measures of gerotranscendence and adjustment to aging and their psychosocial correlates. A structural analysis of the verbatim transcripts of the interviews employed a phenomenological-hermeneutic approach. The quantitative measures informed further interpretations of interview data.

RESULTS

Most participants exemplified aging well with strengths and positive experiences across multiple domains; others evidenced optimal aging as physical challenges began to appear. Seven themes emerged from the structural analysis of the interview transcripts: Accepting/making accommodations for the inexorable physical changes; Being old versus feeling old; Being seen as old; Changing-and growing-psychologically and emotionally; Experiencing time as long and as short; Maintaining meaningful interpersonal relationships; and Speaking and living freely, and authentically.

DISCUSSION AND IMPLICATIONS

Convergences and divergences between the themes identified in this study and prior literature on the phenomenology of aging are discussed. Findings from this and similar studies have implications both for older adults and for those who care for and about them. If an older person is motivated to adapt in positive ways, then the potential to continue developing and growing into very old age is enhanced. On the macro level, an increased understanding of and appreciation for the breadth of older adults' experience of their eighth, ninth, and tenth decades of life should inform the development of policies, programs, and services to enhance their day-to-day lives.

A new conceptual model of experiences of aging in place in the United States: Results of a systematic review and meta-ethnography of qualitative studies

OBJECTIVES

The purpose of this systematic review was to synthesize the evidence on experiences of aging in place in the United States.

DESIGN

Systematic review and meta-ethnography of qualitative studies.

DATA SOURCES

We searched six bibliographic databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, Sociological Abstracts), with no limits on publication date. Eligible studies reported peer-reviewed qualitative research on experiences of aging in place in the United States with full-text available in English.

REVIEW METHODS

Three reviewers independently used Covidence software to screen titles and abstracts followed by full texts. We assessed quality and risk of bias using a modified version of the Joanna Briggs Institute Checklist for Qualitative Research. Qualitative data analysis was conducted using meta-ethnography, following Noblit and Hare's seven-step method of translation and synthesis to generate a novel conceptual model.

RESULTS

Of 2659 papers screened, 37 unique studies were eligible for inclusion, reported in 38 publications. The studies were conducted in 16 states and published between 1994 and 2018. The included samples represented 1199 participants in total, with mean ages ranging from 48 to 91 years. The gender of the samples ranged from 20% to 100% female, with a median of 77%. One-third of the included studies did not report participants' race/ethnicity, and half of the remaining study samples were at least 90% white; however, 20% of the studies focused exclusively on experiences of racial/ethnic minority older adults. Using meta-ethnography, we developed a new conceptual model of aging in place in the United States as a dynamic process of balancing threats and agency in relation to experiences of identity, connectedness, and place. We found that people aging in place were engaged in significant work to cope with unpredictable needs and challenges by changing their mindset, adapting their home environment to accommodate new needs, and finding different ways to connect with important people in their lives. Agency was shaped by resources and restrictions on choice, and where threats to aging in place outweighed an individual's sense of agency, the consequences included feelings of uncertainty, isolation, and dislocation.

CONCLUSIONS

To the best of our knowledge, this is the first systematic review of qualitative studies to evaluate experiences of aging in place in the United States. The findings of our meta-ethnographic synthesis led to the development of a new conceptual model of aging in place highlighting the dynamic tensions involved in balancing threats and agency.

Acceptance and adjustment: A qualitative study of experiences of hearing and vision impairments and daily life among oldest old recipients of home care

INTRODUCTION

The severity of age-related hearing and vision impairments increases with age. Such sensory impairments are risk factors for functional decline, reduced social participation, withdrawal, depression and accidents, and hence they make people vulnerable and adversely affect their quality of life.

AIM

The aim of this study was to explore how the oldest old recipients of home care experience sensory impairments in daily life.

DESIGN

An inductive, descriptive research design was used.

METHOD

Ten recipients of home care with a mean age of 89 years were interviewed in their homes. The study was implemented in accordance with the suggestions from Elo and Kyngäs for inductive content analysis.

FINDINGS

The main theme concerned acceptance and adjustment in daily life. Subcategories concerning the category of reduced hearing were identified as "acceptable though annoying" and "hesitant about using hearing aids." Subcategories concerning the category of reduced vision were "reading is increasingly challenging" and "living with vision diseases." The third category of feeling weak was elucidated in the subcategories "troublesome bodily changes" and "strenuous days with limited energy."

