Educating for wellness: a wellness education group intervention for adults with chronic severe mental illness living in the community

Chronic severe mental illness (CSMI) is a common disorder in the United States associated with numerous adverse health effects. Health promotion educational interventions can be beneficial. The purpose of this project was to implement and evaluate a community-based educational program for adults with CSMI. Analyses of quantitative and qualitative data showed overall satisfaction with the program and achievement of some specific consumer health modifications. Three primary areas of interest and benefit included socialization and support, education and information, and motivation to change. The Wellness Education Group Intervention (WEGI) can serve as a model for wellness education with adults in similar communities.     

Physical health status of older adults with severe mental illness: The PHiSMI‐E cohort study

The objective was to use various somatic parameters as basis for investigating the physical health of older adults with severe mental illnesses (SMI). A cross‐sectional study design is performed by using baseline data from the Physical Health in SMI‐elderly (PHiSMI‐E) study. Data were collected using the Nursing Monitoring of Somatic Status and Lifestyle – Mental Health instrument in adults aged over 60 with SMI in a large Dutch mental health institute. Ninety‐nine elderly SMI patients were included. Somatic comorbidity (84.8%), use of somatic medication (77.7%) and polypharmacy (67.7%) were prevalent. Extrapyramidal symptoms were experienced by 51% of patients, mainly in the subgroup with psychotic disorders (75.6%). Unhealthy diet was reported in 16.2%, obesity in 27.3%, and physical inactivity in 57.6%. Fatigue (67.7%) and dry mouth (66.6%) were the commonest reported physical symptoms. Mean VAS score (scale 0–10) indicating participants’ self‐perceived physical health was 6.7 (SD ± 1.6). After division of the total patient group into tertiles based on the VAS scores, the lowest tertile was characterized by less physical activity, unhealthier diet, more use of medication, more fatigue, somnolence, and inner agitation. In conclusion, impaired physical health status was common in these older patients with SMI. Although they had more psychiatric and somatic comorbidity than adult SMI patients described in the literature, they had a healthier lifestyle. To reduce morbidity and premature mortality in these frail patients, it is essential that healthcare providers are aware of the high prevalence of somatic comorbidity and symptoms, and of their interactions with the psychiatric disorders. This study improves our understanding of differences in vulnerability factors of older patients with SMI. The (early) detection of somatic comorbidities may improve long‐term health outcomes of these patients.     

Family violence among adults with severe mental illness: a neglected area of research

Violence against family caregivers by their adult relatives with severe mental illness is a taboo area of public discourse and scientific research because of fears of further stigmatizing this population. Yet, these families experience violence at a rate estimated to be between 10% and 40%, which is considerably higher than the general population. This article reviews the limited research on violence of adults with severe mental illness against their family caregivers and proposes a conceptual framework that can further stimulate study in an area that has been neglected too long by both mental health and family violence investigators. Research on this topic is essential in developing effective policy and practice interventions.     

The effects of mutual goal-setting practice in older adults with chronic illness

Goal setting is a strategy that can enhance performance. The purpose of this study was to examine how engaging older adults with chronic illness in setting goals for their care would affect their performance in achieving those goals. This study employed a quasi-experimental design with repeated measures to evaluate the effect of an intervention, namely mutual goal-setting (MGS) practice, on elderly patients with chronic illness. Eighty such patients receiving nursing care at home were recruited for the study. Repeated measures showed that the intervention group achieved a higher percentage of their goals, though insignificant group and time interaction effects between groups were found in perceived functional disability, perceived functional health and self-efficacy in self-managing chronic illness. The findings of this study with a specific group, namely elderly patients with chronic illness, support the general premise that patients who participate in determining their care are more likely to improve in physical and mental well-being.     

Functional status of older persons with chronic mental illness living in a home setting.

The purpose of the study was to determine the functional status of older persons with chronic mental illness. One hundred subjects living in their homes were interviewed in face-to-face interviews using the Older Adult Resources Survey (OARS) to determine functioning in five areas: social, economic, mental, physical, and activities of daily living. Pearson product moment correlation showed significant relationships among all functional scores. Twenty-nine percent of the total sample had social relationships of poor quality. Thirty-five percent of subjects had severe economic impairment. The majority (53%) of subjects had psychiatric symptoms. The most common psychiatric diagnosis was depression (42%), followed by schizophrenia (22%), and bipolar illness (13%). Twenty-nine percent of subjects had a serious medical problem that required medical treatment. Cardiovascular diseases were the most frequently reported (92%), followed by arthritis (45%) and urinary tract disorders (19%). All subjects perceived that their physical health had deteriorated over the 5 years. Polypharmacy and drug misuse were common among the sample. A mean of four prescribed drugs was taken daily over the past month. Psychotropic (83%), antihypertensive (32%), and cardiac (20%) medications were the most frequently prescribed drugs. Twenty-five percent of the sample regularly required assistance with at least four activities of daily living.     

