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Individualism and Partnership: A Descriptive Qualitative Analysis of the Chronic Disease Phenomenon as Perceived by Older Adults  [PDF]
Kimberly Sell, Elaine Amella, Martina Mueller, Jeannette Andrews, Joy Wachs
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.510099
Abstract: With the older adult population projected to increase substantially in the next 10 years, the incidence of chronic disease will become a significant factor in the burden of disease both globally and within the United States. The chronic disease state has been shown to decrease quality of life and the life expectancy of those individuals. In Tennessee the incidence of chronic disease, lower incomes, and education levels increases the risk of decreased quality of life and increased mortality in the older adult population. A review of literature by the researcher reveals that scant research has focused upon the older adult’s perspective toward chronic illness and making changes to their health routine. As part of a mixed-method correlational study, focus groups used a descriptive qualitative approach to increase understanding of the phenomenon of chronic illness. The purpose of this qualitative study was to determine the attitudes and perceptions of older adults in East Tennessee towards behavior change and health maintenance in chronic disease.
Preconceptions and expectations of older adults about getting hearing aids
Jorunn Solheim
Journal of Multidisciplinary Healthcare , 2011, DOI: http://dx.doi.org/10.2147/JMDH.S14949
Abstract: econceptions and expectations of older adults about getting hearing aids Original Research (3800) Total Article Views Authors: Jorunn Solheim Published Date January 2011 Volume 2011:4 Pages 1 - 8 DOI: http://dx.doi.org/10.2147/JMDH.S14949 Jorunn Solheim ENT Department, Lovisenberg Diakonale Hospital, Oslo, Norway Aim: The objectives of this study were to describe preconceptions and expectations of older adults about getting hearing aids and to explore the influence of hearing loss (HL), hearing aid experience, gender, age, and marital status on these preconceptions and expectations. Methods: A total of 174 participants aged above 65 years were randomly selected from a waiting list for hearing aid fitting. Hearing threshold was tested using pure tone audiometry. A self-report questionnaire with a specific focus on preconceptions and expectations about getting hearing aids, external influences, and the psychosocial problems associated with HL and the use of a hearing aid was administered. Results: A factor analysis revealed three factors: positive expectations, barriers, and social pressure. Cronbach's a was 0.847 for positive expectations and 0.591 for barriers. Cronbach's a was not statistically applicable to the social pressure factor, as it consisted of only one item. Adjusted linear regression analysis revealed that participants with moderate to severe HL and hearing aid experience had a significant increase in positive expectations. Male gender was associated with fewer barriers to hearing aids. Age and marital status had no influence on the three factors. Conclusion: Less positive expectations and more problem-oriented preconceptions among subjects with mild HL may explain why hearing aids are scarcely used. Additionally, lower estimated need and modest plans for regular use among this group could mean hearing aids are not used. Rehabilitation should focus on investment of time, continuity of use, realistic expectations, and follow-up support.
A descriptive study of older adults with persistent pain: Use and perceived effectiveness of pain management strategies [ISRCTN11899548]
Carol A Kemp, Mary Ersek, Judith A Turner
BMC Geriatrics , 2005, DOI: 10.1186/1471-2318-5-12
Abstract: Adults ≥ 65 years old and living in retirement facilities who reported persistent pain (N = 235, mean age = 82 years, 84% female, 94% white) completed measures of demographics, pain, depression, self-efficacy for managing pain, and a Pain Management Strategies Survey. Participants identified current and previous-year use of 42 pain management strategies and rated helpfulness of each on a 5-point scale.Acetaminophen, regular exercise, prayer, and heat and cold were the most frequently used pain management strategies (61%, 58%, 53%, and 48%, respectively). Strategies used by >25% of the sample that were rated moderately or more helpful (i.e., >2 on a 0 to 4 scale) were prayer [mean (SD) = 2.9 (0.9)], opioids [2.6 (0.8)], regular exercise [2.5 (1.0)], heat/cold [2.5 (1.0)], nonsteroidal anti-inflammatory drugs [2.4 (1.0)], and acetaminophen [2.3 (1.0)]. Young-old (65–74 years) study participants reported use of more strategies than did old-old (85+ years) participants (p = .03). Perceived helpfulness of strategy use was significantly associated with pain intensity (r = -.14, p < .0001), self-efficacy (r = .28, p < .0001), and depression (r = -.20, p = .003).On average, older adults view the strategies they use for persistent pain as only moderately helpful. The associations between perceived helpfulness and self-efficacy and depression suggest avenues of pain management that are focused less on specific treatments and more on how persons with persistent pain think about their pain.Persistent pain is common among adults age 65 years and older [1,2], affecting 58–70% of community-dwelling older adults [3,4]. It is often associated with significant physical and psychosocial disability [5]. The most common types of persistent pain in this age group are neuropathic and musculoskeletal (e.g., low back pain, osteoarthritis pain, and pain in previous fracture sites) [2,5].Despite the prevalence and importance of persistent pain among older adults, little research has systemati
