Growing very old into late life means increased suffering that may lead to despair and call for consolation. This thesis looks at the lived experience of very old people and aim at illuminating the meaning of growing very old and the meaning of consolation when growing old. It is part of the Umeå 85+ Study, and of the Consolation Study at the Department of Nursing, Umeå University. The participants were 85, 90, or 95 years old or over, living in the county of Umeå. The thesis comprises four studies with data from thematic interviews that are analysed using a phenomenological hermeneutic method (Studies I, II, IV) and qualitative content analysis (III). For Study I the transcribed interviews of 15 85-year-old people were analyzed and disclosed the meaning of growing very old as: maintaining one’s identity in spite of the changes that come with aging—that is, being able to balance change with feeling the same. This was based on four themes: balancing weakness and strength, balancing slowness and swiftness of time, balancing reconciliation and regret, and balancing connectedness and loneliness. In Study II, interviews with 12 people between 95 and 103 years old were analyzed and disclosed the meaning of being very old as living in hope and being on the move, based on two themes: Being in stillness and in movement, which involves being in one’s aged body, unable to move, and being in the stillness of the inner person occupied with remembering and reconciling life; and Being at the threshold ready to let go, which implies being at peace and feeling confident despite the anxiety of dying. Study III describes how 90-years old and older people perceive consolation. Qualitative Content analysis of 49 interviews revealed four categories perceiving consolation connected to God, others, self, and things and presented in two themes: “Living amidst consolation in the presence of God” and “Seeking consolation”. Study IV examines the meaning of being consoled when growing very old. The interviews with 13 people over 85 years who scored high on a self-transcendent scale were analysed and disclosed the meaning of being consoled as an immediate experience of being carried and embraced by God and supported by the loving care and affection from others and the world, being relaxed, peaceful and full of joy and experiencing hope. The interpretation was based on the main theme Feeling whole, comprising the following themes: Being connected to self, Feeling connected to fellow beings and the world, Feeling connected to God. The meaning of growing very old and the meaning of consolation when growing very old point at a way of aging into late life interpreted as living in consolation. Reminiscence, reflecting on life and transcendence are resources when growing very old that were interpreted to being related to consolation. Thus growing very old and living in consolation is to transcend and come in communion with the sacred; with goodness, light, joy, beauty and life and hope, carried by a connectedness to God (e.g. Higher power) and supported by a connectedness to fellow beings and the world.

This investigation, comprising two studies, examined the number of barriers to physical activity (Study 1) and barrier strength (Study 2) reported by middle-aged and older adults using a social ecological framework (McLeroy et al., 1988). Researchers were interested in assessing age group (45-54; 55-64; 65-74 yrs) by physical activity group (active, less active) effects for barrier responses using analyses of variance. In Study 1, 180 participants completed a physical activity level survey (Godin & Shephard, 1985) and answered open-ended questions about barriers. Results indicated that 45-54 yr-olds reported more barriers overall, and more intrapersonal barriers than older groups. Less active 45-54 yr-olds reported more organizational-interpersonal barriers than the other groups. Descriptive analyses of coded themes demonstrated that common intrapersonal barrier sub-themes cited by younger adults related to family commitments, while sub-themes reported by middle-aged and older adults related to having a health problem or an injury. In the organizational-interpersonal category, the most common barrier sub-theme related to the workplace. In Study 2, 116 participants completed a survey assessing weekly physical activity and barrier strength for items pertaining to ecological categories and barrier sub-factors. Results showed that less active adults reported each of intrapersonal, interpersonal, and physical environment barriers more strongly than active adults, irrespective of age; the intrapersonal category was relatively the most constraining for our participants. In terms of barrier sub-factors, results showed that significantly higher barrier strength scores are most often associated with physical activity level (i.e., less active), and only occasionally associated with age group. The overall investigation can provide valuable information for improving physical activity interventions for middle-aged and older adults.