CONCLUSIONS

It is imperative to recognise that the oldest old are in a distinct phase of the lifespan. Despite this population being aware of their hearing and vision impairments, they do not always have the strength to alter the situation. Instead they accept it; they often struggle with more serious health challenges. Therefore, they are not prioritising using their limited energy reserves to try to improve or optimise their hearing and vision impairments themselves.

IMPLICATIONS FOR PRACTICE

The oldest old with sensory impairments cannot be expected to perform all the necessary activities of daily living or address their functional sensory impairments. Close monitoring and assistance need to be applied to the oldest old.

What does quality of life mean to older adults? A thematic synthesis

BACKGROUND

Consideration of older adults' quality of life (QoL) is becoming increasingly important in the evaluation, quality improvement and allocation of health and social care services. While numerous definitions and theories of QoL have been proposed, an overall synthesis of the perspective of older adults themselves is lacking.

METHODS

Qualitative studies were identified in PubMed, Ebsco/Psycinfo and Ebsco/CINAHL, through a search on 28 November 2018. Articles needed to meet all of the following criteria: (i) focus on perceptions of QoL, (ii) older adults living at home as main participants, (iii) use of qualitative methodology, (iv) conducted in a Western country and (v) published in English (vi) not focused on specific patient groups. A thematic synthesis was conducted of the selected studies, using the complete 'findings/results' sections from the papers.

RESULTS

We included 48 qualitative studies representing the views of more than 3,400 older adults living at home in 11 Western countries. The QoL aspects identified in the synthesis were categorized into nine QoL domains: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighbourhood, and financial security. The results showed that although different domains can be distinguished, these are also strongly connected.

CONCLUSION

QoL can be expressed in a number of domains and related subthemes that are important for older adults living at home. The findings further support that the concept of QoL should be seen as a dynamic web of intertwined domains.

A Scoping Review: Social Participation as a Cornerstone of Successful Aging in Place among Rural Older Adults

Despite obstacles, many rural-dwelling older adults report that positive aspects of rural residence, such as attachment to community, social participation, and familiarity, create a sense of belonging that far outweighs the negative. By being part of a community where they are known and they know people, rural elders continue to find meaning, the key to achieving successful aging in this last stage of life. This scoping review explored factors influencing social participation and, through it, successful aging among rural-dwelling older adults. We sought to answer the question: what factors enhance or detract from the ability of rural-dwelling older adults to engage in social participation in rural communities? The scoping review resulted in 19 articles that highlight the importance of supports to enable older people to spend time with others, including their pets, engage in volunteer and community activities, and help maintain their home and care for their pets. Overall, the lack of services, including local health care facilities, was less important than the attachment to place and social capital associated with aging in place.

Everyday life in older men living alone - a complex view needing a biopsychosocial perspective

Purpose: To explore how older men living alone, describe their everyday activities and their abilities as well as how they could be helped in everyday life.Materials and methods: Qualitative semi-structured interviews were analysed with inductive content analysis. Eight men aged 65+ years were included. They were all living alone, albeit with home help services. They were able to walk and had sufficient cognitive ability.Results: The analysis resulted in one theme "A driving force of managing activities and overcome hindering factors requires a broad spectrum of prerequisites for participating in everyday life" with the following four categories: Importance of everyday activities; individual prerequisites enabling everyday activities; body and mind inhibit, and react to the decreased, abilities; and importance of the environment.Conclusions: The results generate a complex view of older men's everyday life. It is important for older men's independence that health care and rehabilitation staff adopt a comprehensive view and work from a biopsychosocial (BPS) perspective. Implications for rehabilitationTo be an older man living alone might mean a decreased health and good health is a strong predictor for increased abilities in everyday activities. The living situation of older men living alone is not well studied and needs to be explored to a greater extend, especially from their own perspective.An interaction of biological, psychological, and social factors was expressed as important for older men's everyday life, in accordance with the biopsychosocial (BPS) model.The expressed importance of participation as well as performing both physical and social activities reflects the need of individualised goals in rehabilitation according to the behavioural medicine approach.It is of outmost importance that health care and rehabilitation staff in contact with this group has a comprehensive view and works from a biopsychosocial (BPS) perspective, for maintenance of the older men's independence in everyday life.

