A framework for studying the nutritional health of community-dwelling elders

BACKGROUND: Ensuring nutritional health for elders has been shown to reduce healthcare costs and enhance quality of life. Studies, however, have shown that malnutrition is present in 2% to 51% of community-dwelling elders, depending on the definition used and the population studied. An empirically tested framework for studying nutritional health in community-dwelling elders is not yet available. OBJECTIVE: To test the goodness-of-fit exhibited by the framework of nutritional health among community-dwelling elders based on the Roy Adaptation Model using structural equation modeling (SEM). METHODS: A population-based study investigated 243 elders dwelling in public housing. Demographics, polypharmacy, chronic illness, oral health, depressive symptoms, functional status, and satisfaction with social support were assessed to test their relation with nutritional health according to the propositions of the Roy Adaptation Model and scientific evidence. RESULTS: The SEM analysis indicated that functional status, oral health, depressive symptoms, and satisfaction with social support affect nutritional health directly. Oral health, depressive symptoms, functional status, and satisfaction with support mediated the effects of age, ethnicity, education, and number of medications and chronic illnesses on nutritional health. The model accounted for 35% of the variance in nutritional health and demonstrated a good fit with the data and with the values for Bentler's Comparative Fit Index (0.94) and chi (1.76). CONCLUSIONS: The propositions of the Roy Adaptation Model were supported, and the findings showed that this framework of nutritional health among community-dwelling elders could serve as a theoretical and empirical base for future inquiry.     

Conceptualization and Nursing Implications of Self‐Imposed Activity Limitation Among Community‐Dwelling Elders

ABSTRACT The purposes of this paper are to explore, from a theoretical perspective, explanations for why some community‐dwelling elders self‐impose activity limitations (SIALs); to develop an integrated explanation for SIAL from a nursing perspective; and to identify some clinical implications of relevance to public health nursing practice. Activity limitation is an important risk factor for functional decline, morbidity, and mortality among community‐dwelling elders. Many studies have focused on disease and environmental influences on activity limitations. The intrinsic processes associated with voluntary or SIAL in old age among otherwise physically and mentally capable elders are poorly understood and little studied. The conceptualization of SIAL provides nurses with an understanding of an understudied aging phenomenon and helps nurses understand how elders see activities related to their life priorities. The conceptual framework will facilitate future qualitative and quantitative study of SIAL, assist nurses in the development of a new gerontological nursing theory, and design of interventions for elders with activity limitations. Public health nurses with a better understanding of SIAL may be able to help elders improve or maintain their independence.     

Perinatal depressive symptoms among Thai women: A hospital‐based longitudinal study

The authors of this longitudinal study investigated risk factors for postpartum depressive symptoms and differences in depressive symptoms at late pregnancy and at 1 and 3 months postpartum. In Sakhonnakhon Province, in northeastern Thailand, 449 women were recruited during late pregnancy and followed at 1 and 3 months postpartum with the use of psychosocial factors. Depressive symptom scores were measured using the Edinburgh Postnatal Depression Scale (EPDS). The scores were compared using dependent‐samples t‐tests, and multiple linear regression analyses were used to identify risk factors for depressive symptoms at 1 and 3 months postpartum. EPDS scores decreased from late pregnancy to 1 month postpartum and remained on the same level until 3 months postpartum. Low psychological well‐being scores and low personal monthly income were risk factors for increased EPDS scores at 1 and 3 months postpartum. Pregnant women in Thailand who have a low income, have limited social support, and report low psychological well‐being are at increased risk for postpartum depression. Results of this study suggest they should be screened for depressive symptoms during pregnancy, referred for diagnosis, and provided treatment to reduce the risk of ongoing depressive symptoms during the postpartum period.     

Social media usage,social support,intergenerational relationships,and depressive symptoms among older adults

Many older adults are unable to use social media, which may affect their social support and intergenerational relationships and cause depression. To examine this impact on older Taiwanese adults, we used purposive sampling, a cross-sectional, correlational study design, and a structured questionnaire to collect data on participants’ characteristics, social media usage, social support, intergenerational relationships, and depressive symptoms. We studied 153 older adults (aged 60 years and above) and found higher levels of depressive symptoms among participants who took medication, did not exercise regularly or participate in leisure activities, experienced poor health and sleep quality, and had poorer functional ability compared to their counterparts. Depressive symptoms were significantly associated with social media usage, social support, and intergenerational relationships. We recommend considering risk factors and offsetting depressive symptoms by promoting the use of social media and regular exercise to increase social interactions, social support, and intergenerational relationships among older adults.     

