Well-being Of Older People Research Articles

Structural and functional social support in elderly objective and subjective health ratings

This paper aims to investigate the causes that explain the discrepancies between the effects of social relationships on health and wellness of the elderly people. Several disciplines of health sciences have developed different theories to explain the evidence that confirm the positive effects of social relations. Furthermore, there is acumuative evidence confirming most of the predictions derived from its principles. However, the empirical evidence has not always confirmed these beneficial relationships and sometimes these evidences contradict some of the theoretical predictions. Even, it is not difficult to find reversed effects. In this paper we follow some of the approaches developed from Social Psychology which analyze the different effects of social relationships on the health of older people. Two types of aspects of social relations have served to this purpose. First, the structural aspects (i.e., frequency of intercourse). Second, qualitative-functional aspects of great tradition in estudies of quality of life and wellbeing of older people (i.e. social support). Following the Convoy Model, we measured perceived social support and frecuency of relationships in 168 spaniards, men and women (aged 62 years old and more). We analyze these discrepancies in the light of the underlying mechanisms.

Bed of roses? The role of garden space in older people's well-being

The purpose of this research was to investigate the role of outdoor housing environment (OHE), including front and back gardens, yards, courtyards, patios and balconies, in older people's well-being. Descriptions of their OHEs were collected from 2558 individuals living in 526 distinct housing developments using a postal questionnaire. A large range of background variables were measured, mainly through the questionnaire. Characteristics of respondents’ immediate neighbourhood environments were measured from digital maps and satellite/bird's-eye images. Among the OHE variables, statistically significant predictors of well-being were having one's own patio (as opposed to shared or none), and having a green view from one's living area (a positive effect on well-being). The authors conclude that it would be beneficial for older people's housing to include private patio space, where possible, as well as a large amount of greenery. The research supports the claim that older people benefit from green space as much by viewing it from inside as spending time in it. If older people have no or very little garden space, a green street environment is likely to increase their well-being, especially if it can be seen from their home.

Fear of crime and older people in low- and middle-income countries

ABSTRACTThis paper analyses data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) on the prevalence of reported fear of crime at home and on the street among older people in China, Ghana, India, Mexico, Russia and South Africa. SAGE provides nationally representative data for 35,125 people aged 50 and over. These reveal large national variations in reported crime fear: for example, 65 per cent of older South Africans felt unsafe on the street, compared to only 9 per cent of older Ghanaians. The paper examines factors potentially associated with crime fear, including age, socio-economic status and frailty, and relates these to different theoretical models of crime fear. Female sex and frailty are associated with higher rates of crime fear across the study countries. Other associations are less consistent, e.g. urban residence is associated with higher levels of fear in some countries and lower levels in others. The paper considers the potential effects of crime fear on mobility beyond the home, health status and quality of life. A strong association is found for mobility, but effects on health and quality of life are harder to interpret as the direction of causality can be two-way. Overall, the paper demonstrates the potential impact of crime fear on older people's wellbeing and highlights a need for further, more contextualised research.

Transport, driving and ageing

SummaryTransport is the invisible glue that holds our lives together, an under-recognized contributor to economic, social and personal well-being. In public health terms, the medical profession had previously allowed itself to focus almost exclusively on the downsides of transport. However, the research basis for transport, driving and ageing is steadily evolving and has important academic and practical considerations for gerontologists and geriatricians. For gerontologists, teasing out the critical role of transport in the health and well-being of older people is an imperative, as well as the key challenges inherent in transitioning from driving to not driving. The safe crash record of a group with significant multi-morbidity allows us to focus on the remarkable strategic and adaptive skills of older people. From a policy perspective, strictures on older drivers are an exemplar of institutionalized ageism. For geriatricians, a key challenge is to develop strategies for including transportation in our clinical assessments, formulating effective strategies for assessment of medical fitness to drive, incorporating enabling techniques, giving due consideration to ethical and legal aspects, and developing and promoting multi-modality and alternative transportation options.

Developing the evidence base for hygiene and emollient practices.

Maintaining skin integrity is an essential part of ensuring health and wellbeing in older people, and personal hygiene and emollient practices are central in achieving this aim. As nurses we are expected to deliver evidence-based care. However, there is a significant lack of evidence about how best we should provide day-to-day care that promotes skin health for older people. This article briefly examines the concept of evidence-based practice, reveals the gap in knowledge on skin hygiene and emollient practices for older people and justifies the need for a systematic review in this area. Finally it introduces a Cochrane protocol for a review that will collate and review existing knowledge and identify areas for future research. The application to practice of the new evidence generated either by the Cochrane review or by subsequent research is examined.

