HIV health care access issues for women living with HIV, mental illness, and substance abuse

Nurses at the Well-Being Institute, a community-based nursing outreach clinic in Detroit, Michigan, located 75 women living with HIV, mental illness, and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study. Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered "lost to follow-up" in the HIV clinic. The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection. Women were randomly assigned to two study groups. Women assigned to "care as usual" study group (n = 37) received no additional services beyond study interviews for 1 year. Women assigned to the "nursing intervention" group (n = 38) were provided with nursing services designed to facilitate their return to and continued connection with their HIV clinic. Findings showed that factors related to the women's vulnerability, such as mental illness and drug use, were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the "nursing intervention" or "care as usual" study groups. Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented. The women differed on whether they had stable housing and were accessing care for their mental illness.     

The structure and function of frail male veterans' informal networks

OBJECTIVE: This research focuses on the role of informal networks in providing emotional support, instrumental aid, and assistance with chronic disease management for frail male veterans. METHODS: Telephone interviews were conducted with nursing home eligible veterans living in the community. Name-generating questions were used to illicit network members. RESULTS: Data on 198 frail male veterans indicate that they have about three people they rely on for emotional support, instrumental aid, health appraisal, and health monitoring. Networks are composed primarily of family, and adult sons are mentioned almost as often as adult daughters. DISCUSSION: Findings illustrate not only the role women play as providers of the majority of informal care to veterans but also the substantial role adult sons have in providing support to their fathers. Many veterans are at risk of institutionalization by having no one to provide instrumental support and health monitoring.     

Self care for chronic illness: Older African Americans and whites

In-person interviews with two hundred and twenty-one older African Americans and whites in Allegheny County, Pennsylvania on their use of self care activities in the care of one of four chronic illnesses (chronic obstructive pulmonary disease (COPD), heart disease, diabetes mellitus, and arthritis, addressed which types of self care they used for each of these illnesses) the similarities and differences between African Americans and whites in their use of self care and how self care is initiated, modified and integrated into a context that includes help from others. The most common response in each of the illnesses was the use of medications or medical treatments by both African Americans and whites. However, there were some differences in the self care practices used by these two groups by illness type. Whites reported monitoring their illness significantly more than African Americans for diabetes and using assistive devices in the management of COPD significantly more than African Americans. While both African Americans and whites practice self care similarly in the management of heart disease, African Americans reported greater use of exercise in their management of arthritis. The amount of assistance provided by others in support of self care varied by illness and by African American and white. The differences in self care usage may be attributed to many factors, among them, differences in cultural experiences with the illness, health beliefs regarding its efficacy and the amount of assistance received from informal supports.     

The role of informal carers in supporting gay men who have HIV related illness: what do they do and what are their needs?

Despite calls for a shift from hospital to community based care for people with HIV infection there has been some speculation about whether the facilities will actually be available. One central element of community care is informal care. Structured interviews with 125 people who were supporting gay men with HIV related illness including AIDS (hereafter PWA) provide information about the characteristics of people who were helping on an informal basis, what they did, and what support they needed for themselves. It was mostly male friends and partners who were offering support. Half the carers were carrying out specific physical tasks, though much of the support was more general, particularly emotional support. Where both people had experienced symptoms some reciprocity of caring was taking place. Resistance to being labelled a 'carer' was evident. Carers felt themselves inadequately supported both practically and emotionally and were specific about what could be done to change this.     

Young adults experiences of living with congenital heart disease

BACKGROUND: Advances in care have improved the longevity and quality of life for children with congenital heart disease; however, many of them need lifelong highly qualified specialist care. The cardiac lesion involved may not always be the patient's main problem; issues related to quality of life may dominate. AIM: To explore and gain a deeper understanding of young adults experiences of living with congenital heart disease in order to enhance the quality of care provided by the health care system. METHOD: Transcribed in-depth interviews were analysed using a phenomenological-hermeneutic method. Six adults with congenital heart disease, aged 22-39 years old, were included in the study. RESULTS: Analyses yielded two themes, having the disease and living with illness, both originating from the main theme of ambivalence. The interviewees were ambivalent in how they viewed themselves, how they faced their daily life and how they dealt with their encounters with the health care system. They had to strike a balance between being different and not being different; being sick and being healthy; revealing their congenital heart disease or hiding it and living with a hidden handicap. They also had to cope with the disease and with the health care system. CONCLUSION: Young adults with congenital heart disease are ambivalent. They have a strong wish to be healthy and they might hide their symptoms from the healthcare personnel and sometimes even from themselves. A psychosocial preparedness when meeting these patients is necessary.     

