D954etukansi.kesken.fm Page 1 Wednesday, October 24, 2007 3:08 PM
D 954
OULU 2007
UNIVERSITY OF OULU P.O. Box 7500 FI-90014 UNIVERSITY OF OULU FINLAND
U N I V E R S I TAT I S
S E R I E S
SCIENTIAE RERUM NATURALIUM
Professor Mikko Siponen
HUMANIORA
TECHNICA
Professor Harri Mantila
Professor Juha Kostamovaara
MEDICA
ACTA
U N I V E R S I T AT I S O U L U E N S I S
Danica Železnik
E D I T O R S
Danica Železnik
A
B
C
D
E
F
G
O U L U E N S I S
ACTA
A C TA
D 954
SELF-CARE OF THE HOMEDWELLING ELDERLY PEOPLE
LIVING IN SLOVENIA
Professor Olli Vuolteenaho
SCIENTIAE RERUM SOCIALIUM
Senior Assistant Timo Latomaa
SCRIPTA ACADEMICA
Communications Officer Elna Stjerna
OECONOMICA
Senior Lecturer Seppo Eriksson
EDITOR IN CHIEF
Professor Olli Vuolteenaho
EDITORIAL SECRETARY
Publications Editor Kirsti Nurkkala
ISBN 978-951-42-8636-0 (Paperback)
ISBN 978-951-42-8637-7 (PDF)
ISSN 0355-3221 (Print)
ISSN 1796-2234 (Online)
FACULTY OF MEDICINE,
DEPARTMENT OF NURSING SCIENCE AND HEALTH ADMINISTRATION,
UNIVERSITY OF OULU;
FACULTY OF HEALTH SCIENCES,
UNIVERSITY OF MARIBOR
D
MEDICA
ACTA UNIVERSITATIS OULUENSIS
D Medica 954
DANICA ŽELEZNIK
SELF-CARE OF THE HOMEDWELLING ELDERLY PEOPLE
LIVING IN SLOVENIA
Academic dissertation to be presented, with the assent of
the Faculty of Medicine of the University of Oulu, for
public defence in Kajaaninsali (Auditorium L6), Linnanmaa,
on November 30th, 2007, at 12 noon
O U L U N Y L I O P I S TO, O U L U 2 0 0 7
Copyright © 2007
Acta Univ. Oul. D 954, 2007
Supervised by
Professor Helvi Kyngäs
Doctor Kaisa Backman
Professor Dušanka Mičetić-Turk
Reviewed by
Professor Emerita Maija Hentinen
Docent Riitta Suhonen
ISBN 978-951-42-8636-0 (Paperback)
ISBN 978-951-42-8637-7 (PDF)
http://herkules.oulu.fi/isbn9789514286377/
ISSN 0355-3221 (Printed)
ISSN 1796-2234 (Online)
http://herkules.oulu.fi/issn03553221/
Cover design
Raimo Ahonen
OULU UNIVERSITY PRESS
OULU 2007
Železnik, Danica, Self-care of the home-dwelling elderly people living in Slovenia
Faculty of Medicine, Department of Nursing Science and Health Administration, University of
Oulu, P.O.Box 5000, FI-90014 University of Oulu, Finland; Faculty of Health Sciences, University
of Maribor, Žitna ulica 15, SI-2000 Maribor, Slovenia
Acta Univ. Oul. D 954, 2007
Oulu, Finland
Abstract
This study is focused on the self-care of home-dwelling elderly people living in Slovenia. The study
has two phases. The purpose of the first phase is to describe the self-care of home-dwelling elderly
people living in Slovenia and factors connected to self-care. The purpose of the second phase is to
describe the experiences of the elderly people's ability to manage at home. The aim of this study was
to produce new knowledge about the self-care of home-dwelling elderly people living in Slovenia and
the factors connected with it. The knowledge will be used to develop elderly care and support eldery
people who live at home. The knowledge can be also used to educate nurses to care for the elderly
people.
The study was both quantitative and qualitative. In the quantitative study the sample consisted of
302 home-dwelling elderly people who were clients in domiciliary care. The selection criteria was:
aged 75 years or over and the ability to communicate, no hearing problems, no severe mental
problem/cognitive disability and gave full consent for their participation.
The whole instrument consists of 91 items. A instrument covers background data, types of selfcare, self-care orientation, life satisfaction, self-esteem and functional ability. In the qualitative study,
20 interviews were carried out and a qualitative analysis obtained. Data collection methods included
open-ended questions concerning the following topics: background data, types of self-care, self-care
orientation, life satisfaction, self-esteem and functional ability.
Based on factor analyses, four factors were found which described the self-care. All other factors
describe elderly people's perceptions concerning either the past or the future. The elderly people who
are able to manage their daily activities/routines have a good functional capacity, good family
relations, live qualitatively, accept the future healthily and clearly and are satisfied with their life
because they can take care of themselves, but their self-esteem is not so high. Those elderly people
who do not take care of themselves are abandoned; they are not satisfied with their way of life and
have low-esteem.
The results are going to be the basis for planning care and nursing care for all caregivers,
especially community nurses. On the basis of this result the model of nursing and social care for home
-dwelling elderly people living in Slovenia could be planned.
Keywords: aged, functional ability, home-dwelling elderly people, life satisfication, selfcare, self-esteem, self-orientation
Acknowledgement
This study was carried out at the University of Oulu, Department of Nursing in
Finland. I would like to express my sincere thanks to all those who have been of
special importance to me at all stages of this work.
I would like to take this opportunity to extend my warmest thanks to my
dean, prof. dr. h. c., dr. Dušanki Mičetić – Turk for idea that I start my PhD at
University of Oulu and for all her help and support. I wish to thank prof. Dr. Arja
Isola for all her warmest help and support and dr. Kaisa Backman for all help and
kindly attitude at the beginning of my study. My especial thanks go to my
supervisor, prof. Dr. Helvi Kyngäs, who has given me invaluable help and
support. I wish my warmest thanks also to both referees prof. dr. Maija Hentinen
and prof. dr. Riitta Suhonen for their comments what helped me finished this
work. I am grateful to docent Päivi Voutilainen who is commited to opponent me.
Especially I am very grateful to Mrs. Alenka Marsel for all her invaluable
help and encouragement, without her I could not finish this work.
I would like to give my special thanks to Mr. Alojz Tapajner and to librarian
Mrs. Nevenka Balun and Mrs. Simona Novak.
Warm thanks go to my dearest friend and colleague Mrs. Antonija Ivanuša for
her warm support, empathy, personal growth and friendship.
I have to thank also to my English teacher Mr. Miran Jarc. Thanks goes also
to all community nurses expecialy to Mrs. Tatjana Geč.
Finally, I would like to thank my family for understanding and support from
the bottom of my hart, to husband Milan, daughter Polonca and son Uroš. Without
them I could not make it.
5
6
Contents
Abstract
Acknowledgement
5
Contents
7
1 Introduction
9
1.1 Background of the present study............................................................... 9
1.2 Context of the study .................................................................................11
1.2.1 Principles and general rights of elderly people in the field
of health care in Slovenia ............................................................. 12
1.3 Purpose of the study ................................................................................ 15
2 Self-care of the elderly people
17
2.1 Definitions of self-care............................................................................ 17
2.2 Self-care and factors connected to it ....................................................... 19
2.2.1 Functional capacity....................................................................... 20
2.2.2 Life satisfaction ............................................................................ 21
2.2.3 Self-esteem ................................................................................... 22
2.2.4 Self-care and disability ................................................................. 23
2.2.5 Self - care of the elderly related to mental health......................... 24
2.3 Self-care of elderly people, quality of life and well-being...................... 25
3 Background theory of the study
29
4 Aim of the study and research problems
31
5 Methodology
33
5.1 Sampling ................................................................................................. 34
5.1.1 Phase I .......................................................................................... 34
5.1.2 Phase II ......................................................................................... 37
5.2 Data collection ........................................................................................ 38
5.2.1 Phase I .......................................................................................... 38
5.2.2 Phase II ......................................................................................... 40
5.3 Data analyses .......................................................................................... 41
5.3.1 Phase I .......................................................................................... 41
5.3.2 Phase II ......................................................................................... 42
5.4 Ethical considerations ............................................................................. 43
6 Results
45
6.1 The self-care of home-dwelling elderly people....................................... 45
6.2 The self-care orientation ......................................................................... 55
6.3 The self-esteem of home-dwelling elderly people .................................. 57
7
6.4 The life satisfaction of home-dwelling elderly people ............................ 58
6.5 The functional capacity of home-dwelling elderly people ...................... 58
6.6 Functional capacity, life satisfaction and self-esteem related to
the self-care behavioural styles of home-dwelling elderly people .......... 59
6.7 The experiences of the elderly people concerning their ability to
manage at home....................................................................................... 63
6.8 Main findings of the results..................................................................... 65
7 Discussion
67
7.1 Reliability and validity of the study ........................................................ 67
7.1.1 Validity and reliability of the instrument ...................................... 67
7.2 Validity of qualitative study .................................................................... 71
7.3 Discussion about findings ....................................................................... 72
7.3.1 Functional capacity and self-care ................................................. 75
7.3.2 Life satisfaction of self-care ......................................................... 76
7.3.3 Self-esteem and self-care.............................................................. 77
7.3.4 Self-care connection to functional capacity, life
satisfaction and self-esteem .......................................................... 77
7.4 Discussion about the possibilities for care for home-dwelling
elderly people .......................................................................................... 78
7.5 Challenges for nursing practice and further research .............................. 79
8 Conclusion
81
References
83
Appendices
101
8
1
Introduction
1.1
Background of the present study
At the start of the twenty-first century, one of the most profound social changes to
occur in developing societies is that the population is older (Backman & Hentinen
1999, Dragoš 2000a, Čačinovič Vogrinčič 2000, Dragoš 2000b, Železnik 2003,
Dragoš 2004, Hendry & McVittie 2004, Kempen et al. 2006). This change is a
result of social and scientific developments over the course of the previous
century, resulting in the addition of 25 years to life expectancy (Ramovž 2000,
Dean 2003). This demographic trend has meant that, in Europe, elderly people
represent twenty per cent of the total population and demographic projections
anticipate significant increases in this section of the population; these projections
predict that the proportion of the elderly people in Europe as a whole will increase
to twenty five per cent by the year 2025 (European Commission 2000).
Each life period brings successes, happiness, and joyful events, but
unfortunately also failures, troubles and distress, which are increased with age.
Will an elderly pearson have enough will, ability, strength, knowledge and, of
course, health for overcoming his/her obstacles? It depends a great deal on earlier
gained experiences, his/her readiness to be old and also knowledge of the people
from his/her surroundings (Pečjak 1999, Pentek 1999, Poredoš 2004).
According to Cheng (2006) & Baltes & Baltes (1990), ageing is more than a
series of biological changes. It is defined by gender, class, social standing, and
culture rather than year alone. Ageing is for the individuals regarded as something
unpleasant, useful, and unnecessary and above all, unwanted. Owing to
economical crisis the whole relationship to people in older years has been
changed. The old aged people feel themselves to be useless. There are still some
stereotypes that old aged people are unnecessary and inferior (Mesec 2000,
Zupančič 2004).
From the above mentioned it is evident that life quality is relative. Some
elderly people are satisfied by watching the beauty of nature from their
wheelchairs. Some others, to the contrary, are satisfied by fulfilling their material
needs in the sense of financial resources, travelling around the world and are still
of the opinion that their quality of life is at a low level (Ramovš 2005).
9
The surroundings of elderly people are inevitably becoming narrower. There
are fewer and fewer extended families where grandparents belong and they are
more and more often alone (Juvani et al. 2005). They feel unnecessary, rejected
and lonely. It also happens that a family does not accept the care for ill elderly
people who may have undergone physical and also mental changes (Petek Štern
& Kersnik 2004). Elderly people are confronting numerous losses, death of the
partner, friend or relative, and their children have left home. These events often
cause dementia, delirium, paranoia, depression, sadness and gloomy moods
(Regoršek 2005). Community care is the most common solution for demented
patients if they have somebody to take care of them (Eloniemi-Sulkava et al.
2001).
Estimation of elderly people should be founded on the level of their
functionality and not according to chronological age. Functional level is the
accurate indicator of the difficulties experienced by elderly people and the
required interventions. Functional capabilities range from complete independence
to complete dependence, accompanied by different/various physical, cognitive,
psychological and emotional deprivation. (Hagberg et al. 2004).
The need for help increases with ageing (Forss et al. 1995, Miloševič Arnold
2000, Gerson & Berg 2004). The growing number of frail elderly people is
remarkable from the viewpoint of the future health and social policies of the
Western countries for two major reasons. Firstly, the possibility to continue to live
at home even in old age is a highly valued aspect of health care. Living at home is
thought to improve the quality of old persons’ lives. Secondly, home care is much
less expensive than institutional care.
According to Gerson & Berg (2004) the increase in size of older groups of
the population has set new demands for the development of existing established
means of providing support to the elderly people which, at the same time, calls for
an organised approach to the development of new forms of care - educational
forms in the field of gerontological nursing.
The Regional Committee of the World Health Organization for Europe has
defined 21 goals for the 21st century in their document “Health 21”, where the
fifth goal is healthy ageing. According to it, people over the age of 65 will, by the
year 2020, have gained opportunities to experience their full health potential and
play an active social role. It is predicted that life expectancy and life without
invalidity will be prolonged for at least 20% of people at the age of 65, while the
percentage of people over the age of 80 who will be able to stay in the domestic
environment, keep their dignity and self respect and their place in the society, will
10
rise to at least 50%. This should be achieved by introducing public health policies
and programmes which will enable elderly people to use different services,
ensuring access to adequate health care (Health 21 1999).
1.2
Context of the study
All European countries, as well as Slovenia, are being confronted with big
demographic changes, the characteristics of which are a rapid increase in the
percentage of the elderly in the total population (Zupančič 2004) and a decrease
in fertility (giving birth).
The whole population in Slovenia is 2,003,358 (men 981,465 and women
1,021,893), natural increase -668, live births 18,157 and deaths 18,825 (Statistical
Yearbook of the Republic of Slovenia 2005). According to The Statistical
Yearbook of the Republic of Slovenia 2005, there were a total of 114,330 elderly
people aged between 75 and 85 years: men 36,652, women 77,678. Between 86
and 95 there were a total of 15,988 elderly people: men 3,689, women 12,299.
Between 96 and 99 there were 830 elderly people: men 146, women 684. The
total number of people exceeding 100 years was 117, 18 men and 99 women.
The number of the people in Slovenia, over the age of 65 is rising in
proportion. According to Kokol (2005) in the year 2000 there were 14%, in the
year 2003 there were 15%, and the projection for the year 2015 is 18%. The
number of the people over the age of 65 in the year 2010 will be about 50,000
higher than in the year 2000. This group is a markedly non-homogenous group of
elderly people, which can be divided into younger elderly people (65-74 years of
age), middle old (75-84 years of age) and old elderly people (over the age of 85).
Women prevail in all groups. The majority of them are active and, according to
their self-estimation, in good health and capable of looking after themselves and
also after others. In Slovenia as is shown, 12% of elderly people over the age of
65 are not able to look after themselves completely and 5% need institutional
care. According to Hvalič–Touzery (2005) and the data above, the age structure of
the patients in hospitals and health centres is also changing: in 1997 42% of all
patients were aged from 60 to 74 years and 39% were over 75 years of age; in
2002 37% of patients were aged from 60 to 74 years and 46% were over 75 years
of age. The issue of ageing means that elderly people are more and more present
in different institutions and need a lot of care. In the year 2001, life expectancy at
birth was on average 75 -80 years for women, and 72 years for men. Among
Slovenia’s regions there are big differences in life expectancy, from 75 years in
11
the southwest to 72 in Prekmurje (Eastern Slovenia). In the year 2002, a 65- yearold woman could expect to live on average for 19 years, a man of the same age
for 15 years (Kersnik 2005).
In Slovenia, the main causes of death in elderly people are heart and vascular
diseases and cancer, followed in fourth place by injuries. Data on mortality from
the period around the year 2000, in comparison with previous EU members,
shows that in Slovenia there are people over the age of 65 who die more often
because of injuries and suicides (especially men), malignancies (breast cancer in
women and lung cancer in men), diseases connected with alcohol consumption,
heart and vascular diseases, digestive and partially respiratory tract diseases
(Železnik & Batričević 2003).
1.2.1 Principles and general rights of elderly people in the field of
health care in Slovenia
According to Železnik (2005), treatment of elderly people in their own
surroundings considers many principles and rights, for example, the responsibility
for their own health. Also, old people are obliged to live healthily and in
accordance with their abilities and have to look after themselves and their own
security and, in case of illness, they have to respect their doctor’s and medical
personnel`s instructions (Cijan & Cijan 2003). It was noted by Mihelič (2005)
that other principles are integrity and equality, considering rights to health care,
availability and treatment. The fundamental principle is that an old person should
be treated individually and exclusively according to his /her health status, and not
differently because of their age (Kožuh-Novak 2004).
Independence (Grmič 1997, Tschudin 1999, Kompare et al. 2004) is one of
the important principles. An old person has the right to live independently in
his/her own surroundings, not jeopardising his/her life or the life of others (Mohar
1993, Davies et al. 1997, Kobentar 2004). Of course, this demands adequate
health monitoring and nursing care and also other forms of help and provision
when needed. A very important principle is the freedom to choose their own
doctor, other health personnel and health institutions, and the right to be informed
and make decisions about interventions. Elderly people have a full right to choose
their personal doctor as well as health workers and health institutions, but in
particular cases, because of organisational reasons, this right is partially limited
e.g. admission to ahome for elderly people (Pavliha 2005).
12
An elderly person is also the subject of the health care process. A doctor is
obliged to give an understandable explanation of their health status, method and
predicted treatment procedure and obtain their conscious consent for eventual
treatments. The opinion of an elderly person is more important than the opinion of
their relatives, except when the doctor estimates that the patient`s status does not
allow him/her to make favourable decisions. We also have to mention the right to
privacy and treatment with dignity (Kodeks etike medicinskih sester, babic in
zdravstvenih tehnikov Slovenije 2005). A doctor and other health care staff are
obliged to treat an older person with respect, tolerance and with dignity, regarding
his/her previous life and individuality, and ensure him/her privacy and human
dignity during the treatment. This right does not cease with the death of an elderly
person. Elderly people have the right to receive help regarding health care
provision (Johansen 1994, Council of Europe 2000). According to Grbec (2004)
health care personnel and other staff are obliged to help an old person as much as
possible, through organising examinations and treatments and other services when
the person is not able to do that by him/herself. Above all, elderly people have the
right to die with dignity (Grbec 2002). An old person has the right (Ramovš 2000)
to make a decision on where to spend his/her last days. They should receive
adequate palliative care and be treated with respect at the time of dying and after
death.
According to Uradni list RS, št. 49-2333(2000) policy goals in the field of
health care for elderly people are: (1) to keep them active in all fields and to
increase healthy years; (2) to decrease differences in the health of elderly people,
(3) to enable them to live independently in their domestic surroundings as long as
possible, (4) to provide them with quality and equally available health care in
health and illness, (5) to provide holistic interdisciplinary health care at home or
in an institution, when an elderly person is not able to live independently any
more.
According to Hindle et al. (2004), countries should have already presented
their indicators of the goals achieved in the year 2004. The European social
document, accepted by the European Council and ratified by the Republic of
Slovenia in 1999, among general and other rights, common for all people,
especially for elderly people, defines the right to social care. Within this frame,
the state is obliged to, directly or in cooperation with public or individual
organisations, accept or stimulate certain measures enabling elderly people: to
remain members of society, with adequate support, as long as possible
considering their physical, mental and intellectual abilities; to live in their
13
domestic surroundings independently as long as they want or are able to (offering
them necessary nursing care); to ensure an elderly person residing in an institution
adequate help/support, respecting their privacy and right to participate in making
decisions about living conditions in the institution.
According to the results of research conducted in Slovenia (Ministrstvo za
zdravje RS 2004) about 12% of people over 65 years of age are not able to take
care of themselves fully, and 5% of them need permanent help with personal
hygiene. Between 21% and 25% of elderly people need help with functional
activities – housekeeping and personal hygiene. In the age group between 70 and
80 years there are about 30% of people who need help, and in the age group over
80 years there are 60%. Elderly people are frequently aid givers themselves and
not just users. In many cases they take care of their partners or even their parents
and this hard care of a relative can worsen their health, too.
At the end of 1996 the total number of places in general and special
institutions of social welfare in Slovenia was 13,202. Of this total number 10,763
places belonged to the institutional care of the elderly people. With regard to the
population of Slovenia the above facilities for elderly people would suffice for
4% of the population over 65 years of age.
The programme of institutional care of elderly people is based on the criteria
set in the draft of the National Programme of Social Welfare in Slovenia.
According to these criteria the institutional network of public service needs to be
expanded to be able to provide for 4% of the elderly population. According to the
analysis of the existing capacities and the size of the population in 1996, 11,499
places, or 736 new places, are needed in order to include 4.5% of people over 65
in institutional forms of care, and 12,776 places or 2,013 new capacities are
needed to include 5% of elderly people. If the projection of growth of the number
of people over 65 years of age is taken into consideration however, 13,520 places
or 2,757 places more than in 1996 would be needed in 2005 in order to provide
institutional care for 4.5% of the elderly population. In order to include 5% of
elderly people 15,023 places or 4,260 more than in 1996 would be needed
(Ministrstvo za zdravje 2004).
The increase in size of older groups of the population has set new demands
for the development of existing established forms for providing support to elderly
people which, at the same time, calls for an organised approach to the
development of new forms of care. In the process of planning public care for the
elderly population it is of vital importance that the middle generation of today
becomes prepared in an organized way, for their old age, otherwise the social
14
problems of the elderly population will be impossible to manage (Leichsenring
2004, Commission of the European Communities 2005).
The programme should be focused on those elements of care for the elderly
people which are a part of the framework of social welfare. Realisation of its aims
largely depends on other programmes on a national basis, especially on
programmes in health care, education and housing. The idea of the so called
caring hospitals needs to be realised, which will result in a decrease in demands
for admission to the homes for the elderly people.
Arising from the present situation, and in compliance with the projections of
changing the age structure of the population in the future period, the aim of the
programme of nurse education in the field of nursing and care of the elderly
people in Slovenia is a complementary development of new educational forms in
the field of gerontological nursing.
Prolongation of life period, changing of traditional family styles,
homogeneity of retired families, social disstratification and other demographic, as
well as social changes, also require changes in the attitude of society towards the
elderly population, together with a change in the worry of taking care for them
(Peternelj & Šorli 2004).
Problems with which we are being confronted in Slovenia and which are in
the forefront are the following:an increase in the number of elderly people
requiring proper health care; loneliness and pushing away of the biggest growing
number of the aged to the social margins; bigger social disstratification and,
therewith, the need to offer a differentiated service; changes in values and views
on ageing and old age and the need for using new ways of taking care of the
elderly population (Toth 2004a, Toth 2004b).