Bus use in a developing world city: Implications for the health and well-being of older passengers

The aim of this article is to investigate the implications of bus use on the health and well-being of older passengers in a developing world city. Two complementary methods were used. Twenty-six participants aged 60 and over in Guadalajara, Mexico took part in four focus groups to identify the door-to-door elements of the bus service that impose difficulty in terms of accessing and using it, and their impact on the perceived or actual safety, usability and comfort of older passengers. The second part of the study comprised real time observation of 144 older passengers, to investigate the relationship between the characteristics of the bus service and the observed behaviour of older passengers. The results show that issues such as driver behaviour, features of bus design, crowded buses, pedestrian infrastructure and other passengers׳ behaviour present difficulty to older passengers who need or want to use the bus service. The existence of these issues presents serious implications for older users in terms of perceived or actual safety, usability and comfort. Given the importance of the role of public transport, the overall conclusion is that there is an urgent need for further improvement of bus services to maintain and promote the health and well-being of older people.

The design and initial evaluation of visual cues in carpets to assist walking

Prior research has shown that carpets assist walking thereby reducing the incidence and injury severity of falls, and that visual cues can assist walking. However, little attention has been given to the ability of visual cues in carpets to assist walking. Design guidelines were developed for the colouring and patterning of carpet to provide visual cues to assist walking. The guidelines took into account age-related visual impairments, and were applied in the preparation of a carpet. The designed carpet was compared with two carpets of standard designs in an impaired walking trial. The trial subjects reported a significant preference for walking on the designed carpet, suggesting that appropriate design of carpets can increase their contribution to the well-being of older people and others with impaired walking.

Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review

Objectives: Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe.Method: Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995–2013.Results: A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances.Conclusion: The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.

Social cohesion and belonging predict the well-being of community-dwelling older people

BackgroundThe neighborhood social environment has been identified as an important aspect of older people’s well-being. Poor neighborhood conditions can pose difficulties in obtaining support, especially for older people who live alone. Although social environments have been found to be related to well-being among older people, the longitudinal relationship between the social environment and well-being remains poorly undestood. Research on the effects of changes in neighborhood characteristics, such as social cohesion and social belonging, on well-being is lacking. Therefore, the study aims are (i) describe social cohesion, social belonging, and instrumental goals to achieve well-being among community-dwelling older people, (ii) determine whether these factors varied according to neighborhood social deprivation and compare these findings to those from chronically ill/previously hospitalized older people, and (iii) identify longitudinal relationships between social cohesion and belonging and well-being.MethodsIndependently living Dutch older adults (aged ≥ 70 years) were asked to complete questionnaires in 2011 (T0) and 2013 (T1). Response rates at T0 and T1 were 66% (945/1440) and 62% (588/945), respectively. Descriptive statistics, paired sample t-tests, analysis of variance, univariate analyses and multilevel regression analyses controlling for background characteristics and baseline well-being were performed.ResultsOf 945 respondents [43% male; mean age, 77.5 ± 5.8 (range, 70–101) years], 34.7% were married and 83.3% were Dutch natives. Social cohesion remained constant over time, whereas social belonging improved (p ≤ 0.05). Older people living in socially deprived neighborhoods report poorer overall well-being and instrumental goals to achieve well-being. Baseline social cohesion, changes therein (both p ≤ .001), baseline social belonging, and changes therein (both p ≤ .05) predicted well-being at T1.ConclusionThis study showed that social cohesion, belonging, and changes therein predict the social as well as physical well-being of community-dwelling older people in the Netherlands over time. The creation of stronger ties among neighbors and a sense of belonging is needed.

