African American women's coping with health care prejudice

African American clients have reported racism and prejudice in health care; yet there is limited documentation of the strategies used to cope with these experiences. This study describes African American women's perceptions of prejudice in health care and the strategies used to cope with the experiences. This qualitative study used the constructivist perspective of interpretive interactionism for paradigmatic and methodological guidance. Participants were 20 women ranging from age 26 to 74 years with 50% having a high school education. Individual interviews consisting of five areas were conducted with three instruments measuring ethnic identity, socioeconomic status, and general demographics. The analyses provide two themes: experience with the "White health care system" and strategies for coping with the prejudice, which included getting angry, learning to unlearn, being assertive, and walking away. Consistent with the discussions of race in the United States, racism in health care has become a subtle entity that infuses health care relationships.     

Supporting older adults living with multiple chronic conditions

This qualitative study was conducted using focus groups to explore the strategies commonly employed by older adults (N = 37) to manage multiple chronic conditions. Key strategies identified were relating with health care providers, medicating, exercising, changing dietary patterns, seeking information, relying on spirituality and/or religion, and engaging in life. Although social support was not mentioned as a discrete strategy, the participants' social networks were embedded in all of the categories. This study supports building a partnership of care in which nurses and other health care professionals function in supportive and educative roles to enhance the older person's lifelong self-care management and ability to stay in control of multiple chronic health conditions.     

Associations between neighbourhood characteristics and community mobility in older adults with chronic health conditions

Purpose: To explore associations between perceptions of neighbourhood built and social characteristics and satisfaction with community mobility in older adults with chronic health conditions. Method: Two hundred and thirty-seven community-dwelling adults aged 60 years or more with one or more of arthritis (osteoarthritis or rheumatoid arthritis), chronic obstructive pulmonary disease, diabetes or heart disease completed a cross-sectional, mailed survey. The survey addressed community mobility and 11 neighbourhood characteristics: amenities (three types), problems (six), social cohesion and safety. Analysis involved logistic regression modeling for each neighbourhood characteristic. Results: Satisfaction with community mobility was associated with perception of no traffic problems (OR?=?3.0, 95% CI?=?1.4–6.2, p?≤?0.05) and neighbourhood safety (OR?=?3.4, 95% CI?=?1.2–9.8, p?≤?0.05), adjusted for age, ability to walk several blocks and depressive symptoms.

Conclusion: Satisfaction with community mobility is associated with neighbourhood safety and no traffic problems among older adults with chronic conditions. While further research is needed to explore these neighbourhood characteristics in more detail and to examine causation, addressing these neighbourhood characteristics in health services or community initiatives may help promote community mobility in this population.

• Implications for Rehabilitation

• Community mobility, or the ability to move about one’s community, is a key aspect of participation that enables other aspects of community participation.

• Good community mobility is associated with perception of no traffic problems and neighbourhood safety among older adults.

• Considering and addressing a broad range of environmental influences has the potential to improve community mobility in older adults, beyond traditional approaches.

• Health professionals can work with clients to develop strategies to avoid traffic and safety problems and can work with communities to develop safe spaces within neighbourhoods, to improve community mobility in older adults.

     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

Measuring incentives to health promotion in older adults. Understanding neglected health promotion in older adults.

Health promotion increases longevity and allows older persons to maintain an independent and satisfying life. Determining reasons why an older person participates in health promotion activities through incentives may allow further insight into ways to promote health. As deeper understanding of motivation is gained by health professionals, successful influences to health behavior may be clarified. A nurse's role in health promotion could be to assist in planning a health promotion program, especially after incentives have been identified for a particular person. The Incentive-Health Promotion Scale revealed that the major incentives to health promotion in study sample were "feel good" and "fitness and health".     

Challenges to aging in place for African American older adults living with dementia and their families

A culturally informed community health assessment was conducted to explore the community context of care for older adults in African American urban neighborhoods. The purpose of this study is to explore the challenges to aging in place for African American older adults living with dementia and their family members. Data collection and analysis were conducted as concurrent iterative procedures between photographs, media clippings, semi-structured interviews (N?=?24), observation notes, and journaling. Content analysis revealed shame, improper housing, financial constraints, resource inadequacy, transportation concerns, and knowledge deficit as common challenges faced by the older adults and their families to receiving health services to support aging in place within urban neighborhoods. Data from this report are to inform clinicians, community partners, families, and service organizations, to promote uptake of future research and programing to improve outcomes for African American older adults living with dementia and their family members.     

