Susan M. Hannum

How Personal Control Mediates Suffering: Elderly Husbands' Narratives of Caregiving:

This article is based on ethnographic research that explored experiences of suffering in late life. From a group of 60 oldest-old (age 80 and above) male participants, four were primary, at-home caregivers for wives with dementia. Mens narratives showed the inter-relation between masculinities, a sense of personal control, and experiences of suffering within caregiving. Three thematic “tools” of control emerged as strategies men used to mediate their suffering: 1) the power of the little; 2) preserving self-identity and marriage-identity and, 3) finding purpose in the role of caregiver. We offer insight into the world of the oldest-old male caregiver through mens accounts of suffering, their daily tasks, thoughts about themselves as caregivers, and the manner in which they embody their masculinity in caregiving.

Identity reconstruction among older cancer survivors; Age and meaning in the context of a life altering illness.

ABSTRACT This article evaluates how older cancer patients describe cancer survivorship and incorporate the cancer experience into long-term evaluations of health. From a series of 53 qualitative interviews with adults with histories of breast and prostate cancers and non-Hodgkins lymphoma, we analyzed age-related discussions among those 65 and older (n = 21). Emergent themes revealed the: (1) historical conceptualization of cancer, (2) changed perspective following diagnosis, (3) cancer in the context of a long biography, (4) cancer in the context of the aging body and decline, and (5) meaning of time remaining and quality of life. One important suggestion from our work, relevant to all clinicians regardless of specialty or role, is to incorporate goals for the future into individualized survivor care plans for older survivors.

Generativity in Elderly Oblate Sisters of Providence

PURPOSE OF THE STUDY We explored how generativity and well-being merged in a group of childless older women: African and Hispanic Roman Catholic Religious Sisters, linking two minority identity characteristics. DESIGN AND METHODS We qualitatively interviewed 8 Oblate Sisters of Providence (OSP), by providing a framework for examining the range of the womens generativity-cultural spheres in which generativity is rooted and outlets for generativity. RESULTS Early negative experiences, such as fleeing despotism in Haiti and Cuba and racism within the Catholic Church, occurred alongside positive experiences-families who stressed education, and Caucasian Religious who taught children of color. This became a foundation for the Sisters generative commitment. IMPLICATIONS Findings highlight that research gains from a phenomenological understanding of how religious faith promotes generative cognitions and emotions. Findings also reveal that the experiences of a subculture in society-African-American elderly women religious-add to theories and definitions of generativity.

Meeting the Self at the Crossroads: Thoughts on Aging as a Young Cancer Survivor

Purpose of the study: With nearly 14.5 million cancer survivors currently alive in the United States, it is expected this will rise to roughly 19 million by 2024. As more people will age with a history of cancer than ever before, it is important to consider how experiences of cancer affect the life course through the bending of time and its interpretation. As such, aging as a cancer survivor must be at the forefront of health maintenance across the life course. Design and Methods: Through reference to my own cancer experiences in an auto-ethnographic format, this article interprets the illness experience as co-occurring in a young, aging body. This enhances our understanding of biographical reconstruction and individual liminality through descriptions of wisdom imparted by the cancer experience itself. Knowledge and wisdom are further interpreted as enhancing researchers’ understandings of cancer and cancer survivorship. Results: In this article, I use my illness experiences as a young person to describe evolving interpretations of the life course, the aging body, and the self. Implications: Concepts presented in this article aid researchers’ understanding of how wisdom might be achieved through the experience of protracted illness over time. Such knowledge has important implications for the management of cancer as chronic, which may be most clearly described through the lens of the ill person.

Aging, Spirituality, and Time: A Qualitative Study.

We examined the concepts of aging, time, spirituality, and future care needs in four randomly selected informants from a group of 54 never-married childless older women. Using data from the Generativity and Lifestyles of Older Women (GLOW) study, we questioned how women’s perceptions of these concepts came together in current older age. We employed cultural theory, (our theoretical framework), ethnography, (our methodological framework), and phenomenology, (our philosophical foundation) to produce a portrait of each woman interviewed. Through a three-session interview process, we elicited the women’s life stories, reasons for childlessness, and topics that emerged as significant to the women, including aging, a sense of time remaining, and spirituality. A key finding was that the context of each woman’s life, both biographical and historical, transpired as a foundation for these concepts. That is, a woman’s “place in time” shaped their experiences of aging, as well as her reasons for childlessness and perceptions of finitude.

“We’re Just Not Prepared for Eating Over Our Whole Life”: A Mixed Methods Approach to Understanding Dietary Behaviors Among Longer Term Cancer Survivors

Background: In many countries, there are growing numbers of persons living with a prior diagnosis of cancer, due to the aging population and more successful strategies for treatment. There is also growing evidence of the importance of healthful diet and weight management for survivorship, yet many long-term cancer survivors are not successfully following recommendations. Methods: We explored this issue in a mixed methods study with 53 adult survivors of 3 cancers (breast, prostate, and non-Hodgkin’s lymphoma), living in Maryland. Participants provided three 24-hour dietary recalls, and results were used to classify respondents on 2 metrics of healthful eating (the Healthy Eating Index 2010, and a 9-item index based on current dietary recommendations). Recalls were also used to guide in-depth qualitative discussions with participants regarding self-assessment of dietary behaviors, healthful eating, and diet’s importance in cancer prevention and survivorship. Results: Survivors following a more healthful diet were more likely to be female, have greater socioeconomic resources, more years since diagnosis, normal weight, and no smoking history. Qualitative discussions revealed a more nuanced understanding of dietary strategies among healthful eaters, as well as the importance of household members in dietary decision making. Discussion: Most survivors had received little nutrition counseling as part of their cancer care, highlighting the importance of holistic, household-oriented nutrition education for maintaining health among long-term cancer survivors.

Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care

Background: Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. Objective: To explore older patients’ perspectives on the quality of serious illness care in primary care. Design: Qualitative interview study. Participants: Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic’s quality improvement initiative. Methods: We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. Results: We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians’ perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Conclusions: Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.