Gender-specific changes in well-being in older people with coronary heart disease: evidence from the English Longitudinal Study of Ageing

Objectives: The objective of this study is to investigate gender-specific trajectories in well-being among older people with coronary heart disease (CHD) and to compare them with those of healthy people.Method: The study included a sample of 4496 participants from the first three waves of the English Longitudinal Study of Ageing (2002–2003 to 2006–2007). We measured well-being using quality of life (CASP-19; ‘control’, ‘autonomy’, ‘pleasure’ and ‘self-realization’) and depressive caseness (three or more symptoms on the CESD-8; Centre for Epidemiologic Study Depression scale).Results: After adjustment, at two– and four–years follow-ups, women had three points higher quality of life than men (p < 0.001). When looking at each quality of life's domain we found that women reported higher scores of autonomy compared to men. The gender difference in the probability of having depressive caseness reduced to 7 percentage points at four-year follow-up from 13 percentage points in the previous occasions. Men's quality of life declined progressively over time by 3 points (p < 0.001) (equivalent to the effect of having diabetes) but no changes in prevalence of depressive caseness were found. Women's quality of life only declined after four-year follow-up by less than 2 points (p < 0.001), while in the same period their probability of reporting depressive caseness reduced by 6 percentage points (p < 0.001).Conclusion: Women had better quality of life than men in the two and four years following a CHD event, and were not more likely than men to report depressive caseness in the long term. Men's quality of life deteriorated progressively over time, among women it did not deteriorate in the first two years following a CHD event; women had a long-term improvement in depressive caseness.

Housing: the unacknowledged key to our ageing challenge?

Purpose – The purpose of this paper is to highlight the strategic role of housing for older people and how it can address some of the key challenges facing politicians. The paper aims to encourage decision-makers and service providers to collaborate in new ways locally. Design/methodology/approach – The paper seeks to highlight the strategic role of housing for older people and how it can address some of the key challenges facing politicians. It aims to encourage decision makers and service providers to collaborate in new ways locally. Findings – The paper argues that: Housing for older people is rising up the political agenda, but as a niche issue rather than one of strategic and economic importance. A multi-agency and outcomes-based approach to the wellbeing of older people, based on place-shaping principles, needs to be mainstreamed locally. Older people have not escaped the impact of austerity measures and this has heightened the need for a range of high quality housing options, in supportive communities, in later life. Good housing options for older people could address the key issues vexing politicians, but there are obstacles to older people accessing such options. Originality/value – The paper suggests a radical, systemic approach is required to ensure better outcomes for older people and, in turn, to generate savings for the public purse.

Exploring the boundaries between interpersonal and financial institution mistreatment of older people through a social ecology framework

ABSTRACTInterpersonal financial abuse of older people is well documented but the potential role of financial institutions is rarely examined. Financial institution mistreatment describes direct and indirect practices by financial institutions that threaten the financial wellbeing of older people. This analysis was based on a survey of community-dwelling older people (N = 2,021) aged 65 years and older, and examined self-reports of interpersonal and financial institution mistreatment. The prevalence of interpersonal financial abuse was reported by nearly 2 per cent of respondents compared to 1 per cent for financial institution mistreatment. The socio-demographic and health characteristics of the group who experienced interpersonal financial mistreatment were different from those who reported financial institution mistreatment. The boundaries between the two phenomena were explored using a social ecology framework that reflects the influences of ageism and normative practices on elder abuse. The study confirms previous international evidence on interpersonal financial abuse and provides preliminary data on financial mistreatment by financial institutions. The evidence has implications for policy and current preventative strategies that tend to ignore the influence of macro-contextual factors such as legislative and institutional normative practices, government policies and societal attitudes that can act aspermissorsof some types of financial mistreatment.

Review: Crafting person-centred intermediate care: one team’s journey towards integration and innovation

Development of effective models to support intermediate care is at the forefront of health and social care reform within the United Kingdom, and whilst it could be argued that the key incentive driving this agenda is financial, such models are endorsed as promoting the well-being of older people living in the community. The interesting point, however, made in this paper is the challenges of implementing an agreed policy direction, and I quote ‘‘without a robust supporting evidence base or detailed blueprint’’. This study provides an excellent example of how developments in services can be evaluated using research methodologies that lend themselves to a real-life context, in order to contribute to the evidence base and enhance our understanding of what works in practice. This paper offers insight into the development of an innovative multi-disciplinary, multiagency model for person-centred intermediate care. In my view, the findings present a story of two halves. On the one hand we have patients who were largely satisfied with their care and who felt that they had made an appropriate recovery. On the other hand we have staff who were highly challenged by the change process recounting experiences that were largely negative. Some of the emerging themes identified as problematic for staff included: poor communication; lack of clarity regarding the integrated care model and roles/responsibilities; growth of factions within the team; professional judgments being disregarded; and the perception of leadership that was autocratic. I would concur with the authors’ conclusion that this highlights the complexity of person-centred care, and for me it reinforces the need to understand who we are referring to when we use the term ‘person’. In nursing, our understanding of person-centredness is as applicable to our colleagues as it is to the

