Participant diaries as a source of data in research with older adults

Solicited participant diaries are an excellent source of data that has not been given sufficient attention as a data collection strategy for qualitative research. In a recent grounded theory study designed to explore strategies used by older adults to manage their chronic health problems, solicited diaries, when combined with an initial and follow-up interview, provided a rich source of data about day-to-day activities of participants. There were three options for maintaining the diary: written, audiotaped, or telephone conversation. The solicited diaries were guided by a set of open-ended questions designed to encourage participants to focus on daily activities and reflect on their values. The authors provide examples of data from participant diaries and suggestions for incorporating solicited participant diaries into data collection strategies for qualitative research.     

Patterns and causes of health inequalities in later life: a Bourdieusian approach

This study explores the relationship between social class and health change in older people in a path analysis, using data from the English Longitudinal Study of Ageing (n = 6241) in a Bourdieusian theoretical framework. Bourdieu drew a distinction between the occupational characteristics by which people are classified and the secondary properties of class that relate to lifestyle (economic, cultural and social capitals). Our path model includes both occupational and secondary characteristics of objective social class as well as a measure of subjective social class. We investigate the effects of the predictors on change in three health outcomes (self‐rated health, number of symptoms of depression and number of difficulties with the activities of daily living). The analysis adds to Bourdieusian research by showing how the effects of objective social class on health are partially mediated by perceived social status. It also adds to substantive research on the relationship between class and health by suggesting that class‐related health inequalities do persist for older people, even for those who are not in paid employment. It suggests that a large amount of the effect of occupation on the health of older people is not direct but indirect; through their personal wealth and lifestyle.     

"It's your whole way of life really": negotiating work,health and gender

Recent discussions in contemporary geographies of health have highlighted the need to understand the social contexts in which people experience health and illness. Qualitative and mixed method studies have been shown to be invaluable to such research, especially where investigations seek to understand the circumstances and responses surrounding particular conditions. In this paper, we move beyond biomedical approaches to combine methods in health research and gain insights into the complex contexts and relations affecting men's and women's respiratory health. Drawing on three literatures and past work on respiratory disease in selected primary industries, we report on qualitative research conducted with men and women horse trainers and vegetable growers working in southern New Zealand. We note the gendered work differences that could be affecting contrasting disease rates and focus on notions of 'metaphor' and 'place' to analyse the narratives trainers and growers construct about their health. We report that men and women negotiate a "whole way of life" that involves both specific workplaces and social relations that shape their work and health experiences.     

Social geographies of African American men who have sex with men (MSM): A qualitative exploration of the social,spatial and temporal context of HIV risk in Baltimore,Maryland

This qualitative study utilized a time-geography framework to explore the daily routines and daily paths of African American men who have sex with men (AA MSM) and how these shape HIV risk. Twenty AA MSM aged 18 years and older completed an in-depth interview. Findings revealed (1) paths and routines were differentiated by indicators of socio-economic status, namely employment and addiction, and (2) risk was situated within social and spatial processes that included dimensions of MSM disclosure and substance use. This study highlights the critical need for future research and interventions that incorporate the social and spatial dimensions of behavior to advance our ability to explain racial disparities in HIV and develop effective public health responses.     

Navigating the time-space context of HIV and AIDS: daily routines and access to care

Geographers have shown that daily activities and social networks are constrained by time-space, but there are also enabling facets or opportunities created by daily routines for accessing material and emotional resources, improving quality of life, and even challenging existing power relations. Time-geography in this paper is taken as a starting point to assess how individuals living with HIV and AIDS navigate the complex and often difficult time space contexts defining their access to services. The concept of time space windows of access is offered as a way to understand the opportunities created by daily routines and social network interaction even in highly marginalized social, economic, and political circumstances. Survey data and in-depth interviews conducted with a diverse group of persons living with HIV and AIDS are used to illustrate this conceptual argument. Results indicate that the time space characteristics of daily routines, such as frequency of activities, variety or heterogeneity in activities, and whether activities are self- or social network-oriented, serve to define the availability of temporal and spatial windows of access to services. In addition, daily routines seem to matter for specific types of services, and have a limited role to play in terms of primary medical services or those associated with basic needs. The implications of these findings for theorizing and for enhancing access to services are provided.     

