Michelle Pannor Silver

Patient Perspectives on Online Health Information and Communication With Doctors: A Qualitative Study of Patients 50 Years Old and Over

Background As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet. Objective Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet. Methods For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis. Results Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn’t want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor. Conclusions Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue.

Socio-economic status over the lifecourse and internet use in older adulthood

ABSTRACT This study explored associations between socio-economic status (SES) at different phases in the lifecourse and regular internet use among older adults. A sample (N = 11,035) from the 2010 wave of the United States Health and Retirement Study was used. Odds ratios were estimated to explore the relationship between regular internet use in older adulthood and measures of SES in childhood and in adulthood, and cumulative SES. Findings provided support for the lifecourse perspective, suggesting that variations observed among older adults are reflective of cumulative experiences. Three main themes emerged: higher SES in childhood increased the odds of being an internet user in older adulthood; SES advantages tended to accumulate, so that having at least one period of high SES in the lifecourse increased the odds of being an internet user in older adulthood; age did not appear to modify the positive relationship between cumulative SES and internet use.

Women's Retirement and Self-Assessed Well-Being: An Analysis of Three Measures of Well-Being Among Recent and Long-Term Retirees Relative to Homemakers

Focusing on women from the U.S. over 60 years old in 2006, this study analyzed the relationship between retirement and three subjective measures of well-being: depressive symptoms, financial worries, and health. Drawing on the life course perspective and the heterogeneity of womens labor force experiences, this study contrasted the well-being of recent retirees with those who self-identified as homemakers (n = 1695) and long-term retirees with homemakers (n = 2012). Findings indicated that being a recent retiree was associated with more favorable reports of health and that being a long-term retiree was more favorably associated with accounts of all three outcome measures relative to homemakers. Thus, despite the major role change they experienced, findings support the notion that participating in the paid labor force may have been a protective factor with regard to self-assessed well-being.

''Why Give Up Something That Works So Well?'': Retirement Expectations Among Academic Physicians

For individuals with strong work identities, the decision to retire can be particularly challenging. For academic physicians, retirement is an important personal decision that also has far-reaching implications for the healthcare system. This is because academic physicians are responsible for producing the research from which key medical decisions are made, for training future healthcare providers, and for providing specialized care for patients. For this study, we conducted focus groups with academic physicians from a large research university in Canada and then performed inductive thematic analyses to examine perceptions and concerns about later life career transitions. This study highlights tensions between professional experiences for the next generation of physicians and individual struggles with personal identity. Findings suggest improvements to institutional programs that support flexible, agentive, and respectful retirement transitions will not only be beneficial but necessary as medical and university systems continue to grapple with issues of balanced recruitment and succession.

An inquiry into self-identification with retirement.

ABSTRACT The aim of this qualitative study was to explore patterns in self-identification with being retired using deductive thematic analysis informed by the life course perspective. For this study, a set of women who self-identified as retired (n = 60) were asked to describe their current work status, major career interruptions, and factors that marked their retirement. This study provides important insights into the heterogeneity in women’s retirement including a subset of individuals who self-identified as retired, not based on their own work force transitions but on that of their spouse or peers. Findings highlight the importance of recognizing that the construction of retirement identity can be context driven, varied, and subjective.

Student Expectations About Mental Health and Aging

Drawing from stereotype embodiment theory this study contributes to existing literature by examining whether and how expectations regarding mental health and aging changed for students enrolled in an undergraduate gerontology course at a Canadian research university (N = 51). At the beginning and end of the course, data from an open-ended word association exercise and the Expectations Regarding Aging (ERA-12) survey was collected and later analyzed. Investigators used content analysis and quantization to examine the word association data and statistical tests to analyze the mental health subscale (ERA-MHS). Findings were integrated and presented in a convergence code matrix. Results show that overall participants had more favorable expectations over time; in particular, ERA-MHS scores indicated less favorable expectations at Time 1 (M = 48.86) than at Time 2 (M = 65.36) significant at p < .01, while terms like “successful aging” increased and terms like “depressed” decreased. Findings have implications for geriatric mental health competencies of students in the health professions.