Resilience in the face of post-election violence in Kenya: The mediating role of social networks on wellbeing among older people in the Korogocho informal settlement, Nairobi

Older people in slum settings are a vulnerable sub-group during crises, yet have received minimal attention in the development discourse. This paper examines the protective role of different types of social networks for older slum dwellers' wellbeing during adversity by investigating the relationship between social networks, the Kenyan 2007/08 post-election violence, and dimensions of wellbeing namely self-rated health, life satisfaction and happiness amongst older people in the Korogocho slum, Nairobi. The analyses are based on conditional change logistic regression models using data from a unique longitudinal survey of the health and wellbeing of older people. The results show that maintaining or increasing formal local networks reduced the detrimental effects of the post-election violence for older people's wellbeing, whilst household environment and informal local and non-local networks did not influence the relationship. Consequently, the paper provides evidence that supporting inclusive community organisations which are accessible to older people can be valuable in promoting the resilience of this population group.

Cost-Effectiveness Findings from the Agewell Pilot Study of Behaviour Change to Promote Health and Wellbeing in Later Life

Background: Participation in cognitive and physical activities may help to maintain health and wellbeing in older people. The Agewell study explored the feasibility of increasing cognitive and physical activity in older people through a goal-setting approach. This paper describes the findings of the cost-effectiveness analysis. Method: Individuals over the age of 50 and attending an Agewell centre in North Wales were randomised to one of three conditions: control (IC), goal-setting (GS), or goal-setting with mentoring (GM). We undertook a cost-effectiveness analysis comparing GS vs. IC, GM vs. IC and GM vs. GS. The primary outcome measure for this analysis was the QALY, calculated using the EQ-5D. Participants’ health and social care contacts were recorded and costed using national unit costs. Results: Seventy participants were followed-up at 12 months. Intervention set up and delivery costs were £252 per participant in the GS arm and £269 per participant in the GM arm. Mean health and social care costs over 12 months were £1,240 (s.d. £3,496) per participant in the IC arm, £1,259 (s.d. £3,826) per participant in the GS arm and £1,164 (s.d. £2,312) per participant in the GM arm. At a willingness to pay threshold of £20,000 per QALY there was a 65% probability that GS was cost-effective compared to IC (ICER of £1,070). However, there was only a 41% probability that GM was cost-effective compared to IC (ICER of £2,830) at a threshold of £20,000 per QALY. Conclusion: Setting up and running the community based intervention was feasible. Due to the small sample size it is not possible to draw a firm conclusion about cost-effectiveness; however, our preliminary results suggest that goalsetting is likely to be cost-effective compared to the control condition of no goal-setting, the addition of mentoring was effective but not cost-effective.

The effect of group reminiscence on happiness of the elderly

Background: some studies have confirmed the effectiveness of reminiscence on mental health, although there are conflicting results in this area. There are no interventional, localized and confirmed studies into the effectiveness of this intervention on mental wellbeing of old people in our country. Aim: To determine the effect of reminiscence therapy on the elderly happiness. Methods: In this clinical trial, 64 elderly referred to the Jahandidegan center of Gorgan were selected and randomly divided into control and intervention groups. Happiness scores were measured before intervention, during, and one month after the end of intervention.. Reminiscence was conducted in six sessions over three weeks. Group discussions were held for the control group. Data were collected using valid and reliable happiness questionnaires (oxford) and a brief cognitive-mental examination. Fisher’s exact test, Chi-square, independent, repeated measures ANOVA with Bonferoni post-hoc and SPSS version 20 were used. Results: The mean age of the participants was 65.5±6.2, and 50.8% of them were men. Happiness pre-intervention scores were 43.9±10.6 and 45.6±8.3 in control and the intervention groups, respectively (p>0.05). Multivariate analysis with repeated measures showed that the interaction between treatment group and the time was significantly effective on the elderly happiness score (p<0.01). Bonferroni post-hoc test scores before and after the intervention (P<0.03) and scores during and after the intervention (P<0.03) showed significant differences. Conclusion: group discussion and reminiscence are effective in increasing the elderly happiness scores. However, reminiscence was a more effective intervention; therefore, it can be an inexpensive way to increase the vitality of the elderly with no side-effects.

