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Accepting the inevitable: A mixed method approach with assessment and perceptions of well-being in very old persons within the northern Sweden Silver-MONICA study
Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Development, Region Norrbotten, Luleå, Sweden.ORCID iD: 0000-0002-1022-8741
Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Development, Region Norrbotten, Luleå, Sweden.ORCID iD: 0000-0001-5953-8970
Department of Development, Region Norrbotten, Luleå, Sweden.
Luleå University of Technology, Professional Support.ORCID iD: 0000-0001-9410-1985
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2021 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 92, article id 104275Article in journal (Refereed) Published
Abstract [en]

Background

As the group of very old persons will form an increasing part of society, the study of how well-being is described and affected by specific factors will be of importance to meet the future needs of these persons. The aim of the study was to increase knowledge of well-being in very old persons by combining assessments and perceptions using the Philadelphia Geriatric Morale Scale (PGCMS).

Method

In a mixed method, convergent parallel design, 52 persons 80 years or older were assessed and interviewed using the PGCMS to combine assessment of morale and descriptions of perceptions of well-being using a mixed method approach.

Results

Quantitative and qualitative results converged in four areas: not feeling lonely and being included, rating and perceiving health as good, high physical function/ability and being physically active, living in own house and feeling at home. Areas perceived as important to well-being captured only in qualitative analysis were having freedom and engagement. An example of insights not achievable from the quantitative or qualitative analysis alone was that individuals with high morale expressed anxiety about losing their health due to potential ageing-related threats and that individuals with low morale struggled with acceptance. Acceptance was the key strategy for handling adverse consequences of ageing in all described areas.

Conclusion

When using standardized assessment scales in clinical practice, it could be useful to combine quantitative and qualitative data. Acceptance was key for well-being; however, acceptance could be resigned or reorienting in nature.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 92, article id 104275
Keywords [en]
Well-being, Quality of life, Oldest old, Subjective well-being, Life satisfaction
National Category
Nursing
Research subject
Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-81054DOI: 10.1016/j.archger.2020.104275ISI: 000600899700010PubMedID: 33032185Scopus ID: 2-s2.0-85092063262OAI: oai:DiVA.org:ltu-81054DiVA, id: diva2:1473868
Note

Validerad;2020;Nivå 2;2020-10-07 (johcin)

Available from: 2020-10-07 Created: 2020-10-07 Last updated: 2023-09-04Bibliographically approved
In thesis
1. Healthy Ageing and Well-Being in Old Age
Open this publication in new window or tab >>Healthy Ageing and Well-Being in Old Age
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the decades to come, Sweden will be facing an unprecedented increase in the proportion of inhabitants aged 80 years or older. This age group is characterised by large heterogeneity; however ageing also poses challenges for health and well-being. These challenges apply not only to the individual, but also to the health care systems. Care of this older age group employs much of the nursing resources, affecting society as a whole. Healthy ageing can and should, therefore, be promoted in the decades prior to reaching old age, and once having reached old age, well-being should be a continued focus of health care and society. In this way older adults can continue perceiving good health and well-being. The overall aim of this thesis was to explore and describe areas of importance to healthy ageing and well-being in old age. 

Predictors of healthy ageing were prospectively studied as part of the northern Sweden Silver-MONICA project, from baseline in 1999 (n=1595) to follow-up 20 years later (n=541). For the healthy ageing outcome, a composite outcome comprised of measures of cognition (MMSE), 2.4 metre walking speed, personal independence in everyday life (Katz P-ADL) and depression (GDS15) was constructed. To study perceptions of general well-being in old age, a subsample (n=52) age > 80 was analysed as a cross-section using mixed method with open-ended interviews and the PGCMS well-being measure. A similar approach was used (n=50) to investigate specific aspects of well-being in relation to home. To study the relationship between well-being and objectively measure everyday physical activity, an accelerometer was worn 24 hours per day for at least 5 consecutive days (n=77) and analysed for associations with the PGCMS and its subscales.  

The five top ranking predictors determined by the healthy ageing index, comprising the total baseline cohort including those who passed away before possible follow-up were smoking status, NT-proBNP, waist circumference, leisure time physical activity level and HbA1c. For those who participated in the Silver-MONICA follow-up, the top five ranking predictors as determined by the healthy ageing index were leisure time physical activity, HbA1c, BMI, waist circumference and high sensitivity Troponin I. In interviews of general well-being, six areas were described that related to social context, health, physical activity, home, engagement and freedom. In regression analysis independence in activities of everyday living along with age were significantly associated with well-being. Acceptance was key for handling consequences of ageing that impacted well-being. Home was perceived as a central aspect of well-being; however, participants described being in the margins of home. Morale was higher among persons living in single-dwelling housing compared to those living in apartments. In activity measures, well-being was associated with the number of steps, time spent stepping and time spent stepping at >75 steps/minute.

In conclusion, the combination of qualitative, quantitative and mixed methodology utilised in this thesis to study healthy ageing allowed for the possibility to nuance conclusions and to describe the subject from different points of view. Based on the findings, this thesis suggests that physical ability in old age is the basis for being able to engage in and experience the important factors of well-being described above. However, support from others, often family, can compensate for the lack of physical ability. The support is positive to well-being as long as it does not create feelings of being a burden. As consequences of ageing affect the areas most crucial to well-being, it seems that the extent and way these changed conditions are accepted has an important role in the maintaining of well-being in old age.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2023
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords
Healthy ageing, Well-being, Aged, Aged, 80 and over
National Category
Gerontology, specialising in Medical and Health Sciences
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-95755 (URN)978-91-8048-301-8 (ISBN)978-91-8048-302-5 (ISBN)
Public defence
2023-05-26, A117, Luleå tekniska universitet, Luleå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-04-12 Created: 2023-04-06 Last updated: 2023-05-05Bibliographically approved

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Almevall, Albin DahlinZingmark, KarinForslund, Ann-Sofie

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