Ulrika Söderhamn

Self-care ability among home-dwelling older people in rural areas in southern Norway

INTRODUCTIONnThe growing number of older people is assumed to represent many challenges in the future. Self-care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self-care ability is closely related to perceived health, sense of coherence and nutritional risk.nnnAIMnThe aim of this study was to describe self-care ability among home-dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation.nnnMETHODSnA cross-sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health-related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods.nnnRESULTSnA total of 780 persons were found to have higher self-care ability and 240 to have lower self-care ability using the Self-care Ability Scale for the Elderly. Self-care ability was found to be closely related to health-related issues, self-care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self-care ability were to have higher self-care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age.nnnCONCLUSIONSnWhen self-care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.Scand J Caring Sci; 2012; 26; 113–122 nSelf-care ability among home-dwelling older people in rural areas in southern Norway n nIntroduction:u2002 The growing number of older people is assumed to represent many challenges in the future. Self-care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self-care ability is closely related to perceived health, sense of coherence and nutritional risk. n nAim:u2002 The aim of this study was to describe self-care ability among home-dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. n nMethods:u2002 A cross-sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health-related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+xa0years), and 1050 respondents were included in the study. Data were analysed with statistical methods. n nResults:u2002 A total of 780 persons were found to have higher self-care ability and 240 to have lower self-care ability using the Self-care Ability Scale for the Elderly. Self-care ability was found to be closely related to health-related issues, self-care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self-care ability were to have higher self-care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. n nConclusions:u2002 When self-care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.

Life situation and identity among single older home-living people: a phenomenological-hermeneutic study.

Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., “being able to do” and “being able to be”, and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants.

Living alone, receiving help, helplessness, and inactivity are strongly related to risk of undernutrition among older home-dwelling people

Background Being at risk of undernutrition is a global problem among older people. Undernutrition can be considered inadequate nutritional status, characterized by insufficient food intake and weight loss. There is a lack of Norwegian studies focusing on being at risk of undernutrition and self-care ability, sense of coherence, and health-related issues among older home-dwelling people. Aim To describe the prevalence of being at risk of undernutrition among a group of older home-dwelling individuals in Norway, and to relate the results to reported self-care ability, sense of coherence, perceived health and other health-related issues. Methods A cross-sectional design was applied. A questionnaire with instruments for nutritional screening, self-care ability, and sense of coherence, and health-related questions was sent to a randomized sample of 450 persons (aged 65+ years) in southern Norway. The study group included 158 (35.1%) participants. Data were analysed using statistical methods. Results The results showed that 19% of the participants were at medium risk of undernutrition and 1.3% at high risk. Due to the low response rate it can be expected that the nonparticipants can be at risk of undernutrition. The nutritional at-risk group had lower self-care ability and weaker sense of coherence. Living alone, receiving help regularly to manage daily life, not being active and perceived helplessness emerged as predictors for being at risk of undernutrition. The results indicate difficulties in identifying people at nutritional risk and supporting self-care activities to maintain a good nutritional status. Conclusion Health care professionals have to be able to identify older home-dwelling people at risk of undernutrition, support self-care activities to enable people at risk to maintain a sufficient nutritional status, and be aware that older people living alone, who receive help, feel helpless, and are inactive are especially vulnerable.

Norwegian version of the Nutritional Form for the Elderly: sufficient psychometric properties for performing institutional screening of elderly patients

The objective of this study was to test if the Norwegian version of the nutritional screening instrument entitled Nutritional Form for the Elderly (NUFFE-NO) demonstrates sufficient evidence of reliability and validity, including sensitivity and specificity, when applied to a select group of elderly hospital patients. The hypothesis was that NUFFE-NO has sufficient psychometric properties to be used as a screening instrument. The model used for the testing procedure was designed to test reliability (homogeneity and stability) and validity (criterion-related, concurrent validity, and construct validity) including sensitivity and specificity in a cross-sectional study. One-hundred fifty-eight patients were interviewed using the nutritional screening instruments NUFFE-NO and Mini Nutritional Assessment (MNA). They were interviewed once again (using NUFFE-NO) 2 to 4 days afterward. Background variables were collected. Data from the patients records were collected regarding the nutritional screening instrument Nutrition Risk Screening 2002. Anthropometric measurements were performed. A Cronbach alpha coefficient of .77 was obtained. A majority of the items showed good or very good agreement in a test-retest. A high correlation coefficient (as a measurement of concurrent validity) was estimated between NUFFE-NO and MNA. The NUFFE-NO could separate groups with expected high and low scores, which supported construct validity. Calculated sensitivity and specificity values for NUFFE-NO, with MNA as a criterion and receiver operating characteristic curves with areas 0.79 and 0.80, showed appropriate cutoff points for measuring low, medium, and high risk for undernutrition. In conclusion, NUFFE-NO was shown to have sufficient psychometric properties for performing an institutional screening of elderly hospital patients.

