ERA

Chronicity

The mission of the Chronicity Areas of Excellence (AoE) is to advance and disseminate knowledge and to influence public policy related to living well with chronic health concerns.
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  1. Attitudes to aging mediate the relationship between older peoples’ subjective health and quality of life in 20 countries. [Download]

    Title: Attitudes to aging mediate the relationship between older peoples’ subjective health and quality of life in 20 countries.
    Creator: Low, G.
    Description: Background With ever-increasing life expectancy globally, it is imperative to build knowledge of how older peoples’ views of their own aging, considering their health-related circumstances, affect quality of life for practitioners and policy-makers alike. Based on our literature review, we wanted to determine whether older adults’ attitudes toward their own aging would partly mediate the effect of their health satisfaction ratings upon their quality of life. Furthermore, would these attitudes mediate the relationship between health satisfaction and quality of life in the same way when we account for older adults’ country of origin, and their age and gender? Methods This was a secondary analysis of cross-sectional survey data collected in 20 countries taking part in the 2003 WHOQOL-OLD Field study. The study sample consisted of 4593 adults whom were, on average, 72.10 years of age (range = 60 to 100 years of age); 42.8% were female. The WHOQOL-BREF measured quality of life and health satisfaction. The Attitudes to Aging Questionnaire measured participants’ attitudes toward physical change, psychosocial loss, and psychological growth. All items in both questionnaires were measured on a 5-point Likert scale. Questionnaire responses were analyzed using multilevel modeling and path analysis. Results All three attitudes to aging partly mediated the relationship between health satisfaction and physical, psychological, social, environmental, and global quality of life. These partial mediations manifested in the same way across all 20 country samples, regardless of age or gender. Attitudes toward physical change were the strongest mediator of health satisfaction upon global and domain-specific quality of life, followed by psychosocial loss and psychosocial growth. Conclusions Our study is the first cross-cultural study with a large sample to show that quality of life judgements, between 60 to 100 years of age, are a product of older men’s and women’s perceptions of health-related circumstances, and attitudes toward physical and psychosocial aspects of the aging self. A prospective study of the linkages between older peoples’ subjective views of health and attitudes toward the aging self over time using multiple subjective measures of health is warranted. Understanding these linkages may help practitioners and policy makers consider strategies to enhance quality of life.
    Subjects: quality of life, attitudes to aging, subjective health, statistical models
    Date Created: 2013
  2. Palliative Care Professionals' Perceptions of Effective Interpersonal Communication in the Context of Caring for Older Adults in Rural Settings [Download]

    Title: Palliative Care Professionals' Perceptions of Effective Interpersonal Communication in the Context of Caring for Older Adults in Rural Settings
    Creator: Penz, K.
    Description: The purpose of this article was to report an in-depth appraisal of palliative care professionals’ perceptions of effective interpersonal communication while providing palliative care for older adults in rural settings. A total of four focus group interviews were conducted involving 12 palliative care professionals who were practicing in rural settings in a Western Canadian province. Data were transcribed verbatim and analyzed using thematic analysis. The findings of this study suggest the importance of: a) understanding the context of aging and dying in rural settings, b) focusing on essential information needs, and c) effective interpersonal communication within this context. The factors related to effective interpersonal communication between professionals and care recipients and their family members could be grouped into three themes: i) rural care ‘for your own,’ ii) independence and individuality, and iii) timing and early access/rural rapport. Although the challenges of providing integrated palliative care services in rural areas were apparent in this study, from an interpersonal perspective, the participants were connected to their patients/family members. They often viewed their older care recipients as part of their own lives. Having a rural sense of closeness and community connection seemed to have a positive impact on the professional participants. The participants also felt that their sense of closeness also provided a sense of peace for their care recipients.
    Subjects: Qualitative study, Palliative care professionals, Interpersonal communications
    Date Created: 2012
  3. The changing causal foundations of cancer-related symptom clustering during the final month of palliative care: A longitudinal study [Download]