Reluctance to Retire: A Qualitative Study on Work Identity, Intergenerational Conflict, and Retirement in Academic Medicine

Purpose of the Study Some professions foster expectations that individuals cultivate their work identity above all other aspects of life. This can be problematic when individuals are confronted with the expectation that they will readily terminate this identity in later-career stages as institutions seek to cycle in new generations. This study examines the relationship between work identity and retirement by examining multiple generations of academic physicians. Design and Methods This study used a multimethod qualitative design that included document analysis, participant observation, focus groups, and in-depth interviews with academic physicians from one of the oldest departments of medicine in North America. Results This study illustrates how participants were predisposed and then groomed through institutional efforts to embrace a career trajectory that emphasized work above all else and fostered negative sensibilities about retirement. Participants across multiple generations described a lack of work-life balance and a prioritization of their careers above nonwork commitments. Assertions that less experienced physicians were not as dedicated to medicine and implicit assumptions that later-career physicians should retire emerged as key concerns. Implications Strong work identity and tensions between different generations may confound concerns about retirement in ways that complicate institutional succession planning and that demonstrate how traditional understandings of retirement are out of date. Findings support the need to creatively reconsider the ways we examine relations between work identity, age, and retirement in ways that account for the recent extensions in the working lives of professionals.

When Working Out Works Out: Program Administrators’ Perspectives on Seniors’ Exercise Participation

ABSTRACT This study examined factors that inhibit and promote exercise engagement from the perspective of individuals who administer exercise programming for seniors in a region of Canada with a large and diverse immigrant population. Eight focus group discussions about exercise and aging were examined using thematic analysis. A socioecological framework was applied to develop cross-cutting themes about factors that promote seniors’ exercise engagement. This study highlights the following as factors to consider when addressing multiple barriers to seniors’ exercise participation: the role of athletic identity in relation to participants’ cumulative life experiences, gender differences, and the importance of offering intergenerational environments. Future research should focus on perceptions of athletic identity among seniors from ethno-culturally diverse communities to examine the role of prior exposure to sport and the views on single-gendered programing.

A Systematic Review of PhysicianRetirement Planning

Background: This systematic review identified empirical studies to elaborate on the understudied aspect of retirement timing related to physician’s preparation and engagement with the retirement planning process. Four questions were addressed: 1) When do physicians retire? 2) Why do some physicians retire early? 3) Why do some physicians delay their retirement? 4) What are some strategies that facilitate physician retention and/or retirement planning? Methods and Findings: English-language studies were searched in electronic databases through June 2015 to meet the following inclusion criteria: peerreviewed primary journal articles, published with quantitative or qualitative analyses of planning and opinions about physician retirement. Three independent reviewers assessed each study for methodological quality and a third reviewer resolved inconsistencies. In total, 60 studies meet the inclusion criteria and were analyzed. Representative sampling was used in 75% of studies, however most did not control for confounding variables. The majority were methodologically strong. Physicians commonly reported retiring between 60 and 69 years. Excessive workload and burnout were frequently cited reasons for early retirement. Obstacles to continuing practice included: career dissatisfaction, workplace frustration, and workload pressure; whereas, ongoing financial obligations delayed retirement. Conclusions: This is the first review of literature related to early, late, and on-time retirement of physicians. Health organizations aiming to either delay or encourage retirement should accommodate flexible working hours, provide resources and information about financial planning, and consider stipulations in practice plans that clarify timing and transitions from medicine.

Physician retirement: gender, geography, flexibility and pensions

[See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.170231][2]][2] KEY POINTS Although much attention is given to how to meet the increasing demands placed on Canada’s health care system as its population ages, there has been little consideration of the needs of aging physicians. In