Bjørg Dale

Self-care ability among home-dwelling older people in rural areas in southern Norway

INTRODUCTION The growing number of older people is assumed to represent many challenges in the future. Self-care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self-care ability is closely related to perceived health, sense of coherence and nutritional risk. AIM The aim of this study was to describe self-care ability among home-dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. METHODS A cross-sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health-related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods. RESULTS A total of 780 persons were found to have higher self-care ability and 240 to have lower self-care ability using the Self-care Ability Scale for the Elderly. Self-care ability was found to be closely related to health-related issues, self-care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self-care ability were to have higher self-care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. CONCLUSIONS When self-care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.

Life situation and identity among single older home-living people: a phenomenological-hermeneutic study.

Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., “being able to do” and “being able to be”, and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants.

Nutritional screening of older home-dwelling Norwegians: a comparison between two instruments

Background It is important to obtain knowledge about the prevalence of nutritional risk and associated factors among older home-dwelling people in order to be able to meet nutritional challenges in this group in the future and to plan appropriate interventions. The aim of this survey was to investigate the prevalence of home-dwelling older people at nutritional risk and to identify associated factors using two different nutritional screening instruments as self-report instruments. Methods This study had a cross-sectional design. A postal questionnaire, including the Norwegian versions of the Nutritional Form for the Elderly (NUFFE-NO) and Mini Nutritional Assessment – Short Form (MNA-SF), background variables, and health-related questions was sent to a randomized sample of 6033 home-dwelling older people in southern Norway. A total of 2106 (34.9%) subjects were included in the study. Data were analyzed using descriptive statistics and logistic regression analyses. Results When using the NUFFE-NO and MNA-SF, 426 (22.3%) and 258 (13.5%) older persons, respectively, were identified to be at nutritional risk. The risk of undernutrition increased with age. Several predictors for being at risk of undernutrition, including chronic disease/handicap and receiving family help, as well as protective factors, including sufficient food intake and having social contacts, were identified. Conclusion Health professionals must be aware of older people’s vulnerability to risk of undernutrition, perform screening, and have a plan for preventing under-nutrition. For that purpose, MNA-SF and NUFFE-NO can be suggested for screening older people living at home.

Older home nursing patients' perception of social provisions and received care

Social loneliness and isolation may be some of the consequences that older people experience regarding age-related changes and losses, and nurses should be engaged in identifying social networks and social needs in this group. The aims of this study were to describe perceived social provisions in a group of older home-dwelling care-dependent patients, and to explore the relationship between perceived social provisions, physical functioning, mental state and reception of formal and informal care. The sample consisted of 242 persons aged 75+ years from seven municipalities in southern Norway, all receiving home nursing. Data were collected by means of structured interviews. Social support was assessed using the revised Social Provisions Scale. Physical functioning was assessed using the Barthel Index, and mental state using questions about loneliness, depressive symptoms and anxiety. Types and frequencies of social network contacts and formal and informal care were registered. Descriptive statistics, Mann-Whitney U-tests, Cronbachs alpha coefficient and stepwise multiple regression were used in the analyses. In general, the level of perceived social provisions and togetherness in the study group was high, especially among women and the married. Decreased physical functioning and declined mental state were related to lower level of social provisions. The majority of the individuals had frequently contacts with several types of social networks, like friends, neighbours and religious communities, in addition to close family. Contact with these informal networks was found to be close related to perceived social support and togetherness. Reduced social provisions was related to increased amount of home nursing, which could indicate that demand for home care may work as a strategy to gain social contact. In this sense, dependence in daily life functioning could possibly contribute to social contact rather than reduce it.Scand J Caring Sci; 2010; 24; 523–532 Older home nursing patients’ perception of social provisions and received care Social loneliness and isolation may be some of the consequences that older people experience regarding age-related changes and losses, and nurses should be engaged in identifying social networks and social needs in this group. The aims of this study were to describe perceived social provisions in a group of older home-dwelling care–dependent patients, and to explore the relationship between perceived social provisions, physical functioning, mental state and reception of formal and informal care. The sample consisted of 242 persons aged 75+ years from seven municipalities in southern Norway, all receiving home nursing. Data were collected by means of structured interviews. Social support was assessed using the revised Social Provisions Scale. Physical functioning was assessed using the Barthel Index, and mental state using questions about loneliness, depressive symptoms and anxiety. Types and frequencies of social network contacts and formal and informal care were registered. Descriptive statistics, Mann–Whitney U-tests, Cronbach’s alpha coefficient and stepwise multiple regression were used in the analyses. In general, the level of perceived social provisions and togetherness in the study group was high, especially among women and the married. Decreased physical functioning and declined mental state were related to lower level of social provisions. The majority of the individuals had frequently contacts with several types of social networks, like friends, neighbours and religious communities, in addition to close family. Contact with these informal networks was found to be close related to perceived social support and togetherness. Reduced social provisions was related to increased amount of home nursing, which could indicate that demand for home care may work as a strategy to gain social contact. In this sense, dependence in daily life functioning could possibly contribute to social contact rather than reduce it.

Formal and informal care in relation to activities of daily living and self-perceived health among older care-dependent individuals in Norway.

Background.  Research about formal care of older home-dwelling people in the Nordic countries is comprehensive, while research on informal care has been less inclusive. Aim.  To describe self-reported activities of daily living and perceived health, and to relate them to amount and types of formal and informal care received by a group of care-dependent, home-dwelling older individuals in Norway. Design and methods.  A sample consisting of 242 persons aged 75+ years receiving home nursing services. Data were collected by means of structured interviews with questions about activities of daily living (ADL), amount and types of formal and informal care and demographic variables. Descriptive statistics, chi-square test, Mann-Whitney U-test and multiple stepwise regression were used in the analyses. Results.  ADL dependency was the only predictor for explaining quantity of home nursing received. Those who received a generous amount of formal care also received a lot of care and support from informal networks. The type of care from the two sources differed. The home nurses performed PADL tasks. While the informal caregivers offered help with IADL tasks. Conclusion.  This study of receiving help in this group of older people in Norway shows that formal and informal care resources complement one another.