Migraine and Psychiatric Comorbidities Among Sub‐Saharan African Adults

Background.— Despite being a highly prevalent disorder and substantial cause of disability, migraine is understudied in Africa. Moreover, no previous study has investigated the effects of stress and unipolar psychiatric comorbidities on migraine in a sub‐Saharan African cohort. Objective.— To evaluate the prevalence of migraine and its association with stress and unipolar psychiatric comorbidities among a cohort of African adults. Methods.— This was a cross‐sectional epidemiologic study evaluating 2151 employed adults in sub‐Saharan Africa. A standardized questionnaire was used to identify sociodemographic, headache, and lifestyle characteristics of participants. Migraine classification was based on the International Classification of Headache Disorders‐2 diagnostic criteria. Depressive, anxiety, and stress symptoms were ascertained with the Patient Health Questionnaire and the Depression Anxiety Stress Scale, respectively. Multivariable logistic regression models were used to estimate adjusted odds ratio (OR) and 95% confidence intervals (CIs). Results.— A total of 9.8% (n = 212) of study participants fulfilled criteria for migraine (9.8%, 95% CI 8.6‐11.1) with a higher frequency among women (14.3%, 95% CI 11.9‐16.6) than men (6.9%, 95% CI 5.5‐8.3). Similar to predominantly Caucasian migraine cohorts, sub‐Saharan African migraineurs were more likely to be younger, have a lower education, and more likely to report a poor health status than non‐migraineurs. However, in contrast with historical reports in predominantly Caucasian migraine cohorts, sub‐Saharan African migraineurs were less likely to report smoking than non‐migraineurs. Participants with moderately severe depressive symptoms had over a 3‐fold increased odds of migraine (OR = 3.36, 95% CI 1.30‐8.70) compared with those classified as having minimal or no depressive symptoms, and the odds of migraine increased with increasing severity of depressive symptoms (P trend < 0.001). Similarly, those with mild, moderate, and severe anxiety symptoms had increased odds of migraine (OR = 2.28, 95% CI 1.24‐4.21; OR = 1.77, 95% CI 0.93‐3.35; and OR = 5.39, 95% CI 2.19‐13.24, respectively). Finally, those with severe stress had a 3.57‐fold increased odds of migraine (OR = 3.57, 95% CI 1.35‐9.46). Conclusion.— Although historically it has been reported that migraine prevalence is greater in Caucasians than African Americans, our study demonstrates a high migraine prevalence among urban‐dwelling Ethiopian adults (9.9%) that is comparable with what is typically reported in predominantly Caucasian cohorts. Further, among employed sub‐Saharan African adults and similar to predominantly Caucasian populations, migraine is strongly associated with stress and unipolar psychiatric symptoms. The high burden of migraine and its association with stress and unipolar psychiatric symptoms in our study of well‐educated and urban‐dwelling African adults has important clinical and public health implications pending confirmation in other African populations.     

Short‐term in‐home intervention reduces depressive symptoms in Early Head Start Latina mothers of infants and toddlers

Depressive symptoms may compromise the ability of low‐income Latina mothers with limited English language proficiency to parent their infants or toddlers. Eighty Early Head Start Latina mothers with limited English language proficiency were randomized to an advanced practice nurse‐delivered, culturally tailored, in‐home psychotherapy intervention, or to usual care. Repeated measures regression analysis showed a significantly greater decrease in depressive symptoms for intervention mothers compared to the usual care group at 22 and 26 weeks (4 weeks post intervention). Intervention mothers' reports of their child's aggression diminished significantly from T1 to T4 compared to usual care mothers (p = .03). Self‐efficacy appeared to only partially mediate the intervention effect, and maternal health moderated the intervention impact. Results indicate that the intervention reduced depressive symptoms and, compared to previous studies in this population, retention of mothers in both intervention and control conditions was improved. © 2009 Wiley Periodicals, Inc. Res Nurs Health 33:60–76, 2010     

Predictors of quality of life following stroke

Purpose : To determine the factors predicting quality of life during the course of rehabilitation following stroke. Method : Two hundred and fifteen stroke patients aged 41-93 were studied over a period of three months. Measurement of quality of life, functional ability, social support, demographic and treatment data were taken on admission to the rehabilitation hospital, at two weeks and three months. The instruments used were the Sickness Impact Profile (SIP), the Modified Barthel Index (MBI) and The Social Support Questionnaire, short form (SSQ6). Results : Length of stay, previous stroke, functional ability and social support were found to be significantly correlated with quality of life. Stepwise multiple regression analysis indicated that functional ability, psychological and physical SIP dimensions, social support satisfaction at two weeks and previous stroke explained 47% of the variance in sickness impact at three months following stroke. The factors predicting 53% of the variance in sickness impact at two weeks were baseline functional ability, psychological and physical SIP. Conclusions : The findings indicate that both psychosocial and physical factors are important in predicting quality of life in stroke rehabilitation. Determining such predictors at an early stage will help to guide clinical decisions throughout rehabilitation.     