Self-care ability and sense of coherence in older nutritional at-risk patients

Objective:To investigate self-care ability and sense of coherence in geriatric rehabilitation patients nutritionally screened using the Nutritional Form For the Elderly and to relate the patients perceived health to self-care ability and sense of coherence.Design:Cross-sectional study.Setting:A geriatric rehabilitation ward in a hospital in western Sweden.Subjects:A sample of 172 consecutively recruited patients (65+ years) fulfilled the inclusion criteria. One hundred forty-four patients were included in the study because 16 patients refused to take part and 12 could not complete the entire data collection procedure.Methods:Interviews, using one instrument for nutritional screening and other instruments measuring self-care ability and sense of coherence and one question about perceived health, were performed.Results:Patients at medium or high risk for undernutrition had lower self-care ability (P<0.001) and weaker sense of coherence (P=0.007) than patients at low risk for undernutrition. Lower self-care ability, being single and admitted from another hospital ward was found to be predictors for being at medium or high risk for undernutrition. Patients who perceived good health had higher self-care ability (P<0.001) and stronger sense of coherence (P<0.001) than patients who perceived ill health.Conclusions:There is an indication that older patients at low risk for undernutrition have a greater capability to care for themselves than patients at medium or high risk for undernutrition. Perceived ill health in older patients is associated with lower self-care ability and weaker sense of coherence.Sponsorship:Supported by grants from The Research and Development Council Fyrbodal, Trollhättan; The Lions Research Foundation, Linköping, Sweden.

Nutritional form for the elderly is a reliable and valid instrument for the determination of undernutrition risk, and it is associated with health-related quality of life

Undernutrition is a common problem associated with clinical complications such as impaired immune response, reduced muscle strength, impaired wound healing, and susceptibility to infections; therefore, it is an important treatment target to reduce morbidity and mortality associated with chronic diseases and aging. The aim of the present study was to apply a reliable and valid instrument for the determination of undernutrition risk in an in-hospital patient population and to describe possible associations between risk of undernutrition and some aspects of health-related quality of life in patients with chronic diseases. Fifty-six adult patients with different chronic diseases were interviewed with NUFFE questionnaire and the EQ-5D. Anthropometric measurements were performed. Reliability and validity of the NUFFE instrument was tested, and its correlation with EQ-5D was calculated. Euro-Qol scores correlated significantly with the total NUFFE scores and with the items constructing the most important factor of the instrument, explaining 53.74% of its variance. Nutritional form for the elderly was shown to be a reliable instrument in the study group because its internal consistency measured by Cronbach alpha was 0.62, and the item-total score correlations were significant for the half of the items. Criterion-related validity, concurrent validity, and construct validity of NUFFE were established. We have shown that impaired level of health-related quality of life is an important determinant of risk for undernutrition. Nutritional form for the elderly is an appropriate instrument to estimate undernutrition risk in a general, in-hospital patient population with various chronic diseases and to identify at risk patients who may benefit from professional dietary interventions to reduce undernutrition-related complications.

Ability for self-care in urban living older people in southern Norway

Background The number of older people living in urban environments throughout the world will increase in the coming years. There is a trend in most European countries towards improved health among older people, and increased life expectancy for both women and men. Norway has experienced less increase in life expectancy than some other European countries, and it is therefore important to investigate older urban Norwegian people’s health and ways of living in a self-care environment, with special regard to health promotion. Aim The aim of this study was to describe self-care ability among home-dwelling older (65+ years) individuals living in urban areas in southern Norway in relation to general living conditions, sense of coherence (SOC), screened nutritional state, physical activity, perceived self-reported health, mental health, and perceived life situation. Methods In 2010, a randomized sample of 1044 men and women aged 65+ years who were living in urban areas in southern Norway answered a postal questionnaire consisting of five instruments, some background variables, and 17 health-related questions. Univariate and multivariate statistical methods were used in the analyses of the data. Results The mean age of the participants was 74.8 years (SD = 7.1). Eighty-three percent of the participants had higher abilities to care for themselves. Self-care agency, perceived good health, being active, being frequently active, good mental health, not being at risk of undernutrition, and satisfaction with life were all positively related to self-care ability. Negative factors were perceived helplessness, receiving home nursing, being anxious, and being at a more advanced age. People aged 85+ years had worse mental health, were less physically active, and more at risk of undernutrition. Conclusion Health professionals should focus on the health-promoting factors that reinforce older people’s ability to care for themselves, and be aware of important symptoms and signs associated with a reduction in a person’s self-care ability. Politicians should assume responsibility for health care with a special regard to senior citizens.