1.3
Purpose of the study
This study is focused on the self-care of home–dwelling elderly people living in
Slovenia. The study has two phases. The purpose of the first phase is to describe
the self-care of home-dwelling elderly people living in Slovenia and the factors
connected to self–care. The purpose of the second phase is to describe the
experiences of the elderly people`s ability to manage at home. The knowledge of
elderly people home–dwelling self-care is not clear. Most studies are quantitative
which measure and compare two or more factors which have been defined and
measured in different ways. Because of the lack of knowledge of the levels of self
care of home-dwelling elderly people this study is based on Backman’s theory
15
1999 of the self care of home-dwelling elderly people. According to Backman’s
study 2003 and some other studies (Zasuszniewski 1996, Rabiner et al. 1997,
Blair 1999) the self-care of elderly people is found to be linked to functional
capacity, satisfaction with life and self-esteem (Toljamo & Hentinen 2001, Isola et
al. 2003, Fagerström et al. 2007). These factors are also studied here. The aim of
this study was to produce new knowledge about the self-care of home–dwelling
elderly people living in Slovenia and the factors connected with it. The
knowledge will be used to develop care for elderly people and support eldery
people who live at home. The knowledge can be also used in educating nurses to
care for ederly people.
In this study Literature search concerning the term self-care of homedwelling elderly people was done using terms: self-care, elderly people, homedwelling, functional capacity, self-esteem, life satisfaction, self-care orientation,
aged, ability, gerontological nursing, quality of life, well-being. Databases of
MEDLINE, CINAHL, Academic Search Premier, Health Source:
Nursing/Academy, MEDLINE, Sage Publications - AGE Publications, SAGE
Journals Online and The SAGE Full-Text Collections.
The theoretical framework is firstly dedicated to self-care and factors
connecting to it, such as functional capacity, life satisfaction and self-esteem.
After that there is a short discussion about mental health issues and the quality of
life, because, according to many studies, high functional capacity of elderly
people produces high quality of life, and, on the other hand, mental health
problems have an effect on functional capacity and life satisfaction, as well as the
quality of life. At the end of theoretical framework is introduced the background
theory on which this study is based
16
2
Self-care of the elderly people
2.1
Definitions of self-care
Any synthesis of the self-care of the elderly people and related factors based on
the existing research knowledge is hampered by the fact that self-care and related
factors have been defined from different theoretical viewpoints and
operationalised in a number of different ways. These studies are international and
have been conducted in different cultures and deal with different health problems
and health care systems.
According to Slovar Slovenskega knjižnega jezika (2005) self-care means to
take care of his/her own self. Self-care is a part of an individual lifestyle, which is
shaped by values and beliefs learned in specific cultures. According to Backman
& Hentinen (1999), self-care seems to be connected with the personal experiences
of each old woman or man. Self-care is the personal care that individuals require
each day to regulate their own functioning and development. (Goldstein et al.
1983, Orem et al. 2001, Allender & Spradley 2001). Self-care is supposed to be
the key to health and illness care (Aggleton & Chalmers 1985, Orem 1991,
Toljamo & Hentinen 2001, William 2004, Parissopoulos & Kotzabassaki 2004).
The theory of self-care proposes that individuals learn and deliberately
perform for themselves or have performed for them (dependent care) on a
continuous basis those actions that are necessary to protect human integrity,
physical and mental functioning, and development within norms essential for
promoting life, health and well-being (McAuley et al. 2000, Denyes et al. 2001,
Tomey & Alligood 2002, Rode 2005, Allison 2007). Physical activity seems to be
an important factor when older people assess their health (Leinonen & Jylhä
2001). According to Dill et al. (1995), Tell & Leenerts (2005). Self-care responses
appear to be learned within the social context early in life, be reinforced through
the life cycle, and evolve through cooperation with both professional and lay
persons.
Self-care has traditionally been defined as activities associated with health
promotion (Backman & Hentinen 1999, Backman 2003). It represents the range
of behaviours undertaken by individuals to promote or restore their health
(Kickbusch 1989, Engberg et al. 1995, Clark 1998). The activities of daily living,
such as exercise, nutrition and relaxation, are often used to measure self-care
(Dean 1989a, Dean 1989b, Orem 1991, Allardt 1993, Edwardson & Dean 1999,
17
Ovid Aquero-Torres et al. 2001). Orem (1991) has started: “self-care means care
that is performed by oneself for oneself when one has reached a state of maturity
that enables consistent, controlled, effective, and purposeful action”. The aim of
such rational self-care is to maintain health (DeFriece & Gordon 1993, Metler &
Kemper 1993). In this way, self-care is seen as a rational, conscious way to
operate. In this presentation, self-care activities are not seen merely as rational
ways to maintain health. Self-care is not only a conscious way to act, but partly
also a subconscious routine that has been shaped in the course of life. Self-care is
not a separate part of old men’s or women’s lives. It is associated closely with
both their past life and the future. Such knowledge of the self-care of elderly
people helps us to understand many aspects of self-care and its associations with
vulnerability in later life.
According to Backman & Hentinen (1999), Ory et al. (1998) the self-care
literature has relevance for discussions on independence in assisted living. When
applied to older adults self-care is frequently defined to include a broad range of
behaviours undertaken by individuals, often with support from the others, to
maintain or promote health and functional independence (Goldstein et al. 1983).
In order to understand self-care of the elderly people living in Slovenia it is
necessary to understand that elderly people would like to live as long as possible
at home and care for themselves in daily living. According to Hobbs Leenerts et
al. (2002), Teel & Leenerts (2005), Allison (2007), self-care consists of the action
systems performed by individuals in time and in conformity with health care
requirements that are associated with their growth and development, their state of
health and health-related conditions, the environment, and other influencing
factors.
Smits and Kee (1992) however, found that although functional status did not
significantly correlate with self-care, it was related to the self-care concept,
suggesting that functional health has a role in the maintenance of self-care among
elderly people. It may be that there are internal factors, such as coping strategies
(Burke & Flaherty 1993) and hardiness (Nicholas 1993), which have an impact on
self-care as well as on functional abilities and objectively measured health.
Studies of health beliefs show that an old person’s thoughts concerning her/his
health have an effect on her/his use of health services (Strain 1991).
According to Orem (2001), active participation in caring for oneself
contributes to the behaviour of self –care.
18
In this study the definition of self-care is used in a way that self-care means
taking care of his/her own self. Self -care is a part of an individual lifestyle which
is shaped by values and beliefs learned in specific cultures.
2.2
Self-care and factors connected to it
Self care of home-dwelling elderly people depends on many factors (Söderhamn
et al. 1996, Söderhamn 1998, Söderhamn 2001, Burgio et al. 1994, Ball et al.
2004, Toye et al. 2006). Along with advancing age, people need more and more
time to recover from illnesses and other traumas affecting various aspects of life
which, in turn, is reflected in their abilities and motivation to take care of
themselves (Bendixen et al. 2005) According to research findings (Lukkarinen &
Hentinen 1997, Badzek et al. 1998, Edwardson & Dean 1999), self-care of elderly
people is supported by a high level of education, good socio-economic status and
availability of social support. Stressful life situations, such as discharge from
hospital (Shin & Shin 1999, Bliss et al. 2004, Bliss et al. 2005, De Raedt &
Ponjaert-Kristoffersen 2006), are also critical from the viewpoint of self-care.
According to Stevens – Ratchford (2005), Kilpi et al. (2003), elderly people`s
motivation for autonomy, self-efficacy, and well being can be harnessed for
empowerment wherein seniors take charge of transforming themselves and their
lifestyle so that development and life satisfaction continue through and after
illness and disability (Dean 1989a, Bowling et al. 1993, Dellasega 1990,
McCamish-Svensson et al. 1999, Magnan 2004, Forbes 2005, Hwang et al. 2006,
Borg et al. 2006).
Noted by Gallagher et al. (2003), Gill et al. (2004), Strandmark (2004),
Strandmark (2006) the essence of health is a vital force, which is built up of selfimage of worthiness, ability to overcome obstacles and feeling a zest for life.
According to Anderson & Stevens (1993) an individual gets strength through
having self-respect, coping with their life and experiencing well-being as well as
the meaning of life. Roughly speaking, it can be said that advancing age and
declining functional capacity are likely to affect self-care at some point in the life
span (Norburn et al. 1995, Greiner et al. 1996, Krach et al. 1996). According to
Backman & Hentinen (2001) illness and treatment methods, personal experiences
about illness, social support, personal factors, quality of life and effectiveness of
nursing have been found to be associated with self-care.
The research findings on these correlations are partly contradictory, which is
why the present study will focus on factors related to the self-care of elderly
19
people from these three perspectives, which are functional capacity, life
satisfaction and self-esteem (Rosenberg 1985, Rosenberg et al. 1995, Backman &
Hentinen 1999, Aydin et al. 2006, Benyamini et al. 2004, Chao et al. 2006). In
2001 Backman and Hentinen made a study to examine how functional capacity
(activities of daily living – ADL, instrumental activities of daily living – IADL),
life satisfaction and self-esteem are related to the self-care behavioural styles of
home-dwelling elderly people (Backman & Hentinen 2001).
2.2.1 Functional capacity
Functional capacity as defined by Kutzleb & Reiner (2006) encompasses a
person's ability to carry out the usual activities of day-to-day life (ADL).
Functional capacity was approached from the viewpoint of ADL and IADL,
which are both widely used concepts in concerning the functional capacity of
elderly people. The functional capacities of elderly people have been widely
studied using ADL or IADL as tools, but there are very few studies concerning
the relationships of functional capacities and self-care (Backman & Hentinen
2001, Lehtola et al. 2006). According to Erjavec et al. (2002) and Stineman et al.
(2005), physiological changes and frequent diseases accompany ageing decrease
the functional ability of elderly people and thus limit the selection of physical
activity. Physical activity may be defined as any bodily movement in daily living,
voluntary or involuntary, that is produced by skeletal muscles and results in
energy expenditure (Caspersen et al. 1985, Nevalainen et al. 2004, McDevitt et
al. 2006). It is genetically based on survival (Lees & Booth 2004). Physical
activity quantified by energy expenditure is a reflection of gender, age, and body
mass, as well as the intensity and efficiency of movement (Tudor-Locke & Myers
2001, Center for Disease Control and Prevention 2005, Mc Devitt et al. 2006).
Kono and Kanagawa (2000) investigated physical and psycho social
functional changes in one year and related factors among community-dwelling
frail elderly people. The research showed that they are significantly related to low
ADL level and less verbal contact with their caregivers. Life activities such as
getting out to the garden or around the house, worshipping at a temple, doing
house chores, shopping, and gardening, related to maintained function. The
results suggested that the degree of independence of frail elderly people might
easily change.
20
Kondo et al. (2007) found that a higher level of engagement in the Mujin was
associated with greater functional capacity, especially social role performance,
which means that they have a higher quality of life.
According to Kastumata & Arai (2006), the aim of the study was to examine
the nonlinear association of higher-level functional capacity with the incidence of
falls by elderly people aged 65 years or older. The research showed that the
gender–based difference in the association of higher-level functional capacity
with the incidence of falls might be related to societal role or activity-related
aspects. Farinasso et al. (2006) investigated 86 elderly people, aged 75 years and
more, from Parana, a city in the north of Brazil. The study aimed at characterising
the health perception, functional capacity and prevalence of self-referred disease
among the elderly people in the area covered by the Family Health Strategy. 47.
7% of elderly people evaluated their health between good and excellent, 77, 9%
were independent and 76, 7% presented co-morbidities.
Fagerström et al. (2007), investigated feeling hindered by health problems
among 1,297 elderly people aged 60-98 living at home in relation to ADL
capacity, health problems, life satisfaction, self-esteem, and social and financial
resources, using a self-reported instrument, including questions from Older
American's Resources and Services schedule (OARS), Rosenberg's self-esteem
and Life Satisfaction Index Z (LSIZ). People feeling greatly hindered by health
problems rarely had anyone who could help when they need support, and had
lower life satisfaction and self-esteem than those not feeling hindered. Feeling
hindered by health problems appears to take on a different meaning, depending on
ADL capacity (Chang et al. 2004), knowledge that seems essential to include
when accomplishing health promotion and rehabilitation treatments, especially in
the early stages of reduced ADL capacity (Pihlar 2003).
2.2.2 Life satisfaction
Life satisfaction is defined as an individual's own evaluation of her/his life. It
refers to an overall assessment of one´s life, including a comparison of aspiration
and achievement. According to many studies, perceived health has a remarkable
effect on the satisfaction of elderly people, although divergent results have also
been presented. However, physical health status is obviously important for many
elderly people (Perry & Thomas 1980, Gfellner 1989, Backman & Hentinen
2001, Markson 2003). Important factors for life satisfaction are activity-related
factors, independence-related factors, environmental factors, and adaptive factors.
21
All four themes are connected with the risk of being negatively influenced by the
onset of disease and declining physical functioning. Being active and satisfied
with social life has been found to be protective factors against insomnia at any
age and to promote the essence of well-being and satisfaction with life in general
(Ohayon et al. 2001, Chopra & Simon 2001).
Activity-related factors are physical activity, social activity and continuity of
self- expression (Aberg et al. 2004). Elderly people must also adapt to age-related
physical changes, adjust to the losses that accompany serious illness, and cope
with the death of friends and loved ones. The acceptance of life as it has been
involves an integration of past life with one’s present living experiences (Levy et
al. 2002). Reminiscence, a significant occupation of older adulthood, is especially
important in helping elderly people to integrate present adversities with present
identities and past experiences. Reminiscence is part-oriented thinking (Gibson
2004).
The purpose of the study carried out by Berg et al. (2005) was to examine
factors associated with life satisfaction in the oldest-old within a spectrum of
psychological and health related variables. The results of the study showed that
they emphasise the need to analyse associates of life satisfaction within a broader
context of psychological variables and separately for men and women. Cognitive
process is involved in the evaluation of life satisfaction (Mehlsen et al. 2005).
2.2.3 Self-esteem
Self-esteem is an essential research topic in the human sciences. Self-esteem is a
positive or negative attitude towards one´s self. High self-esteem implies a feeling
that one is “good enough”. The individual simply feels that he/she is a person of
worth; he/she respects him/herself for what he/she is. Self-esteem evolves in
relation to the environment (Backman & Hentinen 2001). Strandmark (2006)
considers that self-esteem implies an assessment of self-worth, which depends on
how the surrounding culture values the individual's characteristic qualities and
how well someone's behaviour matches her/his standards of worthiness.
According to Andersson & Stevens (1993) study, the early experiences with one´s
parents have already had an impact on the self-esteem of elderly people. Selfesteem plays an important role in the life satisfaction of elderly people and it is
related to phychological well- being, and usefulness and competence have an
important influence on well-being (Benyamini et al. 2004, Chao et al. 2006).
22
Self-esteem also may be associated with the feeling of control and hence is
included as a variable in the study (Sparks et al. 2004).
The earlier studies indicate that elderly people’s functional capacity; life
satisfaction and self-esteem may be assumed to be both components of self-care
and factors associated with it (Backman & Hentinen 2001). According to some
studies, social support promotes the self-care activities of old aged people (Abbey
& Andrews 1985, Norburn et al. 1995, Backman & Hentinen 1999). Petry (2003)
found that being independent increased older womens` self-esteem, self-identity
and power.
2.2.4 Self-care and disability
One of the important factors of self-care and functional capacity is the disability
of home- dwelling elderly people (Gill & Feistein 1994, Hardy et al. 2005)
Disability in older people is generally focused on activities of daily living
(Donmez et al. 2005). One of the major criteria used for measuring health levels
of older people is the status of disability (Guralnik et al. 1996, Yang & George
2005). Occurrence of disability affects the life quality of older people (Calmels et
al. 2003, Peruzza et al. 2003) and it is also an important sign for mortality, as it is
accepted as an indicator of death (Guralnik et al. 1991). Older people with
disability also often have poor perceptions about their health levels (Johnson &
Wolinsky 1993, Holmes et al. 2005) and they become increasingly more
dependent on indoor life (Inoue & Matsumoto 2001).
According to previous studies, disability is more frequently seen in higher
ages (Ania Lafuente et al. 1997, Hoeymans & Feskens 1997, Beland &
Zunzunegui 1999, Ostchega et al. 2000, Picavet & Hoeymans 2002, Rosa et al.
2003), females (Arslan & Gokce-Kutsal 1999, Beland & Zunzunegui 1999,
Ostchega et al. 2000, Picavet & Hoeymans 2002), people with visual or hearing
disorders (Ania Lafuente et al. 1997), people who have lower education levels
(Ania Lafuente et al. 1997, Beland & Zunzunegui 1999, Picavet & Van den Bos
1997, Rosa et al. 2003), retired persons and people who live in rented houses
(Rosa et al. 2003). Although disability has been studied in previous research,
these studies do not completely supply theories on the domains.
According to Donmez et al. (2005), the aim of the study was to find out the
frequency and severity level of disability for people aged 65 years and older,
living in Antalya city Center. The aim was also to determine the effects of
disability on living conditions and to detect the variables associated with
23
disability. For this reason, the World Health Organization conducted a new
schedule, with the help of previous studies, in order truly to detect disability in
populations. The World Health Organization - Disability Assessment Schedule
(WHO-DAS-II) was implemented on 840 people who were selected from the
research population by the cluster sampling method. Disability status of these 840
people was measured for six different fields of life (domains). The most domains
of frequent of disability were: “participation in society”, “getting around”, and
“life activities”. Six different domains that are considered to be important in most
of the cultures are included in the schedule. These domains, and the disability
type they represent are: (1) understanding and communication (ability to chat,
learning new tasks, concentrating for 10 minutes and similar activities), (2)
getting around (walking indoor/outdoor, standing for long periods and similar
activities), (3) self-care (taking a bath, feeding, staying alone for a few days and
similar activities), (4) getting along with people (dealing with people he/she does
not know, maintaining friendships and similar activities), (5) life activities
(household responsibilities, doing the household tasks and similar activities), (6)
participation in society (joining in community events such as cinema, festivals
and similar activities). Determining the domains in which the older people most
frequently experience disability will obviously be the key for the planners of
health services. The research population consists of 36,174 persons who were at
least 60 years old living in the region. This was a cross-sectional study. The
sample population was selected by the “cluster sampling method proportionate to
population size (n = 760) to prevent missing the design effect of cluster sampling
caused by communication problems with older people and/or other related
problems. (Donmez et al. 2005).
2.2.5 Self - care of the elderly related to mental health
Mental health issues are connected to self-care (Hansebo & Kihlgren 2002).
Cognitive function in later life is highly individualised, based on personal
resources, health status, and the unique experience of the individual’s life (Blazer
1998). Multiple losses, altered sensory function, and alterations, discomfort, and
demands associated with illness that the elderly people frequently encounter set
the stage for a variety of mental health problems (Beekman et al. 1995, Beekman
et al. 1997, Hatcher et al. 2005). Age-associated cognitive decline (AACD) is a
predictor of dementia and highly prevalent among elderly people (Arvidsson et al.
2001, Okumiya et al. 2005). Many studies indicate that taking care of demented
24
elderly people often causes burdens which decrease after the cessation of care,
followed by positive life changes (Eloniemi-Sulkava et al. 2002).
One of the important factors for the self-care of elderly people is depression
(Daly 2001, Minardi 2004). Depression increases in prevalence and intensity with
age (Chesney 1993, Flaherty et al. 1998). The aim of Arve’s study was to
establish the prevalence of depression in elderly people in different age groups.
To help detect depression, the study shows factors on the basis of which nursing
and medical professionals can distinguish between depressive and non-depressive
elderly patients (Bultema et al. 1996, Ford et al. 1997, Mead et al. 1997, Arve
1999).
Some authors reported that increasing age may be associated with more
melancholia and ruminative thinking, and that the phenomenological presentation
of depression in the elderly people may be more variable (Kivela & Pahkala 1989,
Caine et al. 1993, Neikrug 2003). Most of these symptoms are typical and highly
prevalent in community-living, medical and institutional elderly populations.
Some studies (Salvatore 2000) have shown that the frequency of minor
depression increases with age in a curvilinear fashion: there is a decrease in
middle age, a steady increase in old age and a very steep increase in people over
80 years (Snowdon et al. 1996, Sesso et al. 1998). Minor depression is often a
reaction to the stress commonly experienced in old age and often related to
physical health (Beekman et al. 1997, Tannock & Katona 1995).
Mendes de Leon et al. (1998) found that depression may increase risk factors
among relatively healthy older women, but it was not an independent risk factor
in the elderly population in general. The higher prevalence of depression in
women could still mean that the effect of depression is more significant for them
(DeFriese & Gordon 1993, Jorm 1995, Johnson & Wolinsky 1993, Johnson et al.
2000, Šelb-Šemrl et al. 2004).
2.3
Self-care of elderly people, quality of life and well-being
Quality of life (QoL) has recently become commonly used both as a concept and
as a field of research (Tseng & Wang 2001, Suzuki et al. 2002, Baker et al. 2003,
Berglung & Ericsson 2003). According to Uhlmann & Pearlman (1991), Helström
& Hallberg (2001), on the basis on previous research it might be concluded that
life does not necessarily become miserable when one gets old. Comparisons
between young people and elderly people for instance, have shown that elderly
people were more satisfied with their lives than the young, although a smaller
25
number of elderly people said that they were happy (Campbell & Russo 2001),
and that life satisfaction decreased with age up to 50 or 60 years of age, after
which it increased somewhat or remained stable (Helström et al. 2004).
Functional capacity, perceived health, good housing conditions, an active life
style, and good social relationships were some of the factors that explained life
satisfaction and subjective quality of life (McKevitt et al. 2003, Kamper et al.
2005, Ozcan et al. 2005, Ramovš 2003).
Kempen et al. (2006), states that the problems of older people become more
prevalent with the ageing of the population. Occurrence of disability and its
effects on living conditions are two of the major factors that determine the quality
of life of elderly people (Wenger & Burholt 2003). It is important what the elderly
can recognize health and quality of life, because health is one of the most
important factors for self-care (Ferraro 1980, Kaplan & Camacho 1983, Svanborg
et al. 1988, Idler & Angel 1990, Petek-Štern & Kersnik 2004). Noted by Krajnc &
Krajnc (2005) in the major part of literature health is equal to life quality. This
can be possible only in those cases where there is no emphasis on diseases or state
of physical functioning. Health definition of the WHO is universal and general at
the same time, concentrating on the field of society activity in talking care of
health (Aydin et al. 2006).
