Engagement, knowledge and autonomy : facing a new generation older urban living people : studies on self-care and health

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