Zur Bedeutung biografischer Ansätze in der Pflegewissenschaft

Critical life events (e. g. disease, loss of be loved one) biographically represent important turning points, which concerned people have to cope and deal with. While biographical research, which is established in the human and social sciences, has been dealing for a long time with typical features, such as on the type of a disease-dependent burden and coping processes, biographical oriented research approaches in nursing science are in their early stages. The article at hand has its goal in discussing the connectivity, particularly the social-interpretative biographical research in nursing science and their relevance for the development of supporting concepts regarding nursing; with the intention to rehabilitate the sufferer as the author of his own life story.     

Differenzierte Lebenslagen im Alter

This contribution provides an overview of the discussion on living arrangements and needs of homosexual men in old age. The term "living arrangements" refers to the scope of activities arising from the interaction between external, material/social resources and personal capacity as well as competence. External resources and personal competence change as a person ages and, depending on the given biographical constellation, influence the living arrangements of ageing people in different ways. Furthermore, these arrangements are also affected by social and by cultural shifts/developments, leading to increased differentiation of life situations in old age, and to individual experiences of ageing. The contribution therefore discusses research findings on biographical experience, living arrangements, needs and examples of self-help concepts arising within this particular group of ageing individuals. The aim is to foster understanding of requirements in ageing populations within the diversity of histories, sexualities and living arrangements.     

Alter(n) und Identitätsentwicklung: Formen des Umgangs mit dem eigenen Älterwerden

The article examines in which ways older people react to their own ageing process. Which types of age identities can be observed as reactions to signs and symptoms of age, and with which social and biographical influences do these age identities correlate? First, the theoretical starting point will be explained that a biographical identity is built up as a story in confrontation with social experiences. The suggested approach of a “narrative gerontology” argues that the lived life is experienced as a totality of interconnected stories. Next, a sketch of the social-gerontological state of research about the problem of biographical identity development and old age identity will be presented. In the empirical section, qualitative results about the process of coping with one’s own ageing are discussed, resulting from a research project on “models of life-conduct in old age”. Four ideal-typical reaction styles are distinguished and related to the social contexts of their development: “identification with old age”, “ambivalent acceptance”, “agelessness” and “rebellion against ageing”.     

Life patterns and age styles in older adults.

A biographical approach was used to investigate life themes, life experiences, and personality styles in older adults. Extensive interviews were conducted with fifteen individuals, who sorted index cards with life events and filled out a personality inventory. A typology was developed that distinguished individual life patterns (i.e., specific life themes and life events) and age styles (i.e., personality traits). Three case histories illustrate each of the major life patterns found in the interviews.     

A clinical decision support system using multi-layer perceptron neural network to predict quality of life in diabetes

BackgroundIn diabetes mellitus, quality of life is recognized to be an integral outcome measure of management. We have developed a neural network system which is trained to predict the measurements of quality of life in diabetes, using data generated in real life.MethodsWe developed a multi-layer perceptron neural network (NN) model, which had been trained by back propagation algorithm. Data was obtained from a cohort of 241 individuals with diabetes, which has been published. We used age, gender, weight, fasting plasma glucose as a set of inputs and predicted measures of quality of life (satisfaction, impact, social and diabetes worry).ResultsUsing the NN model, men reported significantly higher levels of satisfaction with the treatment being provided to them than women. Women had greater social and diabetes worry. The results have been considered based on the observation of the normalized system error (NSE) values of the neural network and are consistent with results obtained from traditional statistical methods.ConclusionWe have developed a prototype neural network model to measure the quality of life in diabetes, when biological or biographical variables are given as inputs.     

Zeitliche Ambivalenzen des Alter(n)s

Throughout their lives people are confronted with different time resources and demands that change continuously up into old age. With the help of a qualitative interview study the narrative constructions of subjective time experiences as well as individual ways of dealing with time in retirement were investigated. In particular the influences of older persons’ experience of time within the dimensions of everyday time and life time were analyzed. In addition, the study focused on potential time conflicts between these two dimensions and the question of how older people deal with the ambivalence between everyday time wealth and biographical time poverty in older age. The results of the interviews with 50 retired men and women (aged 56–91 years) in Germany, which were analyzed with “grounded theory” techniques, indicated that time in retirement does not indeed always run smoothly. In particular, the individual perception of increasing biographical time poverty exerts pressure on the arrangement of activities and daily routine in retirement. The resulting time conflicts are reflected in differential patterns of time use through which older ersons try to cope with their ambivalent time experiences.     