According to Juvani et al. (2005), the opportunity to live at home is very
highly appreciated by elderly people as a factor contributing to their quality of life
and produces life satisfaction. As a person ages, the significance of home and its
immediate vicinity increases along with the person’s growing sensitivity and
response to environmental changes. The physical environment may have a major
influence on older people’s health. The physical environment includes concrete
features, such as the climate, residential milieu and nature. These attributes can be
used to define the factors that contribute to the subjective environmental
experiences of elderly people. The key characteristics of the physical environment
are a home-like setting, optimal stimulation, and cues, options for privacy and
social interaction, and safety. The safety of the physical environment has been
studied particularly from the viewpoint of anticipating and preventing falling
accidents among elderly people, because, as people age, decrements in sensory,
motor and cognitive functions often jeopardize their ability tomanage, safely and
comfortably, the activities of daily living in their own homes. Noted by Grindley
& Zizzi (2005) a safe environment is very important for the self-care of elderly
people living at home. The self-care of elderly people has a great influence on
their quality of life.
26
Hellström & Hallberg (2001), investigated older people (age range 75–99
years) and showed that depressed mood, loneliness, fatigue, sleeping problems
and the number of reported diseases were significantly associated with low QoL.
Jakobsson et al. (2004) demonstrated that among older people (85+) pain,
functional limitations, fatigue, sleeping problems and depressed mood, were
associated with low QoL.
The researchers are using various components of life quality in their studies
(Kobentar 2004). They can agree with the estimation of old-age (Bowling et al.
2003). Others define life quality of the old as a combination of elements: views of
an old person, his family and nursing personnel (Calmes et al. 2003, Andersson &
Gottfries 1991). Health care of an old person includes, besides care, also his right
to the feeling of happiness, moral principles, satisfaction with life and its
subjective feeling (Cocherman 1996).
The subjective wellbeing of elderly people is most closely related to their
perceived health (Mossey & Shapiro 1982, Gill & Feinstein 1994, Hennessy et al.
1994, Miilunpalo et al. 1997, Kivinen et al. 1998). Self-assessed health has
proven to be an important predictor of survival in elderly people. Dening et al.
(1998), found that around 70% of people aged 75 or over rated their health as
good or very good in 1997. The figure is comparable to that reported in 1991 in
the United Kingdom General Household survey (Whedstone & Reid 1991). The
association of age and gender with self-perceived health varies in different studies
(Orlifa et al. 2006). According to Lantz (1985), most of the literature indicates
that women are more self-care orientated than men and women perceive
themselves to be in good or excellent health, that they possess self-actualising
traits and exhibit a high degree of wellbeing. It was noted by Whetstone & Reid
(1991) that women regard the clinical health concept as having greater relevance
for them than men do. Elderly men and the older old in particular, tend to report
poorer health than elderly women and younger old for similar objective health
conditions. Other data supports the view that elderly people are more pessimistic
in their perceptions of their own health than younger people. Poor education and
low socio-economic status are associated with poor self-rated health (Allardt
1993, Miller et al. 1996, Amaducci 1997, Kivinen et al. 1998, Šabovič 2004).
27
28
3
Background theory of the study
In this study Backman’s theory of self-care of the home–dwelling elderly people
is used, because it is the only one of its kind existing and appropriate to use and
because there is no other kind of study concerning the self-care of home-dwelling
elderly people living in Slovenia. The aim of the theory developed by Backman
2001 was to develop a model to clarify the exisisting knowledge concerning the
self-care of home-dwelling elderly people living in Oulu, Finland. A grounded
theory method (Glaser & Strauss 1967, Glaser 1978, Glaser 1992) was used and
the result is a model based on an inductive analysis of empirical data. The model
made consists of four modes of self-care with different conditions for action and
different meanings: responsible self-care, formally guided self-care, independent
self-care and abandoned self-care (Backman & Hentinen 1999).
Each type implies a specific self-care behaviour style, life experiences and
orientations towards the future. Along with these basic types, six subtypes
emerged, where the self-care styles were the same as in the basic types, but the
past experiences and/or the orientations towards the future differed from the
original. The theory also shows connections between the functional capacity and
self-care, life satisfaction and self-care and self-esteem and self-care. According
to the theory, there are five factors that characterise the two main trends of selfcare: the nature of the turning-points of life, the way to react, the resources, the
meaning of self-care and the experience of ageing. The individual histories of
self-care were interpreted in terms of these factors, and two main trends of selfcare were recognized: internal, unambiguous self-care and external, ambiguous
self-care. The responsible and independent types of self-care represent internal,
unambiguous self-care. The formally guided and abandoned self-care types
represent external, ambiguous self-care (Backman & Hentinen 1999).
According to Backman & Hentinen (1999), self-care is not a separate part of
old men´s or women´s lives, it is associated closely with their past life and with
the future. As an activity, self-care is not just a rational way to maintain health. It
also reflects the person´s overall attitude towards health care, illness and manner
of living.
In the model developed by Backman (Backman & Hentinen 1999) the
following social process was recognised: the self-care of elderly people living at
home consists of caring for health and illness and carrying out daily activities.
The preconditions of self-care are the person's background, her/his personality
and her/his experiences of health and ageing. The purpose of self-care is
29
composed of attitudes towards other people, ageing and the future. The model
consists of four categiories of self-care with different conditions for action and
different meaning.
Responsible self-care implies activity and responsibility in all the activities of
daily living and caring for health and illness. The precondition of responsible selfcare was a positive orientation toward the future and a positive experience of
ageing. The meaning of responsible self-care was a desire to continue living as an
active agent. They also trusted in the future and thought that when they did need
help from others, they would be taken care of. (Backman & Hentinen 2001).
Formally guided self-care consisted of regular but uncritical observance of
medical instructions and routine performance of daily tasks. These old persons
did what they were told, but did not know the reason for their actions. Formally
guided self-care was based on life experiences of taking care of others. The
meaning of formally guided self-care was a tendency to accept life as it comes
(Backman & Hentinen 2001).
Independent self-care was based on the elderly person´s desire to listen to
her/his internal voice. They had original ways of taking care of their daily
activities, health and illnesses. The precondition of independent self-care was the
aim to manage in life independently. The meaning of independent self- care was
an attempt to maintain the constancy of life (Backman & Hentinen 2001).
Abandoned self-care was characterized by helplessness and a lack of
responsibility. These elderly people did not care about themselves. They were no
longer able to manage daily activities. They felt helpless for different reasons. The
meaninig of abandonment was a desire to give up (Backman & Hentinen 2001).
30
4
Aim of the study and research problems
This study has two phases. The purpose of the first phase is to describe the selfcare of home-dwelling elderly people living in Slovenia and the factors connected
to self – care. The purpose of the second phase is to describe the experiences of
the elderly people’s ability to manage at home. The aim of this study was to
produce new knowledge about the self-care of home – dwelling elderly people
living in Slovenia and factors connected with it. The knowledge will be used to
develop elderly care and enable eldery people to live at home. The knowledge can
be also used to educate nurses to care for elderly people.
The research questions of phase I are:
1.
2.
3.
4.
5.
6.
What is the self-care of the home-dwelling elderly people like?
What is the self-care of the home-dwelling elderly people like from the life
history point of view?
What is the functional capacity of the home-dwelling elderly people like?
What is the life satisfaction of the home-dwelling elderly people like?
What is the self-esteem of the home-dwelling elderly people like?
How are functional capacity, life satisfaction and self-esteem related to the
self-care behaviour styles of the home-dwelling elderly people?
The research question of phase II is:
1.
What are the experiences of elderly people concerning their ability to manage
at home?
31
32
5
Methodology
The study was based upon the method of triangulation to make sure that the
research problems are covered from all relevant angles. Triangluation is defined
as a combination of different methods aimed at providing a more accurate
description of the phenomenon under investigation. In this study both the
qualitative and quantitative methods were used. In methodological triangulation,
combinations of at least two methods, usually quantitative and qualitative ones,
are used to address the same research questions.
Quality in research is concerned with using the most appropriate approach for
investigating research problems and for researchers to adopt a systematic,
rigorous and transparent approach for exploring, discovering, confirming and
understanding. Underlying the practice of research and its findings are
fundamental questions about the nature of knowledge, termed as epistemology,
and what we understand as reality (Gerrish & Lacey 2006).
Quantitative and Qualitative research have different characteristics and derive
from different scientific traditions and forms of knowledge (McKenna 1997,
Burns & Grove 1999, Corner 1993, Gillis & Jackson 2001, Backman et al. 2006,
Silverman 2006). Both of them are used here because it is necessary to study selfcare of elderly people from both quantitative and qualitative perspectives.
Quantitave study is needed to get a general picture and to describe what the selfcare of home - dwelling elderly people is like in Slovenia, because we don’t have
any knowledge of that. Qualitative study is needed to describe the experiences of
elderly care of home - dwelling elderly people. Quantitative research methods
assume that the world is stable and predictable, and phenomena can be measured
empirically (Niccole 1997, Christensen & Kackrow 2003, Piper 2006). The
positivist tradition of quantitative research derives from the biomedical sciences
(Topping 2006). Quantitative researchers focus on a very specific area and plan
every detail, while qualitative researchers initially formulate the question in more
general terms and develop it during the research process (Nicoll 1997, Polit &
Hungler 1995, Polit & Hungler 2006).
Qualitative researchers generally begin with broad questions in the data
collection and become more specific in the process of research, responding to
what they hear and find in the setting (progressive focussing) (Field & Morse
1995, Burns & Grove 1999, Sandelowski 2000, Holloway & Wheller 2002).
Qualitative research methods take an interpretivist perspective, emphasising the
meaning and understanding of human action and behaviour. Trustworthiness in
33
qualitative research means methodological soundness and adequacy. Researchers
make judgements of trustworthiness possible through developing dependability,
credibility, transferability and confirmability (Guba & Lincoln 1989). Qualitative
research may be explained then as involving broadly stated questions about
human experiences and realities, studied through sustained contact with persons
in their natural environments, and producing rich, descriptive data that help us to
understand those persons`experiences (Munhall 2001). The tradition of qualitative
research derives from social sciences (Silverman 2005). Both are appropriate
approaches for nursing research, but the choice of methodology depends on the
nature of the research questions. In some cases the two approaches can be blended
in the same study (Polit et al. 2001). Qualitative research is a systematic,
subjective approach used to describe life experiences and give them meaning
(Leininger 1970, Munhall 1989, Silva & Rothbart 1984). Qualitative research is
not a new idea in social or behavioural sciences (Glaser & Strauss 1967, Kaplan
1964, Scheffler 1967, Glaser 1978, Glaser 1992, Miles & Huberman 1994).
5.1
Sampling
5.1.1 Phase I
The data was collected in Slovenia by interviewing elderly people in their homes.
The purposive sample was used because this study iwas interested in the self-care
of elderly people who are living at home, aged 75 or more and with the ability to
communicate. The purposive sample involves the conscious selection by a
researcher of a certain criterion. Efforts are made to include typical subjects (Polit
& Hungler 1995). The sample consisted of 302 home-dwelling elderly people,
who were clients in domiciliary care. The community nurses selected the elderly
people who fulfilled the criteria (table 1) and interviewed the selected elderly
people in their homes. The whole instrument consists of 91 items. A instrument
covers background data, types of self-care, self care orientation, life satisfaction,
self-esteem and functional ability.
34
Table 1. The criteria used to guide the selection of participants.
Criteria
1. The person is over 75 years old.
2. The person does not have a profound hearing problem.
3. The person does not have a severe mental problem/cognitive disability
4. The person can speak Slovene.
5. The person can give fully informed consent of their participation.
The elderly people involved in research were spread among all Slovenian
countries by the percentage of population. Most of the elderly people were female
according to demographic situation in Slovenia at the age 75 and more matched
by Slovenian national statistics (Nacionalni program varstva okolja 2005).
A large majority of the elderly people were widowed. The results are difficult
in comparison to other researches, since the Slovenian National programme has
not collected these data yet. We faced the same problem in matters of education
too, since there is no exact data about education in Slovenia after the 2nd World
War, but it is generally known that the majority of elderly people completed
primary school. Since the majority of elderly people included in this research
were women, housekeeping presents the main work experience. There is also a
large number involved infarming, an occupation that has practically vanished in
recent years. Most elderly people have, at the age of 75 or more, already lost their
husband or wife, the majority of them live alone, some with their relatives, mostly
children. The results have shown that elderly people in Slovenia mainly live in
their own houses. Although nearly 80% (Nacionalni program varstva okolja 2005)
of the total Slovenian population live in cities, the elderly people represent an
exception (table 2).
35
Table 2. Background information of inquiry participants.
Background
Total
Age in years
75-80
n
81-90
%
n
%
over 90
n
%
n
%
Sex
Male
46
26
29
27
5
39
80
26
Female
134
74
80
73
8
61
222
74
36
Marital status
married/cohabiting
77
44
28
26
2
14
107
Unmarried
7
4
8
7
3
21
18
6
Widowed
90
50
71
66
9
64
170
56
Divorced
6
3
1
1
0
0
7
2
Education
circulating school or less
35
20
21
19
5
37
61
20
primary or junior secondary school
69
38
46
43
3
21
118
39
vocational school
42
23
17
16
3
21
62
20
matriculation examination
13
7
10
9
0
0
23
8
post-secondary education
21
12
14
13
3
21
38
13
Main work experiences
housekeeping
103
57
55
52
6
46
164
54
farming
22
12
14
13
0
0
36
12
work outside home
57
31
37
35
7
54
101
34
Way of living
alone
55
30
33
31
7
50
95
31
with a spouse/partner
62
34
29
27
1
7
92
31
with a spouse/partner and a child
24
14
5
5
1
7
30
10
with a child
29
16
26
24
5
36
60
20
with (an)other relative(s)
8
4
13
12
0
0
21
7
with a friend
3
2
1
1
0
0
4
1
Dwelling
house
110
62
77
70
8
57
195
65
apartment building
52
29
25
23
5
34
82
27
row house
13
7
5
5
1
7
19
6
assisted-living unit
4
2
2
2
0
0
6
2
Place of residence
built-up area
91
51
56
51
7
50
154
51
rural area
88
49
53
49
7
50
148
49
36
5.1.2 Phase II
In phase II the data was collected in Maribor and its rural surroundings by
interviewing elderly people in their homes. The sample group in the qualitative
research was 20 home-dwelling elderly people selected by community nurses.
They were the same elderly people with whom quantitative research had already
been conducted and who were in good physical and mental condition - good
enough to participate and communicate in an interview. The topic of the
interviews was their ability to manage at home.
Community nurses gave to the researcher the elderly person’s name, address
and contact information. Before beginning with the data collection the researcher
contacted 20 selected elderly people by phone and if the elderly people decided to
participate in the study, they arranged a convenient time to visit the person at
home. The interview included 16 female (80%) and 4 male (20%) respondents
(table 3).
37
Table 3. Background information of interviewed participants.
Background
Total
Age
75-80
81-90
n
%
female
7
78
male
2
22
married/cohabiting
4
44
unmarried
0
0
widowed
5
circulating school or less
vocational school
n
%
n
%
9
82
16
80
2
18
4
20
3
27
7
35
2
18
2
10
56
6
55
11
55
7
78
5
46
12
60
1
11
0
0
1
5
matriculation examination
1
11
3
27
4
20
post-secondary education
0
0
3
27
3
15
Sex
Marital status
Education,
Main work experiences
housekeeping
4
45
6
55
10
50
farming
3
33
0
0
3
15
work outside home
2
22
5
45
7
35
Way of living
alone
3
33
5
46
8
40
with a spouse/partner
4
45
3
27
7
35
with (an)other relative(s)
2
22
3
27
5
25
Dwelling
house
4
44
8
73
12
60
apartment building
5
56
3
27
8
40
Place of residence
built-up area
5
56
5
45
10
50
rural area
4
44
6
55
10
50
5.2
Data collection
5.2.1 Phase I
The basic data was collected in the first phase of the survey using a structured
instrument. The original instrument had been used previously in the Finnish
language. In order to use the instrument in this study, it had to be translated from
Finnish into English. The English version, as well as a slightly modified version,
was sent to us by Backman by post, which was subsequently translated into
38
Slovene. The purpose of the translation process was to ascertain the contents of
the items. In order to guarantee a qualitative translation of the English instrument
into the Slovene language it was organised by the cooperation of three
independent official translators. The instrument was primarily translated into
Slovene by the first official translator. Then the instrument was translated from
Slovene back into English by the second official translator. Both English versions
were afterwards compared by the third official translator who verified that all the
questions have preserved the original meaning, and that the reliability and validity
of the translation instrument was ensured. The same type of process was used to
translate the instrument from Finnish to English.
The instrument was based on Backman's theory of the self-care of elderly
people and it was used and tested in Finland. The instrument includes background
data (locality, place of residence, sex, age in years, marital status, education, main
working experience, the way of living, dwelling) and the following subscales
measuring the following factors: the types of self-care, self-care orientation, life
satisfaction (SWLS), self-esteem (Self-esteem Scale) and functional ability
(ADL/IADL Scale) of home-dwelling elderly people. All those types were
summarized by Backman 1999.
When answering the question concerning the types of self-care and self-care
orientation the elderly people had to choose one of the five alternatives (fully
disagree, partly disagree, does not apply, partly agree, and fully agree). By
answering the questions concerning life satisfaction and self-esteem the elderly
people had to choose another five alternatives (strongly disagree, slightly
disagree, neither agree nor disagree, slightly agree, strongly agree), but when
answering questions concerning functional ability they can choose from only
three alternatives (I can manage independently without difficulties, I can manage
independently but with difficulties, I cannot manage independently).
The instrument of life satisfaction was prepared on the basis of Diener’s et al.
(1985). “Satisfaction with Life Scale” (SWLS). Life satisfaction is based on a
cognitive judgemental process, in which a person compares the aspirations and
achievements concerning her/his life. Satisfaction with Life Scale contains five
items that measure general life satisfaction.
According to Backman & Hentinen (2001), the self-esteem of the elderly
people was measured by Rosenberg’s (1965) Self-Esteem Scale. Self-esteem scale
is a 10-item scale. Although the scale was originally designed for adolescents, it
has been used among the elderly population, and it has been shown to have high
internal consistency. The reply alternatives are in the range “strongly agree –
39
strongly disagree”. For this study, a reply alternative “neither agree nor disagree”
was added, to make answering easier and to make the scales of life satisfaction
and self-esteem similar to each other.
The internal consistency of the scales and reliability of the instrument
concerning the factors associated with the self-care of home-dwelling elderly
people was measured using Cronbach’s alpha values. These values varied from
0.75 to 0.95 (Table 4).
Table 4. Cronbach’s alpha coefficients.
Main categories of the instrument
Number of items
Crombach’s α
Self-care
42
0.75
Self-care orientation
14
0.60
Self-esteem
10
0.75
Life satisfaction
5
0.84
Functional capacity
11
0.95
5.2.2 Phase II
In phase II the qualitative interview data was collected. Data collection methods
included open-ended questions concerning the following topics: background data,
types of self-care, self-care orientation, life satisfaction, self –esteem and
functional ability.
Researchers carried out all interviews on the basis of the instrument used in
the quantitative study. Twenty people (16 women and 4 men) were interviewed in
depth, and the interviews were audio-taped. The age of the home-dwelling elderly
people varied between 75 and 90 years or more. The object of the interview was
to gauge their ability to manage at home. A tape-recorder was used the whole
time. The researcher made notes in the transcriptions of the interviews. The
interview took one to two hours or more, dependent on each participant. The
participants were given space to “tell their stories” at their own pace starting
wherever they wish to start and proceeding with minimal interruptions. Noted by
Munhall (2001), Strandmark (2006) the researcher is an active listener who tracks
each story as it is told and notes questions about alternative pathways to be asked
at later time. The interview was an interaction between the two individuals, in
which the actors influenced each other.
40
5.3
Data analyses
5.3.1 Phase I
The data were analysed by exploratory factor analyses (principal component
analyses with varimax rotation and an unlimited number of factors) (Burns &
Grove 2005, Gillis & Jackson 2001). Before the final exploratory factor analyses,
all items with low correlation coefficients (under 0.400) were omitted (Polit &
Hungler 1991, Gillis & Jackson 2001). Items with factor loadings under 0.400
were also omitted, and missing values were excluded likewise. Factors were
extracted using the following guidelines: eigenvalues were greater than one in all
factors and the factors showed a reasonable structure in terms of the theory
underlying the instruments (Gillis & Jackson 2001, Holloway & Wheller 2002,
Gerrish & Lacey 2006). Based on these criteria, a twelve-factor solution was
specified for the first subscale measuring the types of self-care. The factor
analysis started with 42 items and 6 items were omitted based on the above
criterion. The second subscale measuring the self-care orientation four-factor
solution was made with 12 items (two were omitted). Further, two-factor
solutions were specified for the subscales measuring the self-esteem of homedwelling elderly people with 10 items.
Sum variables have been made for each factor of self-care of home-dwelling
elderly people and separated them into three 3 categories (good, moderate, poor),
using percentiles. The procedures of sum variables calculations was done by
adding together all the items of each factor and dividing the total by the number
of those items. The relations between the factor variables were analysed using
cross-tabulations and χ2 test. Also, sum variables of self-care orientation factors
have been made to study connections between internal and external self-care by
χ2 test. Sum variables have been made for each factor, separated into three 3
categories (poor, moderate, good) using percentiles. To classify life satisfaction
sum variables and medians were used; one half of elderly people had good and
the other half low life satisfaction. Median was 3.80, separated into two
categories: low life satisfaction (1.00-3.79) and high life satisfaction (3.80-5.00).
Also sum variables were made to separate the functional capacity of elderly
people into 3 equally strong categories: poor, satisfied and good. According to
statistical calculations (percentiles), elderly people with functional capacity below
1.7273 (on a scale from 1-3, 1 being the best) were classified as poor.
41
In the last step of the quantitative analysis the relation between self-care
behaviour styles and the sum variables was calculated using cross-tabulation. For
that reason elderly people were classified into four different categories of self care
behaviour styles (responsible, formally guided, independent, and abandoned).
Elderly people were classified into the self-care behaviour categories according to
their statements in the instrument. The results were presented as box plots.
The statistical calculation was made by SPSS (Statistical Package for the
Social Sciences) 12.0.1 (licence code: 59405 77973 63044 31074 52597 65917
26825 90336 00, valid until September 2007). SPSS supports all the statistical
methods used in this study.
5.3.2 Phase II
Quantitative research has not sufficiently shown experiences and abilities which
the elderly people have in their home-dwelling. Therefore qualitative research has
also been made by means of which these experiences and abilities of the homedwelling elderly people could be more profoundly analysed in the same
instrument. The interview was carried out according to the content units of the
quantitative instrument (types of self-care, self-care orientation, life satisfaction,
self-esteem, functional ability). In this interview elderly people were orientated
according to these five content units. The elderly people were speaking freely
about their youth, self-care, future expectations and physical abilities in their
every day routines.
