Stephen Neville

Loneliness, health and depression in older males

Loneliness and social isolation, particularly in the older adult, have been shown to influence psychosocial well-being. Loneliness has been related to chronic illness and self-rated health in older adults, and researchers suggest there is an important relationship between loneliness and psychological well-being in older adults particularly in the area of depression. This study investigated relationships between loneliness, health, and depression in 217 older men (≥ 65 years). Participants completed self-report measures of loneliness, social support, depression, and physical health. Regression analysis showed that a diagnosis of illness or disability was unrelated to depression, however self-reported health was associated with depression, with those reporting poorer health experiencing greater depression. Social support variables were unrelated to depression. The most significant relationship to depression was that of loneliness, with lonelier men reporting higher scores on the Geriatric Depression Scale (GDS). Although research suggests that depression is often a response to declining health and functional impairment in the older adult, the present findings suggest that social isolation may also influence the experience of depression. Age-related losses such as loss of professional identity, physical mobility and the inevitable loss of family and friends can affect a persons ability to maintain relationships and independence, which in turn may lead to a higher incidence of depressive symptoms.

Culturally safe research with vulnerable populations.

Abstract Culturally safe research processes, methodologies, and mutually aligned research endeavours are a fundamental right of those being researched. Vulnerable populations are at risk of experiencing inequalities in health experiences and health outcomes, and research beneficial to those being researched is crucial to address disparities. Often vulnerable populations are exposed to research that is driven by dominant epistemologies, research methodologies, and socio-cultural lenses that can exacerbate their vulnerability, negating their socio-cultural reality. In this paper it is contended that researchers should review the way in which research is constructed and developed by creating a culturally safe space for research to occur with those who are vulnerable. A framework based on partnership, participation, protection, and power is presented as a way of creating culturally safe research.

Men Who Have Sex With Men Account for Nonuse of Condoms

Despite several decades of health promotion activity targeted at men who have sex with men (MSM), rates for nonuse of condoms for anal sex among MSM worldwide and in New Zealand have been increasing in recent times. In this article we report on the first local qualitative investigation undertaken in Auckland, New Zealand, of how members of a particular group of MSM account for nonuse of condoms for anal sex with other men. We collected qualitative data from 22 MSM (17 face-to-face interviews, and three online interviews involving 5 men). Thematic analysis led to the identification of five patterns that account for the nonuse of condoms: (a) substance use, (b) psychological aspects, (c) difficulties using condoms, (d) condoms in relationships, and (e) managing risk. We conclude that although this information generally confirms the findings in the wider research literature, it is also important in the local context as the first research that can be used with confidence in developing and refining health promotion initiatives to address this issue.

'Lavender retirement': a questionnaire survey of lesbian, gay and bisexual people's accommodation plans for old age.

Neville S., Henrickson M. International Journal of Nursing Practice 2010; 16: 586–594 ‘Lavender retirement’: A questionnaire survey of lesbian, gay and bisexual peoples accommodation plans for old age A global increase in older people will also mean an increase in the numbers of lesbian, gay and bisexual people requiring residential support. All health practitioners working with older people need to be aware of the existence of older lesbian, gay and bisexual people in order to provide health care that is appropriate. This study describes lesbian, gay and bisexual peoples accommodation plans for old age through a cross-sectional quantitative survey design. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues. A total of 2269 participants completed the 133-item survey. When asked about what accommodation plans they had for their older years lesbian, gay and bisexual people identified that they were least likely to choose living in a retirement community/facility. However, if unable to live independently the majority of respondents identified they would prefer to live in a retirement facility that specifically catered for people who did not identify as heterosexual. This study has found that the residential support sector needs to be prepared to provide a health service that is person-centred, free from discriminatory practices and meets the needs of all health consumers regardless of sexual orientation.A global increase in older people will also mean an increase in the numbers of lesbian, gay and bisexual people requiring residential support. All health practitioners working with older people need to be aware of the existence of older lesbian, gay and bisexual people in order to provide health care that is appropriate. This study describes lesbian, gay and bisexual peoples accommodation plans for old age through a cross-sectional quantitative survey design. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues. A total of 2269 participants completed the 133-item survey. When asked about what accommodation plans they had for their older years lesbian, gay and bisexual people identified that they were least likely to choose living in a retirement community/facility. However, if unable to live independently the majority of respondents identified they would prefer to live in a retirement facility that specifically catered for people who did not identify as heterosexual. This study has found that the residential support sector needs to be prepared to provide a health service that is person-centred, free from discriminatory practices and meets the needs of all health consumers regardless of sexual orientation.

Nursing their way not our way: working with vulnerable and marginalised populations.