Life-span-developmental psychology and gerontology (author's transl)

The recognition that aging processes are considerably influenced by the individuals' life-course from birth on can be traced to antiquity. One of the first attempts of scientific study of the entire life-course was started by Charlotte Bühler (1933). Already in 1951, Thomae emphasized the necessary extension of Developmental Psychology from its restriction to childhood into covering the entire life-span, and initiated numerous empirical studies working with the biographical method. Thus, the "life-span-orientation" of Developmental Psychology, recently ascribed to P.B. Baltes, is rather a rediscovered conceptualization than a genuine 'new' idea. Following this evaluation of the historical roots and origins of "life-span-developmental-psychology", a review of empirical biographical studies is presented, which emphasize a conceptualization of behavior in older age at the intersection of past experience, current situation, and future time perspective of the individual. As an example it is discussed how the mother experiences and reacts to her (last) child's leaving home ("empty-nest-reaction"). In addition, "sociogendtic risk-factors" (Eitner) are discussed, as well as the biographical interdependency of mental and physical activity, of multiple interests and social contacts. Stating the empirical evidence for the strong influence of behavior and experience in younger and middle adulthood on the individual's well-being in older age must not lead to the conclusion that the situation of the aged person cannot be changed: the older individual certainly has the ability and opportunity to learn, to be flexible, and to change--within the given boundaries--his current situation.     

Emergence of the notion of retirement in rural China:

Since the outset of the reform process in 1978, rural China has been undergoing fundamental changes in the relationships between the state, society and individuals. Social policy, including pension policy for rural residents, is an essential factor in this transformation process which has influenced the life chances of many peasants. This paper deals with the relationship between social policy and individual life courses in the case of Shanghai’s rural pension policy. It integrates the theoretical insights from life course research to emphasise the close relationship between the state welfare and the institutionalisation of the life course. By analysing biographical interviews conducted in rural Shanghai, this article has identified the changing nature of welfare mix in rural old-age security as well as the emergence of the notion of retirement among the peasants in rural Shanghai. The introduction of the innovative rural pension policy has given rise to the rudimentary emergence of a modern life course, in the contour of a temporal partition between work and retirement. However, diverse local subsidies and individual household situations have led to different perceptions and biographical orientations of the peasants with respect to their old-age security and retirement.

Transitional phases in human development (author's transl)]

Transitional phases in the course of Human Development which divide the course of development into different steps, have been searched far from the old. These transitional phases are very often seen to be at least initiated by physical resp. biological changes and accompanied by psychological or mental changes. The results of the Life-span-Psychology and especially the findings of the biographical studies of our Psychological Institue, which were started in the Fifties, shows that there are Transitional phases which neither related to biological change nor to role change nor to the change from the one decade of life to the other one. Much more important are very personal experiences which very often lead to a reorientation. - These findings are in agreement with cognitive theory of personality, according to which human behavior is dependent more on the situation as perceived, than on the stimulus-pattern contigent with this situation. Therefore the study of these situational concepts of individual is relevant for the Life-span-Psychology and specially for the analysis of transitional phases.     

A long life--a wish and its limits. Aging with dignity and meaning

In the journal "Gerontologie" (1991, Oswald WD et al. Eds.), the article on "Langlebigkeit" (longevity) is followed by the article on "Lebenszufriedenheit" (satisfaction in life) for purely alphabetical reasons. However, there is a deeper meaning in this order which refers to a connection that should not be neglected. "The number of our days is 70 years. Or maybe 80 years if..." To have a long and satisfying life is a deeply rooted wish in the human mind. Medicine and modern, improved conditions of living let this come true for many. However, what undoubtedly is a value by itself and has been praised as success until recently, now causes personal and social problems. We are dealing with a covert problem in particular: Which decisions that concern us and are likely not to please us, are others going to take when we are old? "I need a coat already. For me the sun is already declining". The wish to live as long as possible is always connected with hope, that is hope to have a fulfilling life. However, there are limits to that hope due to the constancy of maximal life expectation, multiple morbidity related with old age and consequent shortening of life. At the same time basic existential experiences as uniqueness, loneliness and the limits of the human mind increase with age. So what does it mean to fill life in old age with meaning and dignity? Nowadays dignity is constantly talked about. That is possibly why it is on the retreat. Dignity is understood as something that can be ascribed and if that is so, we can simply abandon it since theology is not a known discipline any more. Theology and religion in general could bring about a new understanding of the meaning of life as it could relate something incomprehensible with a potential interpretation. Life in old age also comprises the personal and private wherein the memories of the personal life attain a particularly important function.     