Interviews were audio-taped and transcribed verbatim (297 pages in single –
spacing) by the writer and read by the assistant facilitator to ensure the quality of
the transcription. The transcribed text was analysed by qualitative content
analysis. According to Cavanagh (1997), Berg (2001), qualitative analysis
consists of procedures that use categorical data - that is data that concerns
classifications. Each interview of elderly persons in this study was analysed
separately. Each statement or meaningful unit was taken to constitute a
classicising unit. Noted by Graneheim & Lindman (2004), a basic issue when
performing qualitative content analysis is to decide whether the analysis should
focus on manifest or latent content. Analysis of what the text says deals with the
content aspect and describes the visible, obvious components, referred to as the
manifest content. Analysis of the text deals with the relationship aspect and
involves an interpretation of the underlying meaning of the text, referred to as the
42
latent content. Both manifest and latent contents deal with interpretation but the
interpretations vary in depth and level of abstraction.
In this study the first step in the analysis was to read the transcribed
interviews repeatedly to obtain an overall understanding of the data. The second
step was to search for and create meaningful units in each of the interview texts.
Sentences or parts of sentences were identified as a meaningful unit. In the third
step the meaningful units were categorised into themes and then transformed to a
higher level of abstraction. This was carried out independently. The results of
these analyses, which were very similar to those of the content of the instrument
used in the quantitative study, classified together these results with the items on
the instrument. Classification was done according to the following subscales
measuring the following factors: background, experience of health and ageing,
self-care, orientation towards the future, ageing and the future, internal self-care,
external self-care, life satisfaction, self-esteem and functional ability.
In analysing both phase II and the taped interviews of the elderly people, our
attention was focused on the statements that have been especially emphasised or
repeated several times in order to express the importance or agreement with
definite topics. Emphasised or repeated statements were registered for each
particular interview and then added to one of the 91 questions in the quantitative
instrument. In this way quantitative data within the qualitative analyses have been
realized.
5.4
Ethical considerations
The research plan for this study was reviewed and accepted by the Board of the
University of Oulu, the Faculty of Medicine. The Board of the Ethical Committee
in Slovenia approved this research study into home–dwelling elderly people. The
permission to use the instruments was given by the Ethical Committee in
Slovenia. Noted by Tschudin (1999), Owen (2001), Tschudin (2004), Gerrish &
Lacey (2006), Pavliha (2006) the particular ethical issues that arise within focus
group research are the maintenance of confidentiality, consent, the management
of disclosure and maintaining the respect and feeling of self-worth of each
participant.
In this study it was emphasied that participation was completely voluntary.
Written consent was obtained from each elderly person. Anonymity and
confidentiality were assured and permission for the interviews to be recorded was
obtained. Participants were advised that their participation was entirely voluntary
43
and that they had the right to withdraw from the study at any time. Participants
were assured that their confidentiality would be protected and findings reported
anonymously. Quantitative information was obtained using anonymous
instruments. The qualitative information solicited was stored in a locked drawer
and in password protected files and will be destroyed after the completion of the
study report. Information was supported by a written information sheet and
consent was obtained from all the participants. The researcher interviewed the
participants personally and also carried out the transcription work. The data has
not been made available to anyone else.
According to Latvala (1998), a person's rights during a research process
involve respect for privacy, respect for self-determination and informed consent.
Privacy means (Routasalo & Isola 1996) the protection of a person’s integrity and
the protection of an individual or family secret that may have become known to
the investigators during the research process. The person who participates
voluntarily in the study gives his or her consent based on information given. The
person participates voluntarily, understands the purpose of the study and the
option to withdraw from the study without penalty whenever he or she desires.
Noted by Davis & Aroskar (1983), Capron (1991), privacy and confidentiality are
the components of respect for the individual as an autonomous agent.
The ethical principle governing the communication of information is veracity.
Informed consent is related to the elderly’s special right to adequate relevant
information prior to data collection for research purposes. According to Woods &
Catanzaro (1988), Bandma & Badman (1995), an individual can give informed
consent only if he or she has sufficient information on which to base a decision.
Care was taken to ensure that participants were adequately informed about the
purpose of the research and what participation would entail for them, noted by
Puotinieni & Kyngäs (2004). Through the planning, conducting and reporting of
this study every effort has been made to ensure that the research complies with
the highest standards of ethical practice.
44
6
Results
The purpose of this study was to highlight the items that influence the self-care of
home- dwelling elderly people. The first step was quantitative research and
statistical analyses have been calculated to find the most important items. Five
main factors of the instrument were processed and based on classification of
different self-care behavioural styles, some additional comparisons have been
done. The second step was qualitative research of a smaller sample of the same
population. The results of quantitative analysis were used to determine the
appropriate sample. Summary of the qualitative analysis was combined with
quantitative results and final items that influence the self-care of the homedwelling elderly people have been obtained.
6.1
The self-care of home-dwelling elderly people
A factor analysis was performed on the items that measure self-care of home–
dwelling elderly people (table 5). The cells in table 5 represent item loadings. The
factor analysis started with 42 items, 36 with loadings above 0.400 were
extracted. Factors 1, 3, 7 and 11 describe the self-care behaviour of elderly
people; all other factors describe elderly people’s perceptions concerning either
the past or the future. The connection was analysed between the self-care
behaviour of the elderly people and their perception concerning either the past or
the future.
The items in the first self-care behaviour factor (factor 1: handling of
everyday tasks) describe the awareness and willingness to take care of themselves
(physically and medically). Experiences of health and ageing (factor 2: physical
condition) describe positive attitudes regarding elderly people`s physical
condition. The items in the second self-care behaviour factor (factor 3: relation to
health care staff) describe the relation to their health and their relationships with
health care staff (factor 4: family relations) and (factor 5: meaningful and
stimulating ageing) describe the personal relations of elderly people (attitudes
towards other people). All these factors show positive attitude towards self-care.
The items in factor ageing and the future (factor 6: future perceptions) describe
the social and physical aspects of growing old. The items in the third self-care
behaviour factor (factor 7: medication handling) describe the relations to elderly
people`s health. Factors 6 and 7 both show negative self-care. The first
background factor (factor 8: working habits) describes working experiences of
45
elderly people. This factor is positive. The second background factor (factor 9:
past events), describes sad past events or pains. This factor is negative.
The last of the three background factors (factor 10: confidence) describes the
independence and self-confidence of elderly people. This factor is positive. The
fourth self-care behaviour factor (factor 11: medical treatment) describes some
mental and health aspects of growing old. The last factor of ageing and the future
(factor 12: future perspectives) describes the elderly people`s persistence in
wishing to stay at home at any cost. Factors 11 and 12 both show a negative
attitude towards self-care.
46
47
feel I am getting ahead in life
Even as I am growing older, I
young
I still feel myself to be fairly
have medication
relatively healthy, although I
I consider myself to be
inconvenience in my life
cause hardly any
The problems of growing old
younger
condition as when I was
I am in an equally good bodily
F2 – physical condition
medication
I want to be responsible for my
burden on anybody
It is important for me not be a
anybody
.214
.148
.185
.179
.004
.466
.545
.562
and do not need help from
.726
I can still take care of myself
F1
I take care of my own matters
F1 – handling of everyday tasks
Factor name and items
.579
.671
.681
.714
.758
.146
.012
.327
.252
F2
.072
.140
.077
.219
.048
.432
-.021
.024
.089
F3
.366
.129
.322
-.090
.003
-.082
.009
.182
.126
F4
.236
.200
.004
.060
.015
.189
.233
.054
.154
F5
-.059
-.080
.023
-.135
-.014
.048
.131
-.116
.050
F6
Table 5. Factor model of self-care of home-dwelling elderly people (N=302).
.029
.082
.030
-.014
.103
.129
.046
.283
.220
F7
.046
.020
.032
-.053
.041
.236
.062
-.043
.068
F8
-.067
.077
-.156
.135
-.278
.067
-.183
.131
-.105
F9
-.162
.034
.085
.185
.061
.023
-.093
.076
-.023
F10
.102
-.240
.002
.119
.069
-.085
.279
.183
.054
F11
-.058
.060
-.017
.076
-.093
-.191
.217
-.064
-.075
F12
48
cause me problems
I know best myself what things
me
other people who are close to
with my children and/or the
I have close and warm relations
care of me
and trust that people will take
I am confident about the future
F4 – family relations
prescribed to me help me best
I believe that the treatments
me
the doctor has prescribed for
I obediently take the medicine
them
know how to best take care of
provided by experts, I also
and based on the information
I know what illnesses I have,
need help
personnel as soon as I feel I
I consult the health care
and nurses is natural and equal
My cooperation with doctors
F3 – relation to health care staff
Factor name and items
Table 5 (continued).
.191
.067
-.017
-.075
.013
.201
-.047
-.086
F1
.132
.066
.231
-.017
.118
.187
.057
.123
F2
.238
.157
.128
.447
.616
.663
.722
.781
F3
.564
.650
.710
.204
-.046
.268
.004
.223
F4
-.133
.412
.184
-.027
.083
-.018
.308
.110
F5
.155
-.138
.090
.047
.174
.002
.029
-.058
F6
.230
.015
-.112
-.385
-.311
.035
-.027
-.060
F7
.104
.023
-.048
.050
.042
-.053
.030
-.031
F8
.080
-.136
-.065
-.036
.006
-.041
.101
-.091
F9
.115
-.006
-.058
-.061
-.098
-.018
-.012
.022
F10
-.075
.014
.119
.390
.180
-.150
-.021
.138
F11
.203
-.086
.090
-.164
.096
-.081
.026
.059
F12
49
stimulating
than seek help
diagnosed by the doctor rather
take care of the illnesses
I use my own good ways to
it
I take medicine when I feel like
F7 – medication handling
other people's company
inevitably spend less time in
As I am growing older I
longer able to do
give up the things I am no
As I am growing older I have to
of growing old
I just have to adjust to the idea
F6 – future perceptions
.042
-.075
-.233
-.199
.120
.140
.049
-.198
-.185
.137
.343
.256
that I find meaningful and
.107
.021
.102
F2
I enjoy other people's company
.020
F1
My days are filled with things
relations that help me to cope
I have a few interpersonal
ageing
F5 – meaningful and stimulating
Factor name and items
Table 5 (continued).
-.172
-.029
-.022
.070
.067
.210
.210
.140
F3
.089
-.044
-.030
-.023
.104
.267
.187
.057
F4
-.029
.029
-.137
-.015
.022
.446
.678
.800
F5
.091
.062
.578
.709
.783
.072
-.193
.079
F6
.745
.788
.207
.058
-.013
.050
.051
-.045
F7
.075
-.046
-6.200E-05
-.019
.002
.101
.118
-.050
F8
.084
.026
.140
.077
.068
-.237
-.157
.073
F9
.081
-.020
-.096
.012
.054
.020
.028
.001
F10
.018
.105
.005
-.030
.153
.099
-.001
4.474E-05
F11
-.062
.054
.227
.011
-.038
.025
-.023
-.004
F12
50
become
home, no matter how sick I may
I am going to continue living at
F12 – future perspectives
brought along by the future
I must accept the things that will be
expertise
for, as I trust in my doctor's
illnesses my medicines are meant
I do not need to know what
F11 – medical treatment
live
I have always decided myself how I
breadwinner in my family
I have always been the main
F10 – confidence
pains, aches and other complaints
-.073
.001
-.050
.033
-.109
-.114
-.135
My life is dominated by various
-.002
.367
Past events make me bitter
past
There are sad events in my recent
F9 – past events
house
I enjoy doing the daily chores in the
adolescence
.040
-.041
My life has been full of heavy labour
F1
I had to start working in early
F8 – working habits
Factor name and items
Table 5 (continued).
-.027
.182
-.032
.140
.153
-.176
-.084
-.068
.269
.050
-.042
F2
.024
-.084
.158
.225
-.121
.155
-.061
-.005
.184
-.046
.036
F3
.107
-.043
.090
.318
-.054
-.172
-.091
.002
.164
-.098
.062
F4
-.041
.249
-.113
.081
-.019
-.103
-.163
.037
.245
.059
-.018
F5
.062
.329
-.017
.051
.037
.123
.349
.007
.085
-.152
.098
F6
.025
-.113
.274
.180
.062
.094
.096
.033
.029
-.071
.042
F7
.186
-.088
.059
-.070
.344
.109
.141
.016
-.033
.132
.063
.027
.192
.414
.623
.833
-.187
.060
.440
.090
.781
F9
.816
F8
.002
-.012
.076
.638
.695
-.356
.055
.057
-.238
.028
-.036
F10
-.029
.564
.730
.141
.023
.023
-.072
.135
.130
-.055
.041
F11
.832
.250
-.124
.116
-.062
.116
-.056
-.012
-.113
.221
.022
F12
For all extracted factors sum variables were calculated and, according to
percentiles, separated into 3 equal categories (poor, moderate and good). The
relations between the factor variables were analysed using χ2 tests. There were
statistically significant connections between the self-care behaviour and
experiences of health and ageing and attitudes towards other people (table 6, cells
include p-values). These connections were present in nearly all calculations.
Some relations were also found to ageing and the future and to elderly people`s
background.
Table 6. The self-care behaviour and factors connected to it (N=302).
Elderly
physical
people
condition relations
family
meaningful
future
working
past
and
perceptions
habits
events
confidence
future
perspectives
stimulating
background
ageing
handling of
<.001
<.001
<.001
.453
<.001
.497
.837
.099
.001
<.001
<.001
.542
.003
.079
.708
.046
.049
.901
.002
.033
.241
.124
.229
.298
.365
.019
.024
<.001
.262
.051
.211
.076
everyday
tasks
Relationship
with health
care staff
medication
handling
medical
treatment
The results of χ2-tests for the first extracted self-care behaviour factor (handling
of everyday tasks) showed statistically significant connections to physical
condition, family relations, meaningful and stimulating ageing and to working
habits (all having P<0.001) (Table 7). More than 80% of the elderly people who
managed everyday tasks well had good (52%) or moderate (30%) physical
condition. 60% of the elderly people and more who managed everyday tasks well
had good family relations. More than 80% of the elderly people who managed
everyday tasks well had meaningful and stimulating ageing (good 40% and
moderate 43%). Also nearly 80% of the elderly people who managed everyday
tasks well had good (50%) or moderate (30%) working habits.
51
Table 7. Handling of everyday tasks and the factors connected to it (N=302).
Factors connected to the handling of
Handling of everyday tasks
every day tasks
Poor
Moderate
χ2
Well
n
%
n
%
n
%
Poor
50
67
40
34
20
18
Moderate
21
28
48
40
32
30
Good
4
5
31
26
56
52
Total
75
100
119
100
108
100
Poor
28
37
30
25
22
20
Moderate
27
36
43
36
21
20
Good
20
27
46
39
65
60
Total
75
100
119
100
108
100
Poor
39
52.0
37
31
18
17
43
Physical condition
P-value
<0.001
Family relations
<0.001
Meaningful and stimulating ageing
<0.001
Moderate
26
34.7
54
45
47
Good
10
13.3
28
24
43
40
Total
75
100.0
119
100
108
100
Poor
32
43
23
20
22
20
Moderate
35
47
48
40
32
30
Good
8
10
48
40
54
50
Total
75
100.0
119
100
108
100
Working habits
<0.001
The results of χ2-tests for the second extracted self-care behaviour factor
(relationship with health care staff) showed statistically significant connections to
physical condition, family relations, meaningful and stimulating ageing, working
habits and future perspectives (table 8). Nearly 80% of the elderly people who
enjoyed good relations with health care staff had good (48%) or moderate (29%)
physical condition. More than 60% of the elderly people with good relationships
with health care staff had good family relations. Over 80% of the elderly people
with good relationships with health care staff had meaningful and stimulating
ageing (good 43% and moderate 41%). More than 80% of the elderly people with
good relationships with health care staff had good (54%) or moderate (30%)
working habits. All results confirmed the results of the first self-care behaviour
factor (handling of everyday tasks).
The only contradiction represents factor 12: future perspectives, describing
ageing and the future with only one item: "I am going to continue living at home,
no matter how sick I may become". Nearly 90% of the elderly people with good
52
relationships with health care staff had poor (62%) or moderate (26%) future
perspectives. The elderly people who had good relationships with health care staff
(and also in most cases practice healthy self-care behaviour) have difficulty in
accepting that they will probably have to leave their homes at some stage.
Table 8. Relations with health care staff and factors connected to them (N=302).
Factors connected to relations with
Relation to health care staff
health care staff
Poor
Moderate
χ2
Good
n
%
n
%
n
%
Poor
59
47
36
33
16
23
Moderate
36
29
44
41
20
29
Good
30
24
28
26
33
48
Total
124
100
108
100
69
100
Poor
54
43
21
20
5
7
Moderate
37
30
35
32
19
28
Good
33
27
52
48
45
65
Total
124
100
108
100
69
100
Poor
63
51
21
19
11
16
Moderate
44
35
53
49
28
41
Good
17
14
34
32
30
43
Total
124
100
108
100
69
100
Poor
39
31
27
25
11
16
Moderate
54
44
40
37
21
30
Good
31
25
41
38
37
54
Total
124
100
108
100
69
100
Poor
52
43
46
44
43
62
Moderate
38
31
38
37
18
26
Good
32
26
20
19
8
12
Total
124
100
104
100
69
100
Physical condition
P-value
0.001
Family relations
<0.001
Meaningful and stimulating ageing
<0.001
Working habits
0.003
Future perspectives
0.046
The results of χ2-tests for the third extracted self-care behaviour factor
(medication handling) showed statistically significant connections to physical
condition, meaningful and stimulating ageing and future perceptions (table 9).
Nearly 80% of the elderly people with poor medication handling had good (37%)
or moderate (36%) physical condition. These results show that the elderly people
in good physical condition show some signs of irresponsible self-care, but
53
correlation is not strong. More than 80% of the elderly people with healthy good
medication handling had good (26%) or moderate (55%) family relations. Nearly
80% of the elderly people with good medication handling had good (38%) or
moderate (30%) future perceptions, but also correlation is not strong.
Table 9. Medication handling and factors connected to it (N=302).
Medication handling and factors
Medication handling
connected to it
Poor
Moderate
χ2
Good
n
%
n
%
n
%
Poor
32
27
36
46
42
41
Moderate
43
36
21
27
36
35
Good
44
37
21
27
25
24
Total
119
100
78
100
105
100.0
Poor
42
35
33
42
20
19
Moderate
40
34
30
39
58
55
Good
37
31
15
19
27
26
Total
119
100
78
100
105
100.0
Poor
49
41
23
29
34
32
Moderate
46
39
25
32
31
30
Good
24
20
30
39
40
38
Total
119
100
78
100
105
100
Physical condition
P-value
0.049
Meaningful and stimulating ageing
0.002
Future perceptions
0.033
The results of χ2-tests for the fourth extracted self-care behaviour factor (medical
treatment) showed statistically significant connections to family relations,
meaningful and stimulating ageing and to future perceptions (table 10). The
elderly people with good medical treatment had good (38%) or moderate (38%)
family relations. More than 80% of the elderly people with good medical
treatment had meaningless and unstimulating ageing (poor 35% and moderate
46%).
70% of the elderly people and more with good medical treatment had good
(42%) or moderate (34%) future perceptions.
54
Table 10. Medical treatment and factors connected to it (N=302).
Medical treatment and factors
Medical treatment
connected to it
Poor
Moderate
Χ2
Good
n
%
n
%
n
%
Poor
29
22
32
35
19
24
Moderate
32
24
29
31
30
38
Good
69
53
31
34
30
38
Total
131
100
92
100
79
100
Poor
32
24
35
38
28
35
Moderate
52
40
38
41
36
46
Good
47
36
19
21
15
19
Total
131
100.0
92
100
79
100
Poor
67
51
21
23
19
24
Moderate
35
27
39
42
27
34
Good
29
22
32
35
33
42
Total
131
100
92
100
79
100
Family relations
0.019
Meaningful and stimulating ageing
0.024
Future perceptions
6.2
P-value
0.000
The self-care orientation
The factor analysis was performed on the items that measure self-care orientation
of home-dwelling elderly people. The factor analysis started with 14 items. The
factors 1 (ageing) and 2 (youth) have been studied and compared to factors 3 (life
satisfaction) and 4 (coping with the life problem) shown in table 11. Factors 1 and
2 represent internal self-care; factors 3 and 4 represent external self-care. Internal
self-care is presented as care of the mind, emotions, and spirit, as described in the
items “Growing old causes me to feel bitter and sad” or “I feel I was rejected as a
child”. External self-care is presented as an influence from the environment, like
“I had a carefree youth and grew freely to be independent” or “I have had to be
content with my lot in life”.
Factor 1 Ageing and Factor 2 Youth are mutually connected. Those homedwelling elderly people who felt rejected in their youth and had many
responsibilities as children suffer in their old age because of their uncertainity;
their hard way of life has deprived them of their life reserves.
55
Table 11. Factor model of self-care orientation (N=302).
Factors and items
Factor 1: ageing
Factor 1 Factor 2 Factor 3 Factor 4
.805
.195
-.145
.034
I suffer from the uncertainty of life in old age
Growing old causes me to feel bitter and sad
.780
.211
-.135
-.037
I have had hardships in my life that have exhausted my
.525
.106
-.114
.446
resources
Factor 2: youth
I feel I was rejected as a child
.383
.704
.046
.002
I had many responsibilities when I was young, and I did not
.080
.546
-.062
.393
have time for myself
Factor 3: life satisfaction
Old age is a good time in my life
-.358
-.018
.772
.192
I enjoy life in old age
-.319
-.085
.755
.094
Taking care of my own well-being has always been one of the
.266
-.234
.697
-.195
-.012
-.633
.410
.105
I have had things in my life that have helped me to carry on
-.101
-.194
.003
.759
I have had to be content with my lot in life
.050
.057
.134
.618
Adulthood was mentally the most strenuous in my life
.362
-.013
-.052
.404
most important things in my life
I had a carefree youth and grew freely to be independent
Factor 4: coping with problems in life
For all extracted factors sum variables were calculated and separated according to
percentiles into 3 equal categories (poor, moderate and good). After comparison
we made χ2 tests and found out that internal self-care is connected to external
self-care. More than 80% of the elderly people who had good ageing had good
(41%) or moderate (42%) life satisfaction (p< 0.001). Also more than 80% of the
elderly people with good youth had good (51%) or moderate (33%) life
satisfaction (p=0,003). The results confirmed that internal self-care and external
self-care are related. The results are shown in table 12.
56
Table 12. Life satisfaction and its connection to internal self-care (N=302).
Life satisfaction and its connection to
Life satisfaction (external self-care)
internal self-care
Poor
Moderate
χ2
Good
n
%
n
%
n
%
Poor
46
57
37
33
18
17
Moderate
21
26
35
31
46
42
Good
14
17
40
36
45
41
Total
81
100
112
100
109
100
Ageing (Internal self-care)
P-value
<0.001
Youth
0.003
(Internal self-care)
Poor
32
41
25
22
17
16
Moderate
23
28
37
34
35
33
Good
25
31
48
44
55
51
Total
81
100
112
100
109
100
6.3
The self-esteem of home-dwelling elderly people
The factor analysis was performed on the items that measure the self-esteem of
home dwelling elderly people. Factors were extracted using the following
guidelines: eigenvalues were greater than one in all factors and the factors showed
a reasonable structure in the terms of theory underlying the instruments (table 13).