Adaptation to role transitions can have various outcomes. Health and demographic characteristics as well as environmental control have been shown to affect the transition to the role of patient. The acutely ill elderly's adaptation to the role of hospitalized patient has not been measured from the elderly patient's perspective. This study utilized a random sample of 176 hospitalized elderly medical-surgical patients and the patients' registered nurses to examine the relationships among demographic and health characteristics, latitude of choice and elderly hospitalized patient adjustment. Patients were excluded who had been in ICU for more than 24 hours, had decreased mental status, or were judged to be too physically ill to participate. The study used an adaptation of the Latitude of Choice Scale (a measure of environmental control) developed by Hulicka and colleagues, a nurse-rated hospitalized patient adjustment scale developed by Cicirelli, and an adaptation of the adjustment scale for patients' self-assessment. Results from a series of multiple regression analyses indicate that, taken as a group, neither demographic nor health characteristics predict environmental control, as measured by the adapted version of the Latitude of Choice Scale (LOC). However, one individual health characteristic, length of time since last hospitalization, was a negative predictor of LOC. Further, the results indicate that taken as a group, health and demographic characteristics, along with patient LOC scores are not predictive of either nurse or patient-rated adaptation. The individual health characteristic "patient acuity rating" did negatively predict both nurse and patient-rated adjustment scores. Nurse-rated patient adjustment scores were also negatively predicted by the participants' prior number of hospitalizations. A paired-t test indicated that patients rated themselves significantly better adjusted than did their nurses. This finding was judged to be clinically unimportant because of the small real difference in the mean scores. Random-effects ANOVA found no significant variance between nurses' ratings of patients. / Graduation date: 1991

This study examined the behaviors relating to the utilization of prescription and over-the-counter medications in a small group of elderly subjects in the 65 years and over age range. This group was attending an Elderhostel at Western Oregon State College during the summer of 1991, when the information was obtained. The objectives of this study were to ascertain specific medication taking behaviors, and whether or not directions were adhered to as prescribed by physicians for this highly educated group, or if their behaviors were similar to those referred to in the literature for all elderly. A sample of 38 elderly was obtained during an Elderhostel Wellness Vacation at Western Oregon State College in Monmouth, Oregon during July, 1991. Subjects completed questionnaires regarding medication-taking behaviors as part of a wellness class session regarding the safe use of medications. Questionnaires were filled out prior to the class discussion. Data were assembled using one survey instrument with questions relating to medication usage. Descriptive statistics using histograms showing frequency distributions were used for data analysis. Sixty-five percent of this group were taking prescription medications and sixty-eight percent of this group were taking over-the-counter medications. Medications were being obtained from more than one physician and more than one pharmacy. The subjects took fewer doses of medications per day and less medication per dose than prescribed. Medications were discontinued prematurely if feeling better or worse. Leftover medications from previous prescriptions were being taken. Outdated or expired medications were being taken. Alcoholic beverages were being used in conjunction with the use of prescription medications. In some cases, prescriptions were not filled because they were considered to be unnecessary. Recommendations for education and future research in the problematic area of drug use in the elderly include: 1) More time spent by health care professionals to educate the elderly in the correct and safe use of medications; 2) Community health promotion programs targeted at the well elderly; 3) Personalized "brown bag" medication counselling sessions; 4) Medication education programs at Elderhostels throughout the country; 5) Education programs through the American Association of Retired Persons; and 6) Further studies of larger groups of well-educated, healthy and active elderly. / Graduation date: 1993

This investigation, comprising two studies, examined the number of barriers to physical activity (Study 1) and barrier strength (Study 2) reported by middle-aged and older adults using a social ecological framework (McLeroy et al., 1988). Researchers were interested in assessing age group (45-54; 55-64; 65-74 yrs) by physical activity group (active, less active) effects for barrier responses using analyses of variance. In Study 1, 180 participants completed a physical activity level survey (Godin & Shephard, 1985) and answered open-ended questions about barriers. Results indicated that 45-54 yr-olds reported more barriers overall, and more intrapersonal barriers than older groups. Less active 45-54 yr-olds reported more organizational-interpersonal barriers than the other groups. Descriptive analyses of coded themes demonstrated that common intrapersonal barrier sub-themes cited by younger adults related to family commitments, while sub-themes reported by middle-aged and older adults related to having a health problem or an injury. In the organizational-interpersonal category, the most common barrier sub-theme related to the workplace. In Study 2, 116 participants completed a survey assessing weekly physical activity and barrier strength for items pertaining to ecological categories and barrier sub-factors. Results showed that less active adults reported each of intrapersonal, interpersonal, and physical environment barriers more strongly than active adults, irrespective of age; the intrapersonal category was relatively the most constraining for our participants. In terms of barrier sub-factors, results showed that significantly higher barrier strength scores are most often associated with physical activity level (i.e., less active), and only occasionally associated with age group. The overall investigation can provide valuable information for improving physical activity interventions for middle-aged and older adults.