Characteristics of social participation as defined by older adults with a chronic physical illness

Purpose. To conceptualize social participation in line with the experiences of older adults with a chronic physical illness.

Method. Qualitative study consisting of ten individual interviews and two focus group interviews with older adults with Chronic Obstructive Pulmonary Disease or Diabetes Mellitus Type 2.

Results. Four domains of social participation were identified on the basis of the individual interviews: (i) social contacts and social activities, (ii) work and informal support, (iii) cultural activities and public events, and (iv) politics and media. Three characteristics of social participation could be distilled from discussions in the focus groups: social contact, contributing resources to society and receiving resources from society. In addition, only positive experiences were considered to be social participation.

Conclusions. In our study, older adults with a chronic physical illness perceived social participation as a positive experience having one or more of the following three characteristics: social contact, contributing resources to society or receiving resources from society. This is fairly consistent with the literature about social participation, although previous researchers did not mention a positive experience condition and disagreed whether receiving resources could be considered as ‘genuine’ social participation.     

Psychometric properties of the self-care of chronic illness inventory in Chinese older adults with multiple chronic conditions

Background

Existing self-care measures for the Chinese population are specific to single chronic conditions. No generic self-care measures exist for the Chinese population with multiple chronic conditions.

Objectives

To test the structural validity, concurrent validity and reliability of the Self-care of Chronic Illness Inventory (SC-CII) in Chinese older adults with multiple chronic conditions.

Methods

This cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. A diverse sample of Chinese older adults with multiple chronic conditions (n = 240) was recruited. Structural validity was assessed with confirmatory factor analysis. Concurrent validity was investigated with hypotheses testing of the relationships between perceived stress, resilience and self-care. Reliability was assessed with Cronbach's alpha and McDonald's omega. Finally, a simultaneous confirmatory factor analysis was conducted to test the general model with all items and all three subscales.

Results

Confirmatory factor analysis supported the two-factor structure of the self-care maintenance and self-care management subscales and the one-factor structure of the self-care monitoring subscale. Concurrent validity was supported by the significant negative correlation (r ranged from −0.18 to −0.38, p < .01) with perceived stress and the significant positive correlation (r ranged from 0.31 to 0.47, p < .01) with resilience. Reliability estimates ranged from 0.77 to 0.82 across the three subscales. The simultaneous confirmatory factor analysis did not support the more general model with the combined set of items.

Conclusion

The SC-CII is valid and reliable for Chinese older adults with multiple chronic conditions. Future cross-cultural assessment should be conducted to investigate the measurement equivalence of the SC-CII in individuals from Western and Eastern cultural groups.

Implications for practice

With the increasing number of older adults in China who are living with multiple chronic conditions and the call for culturally tailored self-care interventions, this self-care measure can be used in geriatric primary care settings, long-term facilities and homes to improve the understanding and practice of self-care in older Chinese adults.     

Family carers' experience of caring for an older parent with severe and persistent mental illness

While the burden of caring for older people with chronic medical illness and dementia has been well documented, considerably less is known about how carers develop the strength and resilience to sustain this important role with older family members with mental illness. The aim of the study was to understand the lived experience of primary caregivers of older people with severe and persistent mental illness, and to explore what, if anything, helps to sustain them in their caring role. An interpretative phenomenological analysis approach was adopted, and qualitative interviews were used with 30 primary caregivers. Two overarching themes, and related subthemes, were abstracted from the data. First, caring is a difficult and demanding responsibility. It affects carers adversely, emotionally, physically, socially, and financially, and their lifestyle in general. This is reflected in three subthemes: (i) physically and emotionally draining; (ii) grieving about the loss; (iii) and adverse effects on lifestyle and social relationships. Second, carers develop resilience in caring, which helps sustain them in their role, as illustrated in three subthemes: (i) caring as purposeful and satisfying; (ii) harnessing social support from others; and (iii) purposefully maintaining their own well‐being. Community mental health nurses have a key role in assessing carers' needs and supporting them in their caring role.     