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

The concept of home to women ageing should be visited in the light of ongoing cultural, political, temporal and disciplinary evolutions. In part, to compliment policies increasing focus on supporting older adults to age in place and a growing attention on the home as a place where healthcare is designed and provided. The following concept analysis utilises Rodgers' evolutionary method to inductively analyse literature in order to elicit the meaning and experience of home among older women who are ageing at home. Literature was collected over an 18-month period during 2014-2015 and the sample was made up of 49 articles. The analysis led to the concept of home among women ageing in communities to be defined by four attributes. These attributes are home as (i) a resource, (ii) an attachment, (iii) the precariousness of maintaining and sustaining home and (iv) a cultural expectation. This analysis of the meaning and experience of home among women ageing at home has shed light on the needs for this group of women, while highlighting the need to continue to further clarify and define the concept through research.

Mixed-methods quantitative-qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits

OBJECTIVE

This was a study of positive psychological traits in a group of rural Italians aged 90 to 101 years, and their children or other family members.

DESIGN

Mixed-methods quantitative (standardized rating scales) and qualitative (semi-structured interviews) study.

SETTING

Study participants' homes in nine villages in the Cilento region of southern Italy.

PARTICIPANTS

Twenty-nine nonagenarians and centenarians and 51 family members aged 51-75 years, selected by their general practitioners as a part of a larger study called CIAO (Cilento Initiative on Aging Outcomes).

METHODS

We used published rating scales of mental and physical well-being, resilience, optimism, anxiety, depression, and perceived stress. Qualitative interviews gathered personal narratives of the oldest-old individuals, including migrations, traumatic events, and beliefs. Family members described their impressions about the personality traits of their older relative.

RESULTS

Participants age ≥90 years had worse physical health but better mental well-being than their younger family members. Mental well-being correlated negatively with levels of depression and anxiety in both the groups. The main themes that emerged from qualitative interviews included positivity (resilience and optimism), working hard, and bond with family and religion, as described in previously published studies of the oldest old, but also a need for control and love of the land, which appeared to be unique features of this rural population.

CONCLUSIONS

Exceptional longevity was characterized by a balance between acceptance of and grit to overcome adversities along with a positive attitude and close ties to family, religion, and land, providing purpose in life.

Raising rural women's voices: From self-silencing to self-expression

Within the context of a community-academic partnership, we undertook a mixed-methods study to identify and explore health status, priorities, and management strategies among aging Wisconsin rural women. A questionnaire measuring diverse wellness needs was administered to women participating in personal development programming offered by a rural nonprofit organization. A subgroup participated in qualitative interviews to deepen the understanding of identified health priorities and methods of coping and healing. Findings provide insight into the prevalence of self-silencing among rural women and highlight mechanisms that help to facilitate the dismantling of self-silencing.

Living as an Oldest Old in Rio de Janeiro: The Lived Experience Told

This phenomenological-hermeneutic study was an inquiry into the lived experience of 16 very old persons who were living in their own homes. The nursing perspective was Gadow's existential advocacy for nursing practice. The study findings led to the essence of the phenomenon: pragmatic transition to old age, within a restricted future. Heideggerian concepts were applied and the findings were discussed in relation to the guiding theoretical perspective and related literature. Understanding the meaning of being a very old person is fundamental to developing nursing interventions to help people remain independent, with a sense of self-determination, for as long as possible.

Mediators of marginalisation in discharge planning with older adults

Returning home or moving to a more supportive setting upon discharge from inpatient health-care services can have a tremendous impact on the lives of older adults and their families. Institutional concerns with patient safety and expedience can overshadow health-care professionals' commitments to collaborative discharge planning. In light of many competing demands and agendas, it can be unclear what is driving discharge-planning processes and outcomes. This paper presents the results of a study examining discharge planning in an older adult rehabilitation unit in a Canadian urban setting. Using microethnographic case studies, we explored the perspectives of older adults, family members and health-care professionals. Drawing on concepts of relational autonomy to guide the analysis, we found that discourses of ageing-as-decline, beliefs privileging health-care professionals' expertise and conventions guiding discharge planning intersected to marginalise older adult patients in discharge-planning decision making. Discharge planning in the research setting was driven by norms of ‘protecting physical safety’ at the expense of older adults’ self-declared interests and values. Such practices resulted in frequent recommendations of 24-hour care, which have significant personal, social and financial implications for older adults and their families, and ultimately might undermine clients' or health-care systems' aims. The analysis revealed social, political and institutional biases that diminish the rights and autonomy of older adults.