The factor analysis started with 10 items. Factor 1 represents positive self-esteem
and factor 2 negative. Sum variables were formed for the self-esteem group of
items. A median was used for classification: half of the elderly people had good
and other half low self-esteem. The median was 3.80 and two categories were
specified: low self-esteem (1.00-3.79) and high self-esteem (3.80-5.00).
57
Table 13. Factor model of self-esteem (N=302).
Factors and items
Factor 1
Factor 2
Factor 1: good self esteem
I feel that I have a number of good qualities
.790
-.046
I am able to do things as well as most other people
.699
-.004
-.128
I take a positive attitude towards myself
.686
On the whole, I am satisfied with myself
.682
-.168
I feel that I am a person of worth, at least on an
.648
-.172
equal plane with others
Factor 2: poor self esteem
At times I think I am no good at all
.041
.794
All in all, I am inclined to feel that I am a failure
-.059
.782
I certainly feel useless at times
-.132
.650
I wish I could have more respect for myself
-.179
.619
I feel I do not have much to be proud of
-.161
.614
6.4
The life satisfaction of home-dwelling elderly people
Sum variables were formed for life satisfaction group of items. For classification
a median was used: half of the elderly people had good and the other half low life
satisfaction. The median was 3.80 and two categories were specified: low life
satisfaction (1.00-3.79) and high life satisfaction (3.80-5.00). The results were
used to determine how life satisfaction is related to the self-care behavioural
styles of home-dwelling elderly people (chapter 7.6).
6.5
The functional capacity of home-dwelling elderly people
The elderly people in Slovenia must have good functional capacity in order to
stay living at home. Most of the elderly people were in perfect physical condition
(by sum variables: 70% below 1.73; on scale from 1 to 3, 1 being the best). For
that reason it was impossible to separate them into 3 equal categories. The
histogram chart below shows a lack of normal distribution of functional capacity
variable. The value that is significant for normal distribution is skewness (0.848).
Although by some references the skewness should be between {-1, …, 1}, this
would be okay in our case, but the skewness should also lie below twice the
standard error (in our case 0.280). The histogram chart shows the unsymmetrical
distribution (figure 1).
58
Fig. 1. Distribution of functional capacity average values (N=302).
Figure 1 illustrates the unconfirmed rule that each elderly person in Slovenia
should be in good physical condition if he or she wants to stay at home.
6.6
Functional capacity, life satisfaction and self-esteem related to
the self-care behavioural styles of home-dwelling elderly
people
The classification of the elderly people consists of four self-care behaviour
categories: responsible, formally guided, independent and abandoned. Each
elderly person was classified into the self-care behaviour category according to
the majority of the statements he/she made during the interview. Interviews have
been conducted by community nurses. Mainly formally guided behaviour style
(table 14) was shown by n=158 elderly people (52,3%), responsible n=78
(25,8%), independent n=43 (14,2%) and abandoned n=23 (7,6%).
Table 14. Self care behaviour style (N=302).
Self-care behaviour style
n
%
responsible
78
25.8
formally guided
158
52.3
independent
43
14.2
abandoned
23
7.6
Total
302
100.0
a
Age group = 75+
59
Table 15 presents a detailed classification of the elderly people according to
different self-care behaviour combinations. The classification was done according
to the quantitative survey study. All statements were analysed and calculated. The
individual self-care behaviour styles were varied. One hundred of the three
hundred and two elderly people represented responsible self-care behaviour style,
sixty eight responsible self-care behaviour, twenty abandoned self-care behaviour
and eighteen independent self-care behaviour style. There were many elderly
people who represented self-care behaviour combinations. In some cases the
elderly people had not shown clear self-care behaviour style.
Table 15. Table 15: Classification of elderly people according to different self-care
behaviour styles (N=302).
Predominant self-care behaviour style / other self-care behaviour style
Responsible
Number of elderly people
68
responsible/abandoned
8
responsible/abandoned/independent
1
responsible/formally guided/independent/abandoned
1
Total
78
Formally guided
100
formally guided/independent
42
formally guided/responsible/independent/abandoned
12
formally guided/independent/abandoned
3
formally guided/abandoned
Total
Independent
1
158
18
independent/formally guided/abandoned
11
independent/responsible/formally guided
8
independent/formally guided
4
independent/abandoned
2
Total
43
Abandoned
20
abandoned/independent
1
abandoned/formally guided
1
abandoned/formally guided/independent
1
Total
Total
23
302
Sum variables were formed for functional capacity, life satisfaction and selfesteem categories. The relationship between self-care behaviour styles and the
60
sum variables were analysed by using cross-tabulation, and the results are
presented in the figures 2-4 as box plots.
The results show that almost all whose self care behaviour style was
responsible, formally guided or independent managed the daily activities mainly
without help (responsible and independent being the best). Those with abandoned
behaviour style largely couldn't manage the daily activities alone (figure 2).
Fig. 2. Functional capacity and self-care behaviour style (1 being the highest grade)
(N=302).
According to the median, almost half of all whose self-care behaviour style was
responsible, formally guided or independent, had high life satisfaction (formally
guided having the highest). Those with abandoned behaviour style had mainly
low life satisfaction (figure 3).
61
Fig. 3. Life satisfaction and self-care behaviour style (5 being the highest grade)
(N=302).
More or less half of all whose self-care behaviour style was responsible, formally
guided or independent, had high self-esteem (responsible having the highest).
Those with abandoned behaviour style had mainly low self-esteem (figure 4).
62
Fig. 4. Self-esteem and self-care behaviour style (5 being the highest grade) (N=302).
Almost all the elderly people whose self-care behaviour style was responsible,
formally guided or independent managed the daily activities mainly without help,
and had high life satisfaction and self-esteem. The elderly people with abandoned
behaviour style usually couldn't manage the daily activities and had low life
satisfaction and self-esteem.
6.7
The experiences of the elderly people concerning their ability
to manage at home
The study looked at what were the experiences of the aged regarding their
abilities to manage at home. A qualitative research was made with twenty (20)
elderly people older than 75 years in their home-dwelling. Each interview with an
elderly person was analysed separately and each statement or a meaningful unit
was taken to constitute a classicizing unit.
The analysis has started by reading the transcribed interviews repeatedly, to
obtain an overall understanding of the data. The second step was to search for and
create meaningful units in each of the interview texts. Sentences or parts of the
sentences were identified as a meaningful unit. In the third step the meaningful
63
units were categorised into themes and then transformed to a higher level of
abstraction. The vast majority (n=19) of the elderly people started work at an
early age and more than half of them had worked hard all their life. Less than half
of the respondents, although they were mainly women, answered that they had not
dedicated their life to the family, household or children. Some elderly people
(n=9) experienced sad events in the past. Although the respondents said they
wanted to take care of ADL needs, a few made it clear they did not want to
perform household tasks.
Two elderly people confirmed that old age was associated with problems,
although seven (n=7) of them did not agree with that. Others did not recognise old
age as a problem. Half of the elderly people (n=10) took medicine regularly, but it
was not a burden and they felt healthy. Eight (n=8) of them answered that their
life was full of all kinds of pains and difficulties.
Seven (n=7) elderly people took responsibility for taking medicine; the others
did not discuss that topic. Only six (n=6) elderly people have shown natural and
equal cooperation between a doctor and a nurse. The rest of the respondents did
not answer that question as they had not dealt with doctors and nurses. Nine (n=9)
elderly people answered that their illness was well known to them and they were
continuously getting new information about it. Eleven (n=11) elderly people, or
more than half interviewed, answered that they regularly took prescribed
medicine. More than half looked after themselves. Only two out of twenty elderly
people were not able to do that on their own any more.
Seven (n=7) elderly people, i.e. one third of the respondents, had very close
and warm relationships with their children and other people close to them.
However, they spent most time alone.
Ageing meant advancement only to three (n=3) respondents. Six (n=6) of
them had adjusted to the idea of growing old. The majority (n=14) expressed that
their only wish was not to be a burden to anyone. Half (n=10) of the elderly
people expressed the wish that they would like to live at home no matter how ill
they might be. The other half could not state their wish clearly. However, between
the lines it was realized they were not fond of the home for the elderly people. Six
(n=6) elderly people were afraid of the future; five (n=5) were not, because they
had close relationships with their children, who would look after them. The rest of
them did not want to answer the question or changed the topic of conversation.
Half (n=10) of the elderly people meant that they were loved and accepted by
their family. None of them mentioned that the family did not accept him/her, but
from their conversation it could be concluded that they had lived in hardship
64
when they were young and had had no time to wonder if they had been accepted
and loved. Six (n=6) elderly people enjoyed their life in old age.
Eight (n=8) elderly people actually did not enjoy their childhood, because
they were burdened with different chores and had no time for themselves. More
than half (n = 14) had had to come to terms with circumstances they had lived in
and had had no chances to change anything.
Seventeen (n=17) elderly people expressed satisfaction with their life and
only two (n=2) of them were not satisfied with their life. One (n=1) did not want
to state his/her opinion. Seven (n=7) of them meant that they had got in life what
was most important: before all, healthy children, good relationships with the
family and a more or less healthy lifestyle, and that made them satisfied. Five
(n=5) elderly people said that if they could turn the clock back they would not
change anything at all, although six (n=6) elderly people stated they would have
changed a lot if they could.
Generally speaking, most (n=15) of the respondents were satisfied with
themselves. Seven (n=7) elderly people boasted of their good character features,
eight (n=8) answered that they felt equally as capable as other people. Sixteen
(n=16) said they were comparable with other people regarding their worth,
abilities, intelligence and positive spirit; half (n=10) of those questioned had
positive opinions about themselves.
Most of the elderly people could wash their faces (n=13), dress (n=12), and
move within their house or flat with hardly any difficulties (n=13). However,
getting up (n=13), preparing a meal (n=11), easier chores which demand some
skills, could be carried out, but with some difficulties. Within this group of
questions, shopping (n=7) was pointed out as a big problem by the vast majority
of respondents.
6.8
Main findings of the results
Styles of behavioural self-care are responsible, formally guided, independent and
abandoned. Usually formally guided (52,3%) is the most common behavioural
style of home–dwelling elderly people. Those elderly people have high functional
capacity, high life satisfaction and high self-esteem. Responsible behavioural
style follows (25,8%) and the last is independent (14,2%).Those elderly people
who do not take care of themselves are abandoned (7,6%); they are not satisfied
with their way of life and have low self-esteem.
65
Almost all, whose self-care behaviour style was responsible, formally guided
or independent managed the daily activities mainly without any help (responsible
and independent being the best). Elderly people with abandoned behaviour style
mainly couldn't manage the daily activities alone. Elderly people, whose life was
full of heavy labour, are more responsible for self-care with high levels of life
satisfaction. They are responsible for their health, therapies and maintaining
functional capacity and they are satisfied with their own life. Careful treatment
with medicaments is connected with stimulative ageing and clear acceptance of
the future
The elderly people who had good relations with health care staff were in good
physical condition, had good family relations and had meaningful and stimulating
ageing. They were also proud of their past and present working performance. The
future perspectives factor describes the elderly people`s desire to stay at home at
any cost; this is the only negative experience of their self-care.
Almost half of al the elderly people, whose self-care behavioural style was
responsible, formally guided or independent, had high life satisfaction (formally
guided having the highest). Those with abandoned behavioural style had mainly
low life satisfaction. The elderly people whose self-care behavioural style was
abandoned differed clearly from the other categories with regard to their low life
satisfaction.
The responsibly behaving elderly people had high self-esteem, and the elderly
people whose self-care behavior was abandoned had low self-esteem. More or
less half of all, whose self-care behavioural style was responsible, formally
guided or independent, had high self-esteem (responsible having the highest).
Those with abandoned behavioural style had mainly low self-esteem.
Self-care behaviours are connected with the personal experiences gained in
their personal histories and the view of the future of each old woman or man.
66
7
Discussion
The self-care of home-dwelling elderly people living in Slovenia is represented in
this study. It has two phases. The first phase describes the self-care of homedwelling elderly people living in Slovenia and factors connected to self – care.
The second phase describes the experiences of the elderly people`s ability to
manage at home. The study is devided into quantitative and qualitative research.
7.1
Reliability and validity of the study
The adequacy of the research process was examined by assessing the validity and
reliability of the results. Noted by Polit et al. (2006), Burns & Grove (2005),
DiCenso et al. (2005), validity is a measure of the truthfulness and accuracy of a
study in relation to the phenomenon of interest, while reliability represents the
consistency of the measure attained. Validity or reliability is not an all-or-nothing
question, but rather a matter of degrees. The adequacy of the research control
mechanism and the overall research design can be assessed by means of internal
and external validity estimations. According to Gerrish & Lacey (2006),
reliability refers to the extent to which a instrument would produce the same
results if used repeatedly with the same group under the same conditions. Noted
by Holloway & Wheller (2004) instruments are most commonly used in survey
research but may also be a feature of other research designs. They need to be
designed for this purpose, which is a collection of specific information that will
provide answers to the research questions.
The reliability and validity of this study is first discussed from the point of
view of the reliability and validity of the instrument, point of view of the data,
data collection and data analysis, and finally from the point of view of results.
7.1.1 Validity and reliability of the instrument
Validity refers to the degree to which an instrument measures what it is supposed
to be measuring. Three types of validity are often reported: content validity,
construct validity and criterium validity (LoBiondo-Wood 1990, Sonninen 1997,
Polit & Hungler 2001, Burns & Growe 1999).
67
Content validity
Content validity is used to evaluate how well the concepts in a study have been
operationalised (Polit & Hungler 1999). Content validity can be shown by a broad
literature review and assessed by a panel of experts on the area concerned and
increases through the assumption of a logical tie between various items and the
study area (Burns & Grove 2005). Content validity in this study was firstly
verified by a vast literature review regarding self- care of home-dwelling elderly
people. Furthermore, the instruments used in this study were pre -tested by 5
elderly people and evaluated to ensure the content validity of the instrument.
The original instrument has been used previously in the Finnish language. In
order to use the instrument in this study, it had to be translated from Finnish into
English by using the double check method. The English version, as well as a
slightly modified version (some of the issues have been eliminated because of
cultural specifics, such as sauna), was sent to us by Backman by post, which was
afterwards translated into Slovene.
The purpose and criteria of the translation process was to ascertain the
contents of the items and their understandability. In order to guarantee a
qualitative translation of the English instrument into the Slovene language
cooperation of three independent official translators has been organised. The
instrument was primarily translated into Slovene by the first official translator
with the researcher’s help. Then the instrument was translated from Slovene back
into English by the second official translator. Both English versions were
afterwards compared by the third official translator who ascertained that all the
questions have preserved the original meaning, as noted by Harkness (2003).
Before using the instrument, it was pre-tested by five elderly people. The
researcher asked the participants to read the instrument very carefully and give
their comments. In their opinion, units, sentences and statements were logical,
understandable and unambiguous. It was confirmed that the instrument is
understandable and gives support to begin the study and therefore the criteria of
understability were achieved. The content validity of the instrument was found to
be of quality. According to Campbell & Russo (2001) the contents should be
relevant to enable the respondents to answer the questions. The language needs to
be pitched at the appropriate level for the population. Jenkinson et al. (2003) have
explored the premise that criterion validity considers the extent to which the items
in the instrument actually measure the real-world conditions or events that they
are intended to measure.
68
Construct validity
Determines whether the instrument actually measures the theoretical construct it
purports to measure. Nolan et al. (1999) noted that factor analyses are a statistical
procedure and can be used for this purpose. Because the aim of this study was not
to test the theory, exploratory factor analyses were used. According to the results
of factor analyses reported in the results section, the construct validity of the
instrument was found to be good. The results attune well to the theory what was
behind the study.
According to Polit & Hungler (1991), construct validity is the degree to
which an instrument measures the construct under investigation. Construct
validity refers to which items in the instrument adequately cover the construct
being studied. A related, but somewhat complex concept, is factorial validity,
which refers to the clustering of correlations of responses by the grouping of
items in the instrument. Construct validity concerns the degree to which the
instrument measures the construct it was designed to measure, for example,
whether the instrument intended to identify barriers to research utilisation and
actually achieves these objectives. Noted by Burns & Grove (2005), construct
validity can be analysed, for example, by means of factor analysis (exploratory of
confirmatory), a statistical method that is used to identify groups of items. The
results of factor analyses are used in evaluating the congruence of the theoretical
and empirical data structure.
Reliability
Measuring internal-consistency reliability is the calculation of coefficient alpha,
which shows that homogenous items make up one subdimension (Crombach
1951, Burns & Grove 2005). Therefore the reliability of the instrument in this
study was tested with Crombach’s alpha coefficient.
However, a very high alpha coefficient may also be indicative of too
homogenous a situation (Burns & Grove 2005). The consistency values of items
in factor analyses can be regarded as reliability values: the higher the value, the
higher the level of reliability (LoBiondo-Wood & Haber 1990, Gerrish & Lacey
2006). Each item is correlated with any other item on the instrument. Coefficient
alpha is based on the variance – covariance matrix. The range of values for
coefficient alpha is the same as for the other forms of reliability: values range
between 0 and 1, and values closer to 1 reflect a higher level of interrelatedness
69
among the items. The more interrelated the items are, the greater the reliability
(Konicki Di Iorio 2005).
Cronbach's alpha coefficient of the reliability of the instrument in this study
was highly accepted for self-care orientation. The alpha values were as follow;
self-care 0.75, self-care orientation 0.60, self-esteem 0.75, life-satisfaction 0.84
and functional capacity 0,95 (table 4). According to the earlier Backman studies
the internal consistency of the instrument`s functional capacity, life satisfaction
self-esteem was measured in a pilot test (n=50) and in her final study (n=40) in
1994-1995, using Cronbach’s alpha values. These values varied 0.83 to 0.87,
(ADL/IADL Scale), from 0.83 to 0.70 (SWLS), and from 0.55 to 0.82 (Selfesteem Scale) (Backman & Hentinen 2001).
According to Räsänen (2007), the internal consistency of the instrument
varied from not good for that part of the instrument measuring independent selfcare (Cronbach’s alpha is 0.49) to respectable for the parts measuring the types of
self-care and self-care orientation (Cronbach’s alpha is 0.76-0.79). One
explanation for the lower alpha values in that study can be that only two items
were loaded on the factor measuring independent self-care. On the other hand, the
scales functional capacity (Cronbach’s alpha is 0.90), life satisfaction (Cronbach’s
alpha is 0.80), and self-esteem (Cronbach’s alpha is 0.80) of home-dwelling
elderly people had quite high internal consistency. The reliability and validity
calculated from the study in Slovenia showed comparable values to the above
international studies.
Data collection and sampling
All the home–dwelling elderly people in this study were capable of describing
their experiences of self-care. Data was collected by community nurses and
researchers, but only in one part of one phase of the study. Through the research it
was followed by the structural instrument, therefore no data can be changed.
Some of the home-dwelling elderly people could not concentrate all the time in
the quantitative research, so the conclusion is that the instrument was too long for
them, but the other home–dwelling elderly people in qualitative research took a
lot of time for some questions and therefore the interviews lasted longer. The
interviews with the home-dwelling elderly people went smoothly, but with the
some of them there were obvious problems. For example, some elderly people
had a somewhat limited vocabulary, and if their response was unclear, the
researcher repeated or rephrased the question to make sure the elderly people had
70
understood. Problems were also caused by some elderly people tiring quickly and
not being able to concentrate on the interview for more than a short period of
time.
Credibility refers to the truthfulness of the results, and depends on the
researcher's commitment to research and his / her ability to establish a
confidential relationship with the interviewed persons (Juvani et al. 2005). The
researchers had experiences of interviewing elderly people. The credibility of the
research refers to the veracity of the results. Credibility can be assessed based on
a description of the whole research process on the one hand and from the
contextual perspective of the results on the other (Backman et al. 2006). In this
study credibility was confirmed and a confidential relationship established
because the researcher was experienced in working with elderly people.
The sample in the research consisted of 302 home-dwelling elderly people
(quantitative research) and 20 home-dwelling elderly people (qualitative
research). Reliability of the home-dwelling elderly people's responses was
ensured through strict selection criteria. The following selection criteria were: age
75 years and more, ability to communicate, no hearing and no mental problems,
speak Slovene and written consent. Data collection was carried out in two stages:
first, the quantitative structured data was collected, and second, the qualitative
interview data was collected. The sample was representative.
7.2
Validity of qualitative study
The purpose of assessing trustworthiness and the validity and reliability of a study
is to determine whether or not the data collected provides a true picture of the
phenomenon in the study (LoBiondo-Wood & Haber 1994, Polit & Beck 2001,
Burns & Grove 2005, DiCenso et al. 2005). Trustworthiness in qualitative
research means methodological soundness and adequacy (Strauss & Corbin 1998,
Rolfe 2006). Researchers make judgements of trustworthiness possible through
developing dependability, credibility, transferability and conformability.
The findings of a study have to be dependable; they should be consistent and
accurate. This means that readers will be able to evaluate the adequacy of the
research. Credibility corresponds to the notion of interval validity. This means
that the participants recognize the meaning that they themselves give to a
situation or condition and the truth of the findings in their own social context
(Holloway & Wheller 2002, Hope & Waterman 2003). Credibility increases when
the general structure connects essence and criteria to wholeness and the
71
quotations strengthen the interpretations (Strandmark 2006). The researcher’s
findings are, at least, compatible with the perceptions of the people under study.
Guba & Lincoln (1989) use transferability instead of generalisability. This means
that findings in one context can be transferred to similar situations or participants.
Conformability has taken the place of the term objectivity. As the research is
judged by the way in which the findings and conclusions achieve their aim and
are not the result of the researcher’s prior assumptions and preconceptions, Guba
& Lincoln (1989) demand conformability. This again needs an audit or decision
trail where readers can trace the data to their sources. They follow the path of the
researcher and the way he or she arrived at the constructs, themes and their
interpretation (Long & Johnson 2000, Holloway & Wheeler 2004).
The process of interviews was carried out in such a way that anonymity at
interviews was guaranteed, that the licence for tape-recording of the
conversations was asked for and the questions that seemed not reasonable enough
had to be repeated again and precisely explained. The purpose of the interviews
was to check out whether the data obtained by quantitative research was equal to
the data, obtained by qualitative research and whether the home-dwelling selfcare was explained more precisely. In this way the complete picture of the selfcare of the home-dwelling elderly people was presented, and not just the answers
taken from the instrument, as was the case in quantitative research, but also the
environment, behavioural and non-verbal communication. During the
interviewing the elderly people also answered the questions concerning their
dwelling and their behaviour when giving answers was studied. In this way more
precise information about their experiences and ability to manage at home and
expectations for the future were obtained.