Nutritional screening of older home-dwelling Norwegians: a comparison between two instruments

Background It is important to obtain knowledge about the prevalence of nutritional risk and associated factors among older home-dwelling people in order to be able to meet nutritional challenges in this group in the future and to plan appropriate interventions. The aim of this survey was to investigate the prevalence of home-dwelling older people at nutritional risk and to identify associated factors using two different nutritional screening instruments as self-report instruments. Methods This study had a cross-sectional design. A postal questionnaire, including the Norwegian versions of the Nutritional Form for the Elderly (NUFFE-NO) and Mini Nutritional Assessment – Short Form (MNA-SF), background variables, and health-related questions was sent to a randomized sample of 6033 home-dwelling older people in southern Norway. A total of 2106 (34.9%) subjects were included in the study. Data were analyzed using descriptive statistics and logistic regression analyses. Results When using the NUFFE-NO and MNA-SF, 426 (22.3%) and 258 (13.5%) older persons, respectively, were identified to be at nutritional risk. The risk of undernutrition increased with age. Several predictors for being at risk of undernutrition, including chronic disease/handicap and receiving family help, as well as protective factors, including sufficient food intake and having social contacts, were identified. Conclusion Health professionals must be aware of older people’s vulnerability to risk of undernutrition, perform screening, and have a plan for preventing under-nutrition. For that purpose, MNA-SF and NUFFE-NO can be suggested for screening older people living at home.

The meaning of actualization of self-care resources among a group of older home-dwelling people--a hermeneutic study.

Self-care is an activity of mature persons who have developed their abilities to take care of themselves. Individuals can choose to actualize their self-care abilities into self-care activities to maintain, restore, or improve health and well-being. It is of importance to understand the meaning of the actualization of self-care resources among older people. The aim of this study was to investigate the meaning of the actualization of self-care resources, i.e., actions taken to improve, maintain, or restore health and well-being, among a group of older home-dwelling individuals with a high sense of coherence. The design of this study was to reanalyse narratives revealing self-care activities from 11 (five females and six males) Norwegian older home-dwelling people (65 years or older) identified as having a high sense of coherence. In order to reveal the meaning and get an understanding of why these self-care resources were realized or actualized, a Gadamerian-based research method was chosen. The analysis revealed four themes that showed the meaning of actualization of self-care resources in the study group: “Desire to carry on”, “Be of use to others”, “Self-realization”, and “Confidence to manage in the future”. The findings showed what older people found meaningful to strive for, and this information can be used as a guide for health professionals when supporting older people in their self-care. Older people with self-care resources can also be an important resource for others in need of social contact and practical help. These resources have to be asked for in voluntary work among older people in need of help and, thereby, can be a valuable supplement to the community health care system.Self-care is an activity of mature persons who have developed their abilities to take care of themselves. Individuals can choose to actualize their self-care abilities into self-care activities to maintain, restore, or improve health and well-being. It is of importance to understand the meaning of the actualization of self-care resources among older people. The aim of this study was to investigate the meaning of the actualization of self-care resources, i.e., actions taken to improve, maintain, or restore health and well-being, among a group of older home-dwelling individuals with a high sense of coherence. The design of this study was to reanalyse narratives revealing self-care activities from 11 (five females and six males) Norwegian older home-dwelling people (65 years or older) identified as having a high sense of coherence. In order to reveal the meaning and get an understanding of why these self-care resources were realized or actualized, a Gadamerian-based research method was chosen. The analysis revealed four themes that showed the meaning of actualization of self-care resources in the study group: Desire to carry on, Be of use to others, Self-realization, and Confidence to manage in the future. The findings showed what older people found meaningful to strive for, and this information can be used as a guide for health professionals when supporting older people in their self-care. Older people with self-care resources can also be an important resource for others in need of social contact and practical help. These resources have to be asked for in voluntary work among older people in need of help and, thereby, can be a valuable supplement to the community health care system.

Factors associated with nutritional risk in 75-year-old community living people

AIMnTo identify risk factors for being at nutritional risk, by means of a nutritional screening, in a population based sample of 75-year-old people living in three county councils in Sweden.nnnBACKGROUNDnUndernutrition in older people is known to contribute to poor health. The instrument Nutritional Form For the Elderly (NUFFE) helps to identify those at nutritional risk.nnnMETHODnThe screening instrument Nutritional Form For the Elderly, background variables and health related questions were mail distributed. A total of 1461 persons (75u2003years old) were included in the study. Descriptive statistical methods were used in the analyses.nnnRESULTSnOne percent of the participants had high risk, 21.3% medium and 77.7% low risk for undernutrition. Medium or high risk was predicted by: living alone, receiving help and impaired perceived health. Low Body Mass Index was associated with low risk for undernutrition.nnnCONCLUSIONnBy using a simple nutritional screening instrument, significant risk factors were highlighted. Relevance to practice.u2002 This instrument can identify older people at nutritional risk and is easy to use. Older people living alone have an increased risk of undernutrition. Body Mass Index (BMI) should be used with caution as one and only indicator of nutritional risk in older people.