Classification of Support Needs for Elderly Outpatients with Diabetes Who Live Alone

OBJECTIVES

To investigate the support needs of elderly patients with diabetes and to classify elderly patients with diabetes living alone on the basis of support needs.

METHODS

Support needs were derived from a literature review of relevant journals and interviews of outpatients as well as expert nurses in the field of diabetes to prepare a 45-item questionnaire. Each item was analyzed on a 4-point Likert scale. The study included 634 elderly patients with diabetes who were recruited from 3 hospitals in Japan. Exploratory factor analysis was performed to determine the underlying structure of support needs, followed by hierarchical cluster analysis to clarify the characteristics of patients living alone (n=104) who had common support needs.

RESULTS

Exploratory factor analysis suggested a 5-factor solution with 23 items: (1) hope for class and gatherings, (2) hope for personal advice including emergency response, (3) supportlessness and hopelessness, (4) barriers to food preparation, (5) hope of safe medical therapy. The hierarchical cluster analysis of subjects yielded 7 clusters, including a no special-support needs group, a collective support group, a self-care support group, a personal-support focus group, a life-support group, a food-preparation support group and a healthcare-environment support group.

CONCLUSIONS

The support needs of elderly patients with diabetes who live alone can be divided into 2 categories: life and self-care support. Implementation of these categories in outpatient-management programs in which contact time with patients is limited is important in the overall management of elderly patients with diabetes who are living alone.

Rural definition of health: a systematic literature review

BACKGROUND

The advent of patient-centered care challenges policy makers, health care administrators, clinicians, and patient advocates to understand the factors that contribute to effective patient activation. Improved understanding of how patients think about and define their health is needed to more effectively "activate" patients, and to nurture and support patients' efforts to improve their health. Researchers have intimated for over 25 years that rural populations approach health in a distinct fashion that may differ from their non-rural counterparts.

METHODS

We conducted a systematic review of the literature to assess the extent and strength of evidence for rural definition of health. Studies were eligible for inclusion if they were published in English, reported on original research and presented findings or commentary relevant to rural definition of health, were published over the last 40 years, and were based on observations of rural U.S., Canadian, or Australian populations. Two reviewers were assigned to each selected article and blinded to the other reviewer's comments. For discordant reviews, a third blinded review was performed.

RESULTS

Of the 125 published articles identified from the literature, 34 included commentary or findings relevant to a rural definition of health. Of these studies, 6 included an urban comparison group. Few studies compared rural and urban definitions of health directly. Findings relevant to rural definition of health covered a broad range; however, good health was commonly characterized as being able to work, reciprocate in social relationships, and maintain independence. This review largely confirmed many general characteristics on rural views of health, but also documented the extensive methodological limitations, both in terms of quantity and quality, of studies that empirically compare rural vs. urban samples. Most notably, the evidence base in this area is weakened by the frequent absence of parallel comparison groups and standardized assessment tools.

CONCLUSIONS

To engage and activate rural patients in their own healthcare, a better understanding of the health beliefs in rural populations is needed. This review suggests that rural residents may indeed hold distinct views on how to define health, but more rigorous studies are needed to confirm these findings.

‘At home it's just so much easier to be yourself’: older adults' perceptions of ageing in place

By 2050, the number of people in Australia aged over 85 is expected to quadruple. Yet, from a socio-psychological research perspective, little is known about the experiences of people who continue to live at home during late old age (85 years and over), a period when challenging problems associated with ageing escalate and threaten to compromise independence. Utilising a qualitative methodology, the subjective lived experience of 23 very old adults (19 women, four men, with a mean age of 90.7 years, range 85–101 years) who live independently in rural Australia were elicited. The aims of the research were to understand their thoughts and feelings about ageing in place at home, and what psychological, social and practical adaptive strategies they employ to cope with difficulties encountered during very old age. In-depth interviews were analysed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases and interpretation of exemplars. Participants described how historical, cultural and environmental contexts shaped their everyday thoughts, activities and what was meaningful for them. The findings add to our understanding of the largely unnarrated lives of the very old, suggest a need for person-centred home-care assessment processes and aid significant others (family, friends and neighbours) to understand better what very old adults need to live independently.