7.3
Discussion about findings
Self-care has been studied in nursing sciences (Teel & Leenerts 2005), medicine,
sociology (Billek – Sawbney & Reicherter 2004) and physiology (Grindley &
Zizzi 2005). In nursing sciences, testing and applying Orem’s 1991 self-care
theory in practice is a very topical research area (Whedstone & Reid 1991,
Söderhamm et al. 1996, Sonninen 1997, Teel & Leenerts 2005, William 2004,
Parissopoulus & Kotzabassaki 2004, Kääriäinen & Kyngäs 2005). Different
patient groups and models of self-care associated with different types of treatment
have also been studied (Dellasega 1990, Lukkarinen & Hentinen 1997). The
research area concerning the self-care of elderly people subjects seems to involve
72
evaluating programmes which aim to promote the self-care of the elderly subjects
(Moore 1990, Esposito 1995, Blair 1999). In medicine, the main topics of interest
for the self-care of elderly people are the treatment methods and models of selfcare associated with illness (Cartwright 1990). Noted by Hainsworth (2005), in
sociology such things as social support and psychology and internal factors such
as personal models have been studied in association with self-care.
Many studies have previously been made concerning or touching on the selfcare of elderly people. Most of them have been quantitative, having two or more
factors, such as self-care and functional capacity, measured and compared. Selfcare has also been studied quite briefly in regard to health habits (Nicholas 1993).
Possibly because of these facts, knowledge concerning the self-care of the elderly
people is quite fragmentary and also inconsistent (Backman & Hentinen 1999,
Backman & Hentinen 2001).
Noted by Fung & Carstensen (2002), any synthesis of the self-care of the
elderly people and related factors based on the existing research knowledge is
hampered by the fact that self-care and related factors have been defined from
different theoretical viewpoints and operationalised in a number of different ways.
These studies are international (Fukuhara et al. 1998), and have been conducted
in different cultures and deal with different health problems and health care
systems. Roughly speaking, it can be said that advancing age and declining
functional capacity are likely to affect self-care at some point of the life span
(Norburn et al.. 1995, Greiner et al. 1996).
The findings of this study are consistent with earlier findings according to
Backman, Hentinen (1999). This research of home–dwelling elderly people living
in Slovenia has showed that functional capacity, life satisfaction and self-esteem
are related to the self-care behaviour styles of home-dwelling elderly people. It
has shown that self-care is combined with functional capacity, stimulative ageing
and accepting of the future. Styles of behaviour are responsible, formally guided,
independent and abandoned. Responsible elderly people knew the reasons for any
kind of treatment and wanted to decide whether to have treatments or not. If the
elderly person felt that something was wrong with her/his health, she/he went to
seek help immediately. Responsible elderly people wanted to know the reasons
for their symptoms and the possibilities for treating them; they collaborated with
doctors and nurses all the time and also took good care of their physical
condition. The precondition of responsible self-care was a positive orientation
towards the future and a positive experience of ageing. These elderly people had
often also enjoyed work and they worked hard in their life. Elderly people, who
73
were working hard all their lives, are more responsible for self-care with high
levels of life satisfaction. The meaning of responsible self-care was a desire to
continue having quality of life. They enjoyed various social activities and had
good relationship with their children, neighbours and friends. These elderly
people had a positive orientation towards the future and they also trusted in the
future. The study shows, that responsibly behaving elderly people had high selfesteem too. However they finally take care of themselves. Many elderly people
also showed other concurrent behaviour styles.
Formally guided was based on life experiences of taking care of others and on
a realistic awareness of the effects of old age. In Dill et al. (1995) study, formally
guided self-care consisted of uncritical observance of instructions and routine
performance of daily tasks.
Formally guided elderly people have never prioritised their own needs and
continue to take care of themselves as a matter of routine even in old age. Their
attitude towards the future is characterised by realistic acceptance. They feel close
to their family, neighbours and friends, which makes them confident about the
future and willing to comply with the treatment regimes. Formally guided selfcare behaviour was most common in this study (n =100). This behavioural style
was also mostly connected with the other self-care behaviour styles. Some elderly
people were truly responsible for their daily activities.
The results of this study showed that elderly people whose self-care
behaviour style was independent also managed independently in their daily
activities. This may be partly because these elderly people do not want to have
assistance from others. They work hard to maintain their autonomy. Independent
self-care behaviour was the least of all in this study (n =18).
Independent self-care behaviour implies original and determined ways of
taking care of the daily activities, health and illnesses. These elderly people do not
trust doctors and nurses a lot; they do not follow instructions and regulations.
They always desire to live independently according with own standards. They
have decided to stay at home until they die.
The elderly people whose self-care behaviour style was mainly abandoned
felt helpless and lacked responsibility with low self-esteem. They could, however,
enjoy doing some daily activities similar to the responsible ones or perform
routines in their daily living similar to the formally guided persons. Elderly
people who are not able to manage daily life by themselves may have a different
view of life satisfaction than those with preserved self-care capacity (Borg et al.
2006). Several factors contribute to life satisfaction in elderly people (Baltes &
74
Baltes 1990, McCamish-Svensson et al. 1999, McAuley et al. 2000, Hillerås et al.
2001) and the composition of factors as well as their relative weight may change
when the elderly person`s life conditions change. Abandoned elderly people feel
bitter about life. Grief for one’s own illness or the death of a close person has
begun to dominate life. They do not have the energy to take care of themselves
and are afraid of the future.
7.3.1 Functional capacity and self-care
The functional capacity of elderly people is related to self-care. In this research it
is shown that self-care is combined with functional capacity, stimulative ageing
and acceptance of the future.
Research conducted by Farinasso et al. (2006) showed that functional
capacity and prevalence of self-referred disease among the elderly people in the
area is covered by the Family Health Strategy. According to Lilja & Borell (1997)
functional capacity includes three dimensions: can/does/want. The independent
persons probably badly want to carry out their daily activities by themselves, and
although they do not have the full capacity to manage, they succeeded in
managing their daily living activities. The abandoned elderly people did not
manage their daily activities without assistance from others. This may be because
they do not have enough capacity or willingness to manage independently. Lilja
& Borell (1997), found in their study elderly people of both kinds. The earlier
study (Orlifa et al. 2006) showed that abounding self-care was connected with
loneliness, which appears to be related to low functional capacity. There are
indications however that declining functional capacity promotes social
connections and hence, decreases loneliness. According to Pieper et al. (2002), it
was found that experiences of health and ageing describe positive attitudes
regarding elderly people`s physical condition and positive attitudes toward selfcare. In the present study (Pieper et al. 2002), results were statistically significant
regarding the connection between the self-care behavior style and experiences of
health and ageing and attitudes towards other people. Some relations to ageing
and the future and to elderly people`s background were also found. It was shown
that it has a statistically significant connection to physical condition, family
relations, meaningful and stimulating ageing and to working habits and future
perspectives. It was also found that the elderly people in good physical condition
often take care of their illness, diagnosed by a doctor, by themselves rather than
75
seek help. Elderly people with good medication handling had meaningful and
stimulating ageing and reasonable future perceptions.
Smits & Kee (1992) found that there was no clear connection between selfcare and functional capacity, which the researchers called functional health.
Instead, their research showed strong relationships between self-care and selfconcept and between self-concept and functional capacity. There seem to be
factors concerning the “self” which have an effect on both functional capacity and
self-care.
7.3.2 Life satisfaction of self-care
The elderly people whose self-care behavioural style was abandoned differed
clearly from the other categories with regard to their low life satisfaction. Noted
by Backman & Hentinen (1999), abandoned self-care was related to traumatic life
experience, such as the loss of a spouse. Changes in the life span and coping with
the turning – points also have an effect on life satisfaction in old age. Lichtenstein
et al. (1996) found that the loss of a spouse detracts from life satisfaction and
increases depression. Some studies indicate that high life satisfaction has also
been found to be related to perceived good health (Gfellner 1989, Bowling at al
1993). Activities and self-determination are characteristics of responsible selfcare, and have also turned out to be related to life satisfaction (Vallerand et al.
1989). According to some recent studies (Zika & Chamberlain 1992, Nilsson et
al. 1996), the experience of the meaning of life is connected with high life
satisfaction. Backman & Hentinen (1999) also found that the people whose selfcare behavioural style was formally guided had the highest life satisfaction. This
could be understood through the fact that these elderly people had hardly any
expectations toward life. They had always lived for others, and in old age they
finally felt free, which made them satisfied.
According to many studies (Gfelner 1989, Bowling et al. 1993, Hillerås et al.
2001), perceived health has a remarkable effect on the life satisfaction of elderly
people. Bowling et al. (1993), point out that human emotions are too complex to
be easily explained by a single variable. However, physical health status is
obviously important for many elderly people. Indeed, it makes sense, that health
is a predictor of life satisfaction (Neugarten et al. 1961, Diener et al. 1985). It can
be stated that studies on life satisfaction and self-care indicate that perceptual
well-being, activities, and autonomy are related to life satisfaction. According to
Scott et al. (2003), the perception of personal control plays a critical role in an
76
older person's health and well-being. Social support has been identified as a
powerful mediator of personal well-being. Good social support is associated with
good adaptation.
7.3.3 Self-esteem and self-care
Self-esteem is a positive or negative attitude toward oneself. The self-care of
home–dwelling elderly people is a part of their whole life. It is related to selfesteem, which involves life experiences and life satisfaction, which are composed
from main events.
Self-esteem evolves in relation to the environment (Pruessner et al. 2005).
Anderson & Stevens (1993) have studied self-esteem as a part of well-being in
elderly people. According to Starandmark (2006) the self-image can become more
positive when one meets others who have problems.
According to Andersen and Stevens (1993), the early experiences of parental
care continue to have an impact on the self-esteem of elderly people. The parental
care is recalled as neither warm nor attentive in old age; unattached elderly people
experience more negative self-esteem and loneliness. On the other hand, Krach
(1996) found that social support in old age tends to reduce the deleterious effects
of undesirable life stress by bolstering feelings of self-esteem. He suggested that
the self-esteem of older adults is reinforced when significant others provide
reassurance of worth, caring, love and trust. Correspondingly, the earlier study on
the same data Backman & Hentinen (1999) showed a relationship between
perceived social support and responsible self-care and a relationship between
abandoned self-care and negative experiences of human relations.
7.3.4 Self-care connection to functional capacity, life satisfaction
and self-esteem
Noted by Backman & Hentinen (2001), Berg et al. (2005), elderly people's
functional capacities, life satisfaction and self-esteem may be assumed to be both
components of self-care and factors associated with it. Also according to
Zasuszniewski (1996), Rabiner et al. (1997) and Blair (1999) functional capacity,
satisfaction with life and self-esteem have been found to associate with self-care.
All the results of the qualitative research are comparable with the results of
the quantitative research.
77
In general, the results of both, quantitative and qualitative, have shown that
the elderly people who managed everyday tasks well were in good physical
condition, had good family relations and had meaningful and stimulating ageing.
They were also proud of their past and present working performance. The elderly
people have the ability to manage at home and they wish to stay in their homes as
long as possible.
7.4
Discussion about the possibilities for care for home-dwelling
elderly people
When elderly people living at home are no longer capable of taking care of
themselves, they must leave their home and move to a nursing home, because
there are no services in Slovenia that could take care of those people who are
completely incapable of living alone in their own home. Elderly people who are
completely dependent on the help of others unfortunately cannot be looked after
at home, as our services are not available at night, which seems to be a great
problem. Moving into another environment can cause depression, rejection of
surroundings, rejection of food and hostile mood. Difficulties which elderly
people are confronted with are very different. According to Nacionalne usmeritve
za razvoj kakovosti v zdravstvu (2004), each elderly person must be given the
best possible form of help, ensuring the highest level of independence and safety.
To accomplish this, numerous forms of help are needed on different levels, from
state as well as from non-state organizations.
It is very significant that most elderly people fear becoming immobile, which
is associated with leaving domestic surroundings and moving to a home for the
elderly. Most of the respondents want to stay in their domestic surroundings as
long as possible, regardless of their self-care abilities. Slovenia is striving to equal
other developed countries in considering services, volunteers, and public and
community service (Kožuh – Novak 2004, Ramovš 2004). However, one of the
important factors is also always the lack of money.
The society and the state should find ways to make it possible for the elderly
people to stay in the environment where they lived and worked as long as possible
(Križaj 1999, Habjanič & Železnik 2003). In order to achieve this aim they should
organise different kinds of gerontological services and at, the same time, solve the
housing problems of the elderly; they should further develop the old-age pension
system, establish gerontological out-patient clinics, clubs and centres for the
elderly.
78
7.5
Challenges for nursing practice and further research
By overviewing a lot of literature no other research on self-care for home–
dwelling elderly people in Slovenia has been found and, therefore this research is
the only one and something new in Slovenia. The study is bringing new
knowledge of the self-care of home–dwelling elderly people living in Slovenia.
All results of the study can be used in planning care for elderly people. Noted by
Isola et al. (2003) for good geriatric nursing care, relatives play a very important
role.
In the future, and on the basis of this research, better education about elderly
people is expected to be one of the points that will make elderly people different
from those in this study. High education of elderly people in the future will result
in high levels of self-care and high levels of self-esteem. In planning public care
for the elderly it is essential to prepare the current middle generation for their own
old age, otherwise the welfare problem of the elderly people will escalate.
Increases in the older age group`s demands on the state to be more open to the
development of the present formal forms of help, at the same time forces an
organised approach to the development of the new forms (Black & Hawks 2005).
It is advised that services should be based on an elderly people orientation
(Ashworth et al. 1987, Henrard et al. 2006).
Therefore, gerontology nursing care and rehabilitation should be provided
urgently by the appropriate content, which will be introduced in the
undergraduate professional curriculum of nursing care, as well as into
postgraduate study and specialisation in gerontology nursing care (Salvage 1995,
Božiček 2002, Olenek et al. 2003, Filej 2004). The goal of the educational
development of the nursing care programme for elderly people in Slovenia should
be founded on the present state and also on our projection of the changing
structure of the inhabitants in the future, demanding more complementary
development of the new educational forms of gerontological nursing care.
This knowledge also provides an opportunity for health-care professionals as
well as policy makers to plan for interventions such as meaningful activities,
health-care education with the intention of preserving a high level of functional
ability, participation in preventive health care, which in turn may reduce feelings
of loneliness and worry. The care of elderly people (Gladding 1999, Borg et al.
2006), thus needs an interdisciplinary approach that not only focusses on the
medical problem but also on nurses working in teams, together with other
79
geriatric disciplines to preserve a high level of factors of importance for life
satisfaction among elderly people with reduced self-care capacity.
Community nursing, as a special form of health care at home, must develop
programmes for health promotion in the defined areas and stimulate elderly
people to take care of their own health (Zaletel 1999). Self-care can improve
health outcomes, increase elderly people`s satisfaction and help in developing the
biggest collaborative resource available to the gerontological nursing and social
care. Helping elderly people with self-care represents an exciting opportunity and
challenge for the nursing and social care services to empower elderly people to
take more control over their lives (Kladnik 2002, Kladnik 2003).
Within the health educational and other preventive work in the health centres
and support establishment, the organisation of counselling rooms/offices for
elderly people need to be stimulated, thus enabling them to talk to the doctor,
nurse or social worker. Counselling offices will be available to elderly people
with regard to their health and welfare, helping them to find the way to the
solution to their problem (Pahor 2007). When analysed in short term, the delivery
of home care to the elderly is no less expensive than institutional care. But it is far
more human. When judged over the long term however, home care is actually less
expensive because the state no longer has to invest in building homes for the aged
and because acute hospital beds are no longer occupied by patients who are not in
need of acute care. Because care is now tailored to the individual it is no longer
necessary to offer everything to everybody (Knific 2001-2002). Finally, nurses,
who in the past did not like to work with elderly people (a fact that led to high
rates of job mobility and “burn out”), find satisfaction in their work because their
clients are much happier (Železnik & Batričević 2003). The literature suggests
that the nursing care actually provided is by no means always individualised
(Suhonen et al. 2005).
On the basis of this research other researchers are advised to repeat the same
research on a bigger sample e.g. 10% of all home-dwelling elderly people range
aged from 75–95 years. It is also advised to collect information on home–
dwelling elderly people all over Slovenia. On the base of this result the model of
nursing and social care for home–dwelling elderly people living in Slovenia could
be done. That kind of model could help elderly people to stay longer at home and
their self-care would be higher. If their functional ability is satisfactory, they can
stay longer in their home-dwelling environment, whereby community nursing,
social services and local communities should collaborate in order to take care of
home-dwelling elderly people and their needs.
80
8
Conclusion
The self-care of home-dwelling elderly people who are able to manage their daily
activities, are in good functional capacity and who have good family relations,
live qualitatively and have meaningful stimulating ageing. They are proud of their
past and present working performance. Their self-care is at a high level. Elderly
people whose life was full of heavy labour are more responsible for self-care with
high levels of life satisfaction. They are responsible for their health, therapies and
maintaining functional capacity and they are satisfied with their own life.
Self-care (relations with medical and nursing staff and handling medication)
is connected with functional capacity, family relations, stimulative ageing,
working habits and future perspectives. The elderly people with responsible,
formally guided and independent self-care are capable of high physical activities,
whereas the people with abandoned self-care are essentially behind them. The
same conclusion was also reached through the comparison with life satisfaction
and self-esteem. Those elderly people who do not care for themselves are
abandoned; they are not satisfied with their way of life and have low self-esteem.
Orientation towards the future and ageing is combined with family relations,
stimulative ageing and acceptance of the future. The elderly people with the good
health care are in good family relations and they accepted the future healthily and
clearly. On the other hand where there is also non-stimulation ageing however,
this combination is not so strong. There are two types of different orientation
towards the future: external self-care (youth and ageing) and internal self-care
(life satisfaction and tolerating of life troubles). Internal self-care is connected
with external self-care (hi –square tests). The elderly people with qualitative
childhood and ageing are satisfied with their life (what they have achieved in their
life period).
Half of the elderly people have low self-esteem and low life satisfaction
while the other half have high self esteem and high life satisfaction. The elderly
people in Slovenia who live at home and are completely functionally capable are
also satisfied with their life because they can take care of themselves.
The majority of elderly people whose self care behaviour style was
responsible, formally guided or independent managed the daily activities mainly
without help, had high life satisfaction and high self-esteem. Elderly people with
abandoned behaviour style mainly couldn't manage the daily activities alone, had
low life satisfaction and low self-esteem.
81
From the future perspective, there is the desire of the elderly people to stay at
home in their own house, no matter what happens. Those elderly people also take
care of themselves and have trouble in accepting the fact that they will, at
sometime in the future, also be forced to leave their home because of health
troubles.
82
References
Abbey A & Andrews F (1985) Modelling the psychological determinants of life quality.
Soc Indic Res 16: 1–34.
Aberg AC, Sidenvall B, Hepworth M, O' Reilly K & Lithell H (2004) Continuity of the
Self in Later Life: Perceptions of Informal Caregivers. Qual Health Res 14: 792-815.
Aggleton P & Chalmers H (1985) Models and theories. Nurs Times 81(14): 38-9.
Allardt E (1993) Having, Loving, Being: An Alternative to the Swedish Model of Welfare
Research. In: Nussbam M & Sen A (ed) The Quality of Life. Oxford, Clarendon
Press.
Allender JA & Spradley BW (2001) (ed). Community Health Nursing: Concepts and
Practice. Philadelphia, New York, Baltimore. Lippincott.
Allison SE (2007) Self-Care Requirements for Activity and Rest: An Orem Nursing Focus.
Nur Sci Q: 20(1): 68-76.
Amaducci L (1997) Prevalence of chronic diseases in older Italians: comparing selfreported and clinical diagnoses. The Italian longitudinal Study on Aging Working
Group. Int J Epidemiol 26(5): 995-1002.
Andersson L & Stevens N (1993) Associations between early experiences with parents and
Well-being in old age. Series B, Psychological sciences and social sciences. J
Gerontol 48(3): 109-16.
Andersson M & Gottfries C (1991) Nursing home care: Factors influencing the quality of
life in a restricted situation. Aging 3(3): 229–239.
Ania Lafuente BJ, Suarez Almenara JL, Guerra Hernandez L, Santana Santana AJ, Acosta
Morales CD & Saavedra Rodriguez JM (1997) Healthy ageing and functional
disability among elderly inhabitants of the Canary Islands (Spain). Rev Esp Salud
Publica 71: 161–171.
Arslan S & Gokce-Kutsal Y (1999) A multicenter epidemiological study to evaluate the
prevalence of disability in the elderly. Tur J Geriatr 2: 103–114.
Arve S (1999) Recognition of Depressive Elderly People in health care Services. Turun
Yliopiston Julkaisuja Annales Universitatis Turkuensis. Turku.
Arvidsson B, Löfgren H & Fridlund B (2001) Psychiatric nurses´ conceptions of how a
Group supervision programme in nursing care influences their professional
competence: a 4-year follow-up study. J Nurs Manag 9(3): 161-174.
Ashworth P, Born A, Deelmpoz G, Delmotte N, Kordas E, Kristiansen E, Kyriakidau H,
Šlajmer-Japelj M & Stankova M (1987). People's Needs for Nursing Care.
Copenhagen, WHO Regional Office for Europe.
Aydin S, Yavuz T, Duver H & Kutsal A (2006) Quality of life in the elderly after coronary
bypass surgery. Int Heart J 47: 59- 65.
Backman K & Hentinen M (1999) Model for the self-care of home-dwelling elderly. J Adv
Nur 30: 564-572.
Backman K & Hentinen M (2001) Factors associated with the self-care of home-dwelling
elderly. Nordic College of Caring Sciences. Scand J Caring Sci 15: 195-202.
83
Backman K (2003) Self-care of home-dwelling elderly persons from the view of their
vulnerability. In: Mičetić-Turk D & Kokol P (ed) International Symposium “New
trends in modern nursing”. Maribor, University College of Nursing Studies. 29-34.
Backman K, Paasivaara L & Nikkonen M (2006) Biographical research in nursing science
– two studies as examples of method application. VARD I NORDEN 26(1): 9-14.
Badzek L, Hines SC & Moss AH (1998) Inadequate self-care knowledge among elderly
haemodialysis patients: assessing its prevalence and potential causes. Anna J 25: 239300.
Baker PS, Bodner EV & Allman RM (2003) Measuring life – space mobility in community
– dwelling older adults. J Am Geriatr Soc 51: 1610-1614.
Baltes PM & Baltes MM (1990) Psychological perspectives on successful ageing: The
model of selective optimisation with compensation.In Successful Aging Perspectives
from the Behavioural Sciences (Baltes PM & Baltes MM eds.). New York. Cambridge
University Press. 1-34.
Ball MM , Perkins MM, Whittington FJ, Hollingsworth C, King SV & Combs BL (2004)
Independence in assisted living. J Aging Stud 18: 467-483.
Bandma EL & Bandman B (1995) Nursing Ethics through the life span. Norwalk,
Connecticut. Appleton & Lange.
Beekman ATF , Deeg DJH, van Tilburg T, Smit JH, Hooijer C & van Tilburg W (1995)
Major and minor depression in later life: a study of prevalence and risk factors. J
Affecc Disord 36: 65-75.