    Title: The changing causal foundations of cancer-related symptom clustering during the final month of palliative care: A longitudinal study
    Creator: Olson, K.
    Description: Background: Symptoms tend to occur in what have been called symptom clusters. Early symptom cluster research was imprecise regarding the causal foundations of the coordinations between specific symptoms, and was silent on whether the relationships between symptoms remained stable over time. This study develops a causal model of the relationships between symptoms in cancer palliative care patients as they approach death, and investigates the changing associations among the symptoms and between those symptoms and well-being. Methods: Complete symptom assessment scores were obtained for 82 individuals from an existing palliative care database. The data included assessments of pain, anxiety, nausea, shortness of breath, drowsiness, loss of appetite, tiredness, depression and well-being, all collected using the Edmonton Symptom Assessment System (ESAS). Relationships between the symptoms and wellbeing were investigated using a structural equation model. Results: The model fit acceptably and explained between 26% and 83% of the variation in appetite, tiredness, depression, and well-being. Drowsiness displayed consistent effects on appetite, tiredness and well-being. In contrast, anxiety's effect on well-being shifted importantly, with a direct effect and an indirect effect through tiredness at one month, being replaced by an effect working exclusively through depression at one week. Conclusion: Some of the causal forces explaining the variations in, and relationships among, palliative care patients' symptoms changed over the final month of life. This illustrates how investigating the causal foundations of symptom correlation or clustering can provide more detailed understandings that may contribute to improved control of patient comfort, quality of life, and quality of death.
    Subjects: System, Lung cancer, Patient, Assessment scale, Fatigue, Validation, Depression, Anorexia, Pain, Anxiety
    Date Created: 2008
  4. Nursing practices to detect acute delirium, safeguard patients experiencing acute delirium, and help reduce or eliminate acute delirium [Download]

    Title: Nursing practices to detect acute delirium, safeguard patients experiencing acute delirium, and help reduce or eliminate acute delirium
    Creator: Wilson, D.M.
    Description: Acute delirium is very common among hospital patients, particularly older patients. Nurses have a major role in the care of these patients, yet there are no evidence-based nursing care guidelines to help nurses detect patients who are experiencing acute delirium, safeguard them, and assist their recovery. This study sought to identify and prioritize nursing practices for detecting these patients, safeguarding them, and assisting their recovery from acute delirium. A two-stage voluntary paper Delphi survey was used for this purpose. This study targeted all nurses who worked on adult medical/surgical units at two full-service acute care hospitals in Western Canada who had cared for a patient diagnosed with acute delirium in the past 12 months. The first survey revealed many nursing practices exist to detect, safeguard, and assist recovery. The second revealed one preferred practice and four others for each of the following: Detecting acute delirium, safeguarding patients, and helping patients recover. Research is now needed to establish if these constitute “best practice” nursing care for enhanced patient outcomes.
    Subjects: Delphi technique, Confusion, Acute delirium, Hospital care, Survey, Nursing practice
    Date Created: 2010
  5. Transforming hope: How elderly palliative patients live with hope. [Download]

    Title: Transforming hope: How elderly palliative patients live with hope.
    Creator: Duggleby, Wendy
    Description: Hope is important to palliative patients; however, the process by which these patients live with hope is unknown.The purpose of this study was to describe, using a grounded theory approach, the processes by which palliative patients live with hope. Sixteen interviews were conducted with 10 home-care palliative patients (mean age 75 years) in their homes using open-ended questions.The participants defined their hope as expectations such as not suffering more and having a peaceful death.They described their main concern as wanting to “live with hope” and they achieved this through the basic social process of transforming hope.Transforming hope involved acknowledging “life the way it is,” searching for meaning, and positive reappraisal.The results of this study provide a foundation for future research and the development of interventions to engender hope in older palliative patients.
    Subjects: elderly, hope, qualitative research, palliative
    Date Created: 2009
  6. The transition experience of rural older persons with advanced cancer and their families: A Grounded theory study [Download]

    Title: The transition experience of rural older persons with advanced cancer and their families: A Grounded theory study
    Creator: Duggleby, W.
    Description: Background: Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population. Methods: Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz's constructivist grounded theory approach. Results: Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of \"Navigating Unknown Waters\". This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes. Conclusion: The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population.
    Subjects: Older people, Change, Medical care, Cancer patients, Home care
    Date Created: 2010
  7. Study protocol: Living with hope: Developing a psychosocial supportive program for rural women caregivers of persons with advanced cancer [Download]