Preconceptions and expectations of older adults about getting hearing aids  [cached]
Jorunn Solheim
Journal of Multidisciplinary Healthcare , 2011,
Abstract: Jorunn SolheimENT Department, Lovisenberg Diakonale Hospital, Oslo, NorwayAim: The objectives of this study were to describe preconceptions and expectations of older adults about getting hearing aids and to explore the influence of hearing loss (HL), hearing aid experience, gender, age, and marital status on these preconceptions and expectations.Methods: A total of 174 participants aged above 65 years were randomly selected from a waiting list for hearing aid fitting. Hearing threshold was tested using pure tone audiometry. A self-report questionnaire with a specific focus on preconceptions and expectations about getting hearing aids, external influences, and the psychosocial problems associated with HL and the use of a hearing aid was administered.Results: A factor analysis revealed three factors: positive expectations, barriers, and social pressure. Cronbach's a was 0.847 for positive expectations and 0.591 for barriers. Cronbach's a was not statistically applicable to the social pressure factor, as it consisted of only one item. Adjusted linear regression analysis revealed that participants with moderate to severe HL and hearing aid experience had a significant increase in positive expectations. Male gender was associated with fewer barriers to hearing aids. Age and marital status had no influence on the three factors.Conclusion: Less positive expectations and more problem-oriented preconceptions among subjects with mild HL may explain why hearing aids are scarcely used. Additionally, lower estimated need and modest plans for regular use among this group could mean hearing aids are not used. Rehabilitation should focus on investment of time, continuity of use, realistic expectations, and follow-up support.Keywords: hearing aid, older adults, preconceptions, expectations, barriers
Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey
Christine E Kistler, Carmen L Lewis, Halle R Amick, Debra L Bynum, Louise C Walter, Lea C Watson
BMC Family Practice , 2006, DOI: 10.1186/1471-2296-7-9
Abstract: We performed a mixed qualitative-quantitative cross-sectional study in which 116 healthy adults aged 70+ were recruited from two local retirement communities. We interviewed them regarding their beliefs about physician-estimated life expectancy in the context of a larger study on cancer screening beliefs. Semi-structured interviews of 80 minutes average duration were performed in private locations convenient to participants. Demographic characteristics as well as cancer screening beliefs and beliefs about life expectancy were measured. Two independent researchers reviewed the open-ended responses and recorded the most common themes. The research team resolved disagreements by consensus.This article reports the life-expectancy results portion of the larger study. The study group (n = 116) was comprised of healthy, well-educated older adults, with almost a third over 85 years old, and none meeting criteria for dementia. Sixty-four percent (n = 73) felt that their physicians could not correctly estimate their life expectancy. Sixty-six percent (n = 75) wanted their physicians to talk with them about their life expectancy. The themes that emerged from our study indicate that discussions of life expectancy could help older adults plan for the future, maintain open communication with their physicians, and provide them knowledge about their medical conditions.The majority of the healthy older adults in this study were open to discussions about life expectancy in the context of discussing cancer screening tests, despite awareness that their physicians' estimates could be inaccurate. Since about a third of participants perceived these discussions as not useful or even harmful, physicians should first ascertain patients' preferences before discussing their life expectancies.Estimates of life expectancy assist physicians and patients in medical decision-making [1]. The time-delayed benefits for many medical treatments, such as cancer screening, make an older adult's life expec
Complementary and alternative medicine (CAM) use by african american (AA) and caucasian american (CA) older adults in a rural setting: a descriptive, comparative study
Norma Cuellar, Teresa Aycock, Bridgett Cahill, Julie Ford
BMC Complementary and Alternative Medicine , 2003, DOI: 10.1186/1472-6882-3-8