Aims and objectives: This paper uses the findings of two studies to explore the nature of nurses’ practice when working with vulnerable and marginalised populations, particularly with regard to the attributes of holism and individualised care. A secondary analysis of the findings of two separate studies was undertaken, one on the elderly with delirium and the other with indigenous Māori women. Background: Often considered vulnerable and marginalised, elderly and indigenous experiences of health services are often fraught with their health needs not always identified or addressed. Nursing claims that holism and individualised care are pivotal attributes underpinning nursing practice. However, the secondary analysis of two research studies highlight how vulnerable and marginalised populations accessing health and nursing services experience needs that are neither acknowledged nor integrated into intervention and treatment plans. Design: A secondary analysis of one study with the elderly with delirium used a critical gerontological methodology informed by postmodernism and Foucault’s understanding of discourse. The other study with indigenous Māori women utilised Glaserian grounded theory informed by a Māori-centred methodology. Methods: The research on the elderly with delirium analysed 20 data sources, including interviews with older persons who had experienced delirium, members of their families and health professionals. The research with 38 indigenous Māori women aged between 24 and 65 years, inductively analysed interview data using constant comparative analysis, theoretical sampling and saturation of the core categories to generate a substantive grounded theory. Results: The findings of each study showed that a problem focussed approach to health care is offered to patients that does not incorporate individual health experiences. In addition, the social context integral to people’s lives outside of the health care environment is ignored and as such the very foundations of nursing practice, that of holism, is merely a rhetorical construct. Conclusions: Vulnerable and marginalised patients experience care that neglects their perceived health needs and the realities of their life circumstances. Relevance to clinical practice: Individualised care that extends beyond the presenting issue is vital, but raises challenges when working with those population groups considered vulnerable and marginalised to improve outcomes of their health experience.

Lavender Islands: the New Zealand study.

Abstract Lavender Islands: Portrait of the Whole Family is the first national strengths-based study of lesbian, gay, and bisexual (LGB) people in New Zealand. The 133-item survey was made available both by website and paper copy from April to July 2004. Multidisciplinary interest areas were developed by a community reference group, and included identity and self-definition, families of origin, relationships and sexuality, families of choice, immigration and internal migration, well-being, politics, income and spending, education, careers and leisure, community connections, challenges, and spirituality. A four-axis model of sexual identity was also tested; 2,269 responses were received. Of these 83% were from the website; 45% of responses were from women and 54% from men. Responses identified a robust, highly educated, relatively high-income, politically active LGB community. Male and female respondents experienced same-sex relationships and identity in significantly different ways.

Condom use in men who have sex with men: A literature review

Abstract The aim of this paper is to present a review of the literature on the key issues impacting on the decisions, by men who have sex with men, to use, or not use, condoms for anal intercourse. 250 publications were accessed, reviewed, read and sorted; 200 of these were research based and 50 were opinion pieces of work. In addition, 240 of the 250 had undergone a peer review process. The review presented here shows that men who have sex with men communities are a heterogeneous group and their reasons for engaging in unprotected anal intercourse are inter-related and diverse. Six main themes related to sexual risk behaviour and condom use were identified: the availability of HIV treatments, physical issues, psychosocial issues, intentional practices, internet and substance use. Nurses need to understand these factors if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of HIV infection.

Loneliness and self-reported health among older persons in New Zealand

Aim:  The purpose of this study was to identify the rate, degree and impact of loneliness in a sample of 332 older community‐dwelling New Zealanders.

Resisting the ‘condom every time for anal sex’ health education message

Objective: Ensuring men who have sex with men (MSM) adopt and maintain condom use for anal sex is a challenging health education goal. In order to inform the development of social marketing practices to encourage safe-sex practices, the views of MSM about a key HIV health education message (‘using a condom every time for anal sex’) were sought. Design: Individual and paired interviews were conducted face-to-face and online, with a total of 22 MSM who identified as low users of condoms. Transcripts of interviews were analysed thematically. Setting: Online and various locations in Auckland, New Zealand. Results: Two main themes were identified in relation to the men’s views of the condom every time message: (a) awareness and appropriateness of the message; and (b) resistance to the message. The men interviewed reported a contradictory view with respect to the condom every time message. While it is viewed as an appropriate message for MSM as a group, for some individual men, particularly those in relationships, the message has little resonance. One solution offered was for the sexual practices of such men to be recognized and for appropriate and more relevant health education messages to be developed. Conclusion: Addressing the gulf between professional and (some) lay understandings of what is appropriate for messages that seek to encourage men to adopt and to maintain condom use, and therefore reduce the chances of HIV infection, remains a significant challenge for health promotion agencies.

Identity satisfaction over the life course in sexual minorities

A variety of models have been proposed to understand the process of coming to terms with a sexual minority identity. What has not been so clearly explored is how an individuals satisfaction with his or her sexual identity develops over the life course. This article explores satisfaction with sexual identity in a large cohort (N = 2,269) of self-identified lesbians, gay men, and bisexuals, and considers satisfaction not only from a chronos (life span) but also from a chairos (stage of development) framework. Data show a clear relationship between age group and increased satisfaction with a sexual minority identity. Resilience may be an important contributor to increased satisfaction.