Engagement, knowledge and autonomy : facing a new generation older urban living people : studies on self-care and health
Doctoral thesis
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Date
2015Metadata
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- Institutt for sosialt arbeid [1394]
Abstract
Aim: The overall purpose of this thesis was to explore the phenomenon of self-care among older, urban homedwelling
people in order to enhance health and well-being and be able to inform and improve policy and
practise.
Methods: A mixed methods design was chosen. A descriptive cross-sectional design was applied for Study I and
1,044 randomly chosen men and women aged 65+ years, living in urban areas in southern Norway answered a
postal questionnaire consisting of five instruments measuring risk for undernutrition, self-care ability, self-care
agency, sense of coherence, mental health, background variables, and 17 health related questions. Studies II and
III, had a qualitative design with a descriptive phenomenological (II) and a phenomenological hermeneutical
approach (III). Ten persons 65-82 years, identified to be physically active every day (Study II), and nine single
living persons 70-82 years of age, identified to be in good health (Study III), were interviewed. A randomized
controlled study, was performed (Study IV) for the purpose of evaluating the effects of a telephone-based selfcare
intervention. Fifteen persons aged 75-93 answered a questionnaire about perceived health, self-care ability,
self-care agency, sense of coherence and mental health before and after intervention. In an age and sex matched
control group (n=15), the same questions were answered without any attention except for the questionnaires.
Data in Study I were analysed with univariate and multivariate statistical methods and to compare the
intervention group and control group in Study IV, the McNemar-test and the Wilcoxon signed-rank test were
used. For analysing data in the interview studies, a descriptive phenomenological (II) and a phenomenologicalhermeneutical
(III) method were used.
Main results: A majority (83%) of the participants in Study I had higher self-care ability. Self-care agency,
perceived good health, being active, being frequently physically active, good mental health, not being at risk for
undernutrition, and satisfaction with life, all promoted self-care ability. Negative factors for self-care ability were
perceived helplessness, receiving home nursing, being anxious and advanced age. For the oldest participants,
85+ years of age, frequency of physical activity was the strongest factor promoting self-care ability. Age was a
negative factor for self-care ability among persons being 75-84 years of age. The participants in Study II lived
active everyday lives and were frequently physically active, they were part of a supportive, inclusive, and
promoting fellowship, and they had the opportunity to travel. They utilized their competence and experienced
making themselves useful. It was a privilege to be part of a family life as a husband, wife, parent, and/or a
grandparent. They acknowledged physical and mental limitations, yet they felt they were in good health. For the
single living older persons in Study III, the meaning of self-care and health for the perception of life situation
and identity was characterized as strength and a time dimension. As older persons, the participants were caring,
autonomous, and robust characters who had experienced difficult times in life and in a resilient way moved
towards a new future. They valued and were grateful for what they had learned in their lives and could go
forward and still experience and explore. In Study IV, a significant difference was obtained in the intervention
group showing improved mental health (p=0.037). In the control group, mental health, sense of coherence, selfcare
ability, and self-care agency, all showed worse outcome results after the intervention time (19 weeks).
Conclusions: Important factors promoting self-care and health in older persons living in urban areas in southern
Norway are good mental health, being satisfied with life, perceiving good health, being active, not being at risk
of undernutrition, and being physically active once a week or more. Self-care ability declines in participants
75+years of age. For the oldest people, 85+ years of age, physical activity is the most important factor promoting
self-care ability. A telephone-based self-care intervention may improve mental health that is critical for
establishing self-care ability and self-care actions in older home-dwelling people. Physically active older persons
have valuable resources such as engagement, knowledge and involvement in their surroundings. The single
living older persons seem to represent a new generation of older people living alone and are characterized by
strength, temporality, gratitude, autonomy, and natality. Society needs to acknowledge older people to a greater
extent, involving them in important and necessary work in different fields.
Has parts
Paper 1: Sundsli, Kari; Söderhamn, Ulrika; Espnes, Geir Arild; Söderhamn, Olle. Ability for self-care in urban living older people in southern Norway. Journal of Multidisciplinary Healthcare 2012 ;Volum 5. s. 85-95 http://dx.doi.org/ 10.2147/JMDH.S29388 This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0)Paper 2: Sundsli, Kari; Espnes, Geir Arild; Söderhamn, Olle. Lived experiences of self-care among older physically active urban-living individuals. Clinical Interventions in Aging 2013 ;Volum 8. s. 123-130 http://dx.doi.org/ 10.2147/CIA.S39689 This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0)
Paper 3: Sundsli, Kari; Espnes, Geir Arild; Söderhamn, Olle. Being old and living alone in urban areas. The meaning of self-care and health on the perception of life situation and identity. Psychology Research and Behavior Management 2013 ;Volum 6. s. 21-27 http://dx.doi.org/ 10.2147/PRBM.S46329 This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License.
Paper 4: Sundsli, Kari; Söderhamn, Ulrika; Espnes, Geir Arild; Söderhamn, Olle. Self-care telephone talks as a health-promotion intervention in urban home-living persons 75+ years of age: a randomized controlled study. Clinical Interventions in Aging 2014 ;Volum 9. s. 95-103 http://dx.doi.org/ 10.2147/CIA.S55925 This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License.