Development of the activity card sort--Australia

Aims:   To develop the Activity Card Sort (ACS) — Australia as a tool to measure participation in activities of daily living for older adults.
Methods:   Secondary data analysis of activity diaries of older Australians in Brisbane and Adelaide were utilised for item generation. Survey of older adults and cluster analysis was used for item selection and determination of domains for the ACS-Australia.
Results:   The final ACS-Australia is comprised of 82 activity items, falling under the three domains of household activities, social/educational activities and leisure activities.
Conclusions:   The ACS-Australia has robust properties, wide application and provides a culturally relevant tool to measure participation of older Australians, thus will facilitate rigorous clinical and population-based research.     

Considering daily mobility for a more comprehensive understanding of contextual effects on social inequalities in health: A conceptual proposal

Despite growing interest in integrating people׳s daily mobility into contextual studies of social inequalities in health, the links between daily mobility and health inequalities remain inadequately conceptualised. This conceptual proposal anchors the relationship between daily mobility and contextual influences on social inequalities in health into the concept of mobility potential, which encompasses the opportunities and places individuals can choose (or are constrained) to access. Mobility potential is realized as actual mobility through agency. Being shaped by socially-patterned personal and geographic characteristics, mobility potential is unequally distributed across social groups. Social inequalities in realized mobility may thus result. We discuss pathways by which these may contribute to contextual influences on social inequalities in health. One pathway is reflected in disadvantaged groups encountering more fast-food outlets during their daily activities, which may relate to their higher risk of unhealthy eating. This proposal lays the bases for empirical research explicitly testing hypotheses regarding the contribution of daily mobility to social inequalities in health.     

Food provision and the meal situation in elderly care – outcomes in different social contexts

BACKGROUND: Nutritional problems concerning older people in care can be affected both by their illness and by the standard procedures surrounding food provision, for example rigid routines of food supply and ritualized mealtime situations. METHOD: The aim was to study how organizational structure and staff members' routines and actions influence activities related to food and meals in different caring context in Sweden. The qualitative methodology chosen for this study was participant observation. RESULT: Care recipients were given different opportunities concerning what, how, when and with whom to eat, depending on where their meals were served. In restaurants, older people could choose from several foods and they could also choose the time of and company for the meal. At care units with 'part-of-day' care or 'around-the-clock' care, food choices, time and company were limited, especially at the units with 'around-the-clock' care, where the most ailing older people lived. CONCLUSIONS: Food provision and the mealtime situation for the elderly are shaped by the individual's living arrangements, and the social organization surrounding it, not determined by the individual's needs and wishes, including social and cultural meanings of food and meals, which could, thereby, affect nutritional intake.     

Museum-based programs for socially isolated older adults: Understanding what works

This paper presents research findings that help to understand how museum programs created opportunities to enhance wellbeing and health, and changed experiences of social isolation in older adults. The research conceptualized how program elements enabled both individual experiences and relational processes to occur. These components operated within a context that was enriched by the museum as a place to support wellbeing and enhance social interaction. To meaningfully support socially isolated older people as part of local public health strategies, museums need to be accessible and engaging places that purposively support social interaction by involving people and objects, participating in multiple sessions over time, that are facilitated by skilled and knowledgeable staff.     

“The people make it fun,the activities we do just make sure we turn up on time.” Factors influencing older adults’ participation in community‐based group programmes in Perth,Western Australia

Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community‐based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors’ centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors’ centres in developing activities attractive to a broader cohort of older people.     

The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

PurposeAdolescents are particularly vulnerable during the COVID-19 quarantine periods and may be at risk for developing psychological distress symptoms that extend beyond a crisis, including depression. This study examined adolescents’ postquarantine depressive symptoms associated with pandemic stressors. The primary aim was to identify potential protective factors that may buffer the association between the presence of COVID-19 cases in adolescents’ communities and their postquarantine depressive symptoms.MethodsAdolescents from public schools were recruited from Zhengzhou city, Henan, China (N = 1,487, M_age=13.14 years, 50% girls). Adolescents reported the presence of confirmed or suspected COVID-19 cases in their communities, their daily activities and routines during the 2-month quarantine period, and depressive symptoms after the quarantine period.ResultsThe presence of cases in adolescents’ communities during the quarantine contributed to more depressive symptoms in adolescents after the quarantine. This association was buffered by adolescents’ spending more time on physical activities and better maintenance of daily living routines during the quarantine period. The presence of community infection was also more strongly associated with depressive symptoms in older adolescents.ConclusionsThe presence of COVID-19 cases in communities contributed to adolescents’ poorer mental health, and the association was stronger for older adolescents. Spending time on physical activities and maintaining daily living routines during the quarantine appear to be practical strategies that can be used by adolescents to mitigate the association between pandemic stressors and their diminishing mental health.     