"Embracing the present and fearing the future": the meaning of being an oldest old woman in a rural area

In Western countries, the number of older people receiving home nursing care is increasing, and in rural areas they are at additional risk because of the distance between people and health care facilities. The aim of this study was therefore to illuminate the meaning of being an oldest old woman living alone in a rural area and receiving home nursing care. A sample of 11 oldest old women living in rural areas in the middle of Norway was chosen for this study. Narrative interviews were conducted, and the data were analyzed using the phenomenological hermeneutic method. After a naïve reading and a structural analysis of the text, we identified four themes: being satisfied with life, being thankful, feeling vulnerable, and feeling secure. The comprehensive understanding implied that being an oldest old woman living alone in a rural area meant living in the intersection between embracing the present in solitude and fearing the future with additional declining health. Living in this complex situation meant to enjoy the present, but still fear the future, as the oldest old women knew their present life situations were limited. This challenging emotional situation meant using their inner strength by trying to be optimistic and seeing opportunities in present life, even if losses were many and extensive. By using their inner strength in facing losses and declining health, the oldest old women managed to appreciate aloneness as solitude, and find new meaning in life.

Living Alone During Cancer Treatment: An Exploration of Patients' Experiences

The social environment is an important determinant in the overall experience of having cancer. The purpose of this article is to identify how patients experience living alone during their cancer treatment. Using qualitative methods based on grounded theory techniques, we interviewed a sample of 32 cancer patients. Living alone was an ambiguous experience during cancer treatment: patients experienced both a lack of support as well a gain in privacy, freedom, and know-how. Living alone was also seen as a constitutive element of the patients' identity. Consequently, patients saw living alone as either a threat or as a resource for their adjustment to cancer treatment. These divergent meanings of living alone did share one common attribute, which was that staying independent was their key goal during cancer treatment. Health care providers should be attentive to the heterogeneous aspects of the experience of living alone when critically appraising the independence of patients.

The well-being of community-dwelling near-centenarians and centenarians in Hong Kong: a qualitative study

Background

Hong Kong has one of the highest life expectancy rankings in the world. The number of centenarians and near-centenarians has been increasing locally and internationally. The relative growth of this population is a topic of immense importance for population and health policy makers. Living long and living well are two overlapping but distinct research topics. We previously conducted a quantitative study on 153 near-centenarians and centenarians to explore a wide range of biopsychosocial correlates of health and “living long”. This paper reports a follow-up qualitative study examining the potential correlates of “living well” among near-centenarians and centenarians in Hong Kong.

Methods

Six cognitively, physically, and psychologically sound community-dwelling elders were purposively recruited from a previous quantitative study. Semi-structured interviews were conducted.

Results

Four major themes related to living long and well emerged from the responses of the participants: (a) Positive relations with others, (b) Positive events and happiness, (c) Hope for the future, and (d) Positive life attitude. Specifically, we found that having good interpersonal relationships, possessing a collection of positive life events, and maintaining salutary attitudes towards life are considered as important to psychological well-being by long-lived adults in Hong Kong. Most participants perceived their working life as most important to their life history and retired at very old ages.

Conclusions

These findings also shed light on the relationships between health, work, and old age.

Cultural and socio-economic factors on changes in aging among Iranian women

The aim of the study is to determine the cultural and socio-economic factors that influence changes in aging among Iranian women. This qualitative study was part of a more extensive study designed according to grounded theory method. A purposeful, snowball and theoretical sampling technique was used. Data collection instruments were interviews and field notes. Duration of interviews differed and ranged from 38 to 110 minutes. Data collection process, coding and analysis were performed simultaneously. Collected data were analyzed using the recommended method by Corbin and Straus (1998 and 2008). The factors were formed from 6 subcategories: cultural and socio-economic status in the past, urban/rural life, companionship status, beliefs and attitudes, higher responsibilities of women and women's financial capability. This study explained the various aspects of cultural and socio-economic changes in the elderly participants based on their real experiences.