Abstract: The design was a descriptive, comparative study of 183 elders who reported the number of CAM used and satisfaction with CAM. A convenience sample was recruited through community service organizations in the state of Mississippi. The availability of elders through the support groups, sampling bias, subject effect, and self-report were limitations of the study.The commonest examples of CAM used by rural elders were prayer, vitamins, exercise, meditation, herbs, chiropractic medicine, glucosamine, and music therapy. Significant findings on SES and marital status were calculated. Differences on ethnicity and demographic variables were significant for age, education, and the use of glucosamine.Health care providers must be aware that elders are using CAM and are satisfied with their use. Identifying different uses of CAM by ethnicity is important for health care practitioners, impacting how health care is provided.An increasing number of people are using complementary and alternative medicine (CAM). According to recent studies, 42.1 % of the American population uses some form of CAM, with 39% of the older population using CAM [1,2]. In 1997, total spending on CAM was estimated at $32.7 billion dollars, up from $22.6 billion in 1990, a substantial increase that indicates an escalating portion of the population is seeking CAM [2]. Patients may choose to use CAM as a substitute or in conjunction with conventional medicine for a variety of reasons, including 1) dissatisfaction with health care providers and medical outcomes, 2) side effects of drugs or treatments, 3) high health costs (specifically medications), 4) lack of control in their own health care practices, and 5) impersonal and technological health care [3-5].In reviewing the literature, research studies have not reported on CAM use among rural residents, older adults in culturally diverse groups. In rural settings, limited access to medical care often leads to late diagnosis, postponement of treatment, and greater
Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities
Carmen L Lewis, Christine E Kistler, Halle R Amick, Lea C Watson, Debra L Bynum, Louise C Walter, Michael P Pignone
BMC Geriatrics , 2006, DOI: 10.1186/1471-2318-6-10
Abstract: Face to face interviews with 116 residents age 70 or over from two long-term care retirement communities. Interview content included questions about whether participants had discussed cancer screening with their physicians since turning age 70, their attitudes about information important for individualized decisions, and their attitudes about continuing cancer screening later in life.Forty-nine percent of participants reported that they had an opportunity to discuss cancer screening with their physician since turning age 70; 89% would have preferred to have had these discussions. Sixty-two percent believed their own life expectancy was not important for decision making, and 48% preferred not to discuss life expectancy. Attitudes about continuing cancer screening were favorable. Most participants reported that they would continue screening throughout their lives and 43% would consider getting screened even if their doctors recommended against it. Only 13% thought that they would not live long enough to benefit from cancer screening tests. Factors important to consider stopping include: age, deteriorating or poor health, concerns about the effectiveness of the tests, and doctors recommendations.This select group of older adults held positive attitudes about continuing cancer screening later in life, and many may have had unrealistic expectations. Individualized decision making could help clarify how life expectancy affects the potential survival benefits of cancer screening. Future research is needed to determine whether educating older adults about the importance of longevity in screening decisions would be acceptable, affect older adults' attitudes about screening, or change their screening behavior.Although cancer is an important cause of morbidity and mortality in older adults [1], the incidence of other serious conditions also increases with age. These competing causes of mortality decrease the likelihood that an older individual could experience a survival benef
A Systematic Review of Studies Measuring and Reporting Hearing Aid Usage in Older Adults since 1999: A Descriptive Summary of Measurement Tools  [PDF]
Elvira Perez, Barrie A. Edmonds
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0031831
Abstract: Objective A systematic review was conducted to identify and quality assess how studies published since 1999 have measured and reported the usage of hearing aids in older adults. The relationship between usage and other dimensions of hearing aid outcome, age and hearing loss are summarised. Data sources Articles were identified through systematic searches in PubMed/MEDLINE, The University of Nottingham Online Catalogue, Web of Science and through reference checking. Study eligibility criteria: (1) participants aged fifty years or over with sensori-neural hearing loss, (2) provision of an air conduction hearing aid, (3) inclusion of hearing aid usage measure(s) and (4) published between 1999 and 2011. Results Of the initial 1933 papers obtained from the searches, a total of 64 were found eligible for review and were quality assessed on six dimensions: study design, choice of outcome instruments, level of reporting (usage, age, and audiometry) and cross validation of usage measures. Five papers were rated as being of high quality (scoring 10–12), 35 papers were rated as being of moderate quality (scoring 7–9), 22 as low quality (scoring 4–6) and two as very low quality (scoring 0–2). Fifteen different methods were identified for assessing the usage of hearing aids. Conclusions Generally, the usage data reviewed was not well specified. There was a lack of consistency and robustness in the way that usage of hearing aids was assessed and categorised. There is a need for more standardised level of reporting of hearing aid usage data to further understand the relationship between usage and hearing aid outcomes.