Subjective evaluation of health in old age: the role of immigration status and social environment

The study investigated the role of immigration status on self-rated health, general health, and well-being among elderly persons by comparing two groups of elderly persons who immigrated from Eastern European countries to Israel-veterans and new immigrants. It also examined the factors that explain self-rated health in both groups. Data for this study (n = 784) were taken from a study based on structured home interviews of a random sample of Israeli Jewish elderly (70+) conducted in 1994. The results show that the new immigrants are younger and have higher education than the veterans, but their economic status is lower and they have a lower percentage of men and married persons. The new immigrants also rank themselves lower than the veterans on a variety of measures of health and psycho-social well-being. It is suggested that the stress caused by immigration and factors related to the standard of living and health services in the countries of origin outweigh the relative advantage that the new immigrants have, in terms of age and education, in influencing their health and well-being. Self-rated health among the new immigrants is explained mainly by objective measures of health, economic status and a feeling of control over life, while among the veterans it is explained by these variables as well as by other psycho-social variables such as self-esteem and social support. These findings suggest careful analyses of subjective evaluations of health in different socio-cultural subgroups in society for theoretical reasons and for purposes of planning interventions directed to promote health and psycho-social well-being of elderly persons on the community level.     

STAFF PERCEPTIONS OF CARING FOR ITALIAN GREEK AND CHINESE NURSING HOME RESIDENTS

Despite the fact that Australia is a multicultural society there has been little research into health practitioners' experiences of providing care for patients from various ethnic backgrounds. A survey of Sydney nursing homes obtained staff ratings of the tensions involved in 14 aspects of caring for the ethnic groups with whom they had most experience. These were Italians, Greeks and Chinese. Patterns of tension associated with their care differed significantly and can be related to differences in group characteristics (time in Australia, English speaking skills) and to the degree of similarity of group illness behaviours to Anglo-Australian norms. The implications of the findings for the education of health practitioners are discussed.     

Retirement age caregivers and deprivation of area of residence in England and Wales

Many countries in Europe are beginning to acknowledge the essential contribution of informal caregivers, as policy changes leave more people with greater needs being cared for in the community. Carers who are themselves retired are a vulnerable group. Compared to caregivers in younger age groups, a higher proportion have pre-existing disease; they may be more vulnerable to the adverse effects of caregiving on health, and many survive on low incomes. This study investigated whether ill health amongst older carers and hours of caregiving were greater in disadvantaged areas of England and Wales. We also estimated the cost of replacing this care with formal services. Data were analysed from the 2001 UK census, relating to 9.2 million males and females of pensionable age living outside of communal establishments in England and Wales. Thirteen percent of people over retirement age (1.2 million) provided care for others, more than half of whom (742,182) reported poor health. Pensioners provided care in all areas; the proportion giving care was higher in low deprivation (advantaged) areas, but both the numbers and proportion of pensioners in poor health providing many hours of care were greater in disadvantaged areas. The annual cost of replacing all informal with formal social care was estimated to lie between 14.8 and 43.9 billion Euros. Older carers are an essential support to welfare systems. If demographic shifts require any substitution of formal for informal care, this will place a significant burden on all areas, with the greatest needs likely to be in the disadvantaged areas. Competing interests: all authors declare that they have no competing interests. Ethical permission was not required.     

Expanding the Caring Lens: Nursing and Medical Students Reflecting on Images of Older People

In changing higher education environments, health profession’s educators have been increasingly challenged to prepare future health professionals to care for aging populations. This article reports on an exploratory, mixed-method research study that used an innovative photo-elicitation technique and interprofessional small-group work in the classroom to enhance the reflective learning experience of medical and nursing students. Data were collected from pre- and postquestionnaires and focus groups to explore shifts in perceptions toward older persons following the reflective learning session. The qualitative data revealed how using visual images of older persons provides a valuable learning space for reflection. Students found meaning in their own learning by creating shared storylines that challenged their perceptions of older people and themselves as future health professionals. These data support the use of visual methodologies to enhance engagement, reflection, and challenge students to explore and deepen their understanding in gerontology.     