    Title: Study protocol: Living with hope: Developing a psychosocial supportive program for rural women caregivers of persons with advanced cancer
    Creator: Duggleby, W.
    Description: Background: Hope is defined by caregivers as the inner strength to achieve future good and to continue care giving. Pilot test findings of a Living with Hope Program (LWHP) suggested it is an acceptable and feasible intervention for use by family caregivers. Although it shows promise in potentially increasing hope and quality of life, further testing and development is needed. Questions remain as to: a) what are the mechanisms through which the LWHP affects outcomes and b) how long it is effective? The overall purpose of this time series mixed method study is the further development and testing of the LWHP by: a. Determining the mechanisms of the LWHP by testing a LWHP conceptual model in which self-efficacy, and loss/grief are hypothesized intermediary variables for changes in hope, and subsequently quality of life among rural women caring for persons with advanced cancer, and; b. Exploring the longitudinal effects of the LWHP on hope, quality of life and health services utilization among rural women caring for persons with advanced cancer. Methods/Design: Using a time-series embedded mixed method design, data will be collected from 200 rural women caregivers. Following the collection of baseline and outcome variables, the intervention (LWHP) is applied to all subjects. Subjects are followed over time with repeated measures of outcome variables (1 wk, 2 wk, 3, 6 and 12 months). The journals that are completed as part of the LWHP comprise the qualitative data. Health services utilization data will be collected from the Saskatchewan Health Administrative Database for all subjects one year prior and one year after study enrolment. Path analysis will be used to test the model post LWHP, at 1 and 2 weeks. Two-factor ANCOVA will determine patterns over time and Cortazzi’s narrative analysis will be used to analyze subjects journals completed as part of the LWHP. Discussion: Data Collection began January 2009 and is expected to be completed within 2 years time. Monthly meetings with data collectors and site collaborators have been instrumental in revisions to the original study protocol such as identifying and adding additional study sites.
    Subjects: Rural women, Support programs, Caregivers, Psychosocial support, Cancer patients
    Date Created: 2010
  8. Influence of interpersonal violence on maternal anxiety, depression, stress and parenting morale in the early postpartum: A community based pregnancy cohort study. [Download]

    Title: Influence of interpersonal violence on maternal anxiety, depression, stress and parenting morale in the early postpartum: A community based pregnancy cohort study.
    Creator: Malta, L. A.
    Description: Background Research has shown that exposure to interpersonal violence is associated with poorer mental health outcomes. Understanding the impact of interpersonal violence on mental health in the early postpartum period has important implications for parenting, child development, and delivery of health services. The objective of the present study was to determine the impact of interpersonal violence on depression, anxiety, stress, and parenting morale in the early postpartum. Methods Women participating in a community-based prospective cohort study (n = 1319) completed questionnaires prior to 25 weeks gestation, between 34–36 weeks gestation, and at 4 months postpartum. Women were asked about current and past abuse at the late pregnancy data collection time point. Postpartum depression, anxiety, stress, and parenting morale were assessed at 4 months postpartum using the Edinburgh Postnatal Depression Scale, the Spielberger State Anxiety Index, the Cohen Perceived Stress Scale, and the Parenting Morale Index, respectively. The relationship between interpersonal violence and postpartum psychosocial health status was examined using Chi-square analysis (p 
    Subjects: postpartum mental health, pregnancy cohort, interpersonal violence, parenting morale
    Date Created: 2012
  9. Determinants of hospital nurse intention to remain employed: Broadening our understanding. [Download]

    Title: Determinants of hospital nurse intention to remain employed: Broadening our understanding.
    Creator: Tourangeau A. E.
    Description: Aim.  This paper is a report of a study to identify nurse reported determinants of intention to remain employed and to develop a model explaining determinants of hospital nurse intention to remain employed. Background.  A worsening shortage of nurses globally suggests that efforts must be made to promote retention of nurses. However, effective retention promotion strategies depend on understanding the factors influencing nurse retention. Methods.  A descriptive study using focus group methodology was implemented. Thirteen focus groups including 78 nurses were carried out in two Canadian provinces in 2007. Thematic analysis strategies were incorporated to analyse the data. Findings.  Eight thematic categories reflecting factors nurses described as influencing their intentions to remain employed emerged from focus groups: (1) relationships with co-workers, (2) condition of the work environment, (3) relationship with and support from one’s manager, (4) work rewards, (5) organizational support and practices, (6) physical and psychological responses to work, (7) patient relationships and other job content, and (8) external factors. A model of determinants of hospital nurse intention to remain employed is hypothesized. Conclusion.  Findings were both similar to and different from previous research. The overriding concept of job satisfaction was not found. Rather, nurse assessments of satisfaction within eight thematic categories were found to influence intentions to remain employed. Further testing of the hypothesized model is required to determine its global utility. Understanding determinants of intention to remain employed can lead to development of strategies that strengthen nurse retention. Incorporation of this knowledge in nurse education programmes is essential.
    Subjects: nursing workforce, theory development, focus groups, employment, work environments, hospital nurses
    Date Created: 2010
  10. Adult Conservative Management – Search Strategies [Download]

    Title: Adult Conservative Management – Search Strategies
    Creator: Moore, K.
    Subjects: Urinary Incontinence
    Date Created: 2012/05/01