Loneliness in elderly people: an important area for nursing research

The phenomenon of loneliness occurs in people of all ages but may be a particular problem in the elderly It is acknowledged that loneliness is not a necessary accompaniment to ageing and that ageing is not solely responsible for the development of loneliness in elderly people However, there is a relationship between ageing and loneliness Four major theories of loneliness are reviewed and their utility for application to research in the elderly is examined along with a consideration of the ways in which loneliness can be measured While causal relationships are difficult to determine, there is evidence that loneliness is associated with a number of physical and psychological pathologies and the relevance of these to nursing is discussed There is a growing awareness of the phenomenon of loneliness in elderly people in the nursing literature and some evidence that nursing intervention can be beneficial in this regard both at alleviating loneliness and reducing some of the adverse effects of loneliness Finally some directions for nursing research are presented which are aimed at improving the assessment and nursing intervention for loneliness in elderly people     

Understanding coping strategies among people living with scleroderma: a focus group study

Abstract

Purpose: Systemic sclerosis or scleroderma is a chronic, rare connective tissue disease with negative physical and psychological implications. Coping strategies used by scleroderma patients have not been studied in-depth. The objective of the present study was to gain a greater understanding of the coping strategies employed by people living with scleroderma.

Method: Three semi-structured focus group discussions were conducted with a total of 22 people with scleroderma. Interviews were recorded, transcribed, and analyzed using content analysis. Coping strategies discussed were analyzed through Lazarus and Folkman’s theoretical model of coping, including: (1) problem-focused, (2) emotion-focused, and (3) meaning-focused coping.

Results: Participants reported using a combination of problem-focused (e.g., professional help; seeking disease-related information), emotion-focused (e.g., social support; adaptive distraction techniques), and meaning-focused coping strategies (e.g., benefit finding; goal reappraisal) to help them to cope with and manage their disease. However, many patients reported having difficulty in accessing support services.

Conclusions: Scleroderma patients use similar coping strategies as patients with more common diseases, but they may not have access to the same level of support services. Accessible interventions, including self-management programs, aimed at improving problem- and emotion-focused coping are needed. Further, increased access to support groups may provide patients with opportunities to obtain social support and enhance coping.     

Loneliness and health care consumption among older people

Few studies have investigated loneliness in relation to health care consumption among frail older people. The aim of this study was to examine loneliness, health‐related quality of life (HRQoL), and health complaints in relation to health care consumption of in‐ and outpatient care among frail older people living at home. The study, with a cross‐sectional design, comprised a sample of 153 respondents aged from 65 years (mean age 81.5 years) or older, who lived at home and were frail. Data was collected utilising structured interviews in the respondent's home assessing demographic data, loneliness, HRQoL and health complaints. Patient administrative registers were used to collect data on health care consumption. Loneliness was the dependent variable in the majority of the analyses and dichotomised. For group comparisons Student′s t‐test, Mann–Whitney U‐test and Chi‐square test were used. The results showed that 60% of the respondents had experienced loneliness during the previous year, at least occasionally. The study identified that lonely respondents had a lower HRQoL (p = 0.022), with a higher total number of reported health complaints (p = 0.001), and used more outpatient services including more acute visits at the emergency department, compared to not lonely respondents (p = 0.026). Multiple linear regression analysis showed that a depressed mood was independently associated to total use of outpatient care (B = 7.4, p < 0.001). Therefore, it might not be loneliness, per se, that is the reason for seeking health care. However, reasons for using health care services are difficult to determine due to the complex situation for the frail older person. To avoid emergency department visits and to benefit the well‐being of the frail older person, interventions targeting the complex health situation, including loneliness, are suggested.     

Intervention studies among elderly people

There are not many reports of Nordic intervention studies on the health and medical care of the elderly. Nevertheless much knowledge about old age is available and should be applied in practice under controlled conditions. In this overview article the authors present some experience from four of the Nordic countries to encourage further intervention studies, and focus some important aspects to be taken into consideration.     

Computer use among elderly people

This study investigates the literature on the state of knowledge on computer use among elderly people. Results of this review suggest that benefits may ensue if computer use is advocated. Functional limitations secondary to visual, hearing, and mobility changes; financial inadequacy; and cognitive limitation related to memory use are identified as barriers that may inhibit this population from learning how to use the computer. Methods and techniques dealing with these barriers are presented. Finally, teaching strategies that may be implemented to facilitate the learning process among elderly population on computer use are discussed and elucidated.     

Activities of daily living and social activities in people with multiple sclerosis in Stockholm County

OBJECTIVE: To describe independence in personal and instrumental activities of daily living (ADL), and frequency of social/lifestyle activities in a population-based sample of people with multiple sclerosis in Stockholm. DESIGN: Population-based survey. SETTING: Data collection in home environment. SUBJECTS: One hundred and sixty-six people with multiple sclerosis. INTERVENTIONS: Data were collected using measurements and structured interviews. MAIN MEASURES: Independence in ADL was assessed by the Barthel Index; independence in personal and instrumental ADL by the Katz Extended ADL Index; and frequency of social/lifestyle activities by the Frenchay Activities Index. RESULTS: The mean age was 51 +/- 12 years in the included 166 people with multiple sclerosis, of whom 71% (n = 118) were women. Fifty-two per cent (n = 85) were independent in personal ADL, 30% (n = 50) in instrumental ADL, and 35% (n = 57) had normal frequency of social/lifestyle activities. Most frequently affected ADL items were cleaning indoors and outdoors transportation (62%, n = 102) and the social/lifestyle items of household maintenance (59%, n = 97), walking outside (59%, n = 97), heavy housework (61%, n = 100), and gardening (68%, n = 112). CONCLUSIONS: ADL and social/lifestyle activities were affected in two-thirds of people with multiple sclerosis in Stockholm. The most affected items were items that could be classified as mobility-related and physically demanding, underlining the importance of developing and using evidence-based exercise treatments and rehabilitation to increase independence in people with multiple sclerosis in Stockholm.     