Eating and ageing: A comparison over time of Italy, Ireland, the United Kingdom and France

This research analysed household budget survey data from Ireland, the United Kingdom, France and Italy from 1985/1987 to 2004/2005 to determine how age groups differ in terms of food-related practices, how these patterns are changing and to see if these patterns differ across countries. Descriptive analysis and fractional multinomial logistic regression were used. Food practices seem to be changing over time across all age cohorts in Ireland and the United Kingdom; older people have different food practices now than they would have had a few decades ago. However, in Italy and France, food-related practices seem to be related to age and life course with older people eating out less as they age than they did when they were younger. If these trends continue, older people will continue to prepare their own meals to a greater extent in Italy and France in the future with the retention of home preparation skills, while the home preparation of food will continue to decline in Ireland and the United Kingdom. These trends have implications for the health and well-being of older people in those countries.

The role of pets in the lives of older people: a review

Purpose – The purpose of this paper is to summarise some of the major scientific research projects that identify the value of pet ownership and pet interaction to older people with a view to disseminating such findings to health professionals and care workers engaged in the welfare of older people. Design/methodology/approach – A review of findings from major international studies across a number of health related disciplines. Findings – Pets may serve significant functions that enhance the physical, emotional and social well-being of older people. With recognition from health professionals, pet ownership may rank highly amongst those elements which should be preserved wherever possible. Originality/value – The dissemination of the importance of pet ownership to the health and well-being of older people, with special implications for policy development amongst care providers.

Negotiating Well-being: Older People's Narratives of Relationships and Relationality

This article discusses well-being in old age by drawing on findings from participatory research carried out by older co-researchers exploring how older people learn to sustain their own and others’ well-being. It considers the way in which research based in older people's experience can inform ethical policy and practice capable of delivering well-being. It critiques individualized notions of well-being and provides a counter-perspective based in relational understandings of what it is to be human drawn from feminist care ethics. This offers a different way of understanding the significance of social relationships and networks to older people's well-being from that offered by a focus on ‘community’ which has emerged in the communitarian discourses of the UK Coalition government. It illustrates this with older people's accounts of well-being highlighting the ways in which relationships with people, places and spaces are negotiated with ageing. Finally it argues that this relational conceptualization of well-being embodies values and the ethical dimensions of responsibility based in lived experiences. This provides the basis for alternative values-based policies and practices which we need to distinguish from the instrumental expression of social relationships and ‘community’ within communitarian discourses.

The effect of an outdoor activities' intervention delivered by older volunteers on the quality of life of older people with severe mobility limitations: a randomized controlled trial.

Older community-living disabled people often have unmet activity needs and participation restrictions potentially reducing their quality of life (QoL). We examined the effects of an individualized out-of-home activity intervention delivered by volunteers on QoL among community-living older people, who have difficulty accessing the outdoors independently. Volunteering, Access to Outdoor Activities and Wellbeing in Older People (VOW; ISRCTN56847832) was a two-arm randomized single-blinded, controlled effectiveness trial (RCT) in Jyväskylä, Finland. The inclusion criteria were: age 65 or over, severe mobility limitation, able to communicate, and agree to participate in a RCT. Each intervention group member was assigned a trained volunteer with whom out-of-home activities were done once a week for 3 months (e.g., running errands or recreational activities). The primary outcome was the environmental subscore of QoL assessed with WHOQOL-BREF. Secondary outcomes were the overall QoL, physical capacity, psychological well-being, and social relationships assessed with WHOQOL_BREF and lower-extremity performance assessed with Short Physical Performance Battery (SPPB). 121 people aged 67-92 years (mean age 81.9 years, SD 5.9, 90 % women) were randomized. No treatment effect on the environmental QoL subscore was observed, but for physical capacity subscore a significant treatment effect was observed (General Linear Model, Group by Time p = 0.001). No effects were observed for the other QoL subscores or for SPPB score. This study suggests that individualized out-of-home activity intervention delivered by volunteers may influence the QoL of old severely mobility-limited community-living people in a positive way. Further studies are needed to better understand how to improve QoL of older disabled community-living people and potentially buffer them against more severe care needs and institutionalization.