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Does sense of coherence affect the relationship between self-rated health and health status in a sample of community-dwelling frail elderly people?

Background: The objective of this study was to examine the association between self-rated health (SRH) and physical, functional, social and mental health measures in community dwelling elderly people needing nursing care. Of special interest was how coping resources (SOC) influenced this relationship. Self-rated health is a good predictor of future health status as measured by mortality and morbidity, decline of functional abilities, use of healthcare, and nursing home placement. The high mean age and the relatively high level of care-dependency in this sample, make this investigation important. Methods: A hierarchical regression analysis was applied in a cross sectional sample of 242 elderly (mean age 84.6 years). Results: Subjective health complaints (SHC) in both sexes, and psychological distress (only in men), was associated directly with SRH. Coping resources associated with SRH directly, and indirectly through subjective perceived health (SHC and GHQ) but only in men. The influence of registered illness was mediated through the effects of subjectively perceived health in both women and men. Sex differences moderated the effects of SOC on SRH. Conclusion: Subjectively perceived health was more important in the perception of SRH than objective health measures. Men, in contrast to women, tend to convert physical illness into emotional distress.

Sense of coherence—a determinant of quality of life over time in older female acute myocardial infarction survivors

AIMS To determine the relationships between different sense of coherence levels and quality of life, and in older female myocardial infarction survivors; to investigate how socio-demographic, clinical characteristics, sense of coherence self-reported symptoms and function affect quality of life; and to determine whether sense of coherence and quality of life are stable during a six-month follow-up. BACKGROUND Myocardial infraction confers new physical and mental challenges. However, research on sense of coherence and other factors involved in maintaining physical, psychosocial and environmental aspects of quality of life in older female myocardial infraction survivors is scant. DESIGN Survey. METHODS A postal survey was conducted of 145 women, aged 62-80 years, three months to five years after myocardial infarction (T1), with a follow-up after six months (T2). Self-reported socio-demographic and clinical data and hospital medical records data were collected. The sense of coherence scale (SOC-29) and the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) were used. RESULTS We found a significant difference in quality of life between weak, moderate, and strong sense of coherence groups (p<0.001). Sense of coherence contributed to the level of all quality of life domains (p<0.001). Several clinical characteristics contributed to quality of life: (1) physical domain: comorbidities (p<0.001), previous myocardial infarction (p = 0.013), ejection fraction (p<0.011), length of hospital stay (p = 0.005) symptoms and function (p<0.001); (2) psychological domain: previous myocardial infarction (p = 0.031) and symptoms and function (p<0.001); and (3) environmental domain: education (p = 0.033) and symptoms and function (p = 0.003). On group level, both sense of coherence and quality of life were stable. Experiencing specific health changes (p<0.001), not major life events, influenced quality of life during the six-month follow-up. CONCLUSION Sense of coherence was an important stable determinant of quality of life domains in female myocardial infarction survivors. Although other factors were identified, further research is needed to elucidate additional determinants of quality of life. RELEVANCE TO CLINICAL PRACTICE These specific factors could guide clinicians in making treatment decisions that optimize the quality of life of their patients. Applying a salutogenic perspective through patient education may be important.

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.

Psychological distress and its correlates in older care-dependent persons living at home

Objectives: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined. Method: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale. Results: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis. Conclusion: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.

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.

The Subjective Health Complaints Inventory: a useful instrument to identify various aspects of health and ability to cope in older people?

Aims: The aims were to investigate the factor structure of the Subjective Health Complaints Inventory (SHC) in a population of 75 years and above and to identify whether somatic, psychosocial, and coping factors were associated with the SHC factors. Methods: Data from 242 elderly persons were analyzed. The measures were: the SHC Inventory, Sense of Coherence, Social Provision Scale, Self-Rated Health, General Health Questionnaire, Clinical Dementia Rating, Reported Illness, Barthel ADL Index, sex, age, and education. Results: The factor analysis resulted in four subgroups: musculoskeletal pain (15% of variance), gastrointestinal problems (12% of variance), respiratory/allergy complaints (11% of variance), and pseudoneurology (11% of variance). The occurrence of complaints was 76% for musculoskeletal complaints, 51% for gastrointestinal complaints, 30% for flu, 43% for allergy, and 93% for pseudoneurology. Self-rated health and reported illness were significantly associated with musculoskeletal complaints (15% of variance), impairment in activities of daily living (ADL) with gastrointestinal complaints (3% of variance), and finally sense of coherence, self-rated health, and psychological distress were associated with pseudoneurology (32% of variance). No variables were associated with respiratory/allergy complaints. Conclusions: This study supports the stability of the SHC’s factor structure. The low occurrence of health complaints could possibly be due to survival effects, or that old people to a greater extent than younger people compare themselves with aged peers. The subscales focusing on somatic symptoms were explained by reported illnesses and functional impairments to a limited degree only. The pseudoneurology subscale score was associated with psychological measures, particularly ability to cope.

Testing reliability and validity of Lorensen's Self-care Capability Scale (LSCS) among older home-living, care-dependent individuals in Norway

AIM AND OBJECTIVE The aim of this study was to test reliability and validity of the Lorensens Self-Care Capability Scale (LSCS). BACKGROUND The assessment of self-care capability among older people living at home is essential for maintaining independence for as long as possible. METHOD The study sample consisted of 242 home nursing patients who were 75 + years old and living at home. The responsible home nurses documented their answers. In addition to the LSCS, help dependency, subjective health and demographic characteristics were recorded. Various statistical analyses were used to assess reliability and validity of the LSCS. RESULTS Reliability of the LSCS was supported by a Cronbachs alpha coefficient of 0.97. Regarding validity, six factors extracted in the factor analysis explained 69.8% of the variance in the group. The extracted factors supported the underlying theoretical assumptions of the instrument. Construct validity was supported by significant differences between groups with expected low and expected high LSCS scores, respectively. Concurrent validity was established by a significant correlation between LSCS and Barthels ADL Index. CONCLUSION AND IMPLICATIONS FOR PRACTICE This study has shown that LSCS is a reliable and valid instrument for assessing self-care capability in older people living at home.

Facilitating nursing students’ acquisition of knowledge about the public health perspective in nursing: Experiences from a pilot project

Knowledge about public health and public health work is important for meeting current and future health challenges. A group of nursing students in a cohort participated in a practicum programme pertaining to the study of the academic subject ‘Nursing and Society’. The municipality’s public healthcare services were the learning arena. The purpose of this pilot project was to explore whether participation in the municipality’s public healthcare services is a pedagogical approach that enhances nursing students’ acquisition of knowledge about the public health perspective in nursing. Combined methods were used in the evaluation. Data were collected through focus-group interviews and questionnaire surveys. The results reveal that participation in the municipality’s public healthcare services while studying the subject contributed towards enabling the students enrolled in the practical study to visualize the public health perspective in nursing.

Sense of coherence – A predictor of physical functioning and satisfaction with health in women after myocardial infarction?

Tone M. Norekvåla,b,⁎, Tore Wentzel-Larsen, Bengt Fridlund, Philip Moons, Jan Erik Nordrehaug, Hans Inge Sævareid, Berit R. Hanestad a Department of Heart Disease, Haukeland University Hospital, Bergen, Norway b Department of Public Health and Primary Health Care, University of Bergen, Norway c Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway d School of Health Sciences and Social Work, University of Växjö, Sweden e Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium f Faculty of Health and Sports, Agder University College, Arendal, Norway ⁎ Corresponding author. E-mail: tone.norekval@helse-bergen.no.