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Health in later life: A nursing perspective
Luleå University of Technology, Department of Health, Education and Technology, Nursing and Medical Technology.ORCID iD: 0000-0001-9968-3937
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The ongoing demographic shift towards an older population calls for a corresponding shift to a proactive approach, aiming for health and well-being in old age. This dissertation addresses the need for increased knowledge about health in the context of aging at home. It explores the roles of relationships, home, health, and well-being while examining the various factors influencing health. The disseration also explores how key stakeholders in home care organizations percive a good life for older persons. From a nursing perspective, the disseration explores pathways of change and experiences related to health, guided by the caritative caring theory, which underscores health as wholeness and holiness. By thoroughly examining self-rated health, relationships, and the experiences of older persons receiving home support, along with key stakeholders' perceptions, the dissertation aims to provide valuable insights for nursing practices and the promotion of health in later life.

This dissertation aims to explore health in later life, specifically concentrating on widowed women living alone with extensive home care needs. This exploration encompasses both the perspective of older widows and that of key stakeholders. For a comprehensive understanding health, the disseration also study self-rated health among older persons over a 20-year period, exploring its associations to health and well-being factors, including survival. Additionally, the dissertation explores the shared relationship between older women and nurses.

This dissertation comprises one quantitative and three qualitative studies, all centred around older persons aged 80 years and older. Paper I is a quantitative, longitudinal study investigating changes in Self-Rated Health (SRH) across the aging spectrum. The study included 1595 participants initially (aged 59-79) and 541 participants at follow-up (age 80-96). Most participants rated their health as "Quite good" (54.5%) at baseline. Over the study period, 42.6% had stable SRH, 40.6% had declined, and 16.8% had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p<0.05). Paper II is a qualitative study about the concept of a good life for single-living older women with extensive care needs. This involved individual interviews with 11 participants aged 82-95, analysed through reflexive thematic analysis. Paper III is a qualitative description of key stakeholders' perceptions regarding a good life for the oldest old persons living at home with extensive care needs. The study utilized qualitative focus groups with 28 participants aged 31-69 (1 man, 27 women), analysed through qualitative content analysis. Paper IV is a qualitative study that aim to explore the meaning of relationship between older women and registered nurses in home care. The research employed qualitative methods, including focus groups and individual interviews, with 11 older women (aged 82-95) and 5 registered nurses (aged 35-47), analysed using qualitative content analysis. 

In conclusion, health in later life is not merely about avoiding a decline in health; rather, it involves integrating existing aspects into an ever-changing situation. However, challenges such as living alone, experiencing depressive symptoms, and coping with illness and/or functional disability can pose threats, risking overall health and survival. In contrast, for those living with disabilities and illnesses with extensive care needs, the significance of daily life becomes paramount. Simultaneously, the relationship between older women and registered nurse emerges as a recurring connection with the potential not only to enhance daily life but also to serve as a consistent and supportive presence in the home.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2024.
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords [en]
Aging Population, Home Care Services, Self-Rated Health, Geriatric Nursing, Nurse-Patient Relationship, Health
National Category
Nursing
Research subject
Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-104693ISBN: 978-91-8048-507-4 (print)ISBN: 978-91-8048-508-1 (electronic)OAI: oai:DiVA.org:ltu-104693DiVA, id: diva2:1845882
Public defence
2024-05-24, A117, Luleå university of technology, Luleå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-03-21 Created: 2024-03-20 Last updated: 2024-05-07Bibliographically approved
List of papers
1. Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort
Open this publication in new window or tab >>Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort
Show others...
2024 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 122, article id 105392Article in journal (Refereed) Published
Abstract [en]

Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.

Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.

Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.

Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).

Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
aged 80 and over, aging/psychology, diagnostic self evaluation, longitudinal studies, population characteristics, self-rated health, survival analysis
National Category
Gerontology, specialising in Medical and Health Sciences
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-104692 (URN)10.1016/j.archger.2024.105392 (DOI)38492492 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-01074Swedish Research Council, K2014-99X-22610-01-6Visare NorrSwedish Dementia CentreFoundation for the Memory of Ragnhild and Einar LundströmThuréus stiftelse för främjande av geriatrisk forskningKonung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Note

Validerad;2024;Nivå 2;2024-03-21 (signyg);

Funder: the Borgerskapet in Umeå Research Foundation, the Erik and Anne-Marie Detlof Research Foundation, the Swedish Society of Medicine, the Strategic Research Program in Care Sciences (SFO-V, Sweden);

Full text license: CC BY

Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-03-21Bibliographically approved
2. Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study
Open this publication in new window or tab >>Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study
2024 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 19, no 1, article id 2322757Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Aged 80 and over, independent living, nursing care, women’s health, Thematic Analysis, Aging, Home Care Services, Life Change Events, Home Health Nursing, Widowhood, Qualitative Research
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-104621 (URN)10.1080/17482631.2024.2322757 (DOI)001177089100001 ()38431864 (PubMedID)2-s2.0-85186404144 (Scopus ID)
Note

Validerad;2024;Nivå 2;2024-04-09 (joosat);

Full text license: CC BY-NC 4.0;

Available from: 2024-03-18 Created: 2024-03-18 Last updated: 2024-04-09Bibliographically approved
3. Perceptions of a good life for the oldest old living at home
Open this publication in new window or tab >>Perceptions of a good life for the oldest old living at home
2022 (English)In: International Journal of Ageing and Later Life, E-ISSN 1652-8670, Vol. 16, no 1, p. 25-48Article in journal (Refereed) Published
Abstract [en]

An increasing number of people are growing older and living longer in their homes. This study aims to describe key stakeholders’ (politicians, managers, and professionals) perceptions of a good life for single-living oldest old persons living at home with extensive needs for support. Inter­views with stakeholders were analysed with content analysis. The analy­sis resulted in the theme: An incongruence between intentions and actions in promoting a good life for the oldest old. Our findings show a gap between intentions and actions, which caused feelings of powerlessness in the key stakeholders. To promote a good life for the oldest old persons, a congruence is needed between individual awareness and the prerequisite of promoting a good life. Developing methods that identify and bridge gaps between intentions and actions could support the abilities of organ­isations to promote a good life for the oldest old persons with extensive needs for support.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2022
Keywords
ageing in place, capabilities approach, caring, homecare, oldest old
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-92480 (URN)10.3384/ijal.1652-8670.2234 (DOI)2-s2.0-85142433609 (Scopus ID)
Note

Validerad;2022;Nivå 1;2022-11-25 (hanlid)

Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2024-03-21Bibliographically approved

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