Evaluation of the Chronic Disease Self-Management Program with low-income, urban, African American older adults

A 1-group pretest-posttest design to assess for changes in outcomes at 10 weeks and 6 months was the method used to evaluate the standardized 6-session Chronic Disease Self Management Program (CDSMP) with low income, urban African American older adults. Participants included 153 older adults (primarily African American) with 1 or more chronic health conditions. Classes were provided in the community at senior citizen centers, senior housing, and churches. Significant improvements were noted in selected areas at 10 weeks and 6 months after the program completion. The CDSMP was feasible and well-received with the older adults who participated in the study.     

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.     

Positive and negative affect and health functioning indicators among older adults with chronic illnesses

Emotional states have been linked with physical and mental health outcomes. In this study the role of positive and negative affect was investigated as determinants of health functioning for a community-dwelling sample of 153 older adults (age 60 or older) with chronic illnesses. High positive affect and low negative affect were found to be associated with lower levels of symptom distress, fewer depressive symptoms, higher daily activity scores, and higher perceived physical and mental health-related quality of life. These results have important clinical implications for the use of positive and negative affect as an indicator of life functioning among older adults. The relationship of positive and negative affect to reported health functioning found in this study suggests that measuring affect can provide a valuable means for understanding how individuals view their mental health as well as their symptoms of illness.     

African American participation in public health research.

The author discusses the lack of current African American participation in health research and the historical background regarding the distrust of African American's past experiences in health research.     

A comparison of African American & Caucasian American female caregivers of rural, post-stroke, bedbound older adults

As changes in health care take place, the care of older adults in the home becomes a greater responsibility of informal caregivers. The purpose of this study was to compare African American and Caucasian American female caregivers of post-stroke, bedbound older adults in rural Mississippi. A purposive sample of 74 caregivers reported bedbound older adults' functional impairments, along with caregivers' stress and self-efficacy, social support, coping, depression, and life satisfaction. Significant differences were determined for self-efficacy between the African American and Caucasian American caregivers. Disordinal interactions existed between race and caregiving self-efficacy on the variables of stress and life satisfaction. Nurses must be cognizant of the many stressors influenced by cultural factors, such as race, faced by these caregivers. This is important to include in the curricula of nursing programs for the 21st century.     

Physical and mental health in African American mothers with HIV.

This article examines the physical and mental health of African American mothers during a 2-year period following the birth of an infant seropositive for human immunodeficiency virus (HIV). Participants were 34 African American mothers enrolled when the infants were approximately 3 months of age and reinterviewed when the infants were 6, 12, 18, and 24 months. Three self-report questionnaires were used to assess physical health (perception of health, activity limitation, and physical symptoms) and mental health (depressive symptoms and stigma). Health symptoms most often reported were infections, problems thinking and remembering, low energy, and gynecologic problems. Moderate levels of perceived stigma were reported. Depressive symptoms were high; a large number of women at each data point had depressive symptom scores above the cutoff, indicating risk for depression. There were significant correlations between depressive symptoms and health, suggesting a link between mental and physical health. These findings have significance for the health of the mother and the parenting of her infant. Attention should be paid to the mental and physical health of mothers with HIV, especially during the first 2 years after the birth of a child.     

Use of the chronic pain coping inventory to assess older adults' pain coping strategies.

Little is known about the strategies that older adults use to cope with persistent pain. The purpose of this study was to describe strategies used by older, retirement community-dwelling adults to cope with persistent, noncancer pain, as assessed by the Chronic Pain Coping Inventory (CPCI), to examine the associations of these strategies with disability and depression, and to compare the 65-item and 42-item versions of the CPCI in this population. Two hundred fifty residents of 43 retirement communities in the Pacific Northwest completed baseline measures for a randomized controlled trial of a pain self-management intervention, including the CPCI and measures of demographics, comorbidity, pain-related disability, and depression. The most frequently reported strategies, as assessed by the CPCI, were Task Persistence, Pacing, and Coping Self-Statements. The least frequently used strategies were Asking for Assistance and Relaxation. Regression analyses demonstrated that coping strategies explained 26%, 19%, and 18% additional variance in physical disability, depression, and pain-related interference, respectively, after controlling for age, gender, comorbidity, and pain intensity. Internal consistency for most CPCI-65 and CPCI-42 subscales was adequate. This study clarifies strategies used by older adults to cope with persistent pain and provides preliminary validation of the CPCI in this population. PERSPECTIVE: Findings from this study on pain coping strategies in older adults might suggest potentially useful coping strategies clinicians could explore with individual patients. Investigators can use study findings to design trials of interventions to help older adults cope more effectively with pain.     

Cognitive health in older adults

This article addresses both the theoretical and practical issues associated with cognitive aging, including the implications of neurophysiological changes in the brain as well as practical ways of screening for changes that may be problematic or may actually enhance healthy cognitive adaptations.