"Struggling for independence": the meaning of being an oldest old man in a rural area. Interpretation of oldest old men's narrations

The amount of older people receiving home nursing care is increasing; in rural areas, they are at additional risk because of the distance between people and health care facilities. No specific studies have been found about oldest old men living alone and receiving home nursing care and the meaning of living alone in one's own home. The aim of this study was therefore to illuminate the meaning of being an oldest old man living alone in a rural area and receiving home nursing care. A sample of 12 oldest old men living in rural areas in the middle of Norway was chosen for this study. Narrative interviews were conducted, and data were analyzed using the phenomenological hermeneutical method. After a naïve reading and a structural analysis of the text, we identified three themes: feelings of insufficiency in everyday life, finding hope in life, and feeling reconciliation with life. The comprehensive understanding suggested that being an oldest old man living alone in a rural area means a struggle between a dependent existence and a desire to be independent. Living in the tension between independence and dependency is a complex emotional situation where one is trying to accept the consequences of life and loss--reconciling the wish to live with the fact that life will come to an end.

Resilience, physical performance measures, and self-perceived physical and mental health in older Catholic nuns

BACKGROUND AND PURPOSE

The importance of physical performance measures and their influence on predicting future disability has been suggested; however, the association between resilience and physical performance measures in older women needs further study. The purpose of this research study was to investigate the resilience level in a convenience sample of older women who happened to be Roman Catholic nuns. The relationships of resilience with specific physical performance measures, self-perceived physical and mental health status, and depressive symptoms were also explored.

METHODS

Descriptive correlational cross-sectional design was used. Data from 54 volunteer Roman Catholic nuns, aged 55-94 were collected beginning with self report questionnaires followed by physical performance tests. Self-report measures included the Resilience Scale, Short-Form revised (SF-12v2) Health Survey, and Patient Health Questionnaire (PHQ-9). The 12-point Short Physical Performance Battery (SPPB) and fast gait speed were the physical performance tests measured.

RESULTS

This sample of nuns had moderate levels of resilience. Those with fewer depressive symptoms and better health had higher resilience levels. Fast gait speed was positively associated with resilience.

DISCUSSION

The positive relationship between resilience and gait speed is an important finding of this study because it reinforces the connection between physical and emotional health. Future studies should examine if resilience and gait speed can serve as predictors of disability in a broader sample of older adults or if resilience can be targeted as a means of improving physical performance.

CONCLUSION

Maintaining functional ability and recovering when physical injury is experienced is of great importance in older adults. It is reasonable for physical therapists to consider both resilience and physical performance measures when attempting to identify older women at risk for poor outcomes. Resilience may play a role in helping older adults recover from a physical injury.

Chronic Illness Self-Management While Living Alone in Later Life

Older people living alone (OPLA) are considered vulnerable because of fewer resources, such as social support. As self-management becomes increasingly important in chronic care, evidence is needed on how to better support OPLA. This review synthesizes the evidence from 32 publications on the challenges as well as strategies of OPLA in managing chronic conditions. On the basis of a systematic database search and review process, being independent and being at home were identified as crucial when living alone in later life; both involve decision making and the adjustment of routines to manage everyday life and chronic conditions. These findings show that OPLA are vulnerable because of difficult living situations, limited resources, or a lack of support, and they actively manage their conditions using various strategies to remain independent, but these may cause fragile arrangements that can jeopardize independence. Awareness of these strategies is a starting point to develop interventions for self-management support in chronic illness.

Intentions of older homebound women with regard to reaching help quickly

The purposes of this longitudinal phenomenological study were to describe intentions of older women relative to reaching help quickly (RHQ), to place those intentions in personal-social context, and to compare intentions of subscribers to a personal emergency response system (PERS) and nonsubscribers. The 40 participants were aged 85 or older, resided alone, and needed help to leave home. Two contextual features ("recognizing my risk of being unable to RHQ" and "recognizing my need for a RHQ device to sustain myself") were basic to two phenomena ("negotiating reliance on people to reach quickly if I need help" and "reducing my risk of being unable to RHQ"). There was greater variation in intentions and context within each of the two naturally occurring groups (subscribers and nonsubscribers) than between them. Practitioners cannot assume that women intend to use available RHQ devices in specific situations; preventive nursing involves proactive exploration of intentions relative to RHQ.

