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

Solitude in old age: a scoping review of conceptualisations, associated factors and impacts

OBJECTIVE

This study aimed to map the existing scientific research about solitude in older adults, focusing on its conceptualizations, associated factors, and impacts.

METHOD

A scoping review was conducted, searching Scopus, Web of Science, PubMed, and Academic Search Complete databases for publications from 1985 until December 2023.

RESULTS

Twenty-four studies were included. The main findings suggest a wide-ranging conceptualisation of solitude, with most studies (n = 16) adopting neutral definitions such as "being alone, without communicating with others"; and a subset of studies adopting definitions that alluded to "positive solitude" (as the choice of being with oneself, underscoring potential benefits). Individual characteristics were identified as key associated factors of solitude. Both positive impacts and negative impacts were reported.

CONCLUSION

The variability in conceptualisation and impacts likely stems from methodological and theoretical differences in approaching solitude. This underscores the need for additional research to establish a widely accepted conceptual framework. Such consensus could enhance the understanding of the conditions contributing to positive and negative impacts associated with solitude and inform targeted interventions.

Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study

INTRODUCTION

Studies of older women's life transitions is rare but gains relevance as the aging population, with older women as the majority, expands.

PURPOSE

To explore the meaning of a good life for older widows with extensive home care needs.

MATERIALS AND METHODS

Semi-structured interviews were carried out with eleven women, aged 80 and over (82-95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5-6 hours, mean 3). Data were analysed by reflexive thematic analysis.

RESULTS

The theme "This Day in My Home, the frame of my life" reflects the women's experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely.

CONCLUSION

A day at home may seem static, yet it mirrors life's dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.

The mediating effect of depressive symptoms on the association between childhood friendship and physical function in middle-aged and older adults: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

This study examines the extent to which depressive symptoms mediate the link between childhood friendship (CF) and physical function among middle-aged and older adults in China.

METHODS

China Health and Retirement Longitudinal Study (CHARLS) data were used; specifically, CHARLS life history survey (conducted from June 1-December 31, 2014) and follow-up health survey (conducted from July 1-September 30, 2015) data were used. The Sobel test, Bootstrap test and multivariable logistic regression were performed to examine the mediating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between CF (measured by a standardized retrospective questionnaire) and physical function, which was measured by basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and grip strength.

RESULTS

A total of 12,170 participants aged 45 years or older were included in this cross-sectional study. After controlling for covariates, low-quality CF was associated with an increased prevalence of BADL disability (OR = 1.18; 95 % CI = 1.05-1.32), IADL disability (OR = 1.25; 95 % CI = 1.12-1.40), and low grip strength (OR = 1.21; 95 % CI = 1.09-1.34). The proportion of the mediating effect of depressive symptoms was 48 % for CF and BADL, 40 % for CF and IADL, and 11 % for CF and grip strength. Depressive symptoms and worse CF have a joint effect on BADL disability (OR = 3.30; 95 % CI = 2.82-3.85), IADL disability (OR = 3.52; 95 % CI = 3.03-4.09), and low grip strength (OR = 1.65; 95 % CI = 1.43-1.92).

LIMITATIONS

Not all potential confounding factors (such as childhood behavioural problems, genetic factors, and memory function) were measured in the analysis, and there may have been recall bias in the retrospective collection of CF data.

CONCLUSIONS

Individuals with high-quality CF were more likely to have a decreased prevalence of impaired physical function in later life. Depressive symptoms acted as a mediator associated with the development of CF.

The action logic of the older adults about health-seeking in South Rural China

BACKGROUND

The Chinese government has invested significant resources to build many rural healthcare stations. However, in the face of convenient medical paths and accessible medical resources, the utilization rate of health services for older adults in rural areas is surprisingly low. This study explored why health-seeking behavior among older adults in rural China was not active.

METHODS

Data were collected through participatory rural appraisal (PRA) with 108 participants in 12 villages in southern China. Daily schedule and social and resource mapping were employed to outline the range of activities and the routine of the older adults, as well as in-depth interviews to understand the logic of their healthcare choices. Data collected were analyzed by content analysis.