Factors associated with self-rated health for non-institutionalized aged persons

OBJECTIVE: To determine factors affecting self-rated health among the non-institutionalized elderly in Japan. METHODS: In 20 municipalities in Japan, 6,094 persons aged 65 years and older who were not institutionalized were selected at random. A questionnaire survey was conducted from September through November 2000. The distribution of self-rated health was rated in terms of dependent variables, with odds ratios and their 95% confidence intervals calculated using unconditional logistic models. RESULTS: Of the study population, 5,565 persons (91.8%) responded to the survey. Of the respondents, 64.4% answered that they were healthy, while 28.8% were not. The necessity for periodical visit to hospitals and clinics, and lowering of the activity of daily living greatly lowered self-rated health. Compared with those who were 85 years of age or older, a high health status was observed among those aged between 75 and 84 years, but not those aged 65 to 74 years. Those who tried to have exercise periodically, who had a vice-leadership role in a group, who joined social activities, who lived what they considered a worthwhile life, and who had positive positive activities in daily life, had high levels of self-rated health. Joining social activities for passive reasons elevated the health as well as joining for active reasons such as "because it is fun." CONCLUSION: Even if the reason is passive, joining social activities may elevate the self-rated health levels of elderly people.     

Time use,role participation and life satisfaction of older people: Impact of driving status

Background/aim: Driving cessation has been recognised as affecting the health and wellbeing of older people. Further exploration of the impact of driving status on time use, role participation and life satisfaction was required. Methods: A cross‐sectional survey of 234 older people (current drivers, retired drivers and people who have never driven) was employed. Time use in the previous week, role participation and life satisfaction were measured and compared between the groups, while controlling for sociodemographic variables (health status, activities of daily living and instrumental activities of daily living status, gender, age and living situation). Results: When compared to current drivers, retired drivers had significantly lower life satisfaction (P = 0.01), fewer present roles (P < 0.0001) and were less likely to participate in volunteer (P = 0.005) and family member roles (P = 0.009). Retired drivers spent less time on social leisure (P = 0.002) and away from home (P = 0.0001), and more time in solitary leisure (P = 0.0001). Comparing the participation of retired drivers with those who had never driven indicated that retired drivers spent significantly less time in volunteer work (P = 0.009). Conclusions: The findings indicate that older non‐drivers may require support for participation and wellbeing.     

“My Legs Affect Me a Lot. … I Can No Longer Walk to the Forest to Fetch Firewood”: Challenges Related to Health and the Performance of Daily Tasks for Older Women in a High HIV Context

Compromised health negatively impacts older persons’ ability to participate in expected social roles. Researchers have published little empirical work, however, to explore these issues in HIV endemic African settings. Qualitative interviews with 30 women, aged 60-plus, in rural South Africa, provide insight into the relationship between health and daily activities, with attention to the fulfillment of social roles. In this poor HIV endemic context, older women make connections between their compromised health and their (lack of) capacity to perform the daily tasks that they view as expected of them. By expanding the conceptualization of health to include the capacity to achieve the expectations and perform the tasks expected of one, we better understand how and why health and performance of daily activities are so intricately linked in the minds of respondents. This also provides a starting point for thinking about the social and structural support needed by older persons in these settings, especially as HIV erodes familial supports.     

Social engagement,setting and alcohol use among a sample of older Australians

The harms associated with risky alcohol consumption have long been researched and recognised in the health field. However, little available research has focused on older people or extended analysis of alcohol use by this segment of the population beyond a biomedical perspective. With the rapid ageing of the global population, research that investigates alcohol use among older people from a social perspective is important. This article reports on research with a group of older women and men, to identify and explain factors that influence alcohol consumption. In‐depth interviews were conducted in Perth, Western Australia with 20 men and 22 women aged 65–74 years who were living in either private residences or retirement villages. The study findings indicated that alcohol use was linked with social engagement in activities across both settings, and that moderate alcohol use appeared to serve an important function as a ‘social lubricant’. The major facilitating factors for alcohol use included the frequency of opportunities for social engagement and access to a ready‐made social group in retirement villages. The major constraining factor across both settings was driving. Interestingly, health was not viewed as a major facilitating or constraining factor for alcohol consumption. Conclusions from the research were that alcohol serves an important role in enhancing social engagement, and there appear to be important associations between residential setting and alcohol use.     