Being mobile: electric mobility-scooters and their use by older people

There is increasing use of electric mobility-scooters by older people in South Australia, the fourth largest state in Australia. Although various issues about their use have been raised by users, carers, urban planners and legislators, to date they have received little research attention. The purpose of the study reported in this paper was to explore the factors that influence and impact upon older people who use mobility-scooters, particularly from their own perspectives. Data were collected through a survey of 67 current electric mobility-scooter older users, and through two focus groups with other older South Australian people who were users. The data showed that more than 71 per cent of the participants had owned their scooter for more than two years, most had purchased the scooter as new, and 80 per cent owned a four-wheel scooter. The scooter was used predominantly for getting to and from shops, visiting friends and family, and to go for rides. Most respondents used their scooters three to five times each week and travelled between two and five kilometres from their home. The key findings from the focus groups were categorised into three major themes of ‘obtaining a scooter’, ‘the meaning of mobility’ and ‘issues around sharing spaces’. Each is exemplified. The implications for environmental and building design, for the better training of users, and for public education are discussed.

Papel da autonomia na auto-avaliação da saúde do idoso

OBJETIVO: Compreender os significados atribuídos à auto-avaliação da saúde do idoso. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo, realizado com 17 idosos (> 70 anos) de ambos os sexos residentes em Bambuí, MG, em 2008. Foi utilizada abordagem antropológica baseada no modelo de signos, significados e ações que relaciona ações individuais, códigos culturais e contexto macrossocial. Foram realizadas entrevistas semi-estruturadas centradas na auto-avaliação da saúde, descrição de saúde "boa" e saúde "ruim" e nos critérios utilizados pelos idosos na auto-avaliação da saúde. ANÁLISE DOS RESULTADOS: A idéia organizadora dos relatos vincula a autoavaliação da saúde do idoso às lógicas "participar da vida" e "ancoragem à vida". A primeira tem a autonomia como fio condutor, englobando as seguintes categorias: permanecer ativo dentro das capacidades funcionais instrumentais avançadas, ser dono da própria vida (como oposição a ser dependente), ser capaz de resolver problemas e poder agir como desejar. A segunda lógica unifica as seguintes categorias: capacidade de interação, estar engajado em relações significativas e poder contar com familiares, amigos ou vizinhos. CONCLUSÕES: A saúde é entendida pelos idosos como ter autonomia no exercício de competências funcionais demandadas pela sociedade, tais como capacidade de responder às obrigações familiares e capacidade de desempenhar papéis sociais. Ao definir sua saúde como boa ou razoável, o idoso não se caracteriza como pessoa livre de doenças, mas como sujeito capaz de agir sobre o ambiente.

Resilience in rural community-dwelling older adults

CONTEXT

Identifying ways to meet the health care needs of older adults is important because their numbers are increasing and they often have more health care issues. High resilience level may be one factor that helps older adults adjust to the hardships associated with aging. Rural community-dwelling older adults often face unique challenges such as limited access to health care resources.

PURPOSE

To determine the resilience level of rural community-dwelling older adults and to determine if socio-demographic factors, social networks, and health status are associated with resilience.

METHODS

Data were collected from 106 registered voters, aged 65 years or over from a rural area in New York State using a cross- sectional design. The instruments used in the study include the Resiliency Scale, the SF-12v2, and the Lubben Social Network Scale-Revised.

FINDINGS

The mean resilience level of the sample was high. Resilience was not correlated with any of the socio-demographic factors which included gender, age, income, education, marital, and employment status. There was a weak positive correlation between social networks and resilience levels of rural older adults. Both physical and mental health status were positively correlated with resilience. In a regression model, mental health status was the strongest predictor of resilience levels.

CONCLUSION

If low resilience levels are identified in rural community-dwelling older adults, interventions to build resilience may be helpful in promoting independence; however, further research is needed to determine this.

Doing everyday life--experiences of the oldest old

The purpose of this article is to explore how a group of elderly people, living and managing on their own, describe and experience their everyday doings. Interviews and observations were conducted with 18 community-living people aged 85 and above. The experiences of 'Doing everyday life' are described in five overarching themes: 'Experiencing being old', 'Doings in everyday life', 'Patterns of the day', 'Altered doings', and 'The importance of time'. What is done during an ordinary day does not differ much from earlier in life, but how the doings are performed has changed. Being occupied and staying healthy and sound in mind was stressed as important in old age and even if reduced energy and functional constraints limited the doings, a strong volition to manage independently was expressed. The participants perceived society as regarding the elderly as useless and worthless. Knowledge emanating from the very old themselves is vital to diversify the image of elderly people and to offer interventions and support adapted to their needs and desires.

