Frail elders´experiences of health A combination of qualitative and quantitative studies with a salutogenic perspective

Abstract: The overall aim of the thesis was to explore experiences of health and its´ influencing factors among frail elders and to evaluate the effect of the intervention Continuum of care for frail elderly people, from the emergency ward to living at home. Studies I and II had a qualitative approach, and aimed to explore frail elders’ experiences with and perceptions on the phenomenon of experiences of health (study I), and to explore and identify influences on frail older adults’ experience of health (study II). A sample of frail elders participated in qualitative interviews and reported about their experiences of health and its influencing factors. Eleven men and 11 women aged 67-92 years, who were varied in their ratings of self-perceived health from poor to excellent, were selected through a purposeful strategic sampling of frail elders from the main project Continuum of care for frail elderly people, from the emergency ward to living at home. The interviews were analyzed using Giorgi´s descriptive phenomenology (study I) and qualitative content analysis (study II). Studies III and IV had a quantitative approach, and aimed to analyze the explanatory power of variables measuring health strengthening factors for self-rated health among community-living frail elders (study III) and to evaluate effects of the intervention on self-rated health, experiences of security/safety and symptoms (study IV). The two quantitative studies are based on the data from the intervention Continuum of care for frail elderly people, from the emergency ward to living at home. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the elders in the municipality with a case manager as the hub. Elders who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal were asked to participate. Inclusion criteria were age 80 years and older or 65 to 79 with at least one chronic disease and dependent in at least one Activities of Daily Living. Study III was cross-sectional and study IV was a non-blinded controlled trial with participants randomized to either the intervention group or a control group with follow-ups at 3, 6 and 12 months. Data were collected between October 2008 and November 2011 through a face-to-face structured interview with elders aged 65-96 years (n= 161). In study IV the analyses were made on the basis of the intention-to-treat principle. Data were analyzed using binary logistic regression of a set of independent relevant variables and self-rated health (study III). In study IV the outcome measures were self-rated health, experiences of security/safety and symptoms that were analyzed using Svensson’s method. The results showed that frail elders described health as harmony and balance in everyday life which occurred when interviewees were able to adjust to the demands of their daily lives in the context of their resources and potentials (study I). To feel assured and capable was the main theme, which consisted of five subthemes: managing the unpredictable body, reinforcing a positive outlook, remaining in familiar surroundings, managing everyday life, and having a sense of belonging and connection to the whole (study II).We further found that being satisfied with one’s ability to take care of oneself, having 10 or fewer symptoms, and not feeling lonely had the best explanatory power for community- living frail elders’ experiences of good health (study III). The results from study IV indicated a positive effect of the intervention on the elders’ self-rated health and experiences of symptoms. Regarding elders’ experiences of symptom, the result showed statistically significant differences between intervention- and control group at the six month follow-ups. Concerning elders’ self-rated health, the result showed statistically significant improving within intervention group from baseline up to 6 and twelve month. Conclusion: It is possible even for frail elders to experiences good health. A multidisciplinary and person-centric social and healthcare system is desirable where the focus should not only be on ailments and problems but also to provide supportive services from a salutogenic perspective and thereby enable elders to feel secure in managing their everyday lives as this further reinforces their experience of good health. Keywords: Experiences of health, frail elders, resilience, person-centered care, Salutogenic perspective ISBN: 978-91-628-9055-1