Nursing Research and Practice / 2013 / Article / Tab 1

Review Article

A Qualitative Systematic Review of Older Persons’ Perceptions of Health, Ill Health, and Their Community Health Care Needs

Table 1

Studies included in the qualitative systematic review of health and ill health among old persons’ in need of health care.

Authors, year, countryDesign, analysisSampleSummary of the outcome

Bentley (2003) UK [45]Ethnographic design.
Observations and interviews.
Interview questions focused on the use of primary care services.
Ethnographic analysis.
(6 women, 3 men).
2 lived alone
Community dwelling English older adults.
Age ranged from 68–86 years of age.
Cultural factors were found to influence coping in health and illness and to legitimise primary health care access. No informant found it necessary to exercise her/his rights as a health care consumer, suggesting that despite initiatives to involve patients as partners in health care, the hierarchical position of the elderly people in the village remained unchanged since the days of the medical model and constituted a significant barrier to their use of health services.

Birkeland and Natvig (2009) NORWAY [44]Hermeneutic design.
Hermeneutic analysis.
(12 women, 8 men)
All lived alone
Community dwelling
Norwegian older adults
Age ranged from 72–93 years
All the participants reported living with different chronic illnesses and extensive dysfunction.
The findings revealed that even when physical constraints limited their level of activity, the elderly persons were able to adapt and carry out various activities that did not require physical strength. The main coping strategy comprised accepting the situation, which often took the form of a resigned and passive attitude.

Crawford Shearer (2008) USA [41]Phenomenological design,
Phenomenological analysis.
(women)
Seven lived alone
Twelve white, one Hispanic, and one native American community dwelling older adults
Age from 69–94 years
The women suffered from different chronic illnesses.
The theme of embodiment emerged with theme clusters of caring for the body, viewing their body, and acknowledging changes that explain the lived experience of a changing self and environment, particularly the role of such changes in health empowerment. A description emerged of the self as changed by aging and chronic illness; this description wove together meanings of the past, present, and future.

From et al. (2007) SWEDEN [40]Inductive design.
Individual interviews.
Content analysis.
(12 women, 7 men)
16 lived alone
12 received help both day and night.
Community dwelling Swedish older adults.
Age from 70–94 years.
15 suffered from different illnesses of whom 12 received help day and night.
The findings suggested that the possibility to feel healthy was dependent both on the older person’s ability to adjust or compensate to their situation and on how their caregivers, relatives, and friends could compensate for the obstacles the older person faced. The subcategories that captured the informants’ experiences of health and ill health were described as positive and negative poles of autonomy, togetherness, tranquility, and security in daily life. The significance of the caregivers was clearly evident. Their competence, commitment, and treatment were prerequisites for the older person’s ability to experience health in spite of being dependent on care.

Jacelon (2010) USA [49]A qualitative descriptive design.
Individual interviews.
Constant comparative analysis.
(6 women, 4 men)
Six white, two Afro-American, two immigrants, one Hispanic and one from Ireland. They were community dwelling adults.
Some lived alone, others with spouses or children.
Age from 75–98 years
All the participants had a range of chronic health problems and illnesses.
The participants’ health problems varied and they developed strategies to maintain balance by means of activity, attitude, autonomy, health, and relationships. This research revealed a new perspective on living with chronic illness, and the model might provide a framework for rehabilitation nurses who work with older adults.

Kulla et al. (2006) FINLAND [47]Hermeneutic approach.
Hermeneutic analysis.
(13 women, 9 men).
Community dwelling Swedish-speaking Finns.
Age 75 and over.
The main health resources and strategies employed by the elderly Swedish-speaking Finns were related to social and other activities as well as to personality. Transforming health obstacles into resources could be an important health-promoting nursing strategy.

Manthorpe et al. (2008) UK [48]Mixed methods design.
Inductive analyses.
  
Community dwelling adults.
Data collection was not described.
Three overarching themes underpin elderly persons’ views on health and well-being in rural areas: the changing characteristics of rural communities, the relocation and reconfiguration of health and social care services, and the balance between positive and negative aspects of rural life.

Tohit et al. (2012) AUSTRALIA
[46]
This study is part of a larger cross-national study.
Focus groups.
(20 women, 18 men)
Community dwelling. Malay, Chinese, and Indian adults.
Age 61–95 years.
25 lived alone.
Six themes were identified: spirituality, physical health and function, peace of mind, financial independence, family, and the living environment. Participants reported that good physical health was an important resource that facilitated commitment to their spiritual activities. Participants wished for a “peaceful life” and experienced this by deepening their spirituality. Other ingredients for a peaceful life were financial independence, living in a place they love, and having family members who live in harmony. In this community where religious affiliation is a tradition, spirituality can be fundamental for healthy ageing, and its inclusion in eldercare policy is imperative.

Tsai and Tsai (2007) TAIWAN [43]Interviews.
Conventional content analysis.
(3 women, 6 men)
All lived alone
Age 65–90.
90% of the sample had a low level of dependence on help with activities of daily living.
The elderly persons’ internal resources included self-perception of health status, preventive coping strategies, flexible coping ability, and being resigned to their situation. Their external resources were both human and environmental. Based on their lived experience, they appraised the usefulness of both internal and external resources before deciding whether to seek help from the latter.

van Maanen (2006) CANADA [42]Explorative design.
Individual interviews.
Comparative analysis.
  
One group of healthy, elderly, community dwelling, white, American-born persons.
One group of community dwelling British-born ill-healthy participants.
Age from 65–84 and over 85 years.
The British-born group suffered from different chronic diseases.
Self-defined healthy American-born and ill-healthy British-born elderly persons demonstrated that the perception of health is determined by more dimensions than the absence of disease and illness. The older the person, the more emphasis was placed on health as a state of mind, even with a gradually failing body. It was evident that these respondents, especially the ill-healthy elderly, challenged health providers’ current beliefs about health and illness.

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