Getting out and about in older adults: the nature of daily trips and their association with objectively assessed physical activity
Mark G Davis, Kenneth R Fox, Melvyn Hillsdon, Jo C Coulson, Debbie J Sharp, Afroditi Stathi, Janice L Thompson
International Journal of Behavioral Nutrition and Physical Activity , 2011, DOI: 10.1186/1479-5868-8-116
Abstract: Participants (n = 214, aged 78.1 SD 5.7 years), completed a seven-day trips log recording daily-trip frequency, purpose and transport mode. Concurrently participants wore an accelerometer which provided mean daily steps (steps·d-1), and minutes of moderate to vigorous PA (MVPA·d-1). Participants' physical function (PF) was estimated and demographic, height and weight data obtained.Trip frequency was associated with gender, age, physical function, walking-aid use, educational attainment, number of amenities within walking distance and cars in the household. Participants reported 9.6 (SD 4.2) trips per week (trips·wk-1). Most trips (61%) were by car (driver 44%, passenger 17%), 30% walking or cycling (active) and 9% public transport/other. Driving trips·wk-1 were more common in participants who were males (5.3 SD 3.6), well-educated (5.0 SD 4.3), high functioning (5.1 SD 4.6), younger (5.6 SD 4.9), affluent area residents (5.1 SD 4.2) and accessing > one car (7.2 SD 4.7). Active trips·wk-1 were more frequent in participants who were males (3.4 SD 3.6), normal weight (3.2 SD 3.4), not requiring walking aids (3.5 SD 3.3), well-educated (3.7 SD 0.7), from less deprived neighbourhoods (3.9 SD 3.9) and with ≥ 8 amenities nearby (4.4 SD 3.8).Public transport, and active trip frequency, were significantly associated with steps·d-1 (p < 0.001), even after adjustment for other trip modes and potential confounders. Public transport, active, or car driving trips were independently associated with minutes MVPA·d-1 (p < 0.01).Daily trips are associated with objectively-measured PA as indicated by daily MVPA and steps. Public transport and active trips are associated with greater PA than those by car, especially as a car passenger. Strategies encouraging increased trips, particularly active or public transport trips, in OAs can potentially increase their PA and benefit public health.In the UK, the number of adults aged over 65 years increased between 1983 and 2008 by 1.5 m and thos
"I really should've gone to the doctor": older adults and family caregivers describe their experiences with community-acquired pneumonia
Caralyn Kelly, Paul Krueger, Lynne Lohfeld, Mark Loeb, H Gayle Edward
BMC Family Practice , 2006, DOI: 10.1186/1471-2296-7-30
Abstract: A qualitative study that used face-to-face semi-structured interviews to collect data from a purposeful sample of seniors aged 60+ and their family members living in a mid-sized Canadian city. Data analysis began with descriptive and interpretive coding, then advanced as the research team repeatedly compared emerging thematic categories to the raw data. Searches for disconfirming evidence and member checking through focus groups provided additional data and helped ensure rigour.Community-acquired pneumonia symptoms varied greatly among older adults, making decisions to seek care difficult for them and their family members. Both groups took varying amounts of time as they attempted to sort out what was wrong and then determine how best to respond. Even after they concluded something was wrong, older adults with confirmed pneumonia continued to wait for days, to over a week, before seeking medical care. Participants provided diverse reasons for this delay, including fear, social obligations (work, family, leisure), and accessibility barriers (time, place, systemic). Several older adults and family members regretted their delays in seeking help.Treatment-seeking delay is a variable, multi-phased decision-making process that incorporates symptom assessment plus psychosocial and situational factors. Public health and health care professionals need to educate older adults about the potential causes and consequences of unnecessary waits. Such efforts may reduce the severity of community-acquired pneumonia upon presentation at clinics and hospitals, and that, in turn, could potentially improve health outcomes.Considerable literature exists on how seniors experience and respond to illness, including how they make decisions to use health services. Researchers have learned that many older people find it difficult to determine the importance of their symptoms, and that this "figuring-out" process is potentially time-consuming, [1,2] particularly for people already coping with c
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