Eleanor Palo Stoller

Complementary Therapy Use and Health Self-Management Among Rural Older Adults

OBJECTIVESnThis article describes dimensions of complementary therapy use among rural older adults, employs these dimensions to delineate sets of complementary therapy use, and describes the personal characteristics related to each set of complementary therapy use.nnnMETHODSnData are from in-depth interviews conducted with 62 African American and White rural older adults.nnnRESULTSnThree dimensions of complementary therapy use are delineated: types of therapies used, mindfulness in therapy use, and sharing information with conventional health care providers. The intersection of these dimensions indicates 5 patterned sets of complementary therapy use among rural older adults: (a) mindful use of only home remedies; (b) mindful use of home remedies and contemporary supplements; (c) mindful use of home remedies, contemporary supplements, and complementary practices; (d) nonmindful use of home remedies and contemporary supplements; and (e) use of conventional care only. Involvement in the 5 sets of therapy use is related to sex, ethnicity, educational attainment, and migration.nnnDISCUSSIONnUnderstanding how older adults include sets of complementary therapies in their health self-management is important for improving their health care resources, expectations, awareness, and priorities.

Alcohol Consumption Decisions Among Nonabusing Drinkers Diagnosed with Hepatitis C An Exploratory Sequential Mixed Methods Study

Most studies of decisions to curtail alcohol consumption reflect experiences of abusing drinkers. An exploratory sequential research design is used to explore the applicability of this research to the experience of nonabusing drinkers advised to curtail alcohol consumption after a hepatitis C diagnosis. A qualitative component identified 17 new decision factors not reflected in an inventory of factors based on synthesis of existing scales. Qualitative data were triangulated by supplementing semistructured interviews with Internet postings. A quantitative component estimated prevalence and association with current drinking of these new decision factors. Patients who quit drinking tended to attribute postdiagnosis drinking to occasional triggers, whereas patients who were still drinking were more likely to endorse rationales not tied to specific triggers.

Older Adults' Self-Management of Daily Symptoms: Complementary Therapies, Self-Care, and Medical Care

Objectives: To describe older adults’ use of complementary therapies, self-care practices, and medical care to treat daily symptoms and to delineate gender, ethnic, age, and education differences. Method: A total of 200 African American and White participants (age 65+) selected using a site-based procedure complete a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. The percent of older adults using a therapy and the frequency with which therapies are used are considered. Results: The use of complementary therapies to treat daily symptoms, though important, is substantially less than the use of self-care practices and medical care. Participants differed by age, ethnicity, and education in the use of therapies. Discussion: In considering the percentage of individuals who use a therapy and the frequency with which therapies are used, this analysis adds a new dimension to understanding how older adults manage daily symptoms. Older adults are selective in their use of health self-management.

Communicating About Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives

BackgroundAbstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis.ObjectiveThis study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear.DesignWe conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (Nu2009=u200950) and healthcare providers (Nu2009=u200914) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program.ResultsWe found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients. Patient respondents who reported hearing “stop completely” were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in “medical language” than were GI providers.ConclusionsTo make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.

Gender and Health Lifestyle: An In-Depth Exploration of Self-Care Activities in Later Life

Objective. Evaluate similarities and differences in the self-care domain of health lifestyle among older, rural-dwelling women and men. Method. Qualitative analysis of in-depth interview data from 62 community-dwelling older (M = 74.3 years) African and European American women and men. Results. Both older women and men rely heavily on over-the-counter medications and home remedies for self-care; professional health care is typically sought when self-care is not effective. However, relative to men, women were more knowledgeable about different approaches to self-care, especially home remedies; they used a wider range of self-care activities; and they placed greater priority on self-care over professional health care. Discussion. The structure of older women’s and men’s self-care domain of health lifestyle is similar. However, there are subtle differences in health lifestyle that are likely embedded in gendered role behavior and may contribute to women’s greater health complaints.