Social support and psychosocial adjustment to rheumatoid arthritis quantitative and qualitative findings

One hundred twenty-nine individuals with rheumatoid arthritis were interviewed, and their satisfaction with several aspects of social support was rated. Quantitative analyses showed that patients' overall support satisfaction was related to health care providers' ratings of their psychosocial adjustment, independent of patients' demographic characteristics, illness duration, disease activity, and functional disability. Furthermore, the relation between support satisfaction and psychosocial adjustment increased as a function of patients' level of disability, suggesting a stress-buffering function of support. Among the important qualitative findings emerging from content analyses of interview material was that disruptions in relationships with actual and potential support providers constituted a source of stress. However, several participants stated that the illness had actually strengthened valued relationships. Patients' views of helpful and unhelpful support gestures are also classified and discussed. Directions for future research on the support process are suggested.     

Volunteering and health among older people: a review

This paper presents a review of the available literature on the relationship between volunteering and health among older people. There is consistent evidence that morbidity rates, functional health indices, self reported health and life satisfaction are affected by formal and informal volunteering. Some studies suggest that the benefits of volunteering are reciprocal, in that both those who give and those who receive assistance benefit. The evidence is consistent with the proposal that social capital is generated through volunteering. It is likely that the presence of high levels of social capital supports and maintains the health of older persons, provides informal support in times of sickness and stress and thus enhances quality of life as well as reducing or delaying the onset of illness and death.     

“I Have to Keep Going”: Why Some Older Adults Are Using the Internet for Health Information

This study used an ethnographic approach to understand why older adults in the United States are using the Internet for health information and how this activity may or may not relate to their ideas about aging. Eight (N = 8) older adults were visited in their homes during 4 months. Semi-structured interviewing, informal conversations, and observation techniques were used. Data were thematically coded and analyzed. Findings suggest that older adults’ ideas about aging influenced their definitions of health, health information seeking, and what they considered to be health information. They were using the Internet to demonstrate their independence and remain active. “Health” information went beyond the health/disease/illness constructs and incorporated their ideas of aging and how they were using the Internet for information that they hoped would help them maintain their independence. Insight into why older adults are engaging in this electronic form of health information seeking provides an opportunity to understand how effective this form of health communication is currently, and how it can be optimized to design technologically based health information/programs that are applicable and relevant to older adults’ lifestyles. This study was limited by the small number of individuals that participated, which limits its generalizability. However, it does demonstrate that broader definitions of health, ones which incorporate notions of aging, may help us better understand the types of information older adults consider to be health information- and how these definitions could potentially influence health information seeking via the Internet.     

The influence of intergenerational exchange on nursing home admission in Taiwan

This study examines the effect of intergenerational exchange on nursinghome admissions among functionally disabled older adults in Taiwan. A groupof 317 nursing home residents were randomly selected from all nursing homesin Taipei, the capital of Taiwan. In addition, two community groups wererandomly selected as multiple controls in the study. The results showed thatintergenerational exchange has a statistically significant effect onnursing home admission after controlling for sociodemographic characteristics and health status. The odds of being admitted into a nursing home was lower for those elderly who provided instrumentalassistance to their families before they were disabled. The adjustedrelative risk estimate was 0.2 (95% CI = 0.1 - 0.6). It showsthat the instrumental assistance the elderly provided to the family beforethey became disabled was reciprocated when they needed ADL assistance. Thisfinding provides strong support for the social exchange theory.     

A qualitative exploration of parental experiences of stigma while living with HIV in Bangladesh

With much of the focus on the “risk” groups, families have often been less studied in HIV research. Further, because of a focus on the aetiology and epidemiology of HIV, the social impacts associated with HIV on families and neighbours are sometimes overlooked. This study examined parental experiences of stigma and discrimination while living with HIV within a family context in Bangladesh. A qualitative research design using a grounded theory approach was used for this research. Data was collected through in-depth interviews with 19 HIV-positive parents, recruited with the support of two self-help groups of HIV-positive people, in two settings namely Khulna and Dhaka in Bangladesh. The findings indicate that HIV-positive parents held the view that they continue to experience significant stigma and their narratives clearly show how this affected them and their children. A range of informal practices were enacted in everyday contexts by extended family and community members to identify, demarcate and limit the social interaction of HIV-positive parents. Parents highlighted a number of factors including negative thoughts and behaviours, rejection, isolation and derogatory remarks as manifestations of stigma and discrimination, impacting upon them and their children because of their association with HIV.     