Shedding new light on the (in)compatibility of chronic disease management with everyday life – social practice theory,mobile technologies and the interwoven time‐spaces of teenage life

This article uses a socio‐material approach, social practice theory, to provide new insights into the self‐management of chronic illness. It demonstrates how this theory can bridge arguments about the respective roles of social and individual influences, and how it can foreground an oft‐overlooked aspect of the issue – the demands of self‐care technologies and consequences for participation in social life. Drawing on interviews and focus groups with 25 young type‐1 diabetes outpatients in London, UK, the study points to the conflicts that occur when disease management technologies compete for time and space with the social practices of everyday life, and when self‐care tasks threaten to interrupt the flow of social life and make people feel ‘left behind’. The paper concludes that young people are disabled by the contingent position of self‐care activities in daily life, which oblige them to compromise either their physical health or their immersion in the social world. This disabling effect would be mitigated if social practices were reorganised to make them more amenable to the time‐space requirements of disease management. A social practice theory lens can help throw light onto this issue and make a valuable contribution to the study of the self‐management of chronic illness.     

The influence of daily routines on engaging in diabetes self-management

Abstract

Objective: In contrast to previous research concerning the importance of routines in occupational engagement, most of which have largely focused on the routines of children and families, in this study a qualitative methodology was used to understand how routines function in a specific occupation: diabetes self-management (DSM). Methods: Ten low-income women participated in a multiple-methods study that involved completing a time-geographic diary (TGD) and participating in a TGD interview. Results: Findings reveal that pre-existing routines must be changed so that they may better support engagement in DSM, and that such changes are tied to underlying habits and life situations. The experiences of study participants also showed that the distribution of daily occupations through time and across social spheres can be both supportive of and problematic for engaging in DSM. In addition, the structure and sequence of competing daily occupations influences the available time and opportunities for people to further develop their skills and become more adept self-managers. Conclusions:The implications of these findings for occupational science and therapy are discussed.     

Factors Associated With Health-Related Quality of Life Among an Older Population in a Largely Rural Western Region

CONTEXT: As elderly people become a larger proportion of the rural population, it is important to identify those at risk for poor health. Predictors of health-related quality of life can be useful in designing interventions. PURPOSE: One objective of the present study was to profile the health-related quality of life of community-dwelling, elderly people in a southwestern region of the United States. A related objective was to identify the principal factors associated with health-related quality of life, thereby identifying population subgroups in greatest need of health or social services. METHODS: A telephone survey of approximately 5,000 individuals 65 years and older collected data on need for assistance with activities of daily living, physical and mental health-related quality of life, and worry about health status measures. A modified version of the Behavioral Model was used to more clearly distinguish the different groups at risk for poor health. FINDINGS: Those groups of community-dwelling, elderly people in the poorest health were older than 75 years, had less than a high school education, were retired or unemployed, and had low household income. No differences were found by urban, rural, and frontier residence. CONCLUSIONS: To maintain the physical, social, and psychological health of older people residing in rural and urban areas, social services, medical care, and supportive services are needed, particularly among the most socially and economically disadvantaged.     

Pain in Children and Adolescents With Sickle Cell Disease: An Analysis of Daily Pain Diaries

The purpose of this study was to analyze daily patterns of pain, medication use, health care use, and activity reduction during pain episodes in children and adolescents with sickle cell disease (SCD). The parents of 34 children and adolescents ages 6 to 17 years completed a daily diary about their children's pain response for 14 days. Eight of the adolescents (ages 13-17) concurrently but independently completed the same diaries. The results indicate that children with SCD usually experienced low levels of pain that was managed at home, sometimes without any medications. Multilevel random effects models indicated that as pain levels increased, children were more likely to use narcotic medications and health care services, although overall health care utilization during the 2-week period tended to be relatively infrequent. On average, children considerably reduced school, household, and social activities when in pain. Moreover, parents and adolescents generally agreed on daily pain response, especially for salient events such as health care visits.