Daily Use of Complementary and Other Therapies for Symptoms Among Older Adults: Study Design and Illustrative Results

Objectives: This article describes research designed to specify complementary therapies used among older adults by obtaining daily use data and the specific purposes for use. Design: Two hundred African American and White participants completed a baseline interview and up to six sets of three daily-diary interviews at monthly intervals. Results: Participants provided retrospective information on complementary therapy use and information on the use of therapies for specific symptoms experienced across 3,070 person days. Retrospective information indicated that most participants used complementary therapies (e.g., 85.0% used home remedies in the past year). The use of complementary or other therapies and the number of days the therapies were used varied for specific symptoms. For example, home remedies were used on 86 (9.1%) of the 944 person days for which joint pain was reported. Discussion: The daily-diary design provides detailed information for delineating how elders include complementary and other therapies in their health self-management.

The Structure and Function of Frail Male Veterans' Informal Networks

Objectives: This research focuses on the role of informal networks in providing emotional support, instrumental aid, and assistance with chronic disease management for frail male veterans. Methods: Telephone interviews were conducted with nursing home eligible veterans living in the community. Name-generating questions were used to illicit network members. Results: Data on 198 frail male veterans indicate that they have about three people they rely on for emotional support, instrumental aid, health appraisal, and health monitoring. Networks are composed primarily of family, and adult sons are mentioned almost as often as adult daughters. Discussion: Findings illustrate not only the role women play as providers of the majority of informal care to veterans but also the substantial role adult sons have in providing support to their fathers. Many veterans are at risk of institutionalization by having no one to provide instrumental support and health monitoring.

Lay Management of Chronic Disease: A Qualitative Study of Living with Hepatitis C Infection

OBJECTIVESnTo examine management strategies and goals reported by people diagnosed with chronic hepatitis C.nnnMETHODSnWe analyzed data from semistructured interviews (N = 42) and from electronic sources [illness narratives (N = 79) and Internet threaded discussions (N = 264)]. Line-by-line coding, comparisons, and team discussions generated catalogs of lay management strategies and goals. We analyzed code-based files to identify informants selection of specific strategies for each goal.nnnRESULTSnWe classified lay management strategies into 3 categories: medical self-care, behavior change, and coping. These strategies were used selectively in addressing multiple goals, categorized as fighting the virus, strengthening the body, and managing consequences.nnnCONCLUSIONSnResults underscore the diversity of strategies for living with a disease characterized by uncertain prognosis and variable expression of symptoms.

Calling the Doctor A Qualitative Study of Patient-Initiated Physician Consultation Among Rural Older Adults

Objectives: Guided by Leventhal’s self-regulatory model and Cockerham’s theory of health lifestyles, we explore two questions regarding physician consultation among elderly rural adults: What symptom characteristics prompt patient-initiated physician consultation? Do participants’ accounts of responses to symptoms, including the decision to consult a physician, incorporate descriptions of change over time? Method: We analyze data from semistructured in-depth interviews with 62 older rural adults. Results: Accounts of decisions to initiate contact with physicians support prior research. Some symptoms encouraged immediate consultation; others prompted periods of monitoring and lay management. Physicians were most often contacted if changes were new, unusually severe, persisted or worsened, or failed to respond to lay treatment. Discussion: We characterize participants’ responses to symptoms as bricolages to highlight their construction from available materials. Incorporating the integrating concept of bricolage and Cockerham’s emphasis on both general dispositions and symptom-specific responses represents an important extension of Leventhal’s conceptualization of illness behavior, including patient-initiated physician consultation.

The relationship between cognitive function and non-prescribed therapy use in older adults

Objectives: To examine the association of cognitive function with use of non-prescribed therapies for managing acute and chronic conditions, and to determine whether use of non-prescribed therapies changes over time in relation to baseline cognitive function. Methods: 200 community-dwelling adults aged 65 and older were recruited from three counties in south central North Carolina. Repeated measures of daily symptoms and treatment were collected on three consecutive days at intervals of at least one month. The Mini-Mental State Examination, the primary cognitive measure, was collected as part of the baseline survey. Data were collected on the daily use of common non-prescribed therapies (use of prayer, ignore symptoms, over-the-counter remedies, food and beverage therapies, home remedies, and vitamin, herb, or supplements) on each of the three days of the follow-up interviews for up to six consecutive months. Results: Older adults with poorer cognitive function were more likely to pray and ignore symptoms on days that they experienced acute symptoms. Poorer cognitive function was associated with increased use of home remedies for treating symptoms related to existing chronic conditions. Conclusions: Cognitive function may play a role in why older patients use some non-prescribed therapies in response to acute and chronic conditions.