The health and fitness status of Canadian children has been declining over the past several decades. Children’s health and fitness impacts future health status as many health and fitness indicators track from youth into adulthood and are associated with serious illnesses such as cardiovascular disease (CVD). One potential determining factor of health and fitness may be the level of proficiency exhibited in performing fundamental movement skills (FMS). Failure to master FMS in childhood may decrease the physical activity options available in adulthood because FMS provide a foundation for all forms of physical activity pursuits necessary for health and fitness benefits. Todate, the relationship between health, fitness and proficiency of FMS has not been examined in Canadian children. Therefore, the purpose of the present investigation was to examine the current state of movement skill proficiency in relation to health and fitness in Canadian elementary-aged children. Boys (n = 71) and girls (n = 91 girls) ages 8 to 11 years were recruited from schools participating in the evaluation component of the Action Schools! BC program. Measures of fundamental movement skill proficiency (i.e., running, horizontal jumping, vertical jumping, jumping from a height, hopping, and skipping) and indicators of health and fitness (i.e., blood pressure, arterial compliance, weight status, musculoskeletal and cardiovascular fitness) were assessed. Results indicated low levels of FMS proficiency for both boys and girls. Analysis also revealed significant relationships between EMS and indicators of health and fitness. Correlation analyses found running and hopping to be significantly (p < .01) related to musculoskeletal and cardiorespiratory fitness tests. Significant (p < .01) relationships between vertical jumping and weight status, musculoskeletal and cardiorespiratory fitness were also found by the correlation analyses. Regression analyses were performed to determine the independent relationship between health and fitness indicators. Vertical jump was significantly (p < .01) related to blood pressure (BP) independent of confounding health and fitness variables. Finding significant relationships between FMS proficiencies and health and fitness indicators coupled with the low proficiencies demonstrated by our sample of children suggest the need for a greater emphasis on the development of FMS.

Reprint from: Allergology International 55(1), 2006, p.59-65

Syftet var att beskriva vilka omvårdnadsproblem som kan uppstå i samband med polyfarmacihos äldre personer. Litteraturstudien gjordes med beskrivande design. Datainsamling viadatabaserna PubMed och Cinahl. Resultatet baserades på 12 kvantitativa artiklar. Resultatetvisade att det fanns samband mellan polyfarmaci och flera specifika omvårdnadsproblembland äldre personer. Det omvårdnadsproblem som förekom mest bland de artiklar somstuderades var fall och frakturer. Det framkom att antalet använda läkemedel kundeidentifieras som en riskfaktor för fall och fraktur, men även att läkemedelstyp kunde påverka.Resultatet visade också att yrsel och balanssvårigheter kunde ha ett samband medpolyfarmaci. Andra omvårdnadsproblem som kunde kopplas samman med polyfarmaci varförsämrad nutritionsstatus, så som viktnedgång och undernäring. Det fanns också en kopplingmellan gastrointestinala problem och användandet av många läkemedel. Slutsatsen var att detfanns samband mellan polyfarmaci och flera omvårdnadsproblem bland äldre personer. Totaltfyra kategorier av omvårdnadsproblem identifierades utifrån de studerade artiklarna: fall ochfraktur, försämrad nutritionsstatus och malnutrition, mag- och tarmproblematik samt yrseloch balanssvårigheter. / The aim was to describe the nursing problems that may arise in connection withpolypharmacy in the elderly. The literature review was done with descriptive design. Datacollection through PubMed and Cinahl. The result was based on 12 quantitative articles. Theresults showed that there was a correlation between polypharmacy and several specificnursing problems among older people. The nursing problems that occurred most among thestudied articles were falls and fractures. It was revealed that the number of used medicinescould be identified as a risk factor for falls and fractures, but also drug type could influence.The results also showed that dizziness and balance problems could be associated withpolypharmacy. Other nursing problems that could connect with polypharmacy was impairednutritional status, such as weight loss and malnutrition. There were also a connection betweengastrointestinal problems and usage of many drugs. The conclusion was that a correlationbetween polypharmacy and several nursing problems among older people were found. A totalof four categories of nursing problems were identified in the studied articles: falls andfractures, impaired nutritional status and malnutrition, gastrointestinal problems, dizzinessand balance problems.