New conceptions of care, community, and chronic mental illness

This article reports on the author's observations as a member of the National Advisory Committee to the Robert Wood Johnson Program for the Chronically Mentally Ill (CMI). The article highlights the needs of large city mental health systems, which serve the CMI, employing the concepts of centralization and continuity, as well as financing, housing, and support services reform. The implications for psychiatric mental health nursing are discussed.     

Self-management in older patients with chronic illness

Chronic illness causes the majority of disease burden and health costs in developed countries; however, this could be substantially reduced by optimal patient self-management. This study examined the levels of self-management in patients (n = 300) with chronic illness (chronic heart failure, chronic respiratory disease, Parkinson's disease and chronic schizophrenia) of moderate severity who had experienced an illness exacerbation in the last month. Patient's perceptions of self-efficacy in relation to their self-management and their sense of coherence were also assessed at baseline and 1 month later. No changes occurred in self-perceptions or self-management from baseline to follow-up. Patients at risk of poor self-management included people with low self-efficacy, poor sense of coherence, older age and a primary diagnosis of chronic schizophrenia. As self-efficacy is the only predictor known to be amenable to intervention, self-efficacy enhancing support should be promoted.     

重性精神疾病社区康复管理现状调查

回顾分析国内关于重性精神疾病社区康复管理的发展现状,了解重性精神疾病社区康复管理存在的问题,制定相关管理模式发展的策略,为促进社区精神卫生的发展提供依据.     

Metabolic issues in patients with severe mental illness

This article reviews the epidemiology of weight gain and diabetes mellitus in general and in patients with severe mental illness in particular. Body mass index is defined, and possible predictors for weight gain in patients receiving antipsychotic medications are also enumerated. Information on risk of association with type 2 diabetes mellitus is described, as well as information on dyslipidemias within the rubric of the metabolic syndrome. Recent consensus panel reports and their recommendations for ongoing patient monitoring are reviewed. The issue of switching antipsychotic medication in the context of a developing metabolic disorder is discussed with regard to appropriately balancing risk and benefits. Collaborative treatment between a psychiatrist and an endocrinologist is encouraged. The primary care physician may be required to fulfill both roles.     

The social experience of aging with a chronic illness: Perspectives of older adults with multiple sclerosis

Purpose.?The purpose of this study was to explore the social experiences of older adults with multiple sclerosis (MS) in order to recognize the changes in social experience and social needs that may occur with aging with a chronic illness.

Method.?Analysis of qualitative data from an exploratory study utilizing a phenomenological approach with 27 older adults with MS, aged 55 – 81.

Results.?In-depth interviews revealed that the social experience was influenced by groups of factors including the person's social needs, experience of MS, values and expectations, characteristics of the social support system, the response of the support providers, and the accessibility of the social environment. The participants discussed concerns about the future adequacy of support. A process of negotiation was also described and was seen as an opportunity to change the social experience and social support received.

Conclusion.?This study provides an insider's view of the social changes that older adults living with MS experience. This study also identifies barriers to the acquisition of support and addresses the importance of appropriately responding to the changing needs of this population.     

Presentation of illness in older adults

Although people age at different rates, changes to the composition of the human body are a hallmark of aging. As a result of such changes, disease can present differently in a person over 65 years old than it would in a younger adult or child. This article identifies the critical indicators of underlying conditions, including changes in mental status, loss of function, decrease in appetite, dehydration, falls, pain, dizziness, and incontinence. It also describes the presentation of diseases common to older adults, including depression, infection, cardiac disease, gastrointestinal disorders, thyroid disease, and type 2 diabetes.     

Factors influencing the use and provision of respite care services for older families of people with a severe mental illness

Family carers of people with a severe mental illness play a vital, yet often unrecognized and undervalued role in Australian society. Respite care services can assist these family carers in their role; however, little is known about their access to these services. The paper addresses this knowledge gap. An exploratory field study was conducted throughout the eastern suburbs of Sydney, Australia, to identify and examine the factors influencing the use and provision of respite services for older carers of people with a mental illness. Semistructured, in-depth interviews, and structured self-completed questionnaires were conducted with older family carers, mental health care professionals, and respite care service providers. Additionally, relevant documents (local policies, strategic plans and reports on respite care) were reviewed. It was found that current respite services are problematic for older family carers of Australians with a mental illness, signalling the need for concerted efforts by carers, health professionals, and service providers to improve access. Changes to respite provision and utilization are recommended.