RESULTS

Three themes were generated: (1) perceptions of health status (being healthy or sick): the rural older adults used the ability to handle routine chores as a measure of health status; (2) prioritization of solving symptoms over curing diseases: the older adults preferred the informal self-medication to cope with diseases, as long as there were no symptoms and no pain; (3) 'unpredictable' troubles: they tended to favor the 'optimal' solution of keeping their lives in order rather than the best medical treatment options.

CONCLUSION

This study showed that the medical practices of the rural elderly were profoundly influenced by their perceptions of health and their life experiences. In the face of diseases, they tended to keep their lives in order, preferring self-treatment practices that address symptoms or selectively following medical advice rather than medical and science-based clinical solutions. In the future, the construction of rural health care should focus on changing the 'inaccessibility' of healthcare resources at the subjective level of the rural elderly and develop culturally adaptable health education.

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.

Childhood family risks and mental health of older adults in China: The moderating effect of age

Introduction

Childhood family risks (CFRs) are believed to have long-arm effects on people's mental health. However, it is unclear whether age can alleviate these long-arm effects.

Aim

This study aimed to explore the relationship between CFRs and the mental health of older adults (mean [M] = 62.10, standard deviation [SD] = 8.02) in China and investigate whether age could moderate this relationship.

Methods

This cross-sectional, survey-based study used data from the Chinese General Social Survey conducted in 2015, and the data of 4,237 respondents were included in the final analysis. Mental health was measured by two items, namely negative and positive emotions. The step-by-step regression procedure and moderation analysis technique were used.

Results

For older adults in China, CFRs were significantly negatively associated with their mental health (β = -0.046, t = -2.690, p < 0.01), age was positively correlated with their mental health (β = 0.115, t = 7.157, p < 0.01), and age significantly moderated the relationship between CFRs and mental health (β = 0.277, t = 2.172, p < 0.05). As age increases, the correlation between CFRs and mental health decreases, and when age is one SD above the M, CFRs are no longer significantly associated with the mental health level (b _simple = -0.01, t = -0.077, p > 0.05).

Conclusion

This study showed that CFRs were negatively associated with the mental health level of older Chinese adults, and age could significantly moderate the association. Therefore, it is essential to take preventive measures in advance to protect people's mental health and teach older adults to use emotion-regulation techniques to weaken the association between CFRs and mental health.

Socioeconomic Classes among Oldest-Old Women in South Korea: A Latent Class Analysis

Oldest-old women are known to live at the intersection of multiple socioeconomic disadvantages in South Korean society. This study classified oldest-old Korean women into several socioeconomically homogeneous classes based on various socioeconomic status (SES) risks and compared health characteristics among the identified classes. This cross-sectional study utilized the 2019 Korean Community Health Survey, including data from 11,053 women (≥80 years). Latent class analysis determined the number of underlying socioeconomic classes based on nine selected SES variables. Four distinct socioeconomic classes were identified: “Urban, living alone, recipient of NBLSS, moderate education, leisure activity” (Class 1), “Rural, traditional house, living with others, not financially deprived, low education, employed” (Class 2), “Urban, living with family, financially affluent, not employed, no barriers to healthcare” (Class 3), “Rural, traditional house, living alone, financially deprived, uneducated, employed, barriers to healthcare” (Class 4). Depressive symptoms, subjective stress, and the prevalence of sleep disorder and diabetes were higher in Class 1 compared to other classes. Health-related quality of life, perceived health, and self-rated oral health were the poorest in Class 4. Class 3 reported the best health status. Understanding the intersecting SES risk factors in this group can aid in developing targeted interventions.

