This thesis portfolio examines attitudes to ageing in older adults, and explores the impact that attitudes to ageing have on mental health status and quality of life. Attitudes to ageing are becoming more widely measured in older adults, particularly with the ageing population but also due the recent development of the Attitudes to Ageing Questionnaire. There is growing evidence to suggest a relationship between attitudes to ageing and mental health status in older adults. However, no study has explored the association between attitudes to ageing and quality of life in older adults, incorporating the Attitudes to Ageing Questionnaire and the World Health Organisation Quality of Life measures. Firstly a systematic search of studies exploring the relationship between attitudes to ageing and mental health in older adults (≥55 years) was undertaken. All potentially relevant studies were screened against inclusion and exclusion criteria. Variables related to attitudes to ageing, ageism, age stereotypes, depression and anxiety were considered in this review. Twelve papers met inclusion criteria for the systematic review. The setting, culture and measures incorporated varied across the studies. A negative attitude to ageing was associated with poorer mental health status in older adults across all 12 studies. The second part of this portfolio was an international cross-sectional analysis of attitudes to ageing and quality of life in older adults (≥57 years). Correlation and regression analyses explored the relationship between attitudes to ageing and QOL and investigated the impact of socio-demographic variables, depression and attitudes to ageing on two quality of life measures. The two constructs were positively related; a more positive attitude to ageing was associated with a better quality of life. Further, positive attitudes to ageing was a significant predictor of a better QOL. The sample was then divided into two age groups (57-79 years and 80+ years) and attitudes to ageing and quality of life ratings were compared. Results revealed more negative ratings in attitudes to ageing and quality of life in the over 80 year old age group. Correlation and regression analyses were then explored across both age groups. More positive attitudes to ageing was a significant predictor of better quality of life across both age groups. Overall, the two studies in this thesis portfolio highlight the need to better recognise and target older adults’ negative attitudes to ageing. Appropriate psychological interventions could be provided to challenge negative attitudes and promote attitude change in an attempt to improve mental health difficulties and quality of life in older adults. Continued use of the Attitudes to Ageing Questionnaire and quality of life psychometric measures in clinical practice and research is encouraged.

Hintergrund: Der Zweite Weltkrieg und die damit verbundenen traumatischen Ereignisse können auch Jahrzehnte später bei der ehemaligen Kriegsgeneration Deutschlands mit langfristigen und schwerwiegenden gesundheitlichen Folgen einhergehen. Insbesondere die Erforschung von Langzeitverläufen traumatisierender Erlebnisse befindet sich noch in ihren Anfängen. Ziele: Es werden die Auswirkungen traumatischer Erfahrungen und posttraumatischer Belas-tungssymptomatik auf die heutige gesundheitsbezogene Lebensqualität der älteren Bevölkerung Deutschlands (bis 1948 geboren) untersucht. Die Zusammenhänge werden unter dem Einfluss komorbider Depressivität, somatischer Symptome und körperlicher Erkrankungen analysiert. Material und Methoden: Diese Arbeit untersucht die physische und psychische gesund-heitsbezogene Lebensqualität (SF12v2-Fragebogen zur gesundheitsbezogenen Lebensqua-lität), traumatische Erfahrungen (Traumaliste des M-CIDI), Posttraumatische Belastungsstörung (PTBS) entsprechend des DSM-IV, partielle PTBS (Posttraumatic Diagnostic Scale, PDS), körperliche Erkrankungen (Multimorbiditätsfragebogen), Depressions- und Somatisierungssymptomatik (Patient Health Questionnaire, PHQ-D) in einer repräsentativen Stichprobe der 60-85 jährigen Bevölkerung Deutschlands (N = 1659) mit Hilfe von Selbstbeurteilungsverfahren. Ergebnisse: Personen mit traumatischen Erfahrungen in der Lebensgeschichte berichten eine niedrigere Lebensqualität als Personen ohne traumatische Erfahrungen. Zudem findet sich mit steigender Anzahl der traumatischen Erfahrungen eine niedrigere physische und psychische Lebensqualität. Auch haben Personen mit einer Vollbild- oder partiellen PTBS eine niedrigere körperliche und psychische gesundheitsbezogene Lebensqualität. Beeinträchtigungen in der physischen gesundheitsbezogenen Lebensqualität werden hauptsächlich durch komorbide depressive und somatische Symptome und körperliche Erkrankungen erklärt. Auf die Beeinträchtigungen der psychischen gesundheitsbezogenen Lebensqualität haben sowohl traumatische Erfahrungen und posttraumatische Belastungssymptomatik als auch komorbide Depressions- und Somatisierungssymptomatik Einfluss. Die PTBS führt sowohl bei kategorialer als auch bei dimensionaler Betrachtung zur Beeinträchtigung der gesundheitsbezogenen Lebensqualität; stärkster Einfluss wird auf die psychische Dimension genommen. Schlussfolgerung: Selbst nach Jahrzehnten können potentiell traumatisierende Erlebnisse in der Folge mit erheblichen körperlichen und psychosozialen Beeinträchtigungen einhergehen. Im Umgang mit Älteren sollten neu auftretende oder zunehmende gesundheitliche Beschwerden immer vor dem Hintergrund der historisch-biographischen Perspektive betrachtet werden. Dabei sollte auch subsyndromalen Störungsbildern genügend Beachtung zukommen. Dem Einsatz von Messinstrumenten zur Erfassung der Lebensqualität in der Diagnostik und zur Verlaufsbeurteilung sollte mehr Bedeutung beigemessen werden.