Psychological Resilience and Depressive Symptoms in Older Adults Diagnosed with Post‐Polio Syndrome

Depression is a serious comorbidity in people with disabilities; however, few studies have focused on depressive symptoms in older adults with post‐polio syndrome (PPS). This study used a resilience conceptual framework that focused on patient psychosocial strengths to investigate the relationship between psychological resilience factors (e.g., acceptance, self‐efficacy, personal resources, interpersonal relationships, self‐rated health, spiritual growth, stress management) and depressive symptoms in a large sample (N = 630) of people older than 65 years who were diagnosed with PPS. Forty percent of the sample scored ≥ 10 on the Center for Epidemiologic Studies Short Depression Scale (CES‐D10), which is a higher percentage than what has been previously cited in other studies; however, 53% of the sample had good or excellent self‐rated health, suggesting psychological resilience. Depression scores were regressed on seven selected resilience factors after controlling for functional limitations. Four of the seven variables accounted for 30% of the variance in depressive symptoms, with spiritual growth representing the main predictor (β = ?.26). The implications for rehabilitation nurses in developing a patient‐strengths perspective in the assessment and counseling of older adults with PPS are discussed.     

Peer‐led diabetes self‐management programme for community‐dwelling older people in China: study protocol for a quasi‐experimental design

Aim. A protocol for a new peer‐led self‐management programme for community‐dwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self‐management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi‐experimental. Methods. This study is a non‐equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self‐efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self‐efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self‐efficacy, social support, self‐management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory‐based programme tailored to Chinese patients has potential for improving diabetes self‐management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.     

Effectiveness of home visits by mental health nurses for Japanese women with post‐partum depression

Post‐partum depression affects 10–13% of Japanese women, but many do not receive appropriate treatment or support. This intervention study evaluated the effectiveness of home visits by mental health nurses for Japanese women with post‐partum depression. Eighteen post‐partum women met the inclusion criteria and were randomly allocated into the intervention (n = 9) or control (n = 9) group at 1–2 months after giving birth. The intervention group received four weekly home visits by a mental health nurse. Control group participants received usual care. Two women in the intervention group did not complete the study. Depressive symptoms and quality of life were measured at 1 and 6 weeks' postintervention. In addition, participants completed an open‐ended questionnaire on satisfaction and meaning derived from the home visits. Women in the intervention group had significant amelioration of depressive symptoms over time and reported positive benefits from the home visits, but there were no statistically significant differences between groups. Significant differences (P < 0.05) were observed at times 2 and 3 between groups in terms of increased median scores of physical, environmental, and global subscales, and the total average score of the World Health Organization/quality of life assessment instrument. On the psychological subscale, significant differences (P = 0.042) were observed between groups at time 2. The qualitative analysis of comments about home visitation revealed four categories related to ‘setting their mind at ease’, ‘clarifying thoughts’, ‘improving coping abilities’, and ‘removing feelings of withdrawal from others’. These results suggest that home visits by mental health nurses can contribute to positive mental health and social changes for women with post‐partum depression. A larger trial is warranted to test this approach to care.     

Predictors of quality of life following stroke

Purpose : To determine the factors predicting quality of life during the course of rehabilitation following stroke.

Method : Two hundred and fifteen stroke patients aged 41-93 were studied over a period of three months. Measurement of quality of life, functional ability, social support, demographic and treatment data were taken on admission to the rehabilitation hospital, at two weeks and three months. The instruments used were the Sickness Impact Profile (SIP), the Modified Barthel Index (MBI) and The Social Support Questionnaire, short form (SSQ6).

Results : Length of stay, previous stroke, functional ability and social support were found to be significantly correlated with quality of life. Stepwise multiple regression analysis indicated that functional ability, psychological and physical SIP dimensions, social support satisfaction at two weeks and previous stroke explained 47% of the variance in sickness impact at three months following stroke. The factors predicting 53% of the variance in sickness impact at two weeks were baseline functional ability, psychological and physical SIP.

Conclusions : The findings indicate that both psychosocial and physical factors are important in predicting quality of life in stroke rehabilitation. Determining such predictors at an early stage will help to guide clinical decisions throughout rehabilitation.     

Mediation analysis of health‐related quality of life among people living with HIV infection in China

The effects of stigma, social support, and depressive symptoms on health‐related quality of life are well documented in the literature, but how these psychological factors interact with each other, and the combined effects when taken together on the health‐related quality of life for people living with HIV, remain unclear. This cross‐sectional study investigated 114 people living with HIV who were taking antiretroviral medication using the HIV/AIDS‐related Stigma Scale (Chinese version), the Social Support Rating Scale, the Center for Epidemiological Studies Depression Scale, and the Medical Outcomes Study–HIV health survey. Multiple linear regression analyses were used to examine the mediation effect of the psychosocial factors on health‐related quality of life. Results showed that stigma and social support did not have direct effects, but indirect effects on health‐related quality of life through a full mediation effect of depressive symptoms. The results indicate that interventions targeting depression might be the most effective approach to improving health‐related quality of life among people living with HIV who are taking antiretroviral medication in China.     