Beekman ATF, Penninx BWJH, Deeg DJH, Ormel J, Braam AW & van Tilburg W (1997)
Depression and physical health in later life: results from the Longitudinal Ageing
Study Amsterdam (LASA). J Affect Disord 46: 219-231.
Beland F & Zunzunegui MV (1999) Predictors of functional status in older people living at
home. Age & Ageing 28: 153–159.
Bendixen RM, Mann WC, Tomita M (2005) The relationship of home range to functional
status and cognitive status of frail elders. Phys Occup Ther Geriatr 23: 43-62.
Benyamini Y, Leventhal H & Leventhal EA (2004) Self- rated oral health as an
independent predictor of self-rated general health, self–esteem and life satisfaction.
Soc Sci & Med 59(5): 1109-1116.
Berg BL (2001) Qualitative Research Methods for the Social Sciences. Boston. Allyn and
Bacon.
Berg AI, Hassing LB, Mcclearn GE & Johansson B (2005). What matter for life
satisfaction in the oldest-old? Aging & Ment Health 10(3): 257-264.
Berglung AL & Ericsson K (2003) Different meanings of quality of life: a comparison
between what elderly persons and geriatric staff beleve is of importance. Int J Nurs
Pract 9(2): 112-119.
Billek – Sawbney B & Reicherter EA (2004) Social Cognitive Theory: use by Physical
Therapists in the Education of the Older Adult Client. Top Geriatr Rehabil 20: 319323.
Blair CE (1999) Effects of self-care ADLs on self-esteem of intact nursing home residents.
Issues Ment Health Nurs (29): 559-70.
84
Blazer DG (1998) Depression in late life. Mosby, St. Louis, Toronto, London. 19-31.
Black JM & Hawks JH (2005) Medical- surgical nursing: Clinical management for positive
outcomes. Philadelphia, Elsevier.
Bliss DZ, Fischer LR , Savik K, Avery M & Mark P (2004) The severity of fecal
incontinence in elders at managed care clinic. Res Nurs Health 27: 162-173.
Bliss DZ, Fischer L & Savik K (2005) Managing Fecal Incontinence: Self-Care Practices
of Older Adults. J Gerontol Nurs 31: 35-44.
Borg C, Hallberg IR, Blomqvist K (2006). Life satisfaction among older people (65plus)
with reduced self-care capacity: the relationship to social, health and financal aspects.
J Clin Nurs 15: 607-618.
Bowling A, Farquhar M, Grundy E & Formby J (1993) Changes in life satisfaction over a
two and a half year period among very elderly people living in London. Soc Sci Med
36: 641-655.
Bowling A, Gabriel Z & Dykes J (2003) Let’s ask them: a national survey of definitions of
quality of life and its enhancement among people aged 65 and over. Int J Aging Hum
Dev 56: 269-306.
Božiček V (2002) Zdravstvena vzgoja, usmerjena v delo s starejšim pacientom. Zdrav Var
41: 127-232 .
Bultema JK, Mailliard L, Getzfrid MK, Lerner RD & Colone M (1996) Geriatric patients
with depression. Improving outcomes using a multidisciplinary clinical path model. J
Nurs Adm 26: 31-38.
Burgio KL, Ives DG , Locher JL, Arena VC & Kuller LH (1994) Treatment seeking for
urinary incontinence in older adults. J Am Geriatr Sociaty 42: 208-12
Burke M & Flaherty SMJ (1993) Coping strategies and health status of elderly arthritic
women. J Adv Nurs 18: 7-13.
Burns N & Grove SK (1999) Understanding nursing research. Philadelphia, Pennsylvania.
Saunders Company.
Burns N & Grove SK (2005) The practice of nursing research. Conduct, critique, &
utilisation. The 4 th edition. Philadelphia, the US: W.B. Saunders Company.
Caine ED, Lyness JM & King D (1993) Reconsidering depression in the elderly. American
J Geriatr Psychiatry 1: 4-20.
Calmels P, Bethoux F, Roche G, Fayolle-Minon I & Picano-Gonard C (2003) Evaluation
of the handicap and the quality of life in spinal cord injuries: study in a population of
58 patients living at home, Ann of Readapt Med Physi 46: 233–240.
Campbell DT & Russo MJ (2001) Social measurement. Sage, Thousand Oaks.
Capron AM (1991) Protection of research subjects: Do special roles apply in
epidemiology? J Clin Epidemiol 44 (suppl. l): 81S-89S.
Cartwright A (1990) Medicine taking by people aged 65 or more. Br Med Bull 46: 63-76.
Caspersen CJ, Powell KE & Christenson GM (1985) Physical activity exercise and
physical fitness: Definitions and distinctions for health-related research. Public Health
Rep 100: 126-130.
Cavanagh S (1997) Content analyses: concepts, methods and applications. Nurs Res 4 (3):
5-16.
85
Center for Disease Control and Prevention (2005) Adult participation in recommended
levels of physical activity-United States, 2001-2003. Morb Mortal Wkly Rep 54 (47):
1208-1212.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5447a3.htm(17.03.2007).
Chao SY, Liu HY, Wu CY, Jin SF, Chu TL, Huang TS & Clark MJ (2006) The effects of
group reminiscence therapy on depression, self esteem, and life satisfaction of elderly
nursing home residents. J Nurs Res 14: 36-45.
Cheng CY (2006) Living alone. The choice and health of older women. J Gerontol Nurs 32
(9): 16-23.
Chesney MA (1993) Social Isolation , depression and heart disease: research on women
broadens agenda. Psychosom Med 55: 434-435.
Chopra D & Simon D (2001) Turn back time. Vegetarian Times 289: 68-73.
Christensen BL & Kackrow EO (2003) Fundations of nursing. St. Louis. Mosby.
Cijan R & Cijan V (2003) Zdravstveni socialni in pravni vidiki starostnikov. Maribor:
Visoka zdravstvena šola 117-213.
Clark CC (1998) Wellness self-care by healthy older adults. Image – J Nurs Scholarsh 30:
351-5.
Cocherman W (1996) Health behaviour. Illness behaviour. In: Medical sociology. 6th ed.
New Jersey. University of Alabama in Birmingham: 89–132.
Commission of the European Communities 2005.
Corner J (1993) In search of more complete answers to research questions. Quantitative
versus qualitative research methods: is there a way forward? J Adv Nur 16: 718-727.
Council of Europe (2000) Spremenjena evropska socialna listina. Strasbourg, Council of
Europe.
Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika
16(3): 297-334.
Čačinovič Vogrinčič G (2000) Družina in star človek. Soc delo 39 (4-5): 287-91.
Daly MP (2001) Dementia. In: Adelman AM, Daly MP & Weiss BD (eds.) 20 common
problems in geriatrics. New York. McGraw Hill: 237-260.
Davies S, Laker S & Ellis L (1997) Promoting autonomy and independence for older
people within nursing practice: a literature review. J Adv Nurs 26: 408-417.
Davis AJ & Aroskar MA (1983) Ethical dilemmas and nursing practice. Appelton –
Century – Crofts, Norwalk.
De Raedt R & Ponjaert-Kristoffersen I (2006) Self serving as a cognitive coping strategy to
deal with age-related limitations: an empirical study with elderly adults in a real-life
stressful situation. Aging Ment Health 10: 195-203.
Dean K (1989a) Conceptual, theoretical and methodological issues in self-care research.
Soc Sci Med 29: 117-23.
Dean K (1989b) Self-care components of lifestyles: the importance of gender, attitudes and
the social situation. Soc Sci Med 29: 137-52.
Dean M (2003) Growing older in the 21st Century Growing Older Programme. Swindon.
The ESRC Research programme on Extending the Quality of Life.
86
DeFriece GH & Gordon H (1993) The self-care movement and the gerontological
healthcare professional. Generations 17: 37-40.
Dellasega C (1990) Self-care for the elderly diabetic. J Gerontol Nurs 16: 16-20.
Dening TR, Chi LY, Brayne C, Huppert FA, Paykel ES & Oۢ Connor DW (1998) Changes
in self-rated health, disability and contact with services in a very elderly cohort: a 6year follow-up study. Age & Ageing 27: 23-33.
Denyes MJ, Orem DE & Bekel G (2001) Self-care: a foundational science. Nurs Sci Q 14:
28-54.
DiCenso A, Cullum N, Ciliska D & Guyatt G (2005) Transforming Health Care from the
Inside Out: Advancing Evidence-Based Practice in the 21st Century. J Prof Nurs
21(6): 335-344. Fineout-Overholt.
Diener E, Emmons RA, Larsen RJ & Griffin S (1985) The satisfaction with life scale. J
Pers Assess 49: 71-5.
Dill A, Brown P, Ciambrone D & Rakowski W (1995) The meaning and practice of selfcare by older adults. A qualitative assessment. ResAging 17: 8-41.
Donmez L, Gokkoca Z & Dedeoglu N (2005) Disability and its effects on quality of life
among older people living in Antalya city center, Turkey. Arch Gerontol Geriatr 40:
213-223.
Dragoš S (2000a) Staranje v luči socialnega kapitala (na Slovenskem). Soc delo 39 (4-5):
241-52.
Dragoš S (2000b) Socialne mreže in starost. Soc delo 39 (4-5): 293-314.
Dragoš S (2004) Bo skrb za starost ženskeg spola? Zdrav Ves 73: 531-4.
Edwardson SR & Dean KJ (1999) Appropriateness of self-care responses to symptoms
among elders: identifying pathways of influence. Res Nurs Health 22: 329-39.
Eloniemi-Sulkava U, Rahkonen T, Suihkonen M, Halonen P, Hentinen M & Sulkava R.
(2002) Emotional reactions and life changes of caregivers of demented patients when
home caregiving ends. Ageing Ment Health 6(4): 343-349.
Eloniemi –Sulkava U, Notkola IL , Hentinen M, Kivelä SL, Sivenius J & Sulkava R (
2001) Efects of Supporting Community-Living Demented Patients and their
Caregivers. J Am Geriatr Soc 49(10): 1282-7.
Engberg SJ, McDowell BJ, Burgio KL, Watson JE & Belle S (1995) Self –care behaviours
of older women with urinary incontinence. J Gerontol Nurs 21: 7-14.
Erjavec T, Dobrin M & Bizjak S (2002) Gibanje za zdravo starost. V: Zbornik predavanj:
2. kongres združenja za fizikalno in rehabilitacijsko medicino Slovenskega
zdravniškega društva z mednarodno udeležbo, 3–5 oktober 2002, Portorož.Inštitut
Republike Slovenije za rehabilitacijo, Ljubljana, str. 163-168.
Esposito L (1995) The effects of medication education on adherence to medication
regimens in an elderly population. J Adv Nurs 21: 935-943.
European Commission 2000. Survey of the Current Status of Research into »Ageing« in
Europe by the ad hoc Advisory Committee on Coordination of RTD Policies.
European Commision, Brussels.
Fagerström C, Holst G & Hallberg IR (2007) Feeling hindered by health problems and
functional capacity at 60 years and above. Arch Gerontol Geriatr 44(2): 181-201.
87
Farinasso ALC, Marques S, Rodrigues RAP & Haas VJ (2006) Functional capacity and
referred morbidity of elderly in an area covered by the Family Health Programme.
Rev Gaucha Enferm 27(1): 45-52.
Ferraro KF (1980) Self-Ratings of health among the old and the old -old. “Objective and
self-assessed health in the old and very old.” J Health Soc Behav 21(4):377-383.
Field P & Morse J (1995) Qualitative research methods for health professionals. London.
Sage Publications.
Filej B (2004) Sodobni trendi v zdravstveni negi. V: Trampuš R (ur.) Kakovost
vzdravstveni negi–kako jo prenesti v prakso: Zbornik prispevkov. Nova Gorica.
Društvo medicinskih sester in zdravstvenih tehnikov Slovenije:5-12.
Flaherty JH, McBride M, Marzouk S, Miller DK, Chien N, Hanchett M, Leander S, Kaiser
FE & Morley JE (1998) Decreasing hospitalisation rates for older home care patients
with symptoms of depression. J Am Geriatr Soc 46(1): 31-38.
Forbes DA (2005) An educational programme for primary health care providers improved
functional ability in older people living in the community. Evid Based Nurs 8: 122.
Ford K, Middleton J, Palmer B & Farrington A (1997) Primary healthcare workers:
training needs in mental health. Br J Nurs 6: 1244-1250.
Forss S, Karjalainen P & Tuominen K (1995) Mistä apua vanhana? Tutkimus vanhusten
avuntarpeesta ja eläkeläisten vapaaehtoistyöstä. Helsinki. Eläketurvakeskus,
tutkimuksia.
Fukuhara S, Bito S, Green J, Hsiao A & Kurokawa K (1998) Translation, adaptation, and
validation of the SF-36 health survey for use in Japan. J Clin Epidemiol 51: 10371044.
Fung HH & Carstensen LL (2002) In focus: The knowledge of our years. Ageing Today
23(2): 9-12.
Gallagher R, McKinley S & Dracup K (2003) Effects of a telephone counselling
intervention on psychososocial adjustment in women following a cardiac event. Heart
Lung 32(2): 79-87.
Gerrish K & Lacey A (2006) The Research Process in Nursing. Blackwell Oxford
Publishing.
Gerson L & Berg J (2004) Enhancing Self-Care in Community Dwelling Older Adults.
Geriatr Nurs 25(5): 272-276.
Gfellner BM (1989) Perceptions of health, abilities, and life satisfaction among very old
adults. Percept Mot Skills 68(1): 203-209.
Gibson F (2004) The past in the Present: Using Reminiscence in Health and Social Care.
Baltimore. Health Professions Press.
Gill TM & Feinstein AR (1994) A critical appraisal of the quality of life measurements.
JAMA 272 (8): 619-626.
Gill TM, Allore H & Guo Z (2004) The deleterious effects of bed rest among Communityliving older person. J Gerontol 59(7): 755-761.
Gillis A & Jackson W (2001) Research for nurses: Methods and Interpretation.
Philadelphia. F.A. Davis Company.
88
Gladding ST (1999) Counselling. A comprehensive profession. 4th Edition. Upper Sodlle
River. Prentice Hall, USA.
Glaser BG & Strauss A (1967). The discovery of grounded theory. Chicago. Aldine
Transactisa, IL.
Glaser BG (1978) Theoretical sensitivity. Mill Valley CA. Sociology Press.
Glaser BG (1992) Basics of grounded theory analysis. Mill Valley. Sociology Press.
Goldstein N, Zink M, Stevenson L, Andersson M, Woolery L & Depompolo T (1983)
Self-care: a framework for the future. Teoksessa: Chinn PL (toim) advances in nursing
theory development. Maryland. An Aspen Publication:107-121.
Grbec V (2002) Kodeks etike medicinskih sester in zdravstvenih tehnikov Slovenije V:
Posvet: etika v belem. Portorož, Agencija za management.
Grbec V (2004) 10 letnica Kodeksa etike medicinskih sester in zdravstvenih tehnikov
Slovenije. Obzor Zdr N 38(1): 83-6.
Greiner PA, Snowdon DA & Greiner LH (1996) The relationship of self-rated function and
self-rated health to concurrent functional ability, functional decline and mortality:
findings from the Nun Study. J Gerontol B Psychol Sci Soc 51(5): S234-241.
Grmič V (1997) Politika in morala. V: Rus V (ur) Etika in morala v sodobni družbi:
zbornik. Društvo T.G. Masaryk za filozofsko antropologijo in etiko ter za
humanistične in družbene vede. Ljubljana, Antropos: 225-264.
Graneheim UH & Lindman B (2004) Qualitative content analysis in nursing research:
concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today
24(2): 105-112.
Grindley E & Zizzi S (2005) Using a Multidimensional Approach to Predict Motivation
and Adherence to Rehabilitation in Older Adults. Top in Geriatr Rehabil 21(3): 182193.
Guba EG & Lincoln YS (1989) Fourth Generation Evaluation. New York, Sage.
Guralnik J M, LaCroix A Z, Branch L G, Kasl S V & Wallace R B (1991) Morbidity and
disability in older persons in the years prior to death. Am J Public Health 81(4): 443–
447.
Guralnik JM, Fried LP & Salive ME (1996) Disability as a public health outcome in the
ageing population, Annu Rev Public Health 17: 25–46.
Habjanič A & Železnik D (2003) Modern approaches to gerontological nursing. In:
Mičetić-Turk D & Kokol P (eds) Proceedings: International symposium New Trends
in Modern Nursing, 2nd December, 2003, Maribor, Slovenia. Maribor, University
College of Nursing Studies: 79-82.
Hagberg M, Hagberg B & Saveman BI (2004) The significance of personality factors for
various dimensions of life quality among older people. Ageing & Ment Health 6(2):
178-185.
Hainsworth T (2005) Long-term conditions: A new model of care. Nurs Times 101(3): 2829.
Hansebo G & Kihlgren M (2002) Carers’ interactions with patients suffering from severe
dementia – a difficult balance to facilitate mutual togetherness. J Clin Nurs 11(2):
225-236.
89
Hardy SE, Dubin JA, Holford TR & Gill TM (2005) Transitions between States of
Disability and Independence among Older Persons. Am J Epidemiol 161: 575-84.
Harkness JA (2003) Instrument translation. In: Harkness JA, van der Vijver FJR, &
Mohler PP (eds) Cross-Cultural Survey Methods. New Jersey . John Wiley & Sons.
Hatcher S, Butler R & Oakley-Browne M (2005) Evidence – Based mental Health Care.
Edinburgh. Elsevier Churchill Livingstone.
Health 21: the health for all policy framework for the WHO European Region.(1999).
Copenhagen World Health Organization, Regional Office for Europe.
Helström Y & Hallberg IR (2001) Perspective of elderly people receiving home help, care
and quality of life. Helath Soc Care Community 9: 61–71.
Helström Y, Persson G & Hallberg IR (2004) Quality of life and symtoms among older
people living at home. J Adv Nurs 48: 584-593.
Hendry F & McVittie C (2004) Is quality of life a healthy concept? Measuring and
understanding life experiences of older people. Qual H Res 14: 961-75.
Henrard JC, Ankri J, Frijters D, Carpenter I, Topinkova E, Garms-Homolova V, FinneSoveri H, Wergelanad Sørbye L, Jónsson PV, Ljunggren G, Schroll M, Wagner C &
Bernabei R (2006) Proposal of a service delivery integration index of home care for
older person: application in several European cities. Int J Integr Care 6:
http://www.ijic.org/publish/artlcles/000248/article.pdf
Hennessy CH, Moriarty DG, Zack MM, Scherr PA & Brackbill R (1994) Measuring
health-related quality of life for public health surveillance. Public Health Rev 109:
665-672.
Hillerås P, Jorm A, Herlitz A & Winblad B (2001) Life satisfaction among the very old: a
survey on a cognitively intact sample aged 90 years and above. Int J Aging Hum Dev
52: 71-90.
Hindle D, Dowdeswell B & Yazbeck A (2004) Report of a Survey of Clinical Pathways
and Strategic Asset Planning in 17 EU Countries, http://www.bouwcollege.nl/pdf/
english-573.pdf.
Hobbs Leenerts M, Teel C S & Pendleton M K (2002) Building a Model of Self-Care for
Health Promotion In Ageing. J Nurs Scholarsh 34(4): 355-361.
Hoeymans N & Feskens EJM (1997) Age, time, and cohort effects on functional status and
self-rated health in elderly men. Am J Public Health 87: 1620–25.
Holmes D, Chen WY, Feskanich D, Kroenke CH & Colditz GA (2005) Physical activity
and survival after breast cancer diagnosis. JAMA 293: 2479-86.
Holloway I & Wheller S (2002) Qualitative Research in Nursing. Oxford, Malden, Carlton.
Blackwell Science.
Hope KW & Waterman HA (2003) Praiseworthly pragmatism? Validity and action
research. J Adv Nurs 44(2): 120-127.
Hvalič-Touzery S (2005) Najstarejši ljudje v Sloveniji: demografski pregled. Kakov starost
8(1): 2-19.
Hwang HL, Lin HS, Tung YL & Wu HC (2006) Correlates of perceived autonomy among
elders in a senior citizen home: A cross-sectional survey. Int J Nurs Stud 43: 429-37.
90
Idler EL & Angel RJ (1990) Self-rated health and mortality in the NHANES-I.
Epidemiologic follow-up study. Am J Public Health 80: 446-452.
Inoue K & Matsumoto M (2001) Homebound status in a community-dwelling elderly
population in Japan. Asia Pac J Public Health 13: 109–115.
Isola A, Backman K, Voutilainen P & Rautsiala T (2003) Family members' experiences of
the quality of geriatric care. Scand J Caring Sciences 17(4): 399.
Jakobsson U, Hallberg ILR & Westgreen A (2004) Exploring determinants for quality of
life among older people in pain and in need of help for daily living. Qual Life Res 13:
126-136.
Jenkinson C, Coulter A, Reeves R, Bruster S & Richards N (2003) Properties of the Picker
patient Experience instrument in a randomised controlled trial of long versus short
from survey instruments. J Public Health Med 25(3): 197-202.
Johansen G (1994) Health- care screening among the elderly. Scand J Caring Sci 8: 16972.
Johnson RJ & Wolinsky FD (1993) The structure of health status among older adults:
disease, disability, functional limitation, and perceived health. J Health So Behav 34:
105–121.
Johnson TM, Kincade JE, Bernard SL, Busby-Whitehead J & DeFriese GH (2000) Selfcare practices used by older men and women to manage urinary incontinence: Results
from the national follow-up survey on self-care and ageing. J Am Geriatr Soc 48(8):
894-902.
Jorm AF (1995) The epidemiology of depressive states in the elderly: implications for
recognition intervention and prevention. Soc Psychiatry and Psychiatr Epidemiol 30:
53-59.
Juvani S, Isola A & Kyngäs H (2005) The Northern physical environment and the wellbeing of the elderly aged over 65 yeasrs. Int J Circumpolar Health 64(3): 246-256.
Kamper AM, Stott DJ, Hyland M, Murray HM & Ford I (2005) Predictors of functional
decline in elderly people with vascular risk factors or disease. Age Ageing 34(5): 450455.
Kaplan GA & Camacho T (1983) Perceived health and mortality: a nine-year follow-up of
the human population laboratory cohort. Am J Epidemiol 117: 292-304.
Kaplan A (1964) The conduct of inquiry: Methodology for behavioural science. San
Francisco. Chandler.
Kastumata Y & Arai A (2006) Nonlinear association of higher-level functional capacity
with the incidence of falls in Japan. Am J Phys Med Rehabil 85(8): 688-93.
Kääriäinen M, Kyngäs H (2005) Concept analysis of counselling in nursing science
(abstract). J Nurs Sci 17: 250.
Kempen GIJ, Ranchor AV; van Sonderen E; van Jaarsveld CHM & Sanderman R (2006)
Risk and protective factors of different functional trajectories in older persons:
arethese the same? J Gerontol B Psychol Sci Soc Sci 61(2): 95-101.