Experiences of daily occupations at 99 years of age

The aim was to explore experiences of daily occupations among the oldest old. Ten 99-year-old persons were interviewed in their living environment about an ordinary day. The interviews were analysed according to the phenomenographic approach. The result showed that participants regarded themselves as competent and that they felt proud because they were involved in daily occupations. Being challenged was experienced as a way of performing difficult tasks, thus being confirmed as a capable person who performs and learns new things. The participants' occupational patterns preserve occupational ability and continuity in life in that they have a rhythm and allow the individuals to predict and handle interruptions. Participants experienced being incapable and being restricted as a result of personal, environmental, and social hindrances. The participants adapted to and reshaped their sense of self, which has been disrupted due to the discrepancy between self, the person's ability, and the real world "outside". Experience of daily occupation is unique, supports the sense of self, builds identities, and describes engagement and creative processes. Individual experience must be recognized as it can mean the difference between success and failure in maintaining meaningful daily occupation.

Embracing Opposites: Meanings of Growing Old as Narrated by People Aged 85

Many old people suffer from prolonged and multiple bodily ailments, new diseases, and increased risk for disadvantages and losses in life. Aging also means becoming mature and wise. This study illuminates the meaning of the lived experience with respect to changes in late life. Using a phenomenological hermeneutic method, this study analyzes transcribed interviews of 15 85-year-old people. Four themes were formulated: embracing weakness and strength, embracing slowness and swiftness of time, embracing reconciliation and regret, and embracing connectedness and loneliness. From these analyses, growing old was described as —maintaining one's identity in spite of the changes that come with aging and, embracing opposites—being changed and feeling being the same.

Os idosos mais velhos no meio rural: realidade de vida e saúde de uma população do interior gaúcho

Trata-se de estudo epidemiológico transversal com objetivo de descrever e analisar os dados demográficos, sócio-econômicos e as condições de saúde dos idosos com 80 anos ou mais, residentes no meio rural de Encruzilhada do Sul - RS. Para coleta dos dados dos 137 idosos foram realizadas entrevistas domiciliares entre março a junho de 2006. Os dados foram analisados empregando-se estatística descritiva e inferencial. A idade média das idosas foi de 84,1 (dp= 3,8), e dos idosos, de 85,3 (dp=3,5). Quanto ao estado civil e à escolaridade, existe diferença significativa entre homens e mulheres, 80,0% são idosas e viúvas (p<0,001), e 77,2% analfabetas (p=0,013). O reumatismo e a hipertensão arterial são as morbidades mais referidas. O estudo contribui para dar maior visibilidade a essa parcela populacional, para compreensão do processo de envelhecimento e adequação das políticas públicas.

Using visual methods to uncover context

The accurate assessment of physical activity and dietary intake is essential for assessing the relationships between physical activity, dietary intake, and health outcomes. However, the measurement of physical activity and dietary intake among women, particularly minority women, poses unique challenges related to gender, ethnicity, and social context. Measures that are not culturally relevant or sensitive to the experiences, traditions, or beliefs of ethnically diverse women might result in data that are unreliable, or which cannot be interpreted. Visual methods show promise for elucidating concepts that are important to refine established measures for assessing dietary intake and physical activity in diverse ethnic groups. Hispanic women, a largely understudied subgroup that experiences long-term health risks associated with dietary and physical activity behaviors, serves as the focal group for this discussion of the potential for visual methods to develop culturally and contextually relevant and valid approaches to outcome assessment.

Inner strength as disclosed in narratives of the oldest old

The aim of this study was to illuminate the meaning of inner strength when very old as narrated by women and men 85 and 90 years old. The authors used a phenomenological hermeneutical method to analyze interviews from 11 women and 7 men, aged either 85 or 90, who scored high on scales measuring phenomena related to inner strength. The following themes emerged from the analysis: feeling competent in oneself yet having faith in others, looking on the bright side of life without hiding from the dark, feeling eased and also being active, being the same yet growing into a new garment, and living in a connected present but also in the past and the future. The authors understood the meaning as Life Goes On--Living It All. To illuminate this meaning further, the authors related the findings to the Aristotelian virtues and the golden mean, and to developmental theory.

The Meaning of Time in Oldest-Old Age

In a phenomenological study that described the lived experience of adults older than 85 years, 19 oldest-old adults' lived time is illuminated by 5 themes: Defining Self Through Experience, Being Situated in Time, Knowing Lifetime Is Limited, Planning for the Future, and Leaving a Legacy.