What factors impact upon the quality of life of elderly women with chronic illnesses: Three New Zealand women's perspectives
Pauline Lowe
Liaison Nurse, Capital Coast Rehabilitation, Capital & Coast District Health Board, Kapiti Health Centre, Paraparaumu, Kapiti, New Zealand
Karen McBride-Henry
Clinical Effectiveness Unit, Capital and Coast District Health Board; Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
PP: 18 - 27
Abstract
This descriptive study investigates women's perspectives on their quality of life while living with chronic illnesses. Three women were recruited to this study, and interviewed. Participants discussed how they managed their chronic illnesses, and how they used past experiences, positive attitude, and coping strategies to assist them to create meaning in their lives. Improving our health care systems to respond to the demands of older people with chronic illnesses is one of the greatest challenges health providers face today. By understanding how quality of life is maintained by older people, we can ensure that health provision is tailored to meet the needs of this unique group of people.
Keywords
Quality of life, comorbid chronic illnesses, women's health, descriptive, community, care of the elderly
Article Text
The ageing population is a worldwide phenomenon, and with this are increasing social, economic and political concerns about the health and care needs of individuals in later life (Barlow, Wright, Sheasby, Turner & Hainsworth, 2002; Beckett, Brock, Lemke, Mendes de Leon, Guralnik, Fillenbaum et al., 1996; Gijsen, Hoeymans, Schellevis, Ruwaard, Sataraiano, & van den Bos, 2000; Scanlon-Mogel & Roberto, 2004). With this increasing life expectancy, older adults can expect to live with at least one chronic illness during the later part of their lives (Penrod, Gueldner & Poon, 2003; Westaway, 2010). Therefore, ways of optimising the quality of life of our elderly population must be explored to ensure that old age is lived with meaning, not just with longer years. Due to the lack of literature on this topic a small exploratory, descriptive study, was conducted in New Zealand. The aim was to discover what factors elderly women, who live alone, identify as impacting upon their quality of life when living with comorbid chronic illnesses.
Background
A search of the literature was undertaken, searching years 1990-2010, to explore the issue of quality of life and the elderly woman living with comorbid chronic illnesses. Databases such as Medline, Proquest, CINAHL, and Promed were searched using the keywords of elderly, woman, quality of life, older adult, comorbid, chronic illness, pain, depression, falls, arthritis, attitude, wisdom, family, support, meaning in life, and living alone.
Chronic illnesses are not curable; rather they are lifelong concerns that often require changes in lifestyle to manage or control symptoms and potentially life-threatening outcomes. Living with more than one chronic illness impacts upon a persons' life in many ways and presents a complex interplay of risk factors, symptoms, and treatment regimes. Older adults have to learn to interpret, and respond effectively to, complex ways of managing their health in the face of chronicity (Moffatt, Franks, Doherty, Smithdale & Steptoe, 2009; Penrod, et al., 2003). Research into specific combinations of conditions and their outcomes are important for individual patient care as well as for health care policy, because a large amount of health gain can be achieved by prevention or early recognition and adequate treatment of comorbid diseases (Gijsen et al, 2000).
Living with chronic illnesses and their manifestations affects daily functioning and influences the quality of life of older people (Kemp, Husser, Roberto & Gigliotti, 2004). People use different coping strategies when living with chronic illness. They adapt their lifestyle by slowing down their pace and the amount of activities they perform and impose a degree of dependency on them to prevent or avoid future pain and disability or to leave themselves with the time and energy to focus on other tasks (Gignac, et al., 2000; Kemp et al., 2004). They may think about others who they perceive as being worse off, not dwelling on the problem, have a positive outlook, use distraction, or try to carry on as usual (Marr, 1991). Some people use past success for determining what to do in the present, but one thing is clear - the effectiveness of coping strategies becomes more complicated in chronic comorbidity, and the constant challenge to find effective ways of coping with chronic disease (Penrod et al., 2003).
Since comorbidity in general is significantly related to mortality, functional status, quality of life and other aspects of health care, studies on the relationship between diseases and outcomes should take comorbidity into account (Franzen-Dahlin, Darlsson, Mejhert & Laska, 2010; Gijsen et al., 2000; Warner, Schuz, Wurm, Ziegelmann & Tesch-Romer, 2010). The importance of considering comorbity is clear, due to its high prevalence in older populations and its impact on health and health care. However little has been written about comorbidities, especially from a nursing perspective. It is difficult to define exactly what comorbidity is from a nursing perspective, however, clearly medicalised conceptualisations of comorbidity fail to capture adequately the underlying health care needs of patients (Gijsen et al., 2000; Williams, 2004). Co-ordinated and seamless delivery of care may improve this group of patient's satisfaction and corresponding well-being, factors that have the potential to reduce complications, readmission rates and associated healthcare costs. Opportunities exist to expand the role of nursing by utilizing episodic events to review the overall management and care of patients (Williams, 2004). To achieve this, however, research needs to be undertaken to explore the impact of comorbid conditions on elderly populations' life experiences.
The impact of chronic illness can be dire, especially for women. They live longer than men, are more likely to experience decline in function, are less likely to recover from disability, and greater numbers live alone (Morrissey, 1998). As Morse and Johnson (1991) maintain, it is only by eliciting first-hand descriptions of the client's experience with illness can an understanding of the client's needs be developed and anticipated.
Aim of study
Given these issues, the aim of this research was to explore factors that older women living with chronic illness identify as key to maintaining or improving their quality of life. This will assist health care professionals to better understand how they can effectively support these women.
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