The Finnmark Intervention Study: do community-based intervention programmes threaten self-rated health and well-being? Experiences from Batsfjord, a fishing village in North Norway.
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AIM: Examine negative side-effects on self-rated health and well-being of a community-based intervention in a fishing community in the Norwegian Arctic. METHOD: A cohort study with quasi-experimental design with one intervention community and three control communities from the same area. There was a baseline screening (1987), three years intervention (1988-1991) and a rescreening (1993). Of the invited (aged 20-62 years in 1987), 668 (64%) males and 656 (72%) females met at both screenings. The main outcome variables were self-rated health, mental health variables, and preoccupation with health. Those answering the relevant questions at both screenings were analysed. High-risk and low-risk males were analysed separately. There were too few females in the high-risk group to do separate analyses. RESULTS: The main findings among the low-risk group were: Males in Batsfjord did not differ from males in the control communities. Among females, there was a reduction in the proportion depressed of 20.4% points in Batsfjord and 9.6% in the control communities (p adjusted=0.060). There was also a decrease in the proportion lonely of 19.2% points and 5.8% respectively (p adjusted=0.005). In the male high-risk group there was a decrease in the proportion lonely by 14.7% points in Batsfjord and an increase by 5.9% in the control communities (p adjusted=0.004). CONCLUSION: We have not found that an intervention programme using local empowerment, mass strategies, and intervention on high-risk cases has serious negative side effects on self-rated health, well-being or preoccupation with health. (+info)
Adolescents with chronic illnesses: school absenteeism, perceived peer aggression, and loneliness.
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Frequent school absence is often cited as a risk factor for peer relationship problems in youngsters with chronic illnesses, but this assumption has not been subjected to quantitative empirical examination. This issue was examined in the present study by exploring the relationship between school absenteeism, peer aggression, and loneliness in adolescents with chronic illnesses. Forty-one adolescents with chronic illnesses completed a modified version of the Direct and Indirect Aggression Scale and the Asher Loneliness Scale. Details of school absences and hospitalizations were obtained from parents and school and hospital records. No evidence was found to support the notion that peer aggression and loneliness are related to absenteeism, but social aggression (for both boys and girls) and verbal aggression (more markedly for girls) were associated with loneliness. Of the group, 19% reported experiencing verbal aggression and 12% social aggression at least weekly; informal qualitative data suggesting that such aggression is often related to limited sporting ability and appearance. Interventions at both the individual and school community level are warranted. (+info)
Aging with quality of life--a challenge for society.
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This article focus on biological, nutritional, psychological, medical and social variables which have proven useful indicators for assessing wellbeing of individuals. Such objective data (measured by the two investigators) and subjective information (self-reported by the participants) were collected between 2002-2003 from samples of healthy, free living females and males aged between 59 and 92 years from Vienna and surroundings. In both these groups some habitual practices (habit variables) were observed of elderly and old which have a negative influence on health i.e low daily liquid uptake and smoking. There is also a fair amount of overweight and obesity (BMI>or=30) and also of hypertension, particularly in males, There is also malnourishment, predominantly in females, as reflected by the Body Cell Mass Index. Several participants either were not aware of being hypertensive or admitted that they deliberately ignored medical advice. With respect to social variables there are greater percentages of married males and widowed females. Possibly partially resulting from this loss of the partner a greater number of females report feelings of loneliness than do males. Positive results relate to the overall high percentages of family contacts, positive feelings towards life and physical activity as reported by the large majority of the participants. These findings stress the need for further information of living habits of the elderly and old as a possible guide of helping improve their quality of life. (+info)
Influence of a computer intervention on the psychological status of chronically ill rural women: preliminary results.
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BACKGROUND: Adaptation to chronic illness is a lifelong process presenting numerous psychological challenges. It has been shown to be influenced by participating in support groups. Rural women with chronic illness face additional burdens as access to information, healthcare resources, and sources of support are often limited. Developing virtual support groups and testing the effects on psychosocial indicators associated with adaptation to chronic illness may help remove barriers to adaptation. OBJECTIVE: To examine the effects of a computer-delivered intervention on measures of psychosocial health in chronically ill rural women including social support, self-esteem, empowerment, self-efficacy, depression, loneliness, and stress. METHODS: An experimental design was used to test a computer-delivered intervention and examine differences in psychosocial health between women who participated in the intervention (n = 44) and women in a control group (n = 56). RESULTS: Differences between women who participated in the intervention and controls were found for self-esteem, F(1,98) = 5.97, p =.016; social support, F(1,98) = 4.43, p =.038; and empowerment, F(1,98) = 6.06, p =.016. A comparison of means for depression, loneliness, self-efficacy, and stress suggests that differences for other psychosocial variables are possible. DISCUSSION: The computer-based intervention tested appears to result in improved self-esteem, social support, and empowerment among rural women with chronic illness. Descriptive but nonsignificant differences were found for other psychosocial variables (depression, loneliness, self-efficacy, and stress); women who participated in the intervention appeared to improve more than women in the control group. (+info)
A mixed-methods approach to understanding loneliness and depression in older adults.
