Lack of Resilience Among Very Old Men and Women: A Qualitative Gender Analysis

Gender differences in perceived pain and health-related quality of life in people with chronic non-malignant pain: a cross-sectional study

BACKGROUND

Chronic pain has a disproportionate impact on members of vulnerable population groups, and women are at substantially greater risk than men of suffering multiple chronic pain disorders. Moreover, one of the aspects most affected by the presence of chronic pain is that of health-related quality of life (HRQoL), worsening over time, as the disease persists.

OBJECTIVES

To describe the profile of patients who suffer non-malignant chronic pain, from a gender perspective, and to identify factors related to their HRQoL and mental health.

DESIGN

A cross-sectional study was carried out in patients with chronic non-cancer pain.

METHODS

Sociodemographic variables, pain intensity at rest and in motion, SF-36 health questionnaire, anxiety, and depression were evaluated.

RESULTS

The study population consisted of 531 subjects, of whom 64.2% were women. The mean age was 52.9 (SD: 10.4) years. The pain intensity recorded on the visual analogue scale was 6 (SD: 2.7) at rest and 8 (SD: 2) in motion. Physical component score and mental component score of quality of life were worse in women vs men: 33.73 (6.77) vs 32.33 (6.20), for the physical component; 36.89 (12.77) vs 32.91 (11.51), for mental component. Anxiety, depression and pain intensity, showed poorer results in women.

CONCLUSION

Gender is a factor that should be considered in assessing and managing chronic pain, due to its influence on the perception of pain, and HRQoL.

IMPACT STATEMENT

Gender is an important modifier of the perception of pain, and HRQoL. To achieve a patient-centred approach, nurses should incorporate gender as a differential factor to adapt and individualize pain management and patient education.

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.

Resilience in context: the special case of advanced age

OBJECTIVES

Advanced age is a time shaped by the current experience of physical, social and psychological characteristics associated with living into an eighth decade and beyond and also by reflection upon past experiences. Understanding the specific factors that contribute to ageing well is increasingly important as greater numbers of older people remain living independently in the community and may require targeted and sustainable support to do so. This paper offers a conceptualisation of resilience for advanced age (age 85+), a life stage currently under-researched.

METHOD

We utilise a developmental and socio-historical context to develop key arguments about adversity, resources and positive outcomes that affect the experience of resilient ageing.

RESULTS

Very late life is characterised by a unique balance between losses, associated with vulnerability and resource restrictions, and potential gains based upon wisdom, experience, autonomy and accumulated systems of support, providing a specific context for the expression of resilience. Post-adversity growth is possible, but maintenance of everyday abilities may be more relevant to resilience in advanced age.

CONCLUSION

An increasing life-span globally necessitates creative and conscientious thought about wellbeing, and resilience research has the important aim to focus health and wellness on success and what is possible despite potential limitations.

Inner strength in relation to perceived physical and mental health among the oldest old people with chronic illness

OBJECTIVES

The aim of this study was to examine inner strength, defined as connectedness, firmness, flexibility, and creativity, and its relation to mental and physical health in a sample of the oldest old chronically ill women and men living at home.

METHODS

A sample of 79 older women and 41 men in the age range of 80-101 years old (mean = 87.5) participated in this study. Inner strength measured by Resilience Scale, Sense of Coherence Scale (SOC), Purpose in Life Test (PIL), and Self-Transcendence Test (STS) was viewed in relation to mental and physical health (SF-36 Health Survey).

RESULTS

Experiencing connectedness, firmness, flexibility, and creativity were equal for women and men. SOC, PIL, and STS showed moderate inner strength. Medium and low resilience made the participants feel vulnerable. A significant correlation was observed between the variables for inner strength and mental health for women, men, and the total sample. STS was associated with mental and physical health for the total sample and for women.

CONCLUSIONS

Although the oldest old women and men were vulnerable, they had inner strength. Encouraging participation using the inner strength of the oldest old can contribute to strengthen their experiences of independence, integrity, and enjoying life.

Resilient ageing: a concept analysis

AIM

This paper is a report of an analysis of the concept resilient ageing. Unique in comparison with other healthy ageing concepts, resilient ageing can be applied to all older people, regardless of age or affliction.

BACKGROUND

The state of global population expansion in older people over the next 50 years calls for increased health promotion research efforts to ensure the maintenance of health and optimal quality of life for all older people.

DATA SOURCES

Literature for this concept analysis was retrieved from several databases, CINAHL, PubMed PsycINFO, for the years 1990-2012.

DESIGN

Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving.

METHODS

An integrative research review methodology was applied to peer-reviewed journal articles (n = 46) for an inductive analysis of the concept of resilient ageing.

RESULTS

The antecedents, defining attributes, and consequence of resilient ageing were identified. Antecedents to resilient ageing were found to be adversity and protective factors, while the core attributes include coping, hardiness and self-concept. The consequence of the process of resilient ageing was optimal quality of life. Sense of coherence was found to be the surrogate term. The results obtained were further substantiated using Antonovsky's (1979) theory of salutogenesis.

CONCLUSION

A theoretical definition and a model of resilient ageing were developed. In addition, a discussion was provided on the practice, policy and research implications for promoting the development of protective factors and resilient ageing.

Resident strategies for making a life in a nursing home: a qualitative study

AIM

To identify strategies that older adults use to adapt to live in long-term care.

BACKGROUND

The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Moving into a long-term care setting has been documented internationally as an overwhelming life change for many older adults. It has been observed that residents adjust differently over time, but the basis for these differences needs further exploration.

DESIGN

A qualitative design using grounded theory method was employed.

METHODS

A total of in-depth interviews were conducted in October 2008-February 2009 with a sample of 21 participants. Participants ranged in age from 65-93 years, 81% women and 19% men; mainly Caucasian with one African American and one Hispanic. Length of stay ranged from 3 days to over 9 years living in long-term care so that all stages of adjustment were included in the study. Ground theory method was used to analyse the data.

FINDINGS

The results of this study yielded 21 facilitative strategies. The core category identified was personal resiliency, which served as the underpinning for the strategies used by the participants. Strategies were identified in making the decision to move into long-term care and in day-to-day living.

CONCLUSION

Understanding the strategies that facilitate residents to make a successful transition to long-term care life will assist nurses to intervene in ways that are supportive. The strategies identified in this study may be used to develop interventions for residents that are having difficulty living in long-term care. Further exploration of how resiliency has an impact on strategies used by residents is clinically relevant, but further research is needed.