Childhood adversity and healthy ageing: a study of the Chinese older population

This study examines the relationship between childhood adversities and healthy ageing in the Chinese older population. The data come from the China Health and Retirement Longitudinal Survey (CHARLS), a national survey that collected life history and ageing-related information on 9248 older people aged over 60 in 2014 and 2015. The analysis of healthy ageing focuses on seven indicators: IADL limitations, ADL limitations, cognitive functioning, depressive symptoms, life satisfaction, self-reported health, and chronic illness. Using k-means clustering, an unsupervised learning technique, we identified four qualitatively different groups according to their achievement in healthy ageing. We studied 17 types of childhood adversities and found that experiencing multiple childhood adversities is associated with a lower probability of achieving healthy ageing. This relationship is moderated by age and gender. Women are more vulnerable than men to the negative impacts of childhood adversities. The threat of childhood adversities to healthy ageing is greatly attenuated among people aged over 80. We argue that the policy response to healthy ageing should not be confined to those services and programmes that directly target older people. Instead, healthy ageing can be better addressed by concerted efforts in different areas of social policy.

Older Adults’ Self-Perceptions of Aging and Being Older: A Scoping Review

Background and Objectives

Older adults’ self-perceptions of aging and being older can influence well-being and quality of life. This systematic scoping review aimed to map out current research on older adults’ self-perceptions of aging and being older.

Research Design and Methods

The scoping review followed Arksey and O’Malley’s methodological framework. A total of 5,037 records were identified (duplicates removed). After screening, a final 148 papers were included. Descriptives, including year of publication, methodology, age, gender, and location of participants, were calculated. Thematic analyses were conducted examining ways in which the topic was conceptualized.

Results

The most frequent method used in the research was quantitative. Participants were from 38 different countries. There were more female participants than male. Seven themes representing the main research emphasis emerged: attitudes towards one’s own aging (n = 48), aging well (n = 23), aging stereotypes, self-stigma (n = 23), construction of aging identities (n = 22), subjective age (n = 18), the aging body (n = 8), and future self-views (n = 6).

Discussion and Implications

The research within these themes approach self-perceptions of aging using varying points of reference for what participants compare their age to. The methods used to illicit aging perspectives held their own assumptions about aging.

Experiences of elderly patients regarding participation in their hospital discharge: a qualitative metasummary

BACKGROUND

Ageing patients are discharged from the hospital 'quicker and sicker' than before, and hospital discharge is a critical step in patient care. Older patients form a particularly vulnerable group due to multimorbidity and frailty. Patient participation in healthcare is influenced by government policy and an important part of quality improvement of care. There is need for greater insights into the complexity of patient participation for older patients in discharge processes based on aggregated knowledge.

OBJECTIVE

The aim of this study was to review reported evidence concerning the experiences of older patients aged 65 years and above regarding their participation in the hospital discharge process.

METHODS

We conducted a qualitative metasummary. Systematic searches of Medline, Embase, Cinahl, PsycINFO and SocINDEX were conducted. Data from 18 studies were included, based on specific selection criteria. All studies explored older patients' experience of participation during the discharge process in hospital, but varied when it came to type of discharge and diagnosis. The data were categorised into themes by using thematic analysis.

RESULTS

Our analysis indicated that participation in the discharge process varied among elderly patients. Five themes were identified: (1) complexity of the patients state of health, (2) management and hospital routines, (3) the norm and preference of returning home, (4) challenges of mutual communication and asymmetric relationships and (5) the significance of networks.

CONCLUSIONS

Collaboration between different levels in the health systems and user-friendly information between staff, patient and families are crucial. The complexity of patient participation for this patient group should be recognised to enhance user involvement during discharge from hospital. Interventions or follow-up studies of how healthcare professionals can improve their communication skills and address the tension between client-centred goals and organisational priorities are requested. Organisational structure may need to be restructured to ensure the participation of elderly patients.

A hermeneutic phenomenological explorations of living in old age

Although there have been some studies that explore the meaning of aging and give voice to older people, the impact that the aging experience can have on them justifies continued research in this area. In this study, with a hermeneutic phenomenological design and an interpretation method inspired by the philosophy of Ricoeur, we conducted in-depth interviews with 14 elderly people at a social day center in Rome (Italy). The analysis revealed three central themes associated with the experience of being old: changes and limitations related with being aged, the experience that comes from having lived a long life, and an awareness of death. The findings could help health professionals, families and caregivers to achieve a deeper understanding of what old age entails, and may also serve as a platform for interventions that seek to enable older people to experience aging as a meaningful and positive process.