The meaning of actualization of self-care resources among a group of older home-dwelling people--a hermeneutic study.

Self-care is an activity of mature persons who have developed their abilities to take care of themselves. Individuals can choose to actualize their self-care abilities into self-care activities to maintain, restore, or improve health and well-being. It is of importance to understand the meaning of the actualization of self-care resources among older people. The aim of this study was to investigate the meaning of the actualization of self-care resources, i.e., actions taken to improve, maintain, or restore health and well-being, among a group of older home-dwelling individuals with a high sense of coherence. The design of this study was to reanalyse narratives revealing self-care activities from 11 (five females and six males) Norwegian older home-dwelling people (65 years or older) identified as having a high sense of coherence. In order to reveal the meaning and get an understanding of why these self-care resources were realized or actualized, a Gadamerian-based research method was chosen. The analysis revealed four themes that showed the meaning of actualization of self-care resources in the study group: “Desire to carry on”, “Be of use to others”, “Self-realization”, and “Confidence to manage in the future”. The findings showed what older people found meaningful to strive for, and this information can be used as a guide for health professionals when supporting older people in their self-care. Older people with self-care resources can also be an important resource for others in need of social contact and practical help. These resources have to be asked for in voluntary work among older people in need of help and, thereby, can be a valuable supplement to the community health care system.

Narrated lived experiences of self-care and health among rural-living older persons with a strong sense of coherence

Sense of coherence (SOC), with its components comprehensibility, manageability, and meaningfulness, is a major factor in the ability to cope successfully with stressors and is closely related to health. Qualitative studies related to SOC are scarce, and in this phenomenological interview study, self-care is investigated in relation to SOC. The aim of this study was to describe the lived experiences of self-care and features that may influence health and self-care among older home-dwelling individuals living in rural areas and who have a strong SOC. Eleven persons with a mean age of 73.5 years and a SOC value in the range of 153–188, measured by Antonovsky’s 29-item SOC scale, were interviewed. The interviews were recorded, transcribed verbatim, and analyzed with a phenomenological descriptive method. The findings showed that successful self-care involves having, when needed, contact with the health care system, being conscious of a sound lifestyle, being physically and mentally active, being engaged, having social contacts with family and/or others, and being satisfied and positive and looking forward. Formal and informal caregivers should be conscious of the importance of motivating and supporting older individuals with respect to these dimensions of self-care.

Testing and using Goldberg's General Health Questionnaire: Mental health in relation to home nursing, home help, and family care among older, care-dependent individuals

The aims of this study were to test the Norwegian version of Goldbergs 30-item General Health Questionnaire (GHQ-30) in a group of older, care-dependent individuals living at home; to describe self-reported mental health; and to relate mental health to receiving home nursing, home help, and family care. A sample of 234 home nursing patients in Norway aged 75 years and older was interviewed. Mental state was assessed using the GHQ-30. Reliability and validity were calculated with Spearmans rank correlations, Cronbachs alpha coefficient, and Mann-Whitney U-test. The factor analysis was performed using the principal components analysis with varimax rotation and Kaiser normalization. Demographic characteristics and amounts of formal and family care were recorded, and descriptive statistics and stepwise multiple regression were used in the analyses. Cronbachs alpha coefficient for the GHQ was 0.92. The item-total correlations were generally acceptable. For items concerning depression and anxiety, the item-total correlations ranged from r(s)= 0.60 to 0.77. The factors extracted in the factor analysis explained 70% of the variance in the group. Females <85 years of age living in urban areas were associated with reduced mental health. There were no associations between general mental health and the amounts of formal and family care provided.

Psychometric properties of the Norwegian version of the General Health Questionnaire (GHQ-30) among older people living at home

Introduction The incidence and prevalence of mental problems among older people are difficult to map because the causes are often complex and the symptoms manifest in a range of ways. Therefore, there is a need for robust and useful instruments for screening mental problems in this group. One instrument used in Norway and around the world is the 30-item version of the General Health Questionnaire (GHQ-30). Nevertheless, studies testing reliability and validity of the Norwegian version are scarce. Aim The aim of this study was to test the psychometric properties, by means of reliability and construct validity, of the Norwegian version of the GHQ-30 in a sample of older people living at home. Methods A cross-sectional design was used. A postal questionnaire including background variables and a range of health related questions, including the GHQ-30, was mailed to 6033 older people (age 65 years or more) who lived in their own homes in southern Norway. A final sample of 2106 persons (34.9%) responded to and returned the questionnaire. Data were analyzed statistically regarding reliability and construct validity of the GHQ-30. Results The reliability of the instrument, reflecting its homogeneity, was shown in a Cronbach’s alpha coefficient of 0.93 and in significant item-to-total correlations. Construct validity was supported as the GHQ-30 demonstrated robustness in separating groups with known mental problems. Construct validity was also demonstrated in a logical four factor solution, which accounted for 50.0% of the variance in the study group. The factor structure supported previous testing studies of the instrument. Conclusion The GHQ-30 showed satisfactory psychometric properties regarding reliability and construct validity in this study group, which may indicate that the instrument is suitable for use in screening mental problems in older people living at home.

Administration of care to older patients in transition from hospital to home care services: home nursing leaders' experiences

Background Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. Methods A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach. Results Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture. Conclusion To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the different organizational levels and units were pointed out as major factors requiring improvement.