Background: Multiple sclerosis (MS) is a chronic neurological autoimmune disease. The disease affects most young people between 20-40 years of age, mainly women. There are about 2.5 million people worldwide are affected by MS. The most common symptoms that a patient with MS suffers from are the fatigue (tiredness), pain, depression, sleep disturbance, balance disorder, dizziness, palsies (paralysis) and heat intolerance. There are also other physical and mental dysfunctions. Aim: The purpose of this study was to describe patients' experiences of MS disease symptoms and the nurse's possible role in disease progression. Method: A literature study based on nine scientific articles. Articles were searched in the databases CINAHL and PubMed in the fall 2015th.   Results: This study showed how the experiences of the symptoms for patients with MS affected their health, social life and quality of life in a negative way. The study also showed that nurses have an important informative, supportive and integrated role for the patient and family, during the course of the disease. Conclusions: MS disease affects the sufferer's life in a negative way, both physically and mentally. The disease usually means that the patient is facing uncertain and unpredictable future, and suffers unpleasant symptoms. These experiences involve not only a part of the body but the whole person. The assistance of the care and especially the nurse is of great importance to facilitate the patient's situation and help the patient to preserve their quality of life as good as possible. The nurses’ informative and caring role is a great support to patients with MS. Better understanding of patients' experience can be valuable for a better communication and care.

published_or_final_version / Urban Planning / Master / Master of Science in Urban Planning

published_or_final_version / Dentistry / Master / Master of Dental Surgery

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Urban Planning / Master / Master of Science in Urban Planning

ALS är en förkortning av Amyotrofisk lateral skleros. Nervceller som styr kroppensmuskulatur förtvinas och leder till förlamning. Till slut påverkas andningsmuskulaturen och man får svårigheter med andningen, vilket till sist leder till döden. Sjukdomen delas in i grupper och det skiljer sig åt i symptom och aggressivitet dock är utgången densamma. Överlevnaden är vanligtvis 3-5 år. Det bedrivs mycket medicinsk forskning men än så länge har man inte hittat botemedel. Orsaken är oklar men det finns vissa teorier. Behandlingen går ut på att lindra symtom och bromsa sjukdomförloppet. Syftet med denna studie är att belysa upplevelsen att leva med ALS.  Därför gjordes en litteraturstudie ur ett vårdvetenskapligt perspektiv, utifrån nio forskningsartiklar. Sökningar har gjorts i databaserna Cinahl, PubMed och Medline.I analysen framkom två teman: Förändrad livsvärld och Välbefinnande. Under Förändrad  livsvärd  framkommer  tre  underteman:  Lidande,  Skuld  och  skam  samt Vården av en anhörig. Under Välbefinnande hittades två underteman: Finna mening i livet och Konsten att leva i nuet. Studien visar att ALS skapar mycket lidande och existentiella funderingar både för patient och anhöriga. Den visar också att det är de anhöriga som står för den mesta vården och tar ett stort ansvar för patienten. Mitt i allt lidande kan man trots allt finna glädje och välbefinnande, vilket familj och vänner bidrar till.

Antidepressants are associated with sexual side effects (Clayton, Keller, & McGarvey, 2006). Sexual side effects are associated with non-compliance or discontinuance of antidepressants (Werneke, Northey, & Bhugra, 2006). Despite this, there are few empirically supported treatments for antidepressant side effects. However, in laboratory studies, exercise immediately before sexual stimuli improved sexual arousal of women taking antidepressants (Lorenz & Meston, 2012). I evaluated if exercise improves sexual functioning in women experiencing antidepressant-induced sexual side effects. Fifty-two women reporting antidepressant sexual side effects were followed for 3 weeks of sexual activity only. They were randomized to complete either three weeks of exercise immediately before sexual activity (3x/week) or 3 weeks of exercise separate from sexual activity (3x/week). At the end of the first exercise arm, participants crossed to the other. I measured sexual functioning, sexual satisfaction, depression and physical health. Completers showed modest improvements in sexual functioning and satisfaction. For women taking selective serotonin and norepinephrine reuptake inhibitors, exercising immediately before sexual activity was superior to exercise in general. As well as known effects in improved physical and psychological health, exercise may help improve sexual health and pleasure in women taking antidepressants. These findings have important implications for public health, as exercise is accessible, cheap, and does not add to burden of care. / text

Background: The Adult Social Care Outcomes Toolkit was developed to measure outcomes of social care in England. In this study, we translated the four level self-completion version (SCT-4) of the ASCOT for use in the Netherlands and performed a cross-cultural validation. Methods: The ASCOT SCT-4 was translated into Dutch following international guidelines, including two forward and back translations. The resulting version was pilot tested among frail older adults using think-aloud interviews. Furthermore, using a subsample of the Dutch ACT-study, we investigated test-retest reliability and construct validity and compared response distributions with data from a comparable English study. Results: The pilot tests showed that translated items were in general understood as intended, that most items were reliable, and that the response distributions of the Dutch translation and associations with other measures were comparable to the original English version. Based on the results of the pilot tests, some small modifications and a revision of the Dignity items were proposed for the final translation, which were approved by the ASCOT development team. The complete original English version and the final Dutch translation can be obtained after registration on the ASCOT website (http://www.pssru.ac.uk/ascot). Conclusions: This study provides preliminary evidence that the Dutch translation of the ASCOT is valid, reliable and comparable to the original English version. We recommend further research to confirm the validity of the modified Dutch ASCOT translation. (authors' abstract)