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The Influence of Life Experiences on the Development of Resilience in Older People With Co-morbid Health Problems.

ABSTRACT: Background: Co-morbidity is a major late-life challenge with poor outcomes, yet many older people are resilient. We consider an ecopsychosocial framework of resilience to investigate this disparity. This theorises that sources of resilience may be personal, social and structural. We explored older people's responses and reactions to significant life experiences, to understand resilience development for managing later life health challenges. Methods: We applied a two-stage, cross-sectional mixed-methods design to the Cognitive Function and Ageing Studies Wales (CFAS Wales). Participants' defined quantitatively as resilient (high level of well-being despite co-morbidity) were identified in the wave 1 dataset. A sub-sample of the resilient participants aged 65+ were randomly selected for semi-structured interviews (N = 20). Qualitative thematic analyses were both inductive and deductive. Results: The analyses revealed four primary life experiences reflecting different developmental trajectories. "Early years as formative" and "work and employment as formative" occurred at normative developmental stages in the life-course. In contrast non-normative life events such as loss, bereavement, illness of self, and others underpinned the themes of "adverse events and experiences" and "caring experiences." Four potential mechanisms for resilience were central to these life experiences, reflecting reactions, actions, and development: "character and self-identity;" "approach to life and insight;" "meaningful relationships and belonging." Conclusions: This work contributes further theoretical insights into the ecopsychosocial resilience framework. It highlights the process of interdependence between the individual and the wider environment, suggesting how the availability and accessibility of resources and human agency (protective factors), can influence, and be influenced by, the timing of significant events and experiences. In doing so, it corroborates international healthy ageing policy which recognises resilience as important for a public health response to support older people to adjust to changes and losses experienced in later life. It highlights the importance of current and future policies and services for supporting the management of adverse events earlier in the life-course, and recommends that policies and services take a "long view" on population health and well-being and consider the whole life-course, in addition to specific points in the ageing process.

SUBMITTER: Windle G

PROVIDER: S-EPMC7536341 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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The Influence of Life Experiences on the Development of Resilience in Older People With Co-morbid Health Problems.

Windle Gill G Bennett Kate M KM MacLeod Catherine C

Frontiers in medicine 20200922

<b>Background:</b> Co-morbidity is a major late-life challenge with poor outcomes, yet many older people are resilient. We consider an ecopsychosocial framework of resilience to investigate this disparity. This theorises that sources of resilience may be personal, social and structural. We explored older people's responses and reactions to significant life experiences, to understand resilience development for managing later life health challenges. <b>Methods:</b> We applied a two-stage, cross-se ...[more]

PMID: 33072779

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Project description:BackgroundPeople living with diabetes and chronic kidney disease (CKD) experience compromised quality of life. Consequently, it is critical to identify and understand factors influencing their health-related quality of life (HRQoL). This study examined factors associated with HRQoL among patients with diabetes and CKD.MethodsA cross sectional study among adults with comorbid diabetes and CKD (eGFR <60 mL/min/1.73m2) recruited from renal and diabetes clinics of four large tertiary referral hospitals in Australia was performed. Each participant completed the Kidney Disease Quality of Life (KDQoL ™ -36) questionnaire, which is comprised of two composite measures of physical and mental health and 3 kidney disease specific subscales with possible scores ranging from 0 to 100 with higher values indicating better HRQoL. Demographic and clinical data were also collected. Regression analyses were performed to determine the relationship between HRQoL and potential predictor factors.ResultsA total of 308 patients were studied with a mean age of 66.9 (SD = 11.0) years and 70% were males. Mean scores for the physical composite summary, mental composite summary, symptom/problem list, effects of kidney disease and burden of kidney disease scales were 35.2, 47.0, 73.8, 72.5 and 59.8 respectively. Younger age was associated with lower scores in all subscales except for the physical composite summary. Female gender, obese or normal weight rather than overweight, and smoking were all associated with lower scores in one or more subscales. Scores were progressively lower with more advanced stage of CKD (p<0.05) in all subscales except for the mental composite summary.ConclusionIn patients with diabetes and CKD, younger age was associated with lower scores in all HRQoL subscales except the physical composite summary and female gender, obese or normal weight and more advanced stages of CKD were associated with lower scores in one or more subscales. Identifying these factors will inform the timely implementation of interventions to improve the quality of life of these patients.

Project description:BackgroundMental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting.MethodsA naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis.ResultsHealth professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients.ConclusionsEstablished divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.

Project description:In Western countries, the concepts of healthy ageing and active ageing, that is, concepts that favour health, participation, and security to increase the quality of life of older people, have become key issues. Hence, the effective design of public green spaces in urban areas is crucial, as visiting these areas encourages social relations and interactions in natural, healthy contexts. Consistent with these perspectives, existing landscape design criteria emphasise the importance of considering not only the functional and aesthetic elements, but also the ecosystemic and biophilic relationships between people and the environment, producing positive effects for both. To maximise the impact of such design criteria, proper engagement strategies are desirable, both to assign an active role to older people themselves and to inform the fine-tuning of the design process according to the specific needs of the local population. This study presents an interdisciplinary co-design method that encourages and informs a biophilic approach by describing the experiences of people in natural environments, actual and designed, through the application of attention restoration theory (ART). The case study was developed through six focus group meetings with older people for the co-design of a restorative area in a community garden in the Ortica district in Milan (Italy). Results show how the main needs expressed by participants can be classified into the ART factors of "compatibility" (a multifunctional garden), "fascination" (sense of contact with nature), and "being away" (metaphorical escape from nursing homes). The garden designed includes biophilic principles that respond to such needs, and specific links with designed elements were identified. For example, "being away" (e.g., isolation from daily routine and visual occlusion of the surroundings) and "compatibility" (e.g., pergola and aesthetic value) are the factors that include the elements that more satisfactorily answer previous needs. "Fascination" also includes many positive aspects, allowing space for improvements (e.g., more water elements, interaction with animals). Implications of the method are discussed, including the importance of subjective experience in informing design, the use of different psychological constructs to describe it, and the methodological alternatives for psychological assessment.

Dataset Information

The Influence of Life Experiences on the Development of Resilience in Older People With Co-morbid Health Problems.

Publications

The Influence of Life Experiences on the Development of Resilience in Older People With Co-morbid Health Problems.

Similar Datasets

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