Purpose: From an activity-perspective examine the meaning of housing accessibility and older persons´ perception of participation. Method: Systematic literature review of articles searched in the databases, Medline, Pubmed, Ahmed, Cinahl, Scopus and Google Scholar. Search on individual keywords, and in various combinations of the words home environment, home modification, occupational therapy, aging, accessibility and participation. Nine scientific articles were examined. Results: The articles were published between 2005 and 2009. Housing accessibility is important for a better well-being and independence in daily activities of elderly persons. Older persons´ participation and perceived satisfaction with participation, become lower with reduced ability to perform daily activities. Conclusion: Interventions designed to increase accessibility in the home environment may be important for older persons´ well-being. Interventions should be preceded by careful assessment of what is important for the individual as older persons´ perception of participation are individual and change over time.Further knowledge on this subject is needed, particularly studies with participants in very old age and poor health.

<p>Background: Each year, 2 million older Americans complete three to four week courses of post-acute care in nursing homes and return home; however, scant research describes services to protect older adults during their transitions from nursing homes to home. In hospital-based studies, transitional care interventions were associated with improved health outcomes for older adults, but these interventions added new staff positions, which are likely cost-prohibitive in nursing homes. Further, no prior study explored transitional care provided for vulnerable, post-acute care patients in nursing homes. Thus, this dissertation was designed to develop new understandings about transitional care provided by existing staff members in nursing homes. The study has two specific aims: (a) describe transitional care and outcomes for older adults who obtain post-acute care in nursing homes from the day of admission through discharge; (b) explore the influence of interactions, among selected older adult patients and their group of nursing home caregivers, on their ability to accomplish transitional care processes.</p><p>Method: Using data from a literature review and theoretical models, including Donabedian's Model of Healthcare Quality and Anderson's Local Interaction Model, a conceptual model of transitional care for post-acute care patients in nursing homes was constructed. The conceptual model was then used to guide exploration of the research aims with a longitudinal, multiple case study of transitional care in a nursing home. The unit of analysis was the patient care-team, defined as individual post-acute care patients, family caregivers, and 6 to 8 professional staff in each team (e.g., rehabilitation therapists, physicians, nurses and social workers). Three patient care-team members were purposively sampled for study. Moreover, longitudinal data were collected using repeated interviews and observations with patients, family caregivers, and staff; document and daily chart reviews; and surveys of patient preparedness for discharge. Manifest content analysis and thematic analysis (qualitative methods) were used to conduct within- and across-case analyses of trajectories of transitional care and to identify strengths, gaps and inconsistencies in care. </p><p>Results: Findings related to the first research aim include a description of transitional care in the study nursing home. Serious gaps and inconsistencies in transitional care exposed older, post-acute care patients to risks for complications in their transitions from the study nursing home to home: (a) systemic supports were not available to support nursing home staff who provided transitional care; further, nursing home staff and leadership were unaware that they provided transitional care; (b) care processes were not in place to prepare older adults and their caregivers to continue care at home; (c) care-team interactions often excluded family members; and (d) post-acute care patients left the nursing home without resources needed to support safe transitions in care, including transitional care plans, education to appropriately respond to acute changes in health, written materials to guide care at home, referrals for medical follow-up after discharge, and transfers of clinical information to primary care physicians. </p><p>Findings related to the second research aim include a description of local interaction strategies and the effectiveness of transitional care processes. When professional staff more consistently used local interaction strategies, specified in the model, care-team members exhibited greater capacity for connections, information exchange, and cognitive diversity. Further, when care-team interactions were of high quality and sufficient frequency, there were multiple indications of more effective transitional care, such as patient engagement in care, inclusion of patient priorities in care plans, and problem solving which included family members and diverse members of the patient care-team. Thus, local interaction strategies were essential staff behaviors needed to adapt care processes to the specific transitional care needs of individual patients.</p><p>Because transitional care is a grossly under-developed care process in nursing homes, these findings will likely have immediate implications for practice and research. Findings will provide nursing home administrators and staff with resources to develop and evaluate care in nursing homes; further, the findings will help to create targets for protocol and care process development to strengthen existing practice and address deficiencies. Findings will provide researchers with resources for studying transitional care in diverse samples of nursing homes, which should facilitate development of testable hypotheses for needed intervention studies. In addition, the local interaction strategies findings in the study may generalize to other settings of care, where interdependent staff work is required to establish connections, information networks, and to coordinate care among multiple staff members.</p> / Dissertation