Family Caregiving of Older People with Dementing Illnesses in Nursing Homes: a Lifeline of Special Care

Objective: Explore the meaning of the care given by family caregivers to family members with a dementing illness after their placement in a nursing home. Method: A constructivist approach, informed by symbolic interactionism, and using grounded theory methods, served as the theoretical and analytical underpinnings of this study. In all, 14 family caregivers (predominantly daughters caring for mothers) were interviewed. Results: There is a dual meaning inherent in family caregiving activities in this context. It is perceived as a lifeline of special care for the family member in the nursing home, and is meaningful and constructive for the caregivers themselves. Conclusion: Understanding this ‘;dual’ meaning of family caregiving activities is highly relevant for health care workers and others who interact with family members in the nursing home situation.     

卒中患者非正式照顾者的心理健康

卒中的致残率很高，残疾患者通常需要他人照顾。研究表明，非正式照顾者对卒中患者的康复起着非常重要而且不可替代的作用，可在一定程度上降低政府在职业护理上的财政支出。因此，了解非正式照顾者的心理健康状况，探讨影响其心理健康的因素，实施相应的干预措施非常必要。     

Effect of outpatient treatment of asthma with beta agonists on the response to sympathomimetics in an emergency room

It has been suggested that tolerance to the bronchodilating effects of sympathomimetics may develop in asthmatic patients after long-term use of these agents. In an emergency room setting, the effects of inhaled and injected sympathomimetic therapy in 58 patients who had pretreated themselves with beta agonists were compared with the results observed in 38 patients who had not used such drugs. The two groups had similar degrees of obstruction on presentation and were also well-matched with respect to the clinical features of their illness. Both populations showed equal responses to treatment; no significant differences were found in either the amount of bronchodilation or the incidence of adverse effects in those who had or had not taken sympathomimetics as outpatients. These findings indicate that drug resistance does not account for outpatient treatment failures with sympathomimetics and that beta agonists can be usefully employed in the treatment of acute asthma, irrespective of a patient's medication history.     

Diurnal blood pressure patterns in long-term care settings

BACKGROUND: Some research suggests that individuals whose blood pressure does not decline at night may be at increased risk of end-organ damage. Few studies have examined ambulatory blood pressure among elders, particularly those living in institutions. This study therefore evaluates ambulatory blood pressure variation in two groups of institutionalized elderly, independent living and nursing home residents. It was suggested that the nursing home sample would have a higher rate of non-dipping than the independent-living residents. DESIGN AND METHODS: Twenty-seven residents (aged 87 +/- 8 years) of a nursing home facility and 29 residents (aged 80 +/- 6 years) from two independent living facilities wore ambulatory monitors for approximately 24 h. Several definitions of dipping were examined. RESULTS: Neither mean daytime nor mean night-time systolic blood pressure differed between the two groups. Daytime diastolic blood pressure was significantly higher in the independent living sample, as was night-time diastolic pressure in the nursing home residents. Neither asleep nor awake blood pressure varied significantly between groups. The decline in night-time blood pressure and sleep blood pressure was significantly greater among the independent living residents (P < 0.05). Ratios of night-time/daytime and asleep/awake blood pressure were significantly higher in the nursing home group. Non-dippers were significantly more frequent among the nursing home residents. CONCLUSIONS: Nursing home residents were significantly more likely to be non-dippers. Both groups of resident were more frequently non-dippers than were individuals in community-dwelling samples. The high prevalence of non-dipping among institutionalized elderly people may be a result of age, health status or institutional activity patterns.     

Using Reminiscence Group Members' Family Slogans and Epitaphs to Enhance Their Planning Abilities

Abstract

Introducing a focus on family slogans and epitaphs into reminiscence groups serves three functions. It facilitates the group process by engaging all members in selecting the slogans and epitaphs that they discern in the memories the reviewers share. It also shows how these family dynamics over the grandparents' and parents' generations condition, if not determine, the slogans and epitaphs of the reviewers themselves. Finally, it enhances reviewers' planning for themselves by alerting them both to the accommodations they may need to make to their programming and to the talents they can draw upon because of the family they were born into.