Psychosocial components in stroke. Implications for adaptation

Relatively little is known about poststroke psychosocial adjustments when compared to the wealth of data present regarding functional recovery. Recent studies have shown depression to exist in a large portion of the stroke population. Varying degrees of depression may be associated with lesion location, functional capacity, and personal and social support. Identification of depression in stroke patients and the implications for care interventions are in their infancy. Beginning efforts at assessing coping strategies and personal resources are indicating some correlation between how people cope and their ability to manage stressful illness situations such as stroke. At present, there is no conclusive evidence that any intervention can improve emotional and social well-being. Efforts are being pursued to treat stroke depressive disorders. These efforts, combined with the initiation of stroke support groups, ongoing community follow-up, and psychosocial treatment approaches, may improve the quality of life of stroke victims.     

Stress,perceived support,resourcefulness and depressive symptoms in Taiwanese adolescents

Aims and objective. This study investigated (1) the prevalence of self‐reported depressive symptoms among first‐year students at an Institute of Technology in southern Taiwan; (2) whether perceived support and resourcefulness were associated with these adolescents’ depressive symptoms and (3) the moderating and mediating effects of learned resourcefulness on the relationship between stressors and the adolescents’ depressive symptoms. Background. An individual with adequate social support or resourcefulness may see stressors as less threatening or be more resilient in dealing with stressors compared with depressed individuals. The prevalence of depression in the global population increased rapidly during this past decade and consequently may have had a negative impact on population health outcomes. Among adolescents there has recently been an increased incidence of depression‐related suicide reports. Design. A cross‐sectional, correlational design. Method. Adolescents (n = 913) were recruited to complete the following: the SDI in Chinese, the Inventory of Social Supportive Behaviours Scale – Modified and the Self‐Control Schedule. Data analysis consisted of Pearson correlation and multiple regression analysis. Results. The prevalence of depression among participants was 13·4%. Participants who were younger, expressed lower satisfaction with their grades, perceived their health as worse, described peer relationship problems and exhibited smoking behaviour were more likely to have depressive symptoms. We observed five partially mediating effects of resourcefulness on stressors (age, perceived health, peer relationships, grades satisfaction and smoking behaviour) and depressive symptoms and one moderating effect of resourcefulness on the relationship between peer and depressive symptoms. Conclusions. Learned resourcefulness may play a critical role in decreasing depressive symptoms. Relevance to clinical practice. These findings offer healthcare providers and educators information about the need for possible cognitive–behavioural interventions that could improve adolescents’ relationships with their peers, enhance their satisfaction of grades and moderate or prevent depressive symptoms among this population. Moreover, it might decrease the prevalence of adolescent suicide.     

Describing quality of life and psychosocial outcomes after traumatic brain injury

OBJECTIVE: To describe the quality of life (QOL) and psychosocial outcomes of a sample of adults with traumatic brain injury in 50 community dwelling adults with traumatic brain injury and examine the associations among these variables. DESIGN: Cross-sectional. RESULTS: Mean QOL rating was low average. Standardized measures had acceptable internal reliability and normal distributions in this sample. Subjects had significantly lower QOL and social support, higher negative affect, and similar positive affect and spirituality compared with standardization and other nondisabled samples. They also had a significantly higher level of community integration than other traumatic brain injury samples. Regression analyses suggested that social support, community integration, and positive affect make a unique and significant contribution to the QOL variance with R of 0.492. The addition of spirituality reduced their respective unique variance, reducing positive affect to nonsignificant levels due to their high intercorrelation. CONCLUSIONS: Findings suggest that this sample experiences a wide range of QOL. Factors significantly associated with good QOL include community integration, positive affect, and social support; demographic variables had virtually no association with QOL. Evaluation of the sample's response to standardized scales not designed for a traumatic brain injury population support their use in similar QOL investigations.     

Self‐worth therapy for depressive symptoms in older nursing home residents

Title. Self‐worth therapy for depressive symptoms in older nursing home residents. Aim. The aim of this study is to report the effects of self‐worth therapy on depressive symptoms of older nursing home residents. Background. Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non‐pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side‐effects. Method. A quasi‐experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti‐depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one‐to‐one self‐worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t‐test, chi‐squared test and univariate anova . Findings. Self‐worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. Conclusion. Self‐worth therapy is an easily‐administered, effective, non‐pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.