The effect of living in a nursing home on socialization in elderly people

The effects of institutionalization on elderly people are of significance both socially and physically Currently, about 5% of elderly people in the United States live in long-term care institutions, although approximately 33% of all elders will be institutionalized for at least a short period of time The effects on socialization of living in a nursing home have been studied and commented on from several perspectives Several studies directed attention to the elderly person living in an institution Others investigated the institution's response to residents' needs Some studies have focused on attitudes of health care workers towards elderly people, and still others have examined the interaction between workers and residents This review of the literature will first present studies focused on nursing home residents, then the institutions themselves, followed by studies of nursing home staff, and finally those focusing on the interaction between staff and residents Discussion of possible directions for both practice and research will follow The studies reported here were conducted in the United States, England, Northern Ireland and Finland     

Loneliness: a challenge for nurses caring for older people

Loneliness is a complex concept that involves both psychological and social aspects. This article explores loneliness and the impact it can have on older people. It considers the challenges facing nurses and other healthcare professionals in helping older people to deal with loneliness.     

Coping with ageing and failing health: A qualitative study among elderly living alone

The purpose of this study was to gain a more comprehensive understanding of how the elderly cope with being sick, unhealthy and living alone. Qualitative research interviews using a hermeneutic approach was undertaken to explore how the patients experienced coping with their daily life. Twenty patients with an average age of 82 years having different injuries and diseases were interviewed. The interviews were audiotaped, transcribed and analysed in a hermeneutical tradition of the hermeneutic circle: part–whole, pre-understanding–understanding, and primary, secondary and basic themes. Findings showed that even if physical constraints put limits on their level of activity, the elderly were able to adapt and carry out different activities that did not require any physical strength. The main coping strategy was to accept the situation, but the acceptance was often coloured by a resigned and passive acceptance. If the elderly tend to be passive and resigned, it can be necessary for the community nurses to have a more active problem-solving approach to these patients, in order to help them creating a daily rhythm with which they can feel comfortable.     

An intervention study among elderly people. Methodological and practical experiences

Based on a three years controlled intervention study among elderly subjects, aged 75 years or more and living in their own homes, the methodological and practical experiences achieved through interdisciplinary cooperation is described. The combination of social, medical and psychological interventions within the framework of a clinical controlled trial has documented remarkably favourable consequences for the intervention group. The planning, intervention, work up and publication periods of the study are described in the wish that future necessary intervention studies may be guided to an easier procedure.     

Ocular manifestations and refractive errors among people living with HIV in Pune,India: a cross-sectional study

ObjectiveWe aimed to determine the ocular manifestation and refractive error prevalences among people living with HIV (PLHIV) in Pune, India.MethodsThis cross-sectional study included HIV-infected adults attending a National AIDS Research Institute clinic. Ophthalmologic examination included visual acuity estimation, refraction, orthoptic evaluation, slit lamp and fundus examination, and photography.ResultsIn total, 441 HIV-infected individuals were enrolled. The participants'' median age was 44 (interquartile range 38–49) years and 227 (51.5%) were men. Refractive errors occurred in 132 (29.9%) individuals. Ocular manifestations were present in 93 (21.1%) participants and the most frequent was cataract in 59 (13.4%) participants. Multivariate logistic regression analysis showed that participants who were illiterate (adjusted odds ratio [AOR] 2.80, 95% confidence interval [CI] 1.47–5.33) and those aged greater than 40 years (AOR 5.59, 95% CI 2.69–11.61) were more likely to have ocular manifestations. The odds of having ocular manifestations were greater in participants with treatment substitution or changes (AOR 2.11, 95% CI 1.16–3.82).ConclusionsCataract and refractive errors were prevalent among PLHIV. PLHIV should be encouraged to have regular ophthalmic checkups. Individuals with lower education levels and older age should be counseled regarding eye care and timely reporting of ocular symptoms.     

Disclosure challenges among people living with HIV in Thailand

One of the main challenges facing people living with HIV (PLH) in Thailand is HIV disclosure. The goal of this study was to examine HIV disclosure barriers and motivators in Northeastern Thailand. Focus groups were conducted with 40 PLH to explore the barriers and motivators. To confirm the themes identified in the focus groups, face‐face interviews were conducted with 50 PLH. Focus group findings revealed barriers to HIV disclosure in three domains: perceived stigma, shame and fear of rejection. Motivators to HIV disclosure consisted of the following: coping with illness, seeking help and common experiences. Findings from the face‐to‐face interviews included the following barriers: fear of privacy breach, fear of rejection and communication difficulties. The motivators to HIV disclosure included seeking supportive relationship, duty to inform and catharsis. Based on these findings, we are currently developing family‐focused HIV disclosure intervention in Northeastern Thailand.     

Self-care ability in a group of elderly Swedish people: a phenomenological study

Self-care ability in a group of elderly Swedish people: a phenomenological study The aims of this study were to describe self-care ability in a group of Swedish elderly and to elucidate the meaning of actualizing this self-care ability into self-care activity. Two different phenomenological methods were applied in the analyses of 11 self-reports written by home dwelling elderly in the community. The eidetic structure of self-care ability was twofold; it entailed, first, being present to the opportunity to act on certain perceived influences on the body and, second, alone or with support from somebody else to be able to bring about a change in attitude towards one's personal lifestyle or life situation. The meaning of actualizing this ability was interpreted as self-realization or self-transcendence.