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OBJECTIVE: Depression in late life may be difficult to identify, and older adults often do not accept depression treatment offered. This article describes the methods by which we combined an investigator-defined definition of depression with a person-derived definition of depression in order to understand how older adults and their primary care providers overlapped and diverged in their ideas about depression. METHODS: We recruited a purposive sample of 102 persons aged 65 years and older with and without significant depressive symptoms on a standardized assessment scale (Center for Epidemiologic Studies-Depression scale) from primary care practices and interviewed them in their homes. We applied methods derived from anthropology and epidemiology (consensus analysis, semi-structured interviews, and standardized assessments) in order to understand the experience and expression of late-life depression. RESULT: Loneliness was highly salient to older adults whom we asked to describe a depressed person or themselves when depressed. Older adults viewed loneliness as a precursor to depression, as self-imposed withdrawal, or as an expectation of aging. In structured interviews, loneliness in the week prior to interview was highly associated with depressive symptoms, anxiety, and hopelessness. DISCUSSION: An improved understanding of how older adults view loneliness in relation to depression, derived from multiple methods, may inform clinical practice. (+info)
Preventing and treating homesickness.
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Homesickness is the distress and functional impairment caused by an actual or anticipated separation from home and attachment objects such as parents. It is characterized by acute longing and preoccupying thoughts of home. Almost all children, adolescents, and adults experience some degree of homesickness when they are apart from familiar people and environments. Pediatricians and other health care professionals are in a unique position to assist families in understanding the etiology, prevention, and treatment of homesickness. In the case of planned separations, such as summer camp, techniques are provided that may aid in prevention. In the case of unanticipated or traumatic separations, such as hospitalization, effective treatment strategies are available. (+info)
Health risk appraisal in older people 1: are older people living alone an "at-risk" group?
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BACKGROUND: In the UK, population screening for unmet need has failed to improve the health of older people. Attention is turning to interventions targeted at 'at-risk' groups. Living alone in later life is seen as a potential health risk, and older people living alone are thought to be an at-risk group worthy of further intervention. AIM: To explore the clinical significance of living alone and the epidemiology of lone status as an at-risk category, by investigating associations between lone status and health behaviours, health status, and service use, in non-disabled older people. DESIGN OF STUDY: Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal in older people. SETTING: Four group practices in suburban London. METHOD: Sixty per cent of 2641 community-dwelling non-disabled people aged 65 years and over registered at a practice agreed to participate in the study; 84% of these returned completed questionnaires. A third of this group, (n = 860, 33.1%) lived alone and two-thirds (n = 1741, 66.9%) lived with someone else. RESULTS: Those living alone were more likely to report fair or poor health, poor vision, difficulties in instrumental and basic activities of daily living, worse memory and mood, lower physical activity, poorer diet, worsening function, risk of social isolation, hazardous alcohol use, having no emergency carer, and multiple falls in the previous 12 months. After adjustment for age, sex, income, and educational attainment, living alone remained associated with multiple falls, functional impairment, poor diet, smoking status, risk of social isolation, and three self-reported chronic conditions: arthritis and/or rheumatism, glaucoma, and cataracts. CONCLUSION: Clinicians working with independently-living older people living alone should anticipate higher levels of disease and disability in these patients, and higher health and social risks, much of which will be due to older age, lower educational status, and female sex. Living alone itself appears to be associated with higher risks of falling, and constellations of pathologies, including visual loss and joint disorders. Targeted population screening using lone status may be useful in identifying older individuals at high risk of falling. (+info)
Ethical challenges related to elder care. High level decision-makers' experiences.
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BACKGROUND: Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. METHODS: A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. RESULTS: Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. CONCLUSION: Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet. (+info)