Gift wrapping ourselves: the final gift exchange

OBJECTIVE: This qualitative study examines the "final gift exchange" process by which older adults give cherished possessions in return for lasting appreciation. METHODS: We interviewed 54 middle- and upper-middle-class people (39 women) aged 50-90 who had to dispose of personal objects when moving to smaller residences. RESULT: We used Goffman's spiraling strategy in our analysis of people's reports of disposing of personal possessions. We identified three salient dimensions (family, economy, and self) of this process and created a heuristic describing eight ideal-type gift exchange scenarios by categorizing objects as valued or not valued by family and the economy as well as being an important aspect of the gift giver's material self. DISCUSSION: By applying the heuristic, we observed that a lack of shared definitions of the meaning and value of objects created dilemmas in disposing of personal objects, particularly those connected to a person's material self. We also offer suggestions for making the process go more smoothly, such as inquiring about the preferences of others and telling stories associated with objects to create shared definitions of the objects' significance to the giver and/or to family history.     

Quality of life measurement in gastrointestinal and liver disorders

Modern medicine has had a considerable impact on mortality rates for serious illness. Many chronic diseases which have previously been associated with an increased mortality now have survival rates approaching those of the background population. However, chronic diseases such as cancer, chronic pain syndromes, and chronic inflammatory conditions impose a considerable burden on families, the health care system, and society. Health related quality of life (HRQOL) is a concept that has developed from the need to estimate the impact of such chronic diseases. HRQOL measurement is a conceptual framework which attempts to predict daily function and well being based on subjective attitudes and experiences of physical, social, and emotional health. It has been evaluated predominantly from the patient's viewpoint as proxy respondents appear to underestimate the full effect of chronic illness on functional status. Measuring HRQOL in clinical research is most frequently undertaken using multi-item questionnaires to estimate daily function. Factors which affect HRQOL can be broadly classed as disease related and disease independent. The use of different assessment techniques permits comparisons between and within disorders. Generic and disease specific instruments used together enhance the ability to direct treatment for individuals and patient populations. Psychometrically sound questionnaires must be used. However, the type of instrument and research methods adopted depend on the question of interest. We have attempted to catalogue and critically assess the disease specific instruments used in the assessment of chronic gastrointestinal disease.     

Themes of suffering in later life

OBJECTIVES: This qualitative research study explored the personal meaning of suffering to a group of 40 community-dwelling elders, stratified by gender and race. METHODS: We recruited 40 informants who were 70 years old or older from the Philadelphia, PA, area for extended qualitative interviews, which elicited their life story and experiences and philosophies about suffering. Cells contained 10 African American men and women and 10 European American men and women each (N = 40). Through analysis of data, we placed elders' experiences of suffering under three general themes: suffering as lack of control, suffering as loss, and the value of suffering. RESULTS: Informants developed a unique definition, attribution, theory, and theodicy about suffering based on the particularity of the experience as well as how they "fit" suffering into their lives as a whole. Brief case studies illustrate how themes emerged in elders' stories of suffering. DISCUSSION: On the basis of this research, it appears that, although they have some similarities, elders' experiences of suffering are unique and incomparable. Similarities concern informants' connection of suffering with finitude. The incomparability of suffering experiences relate to informants' unique personal histories, perceptions, and "cause" of suffering. Through the process of the interview, elders connect the suffering experience to the entirety of the life lived and the story of suffering to the life story.     

Bioergography of Max Bürger

For the inquiry into changes during ageing apart from the usual methods of the cross-sectional and longitudinal research the biographical analysis is at our disposal. The establishment of statistics of works is called bioergography. This method is particularly suitable for the recognition of changes of creativity of productive persons, as it is shown at the instance of Ludwig van Beethoven. The bioergography of Max Bürger reveals how form and essence of his work have changed in the course of his life without speaking about a decline of his vigour.     

Narrative research: a review of methodology and relevance to clinical practice

Using qualitative narrative research to explore how people proceed through cancer diagnosis and treatment may help clinicians render better care and consequently enhance the probability of optimal health outcomes. Narrative research can be defined as collecting and analyzing the accounts people tell to describe experiences and offer interpretation. Often, oncology clinicians use narrative methods to investigate issues such as clinical outcomes, coping, and quality of life. Narrative research provides an option to explore personal experiences beyond the boundaries of a questionnaire, providing insight into decisions involving treatment, screening or various health practices, which can help guide how health care services are developed and provided. The purpose of this article is to illustrate the use of narrative research methods to a clinical audience who may not be as familiar with narrative technique. Definitions of narrative research, examples of published research using narrative methods in healthcare, validity and data analysis will be addressed. A review of current literature from sociology, anthropology, nursing and psychology demonstrates that narrative methods are an effective research option that can lead to enhanced patient care.     

Conceptualisation of self-management intervention for people with early stage dementia

Dementia is a major challenge for health and social care services. People living with dementia in the earlier stages experience a “care-gap”. Although they may address this gap in care, self-management interventions have not been provided to people with dementia. It is unclear how to conceptualise self-management for this group and few published papers address intervention design. Initial focusing work used a logic mapping approach, interviews with key stakeholders, including people with dementia and their family members. An initial set of self-management targets were identified for potential intervention. Self-management for people living with dementia was conceptualised as covering five targets: (1) relationship with family, (2) maintaining an active lifestyle, (3) psychological wellbeing, (4) techniques to cope with memory changes, and (5) information about dementia. These targets were used to focus literature reviewing to explore an evidence base for the conceptualisation. We discuss the utility of the Corbin and Strauss (Unending work and care: managing chronic illness at home. Jossey-Bass, Oxford, 1988) model of self-management, specifically that self-management for people living with dementia should be conceptualised as emphasising the importance of “everyday life work” (targets 1 and 2) and “biographical work” (target 3), with inclusion of but less emphasis on specific “illness work” (targets 4, 5). We argue that self-management is possible for people with dementia, with a strengths focus and emphasis on quality of life, which can be achieved despite cognitive impairments. Further development and testing of such interventions is required to provide much needed support for people in early stages of dementia.     

Aging and Social Change Among Abaluyia in Western Kenya: Anthropological and Historical Perspectives

This article presents narrative accounts which illustrate ways that modernization and social change have transformed the daily lives of Abaluyia, especially older people, in rural western Kenya since the late nineteenth century. The narratives reveal history as lived experience, as observed and recorded by an anthropologist who has been doing research among Abaluyia in Bunyala and Samia over the past 25 years. The story involves continuity of cultural beliefs and practices, and it involves change-change imposed by the macro-events of globalizing processes, from colonialism to Structural Adjustment Programs, and change as people's adaptive responses to those processes, particularly how changing cultural practices have impacted elders. The grand narrative is historical, the overarching story of the incorporation of Kenya and Kenyans into the global political economy from the colonial period to the present. Other narratives are biographical, case studies of individuals from two extended families and their personal experiences of social change over the past century. The background narrative is autobiographical, the anthropologist's story of the practice of anthropological fieldwork and her own experiences and observations of social change in western Kenya. Since anthropological data over time become history, the approach here is both anthropological and historical.     

Coping with the empty nest situation as a developmental task for the aging female--an analysis of the literature

This paper examines the widespread notions on the effect of children's departure from home. Several studies describe this situation as one of major role loss for the mother who reacts with feelings of depression and loneliness: the so-called "empty nest syndrome". Thirty studies were analyzed. There are no data which allow a generalization of such assumptions: The experience of facing the empty nest is individualistic for each woman due to her own biographical and actual factors of life context. Feelings range from loss and sadness to relief and freedom. Further empty nest research should define the term "empty nest" more thoroughly, including numerous variables about mothers' and children's life situations. Developmental counseling for middle-aged women cannot exist in standard programs with same aims for all participants, but has to begin with individual and situational determinants of each woman.     

Asthma and Human Excellence

As part of our ongoing series of biographical information on individuals who have achieved excellence despite the fact that they have asthma, we will be presenting biographies of those young athletes who have recently received awards as National Asthma Athlete of the Year. The first biographical sketch features Carol Sue Hollenbeck of Cheyenne, Wyoming. Ms. Hollenbeck was the recipient of the first annual National Asthma Athlete award in 1984. She was born and has lived in Cheyenne, Wyoming all of her life. Despite having significant asthma, which has been treated by Dr. Russell L.

Williams, Jr., Ms. Hollenbeck has won numerous awards in athletics as well as in academics throughout her high school and college career. She is presently a student at the University of Wyoming where she is majoring in biology with the intent of going on to medical school in the future. She continues to maintain academic excellence while participating in various sports at the university, and continues to keep her asthma under good control. Ms. Hollenbeck is a fine example of excellence that can be achieved in various aspects of life in spite of being a life-long asthmatic sufferer.