Kersnik J (2005) Kakovost v sistemu zdravstvenega varstva Republiki Sloveniji. Pregled
stanja in bodoče usmeritve. Copenhagen. Regionalni urad SZO.
91
Kickbusch I (1989) Self-care in health promotion. Social Science and Medicine 29: 125130.
Kilpi HL, Valimaki M, Dassen T, Gasull M, Lemonidou C, Scott PA, Arndt M & Kaljonen
A (2003) Perceptions of autonomy, privacy and informed consent in the care of
elderly people in five european countres: comparison and implications for the future.
Nursing Ethics. 10(1): 58-66.
Kivelä SL & Pahkala K (1989) Dysthymic disorder in the aged in the community. Soc
Psychiatry Psychiatr Epidemiol 24(2): 77-83.
Kivinen P, Halonen P, Eronen M & Nissinen A (1998) Self-rated health, physician-rated
health and associated factors among elderly men: the Finnish cohorts of the seven
countries study. Age and Ageing 27: 41-47.
Kladnik T (2002) Razvoj in pomen projekta skupine starih ljudi za samopomoč v
Sloveniji. Prepletanja 1: 11-4.
Kladnik T (2003) Skupine za samopomoč - prostor za zadovoljevanje nematerialnih potreb
starih ljudi. Prepletanja 8: 1-7.
Knific B (ed). Usposabljanje in izobraževanje za vodenje medgeneracijskih skupin starih
za samopomoč ( zbornik izbranih tem). Združenje za socialno gerontologijo in
gerontagogiko Slovenije: 2001-2002.
Kobentar R (2004) Socialni odnosi v starosti. Prepletanja 11: 7-9.
Kodeks etike medicinskih sester, babic in zdravstvenih tehnikov Slovenije 2005. Ljubljana.
Zbornica - Zveza medicinskih sester, babic in zdravstvenih tehnikov Slovenije.
Kokol M (2005) Samooskrba starostnika: diplomsko delo. Maribor. Visoka zdravstvena
šola.
Kompare A, Stražišar M & Vec T (2004) Psihologija-spoznanja in dileme. DZS Ljubljana
DZS: 26-35.
Kondo N, Yamagata Z, Minai J & Imai H (2007) Engagement in a cohesive group and
higher-level functional capacity in older adults in Japan: a care of the Mujin. Soc Sci
Med 64(11): 2311-2323.
Konicki Di Iorio C (2005) Measurement in health behaviour. Methods for research and
evaluation. San Francisco. Jossey-Bass.
Kono A & Kanagawa G (2000). Functional changes in one year and related factors among
community-dwelling frail elderly. Nippon Ketsveki Gakkai Zasshi 47 (6): 508-16.
Kožuh Novak M. (ur) (2004) Odprimo poti k sočloveku Ljubljana. Slovenska filantropija.
Krach P, DeVaney S, DeTurk C & Zink MH (1996) Functional status of the oldest-old in a
home setting. J Adv Nur 24: 456-64.
Križaj M (1999) Zdravstvena nega-pomemben dejavnik kakovosti življenja v tretjem
življenjskem obdobju. Obzor Zdr N 33: 269-74.
Krajnc S & Krajnc M (2005) Vpliv skupin starih za samopomoč na kakovost življenja
vlokalni skupnosti. Obzor Zdr N 39: 221-7.
Kutzleb J & Reiner D (2006) The impact of nurse-directed patient on quality of life and
functional capacity in people with heart failure. J Am Acad Nurse Prac 18(3): 116123.
Lantz JM (1985) In search of agents of self-care. J Gerontol Nurs 11(7): 10-14.
92
Latvala E (1998) Patients initiatives in psychiatric nursing in a hospital environment. Acta
Univeristatis Ouluensis, D 490, Oulu.
Lehtola S, Koistinen P & Luukinen H (2006) Falls and injurious falls late in home –
dwelling life. Arch Gerontol Geriatr 42: 217-24.
Leichsenring K (2004) Developing integrated health and social care services for older
persons in Europe. Int J Integr Care 4:h15. ttp://www.ijic.org/publish/artlcles/000193/
article.pdf
Leininger MM (1970) Nursing and anthropology: Two worlds to blend. New York, Wiley.
Leinonen R, Hekkinen E & Jylhä M (2001) Predictors of decline in self-assessments of
health among older people- a 5-year longitudinal study. So Sci Med 52(9): 1329-1341.
Lees SJ & Booth FW (2004) Sedentary death syndrome. Can J Appl Physiol, 29(4): 447460.
Levy B, Slade M, Kunkelj S & Kasl S (2002) Longevity increased by positive selfperceptions of ageing. J Pers Soc Psychol 83(2): 261-270.
Lichtenstein P, Gatz M, Pedersen NL, Berg S & McClearn GE (1996) A co-twin-control
study of response to widowhood. J Gerontol: Psychol Sci Soc Sci 51: 279-289.
Lilja M & Borell L (1997) Elderly people’s daily activities and need for mobility support.
Scand J Caring Sci. 11: 73-80.
LoBiondo-Wood G & Haber J (1990) Reliability and validity. In: LoBiondo-Wood G,
Haber J (ed). Nursing research: methods, critical appraisal, and utilisation, second
edition. St. Louis, MO: Mosby: 247-264.
Long T & Johnson M (2000) Rigour, reliability and validity research. Clin EffectNurs
4(1): 30-37.
Lukkarinen H & Hentinen M (1997) Self-care agency and factors related to this agency
among patients with coronary heart disease. Int J Nurs Stud 34: 295-304.
Magnan MA (2004) The effects of fatigue-related self-care methods and strategies used by
radiation oncology patients. Self-care and Depended Care Nursing 12(3): 12-21.
Markson EW (2003) Personality, adult development, and cognition. In: Markson EW (ed).
Social gerontology today. 157-179. Roxbury. Los Angeles.
McAuley E, Blissmer B, Marquez DX, Jerome GJ & Kramer AF (2000) Social relations,
physical activity, and well-being in older adults. Prev Med 31(5): 608-617.
McCamish-Svensson C, Samuelsson G, Hagberg B, Svensson T & Dehlin (1999) Social
relationships and health as predictors of life satisfaction in advanced old age: results
from a Swedish longitudinal study. Int J Aging 48: 301-324.
McDevitt J, Synder M, Miller A, & Wilbour J (2006) Perceptions of barriers and benefits
to physical activity among out-patients in psychiatric rehabilitation. J Nurs Scolarsh
38(1): 50-55.
McKenna H (1997) Nursing Theories and Models. Routledge, London.
McKevitt C, Redfern J, La-Placa V & Wolfe CD (2003) Defining and using quality of life:
a survey of health care professionals. Clin Rehabil 17: 865-70.
Mead N, Bower P & Gask L (1997) Emotional problems in primary care: what is the
potential for increasing the role of nurses? J Adv Nurs 26(5): 879-890.
93
Mehlsen M, Thomsen DK, Viidik A, Olesen F & Zacharae R (2005) Cognitive processes
involved in the evaluation of life satisfaction: implications for well-being. Ageing
Ment Health 9(3): 281-290.
Mendes de Leon CF, Krumholz HM, Seeman TS, Vaccarino V, Williams CS, Kasl SV &
Berkman L F (1998) Depression and risk of coronary heart disease in elderly men and
women: New Haven EPESE, 1982-1991. Arch Intern Med 158(21): 2341-2348.
Mesec B (2000) Teorija Roberta Atchleya o kontinuiteti v starosti. Soc delo 39(4-5): 35564.
Metler M & Kemper DW(1993) Self-care and older adults: making healthcare relevant.
Generations 17: 7-10.
Mihelič K (2005) Varstvo človekovih pravic v Evropski uniji. Kranj. Fakuleta za
podiplomske državne in evroske študije.
Miilunpalo S, Vuori I, Oja P, Pasanen M & Urponen H (1997) Self-rated health status as a
health measure: the predictive value of self reported health status on the use of
physician services and on mortality in the working age population. J Clin Epidemiol
50: 517-528.
Miles M & Huberman A (1994) Qualitative data analysis. Thousand Oaks, CA. Sage
Publications.
Miller MD, Schulz R, Paradis C, Houck PR, Mazumdar S, Frank E, Dew MA & Reynolds
CF (1996) Changes in perceived health status of depressed elderly patients treated
until remission. Am J Psychiatry 153(10): 1350-52.
Miloševič Arnold V (2000) Profesionalne vloge socialnih delavcev pri delu s starostnikom.
Soc delo 39 (4-5): 253-62.
Minardi HA & Blanchard M (2004). Older people with depressive: pilot study. J Adv Nurs
46 (1): 23-32.
Ministrstvo za zdravje Republike Slovenije 2004. Strategija skrbi za starejše na področju
zdravstvenega varstva v obdobju 2005 – 2010, Ljubljana.
Mohar P (1993) Temelji medicinske etike in deontologije. Ljubljana. Zavod Republike
Slovenije za šolstvo in šport.
Moore EJ (1990) Using self-efficacy in teaching self-care to the elderly. Holist Nurs Pract
4(2): 22-29.
Mossey JM & Shapiro E (1982) Self-rated health: a predictor of mortality among the
elderly. Am J Public Health 72(8): 800-808.
Munhall PL (2001) Nursing Research. (3rd edition). A Qualitative Perspective. Sadbury.
Jones and Bartlett Pub.
Munhall PL (1989) Philosophical ponderings on qualitative research methods in nursing.
Nurs Sci Q:2(1): 20-8.
Nacionalne usmeritve za razvoj kakovosti v zdravstvu (2004). Ljubljana. Ministrstvo
zazdravje Republike Slovenije,. Nacionalni program varstva okolja, 2005.
http://www.sigov.si/mop/podrocja/uradzaokolje_sektorokolje/porocila/npvo/novice.ht
ml, 17.5.2006.
Neikrug S (2003) Worrying about a frightening old-age. Ageing Ment Health 7:326-33.
94
Neugarten BL, Havighurst RJ & Tobin SS (1961) The measurement of life satisfaction. J
Gerontol 16: 134-143.
Nevalainen TH, Hiltunen LA & Jalovaara P (2004) Functional ability after hip fracture
among patients home-dwelling at the time of fracture. Centr Eur J Public Health
12(4): 211-216.
Nicholas PK (1993) Hardiness, Self-care practices and perceived health status in older
Adults. J Adv Nurs 18: 1085-94.
Niccole LH (1997). Perspectives on nursing theory (3rd ed.). Philadelphia. LippincottRaven.
Nilsson M, Ekman SL, Ericsson K & Winblad B (1996) Some characteristics of the quality
of life in old age illustrated by means of Allardt’s concept. Scan J Caring Sci 10: 166121.
Nolan M, Morgan L, Curran M, Clayton J, Gerrisg K & Parker P (1999) Evidence- based
care: can we overcome the barriers? Br J Nurs 7(20): 2173-2178.
Norburn JEK, Bernard SL, Konrad TR et al. (1995) Self – care and assistance from others
in coping with functional status limitations among a national sample of elder adults. J
Gerntol 50: 101–109.
Ohayon MM, Zulley J, Guilleminault C, Smirne S & Priest RG (2001). How age and
daytime activities are related to insomnia in the general population: consequences for
older people. J Am Geriatr Soc 49(4): 360-366.
Okumiya K, Morita Y, Nishinaga M, Osaki Y, Doi Y, Ishine M, Wada T, Ozawa T &
Matsubayashi K (2005) Effects of group work programmes on community-dwelling
elderly people with age-associated cognitive decline and/or mild depressive moods: A
Kahoku Longitudinal Aging Study. Geriatrics Gerontol Int 5(4): 267-275.
Olenek K, Skowronski T, Schmaltz D (2003) Assessment: Geriatric nursing assessment. J
Gerontol Nurs 19(8): 5-9.
Orem D, Taylor S & McLaughlin K (2001) Nursing: concepts of practice. St. Louis.
Mosby.
Orem DE (1991) Nursing. Concepts of Practice. StLouis. Mosby Year Book.
Ory M, DeFriese G & Duncker A (ed) (1998) The nature, extent, and modifiability of selfcare behaviours in later life. In: Ory M & DeFriese G (ed) Self-care in later life:
Research, programme, and policy issues. New York. Springer 3-10.
Orlifa F, Ferrer M, Lamarca R, Tebe C, Domingo-Salvany A & Alonso J (2006) Gender
differences in health-related quality of life among the elderly: the role of objective
functional capacity and chronic condition. Soc Sci Med 63(9): 2367-2380.
Ostchega Y, Harris TB, Hirsch R, Parsons VL & Kington R (2000) The prevalence of
functional limitations and disability in older persons in the US: data from the National
Health and Nutrition Examination Survey III. J Am Geriatr Soc 48(9): 1132–1135.
Owen S (2001) The practical, methodological and ethical dilemmas of conducting focus
groups with vulnerable clients. J Adv Nurs 36: 652-658.
Ovid Aquero-Torres HAB, Hillerås PK, Winblad Bengt (2001) Disability in activities of
daily living among the elderly. Curr Opin Psychiatry 14: 355-359.
95
Ozcan A, Donat H, Geleck N, Ozdirenc M & Karadibak D (2005) The relationship
between risk factors for falling and the quality of life in older adults. BMC Public
Health 5: 90.
Pahor M & Domajnko B (2007) Kdo me bo gledal? Socialna opora, zdravje in bolezen
starejših ljudi. Teor praksa 44(1/2): 254-76.
Parissopoulos S & Kotzabassaki S (2004) Orem’s self-care Theory, transactional analysis
and the management of elderly rehabilitation. ICUS and Nursing Web Journal 17:
http://www.nursing.gr/OREM.pdf (11p).
Pavliha M (2006) Pravice in soodgovornost življenja v starosti. Velenje. Pozoj, Tecum.
Pavliha M (2005) Izkušnje v razvoju soacilanega varstva – izkušnje seniorjev, Socialni
izzvi. 20: 11.
Pečjak V (1999) Nov psihološki pogled na staranje. Zdrav Var 38(1/2): 10-13.
Pentek M (1999) Stereotipi o značilnostih starejše populacije. Zdrav Var 38: 1-4.
Perry JS & Thomas P (1980) Attitudes toward present and expected life satisfaction for
self and others. Psychol Rep 47: 1086.
Peruzza S, Sergi G, Vianello A, Pisent C, Tiozzo F, Manzan A, Coin A, Inelmen E M &
Enzi G (2003) Chronic obstructive pulmonary disease (COPD) in elderly subjects:
impact on functional status and quality of life. Respir Med 97: 612-617.
Petek Štern M & Kersnik J (2004) Obravnava starostnika v družinski medicini. Zdrav
Vestn 73(10): 767-71.
Peternelj A & Šorli J (2004) Neakutna obravnava – nepogrešljivi del v celostni zdravstveni
oskrbi. Zdrav Vestn 73(10): 743-748.
Petry H (2003). Ageing happens: Experiences of Swiss women living alone. J Women and
Ageing. 15(4): 51-68.
Picavet H S & Hoeymans N (2002) Physical disability in The Netherlands: prevalence, risk
groups and time trends. Public Health 116: 231-7.
Picavet H S & Van den Bos G A (1997) The contribution of six chronic conditions to the
total burden of mobility disability in the Dutch population, Am J Public Health 87:
1680–82.
Pihlar Z (2003) Vloga delovnega terapevta v rehabilitaciji starostnika na domu. V: Erjavec
T & Marn-Vukadonović D (ur) Možnosti in potrebe po rehabilitaciji straostnikov na
domu. Ljubljana. Združenje za fizikalno in rehabilitacijsko medicino–SZD,
Gerontrološko društvo Slovenije. 64-67.
Pieper R, Vaarama M & Fozard J L (2002) Gerontechnology. Technology and Ageing –
starting into the Third Millennium. Shaker Verlag. Aachen.
Piper S (2006) Qualitative theory testing as mixed-method research. J Res Nurs 11(3): 183193.
Polit DE & Hungler B P (1991) Nursing research: Principle and methods. Philadelphia,
London, Hagerstown. J. B. Lippincott.
Polit DE & Hungler B P (1995) Nursing research: Principle and methods. Philadelphia. J.
B. Lippincott.
Polit DE, Beck CT, Hungler BP (2001). Essentials of nursing research: methods,
appraisals, and utilization. Philadelphia, New York, Baltimore J. B. Lippincott.
96
Polit D E., Beck CT., Hungler BP (2006). Essentials of nursing research: methods,
appraisals, and utilization. 6th ed. Philadelphia, New York, Baltimore. J. B. Lippincott.
Poredoš P (2004) Zdravstveni problemi starostnikov. Zdrav Vestn 73/(10): 753-756.
Pruessner JC, Baldwin MW, Dedovic K, Renwick R, Mahani NK, Lord C, Meaney M &
Lupien S (2005) Self-esteem, locus of control, hippocampal volume, and cortisol
regulation in young and old adulthood. Nevroimage 28(4): 815- 26.
Puotiniemi TA & Kyngäs H (2004) The coping of an adolescent who has been in
psychiatric inpatient care and her mother in every day life. J Psychiatr Ment Health
Nurs, 11(6): 675-682.
Rabiner DJ, Konrad TR, DeFriece GH, Kincade J & Bernard SL (1997) Metropolitan
versus nonmetropilitan differences in functional status and self-care practice. Findings
from a national sample of community-dwelling older adults. J Rural Health (13): 1428.
Ramovš J (2000) Medgenaracijska povezanost, samopomoč in kakovostna starost. Soc
delo 39(4-5): 315-28.
Ramovš J (2003) Kakovostna starost:socialna gerontologija in gerontagogika. Ljubljana.
Inštitut Antona Trstenjaka.
Ramovš J (2004) Specifika potreb in oskrbe starih ljudi s stališča socialnega dela. Zdrav
Vestn 73:7 21-730.
Ramovš J (2005) Izhodišča in predlogi za nacionalni program socialnega varstva starih
ljudiv obdobju 2006 do 2010 ter za nacionalno strategijo razvoja družbe z velikim
deležem starega prebivalstva. Kakov starost 8(3): 2-38.
Räsänen P, Backman K, Kyngäs H (2007) Development of an instrument to test the
middle-range theory for the self-care of home-dwelling elderly. Scand J of Carinäg
Sciences 21(3): 397-405.
Regoršek V (2005) Stari ljudje v Sloveniji danes in jutri. V: Ali smo pripravljeni na starost
jutrišnjega dne? 1. večdisciplinarno psihogeriatrično srečanje. Maribor. Splošna
bolnišnica. 1-9.
Rode N (2005) Translation of Measurement Instruments and their Reliability: An Example
of Job-Related Affective Well-being Scale. Metodol zv 2(1): 15-26.
Rolfe G (2006) Technical rationality and the theory practice gap. Nurs Sci Q 19: 39-43.
Rosa TE, Benicio MH, Latorre M, Mdo R & Ramos LR (2003) Determinant factors of
functional status among elderly. Rev Saude Publica 37(1): 40–48
Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press.
Rosenberg M (1985) Self-concept and psychological well-being in adolescence. In The
Development of the Self (Leahy R. ed).Academic Press, Orlando: 205-246.
Rosenberg M, Schooler C, Scoenbach C, Rosenberg F (1995) Global Self-Esteem and
Specific Self-Esteem: Different concepts, different outcomes. Am Sociol Rev 60(1):
141-156.
Routasalo P & Isola A (1996) The right to touch and be touched. Nurs Ethics 3(2): 165176.
97
Salvage J. Nursing in action. Strengthening nursing and midwifery to support health for
all. Translated by Filej B (1995) Nove usmeritve v razvoju zdravstvene nege Maribor.
Kolaborativni center SZO za primarno zdravstveno nego, Zdravstveni dom dr. Adolfa
Drolca Maribor.
Salvatore T (2000). Elder suicide: A preventable tragedy. Caring 19: 34-37.
Sandelowski M. (2000) Combining qualitative and quantitative sampling, data collection,
and analysis techniques in mixed-method studies. Res Nurs Health 23: 246-255.
Scheffler I (1967) Science and subjectivity Indianapolis. Bobbs-Merill.
Sesso HD, Kawachi I, Vokonas PS & Sparrow D (1998) Depression and the risk of
coronary heart disease in the Normative Ageing Study. Am J Cardiol 82(7): 851-856.
Scott PA, Välimäki M, Leino-Kilpi H, Dassen T, Gasull M, Lemonidou C, Arndt M,
Schopp A, Suhonen R & Kaljonen A (2003) Perceptions of autonomy in the care of
elderly people in five European countries. Nurs Ethics 10(1): 28-38.
Shin SN & Shin FJ (1999) Health needs of lone elderly Chinese men with heart disease.
Nurs Ethics (6): 58-72.
Silva MC, & Rothbart D (1984). An analysis of changing trends in philosophies of science
on nursing theory development and testing. AdvNurs Sci 6(2): 1-13.
Silverman D (2006). Interpreting qualitative data: Methods for analysing talk, text and
interaction.(3rd ed.). Thousand Oaks, CA. Sage.
Silverman D (2005) Doing qualitative research: A practical handbook (2nd ed.). London.
Sage. Slovar slovenskega knjižnjega jezika (2005). Ljubljana. DZS.
Smits MW & Kee CC( 1992) Correlates of self-care among the independent elderly.Selfconcept affects well-being. J Gerontol Nurs 18(9): 13-8.
Snowdon J, Burgess E, Vaughan R & Miller R (1996) Use of antidepressants, and the
prevalence of depression and cognitive impairment in Sydney nursing homes. Int J
Geriatr Psychiatry 11: 599-606.
Söderhamn O, Evers G & Hamrin E (1996) A Swedish version of the Appraisal of Selfcare Agency (ASA) Scale. Scand J Caring Sci 10: 3-9.
Söderhamn O (1998) Self- care ability in a group of elderly Swedish people: a
phenomenological study. J Adv Nurs 28(4): 745-53.
Söderhamn O (2001). Health and the internal Structure of the self-care Ability Scale for
the elderly (SASE). Scand J Occup Ther 8(2): 67-71.
Sonninen AL (1997) Testing Reliability and Validity of the Finnish Version of the
Appraisal of Self-Care Agency (ASA) Scale with Elderly Finns. Kuopion yliopiston
julkaisuja E. Yhteiskuntatieteet 44, Kuopio.
Sparks M, Zehr D & Painter B (2004) Predictors of life satisfaction. Perceptions of Older
Community-Dwelling Adults. J Gerontol Nurs 30: 47-53.
Statistical Yearbook of the Republic of Slovenia 2005.Ljubljana.Statistical office of the
Republic of Slovenia
Stevens–Ratchford RG (2005) Occupational Engagement. Motivation for Older Adult
Participation.Top Geriatr Rehabil 21: 171-181.
98
Stineman MG, Ross RN, Maislin G (2005) Functional status measures for integrating
medical and social care. Int J Integr Care 5: http://www.ijic.org/publish/articles/
000236/article.pdf .
Strain LA (1991) Use of health services in later life: the influence of health beliefs. J
Gerontol 46(3): 143-150.
Strandmark KM (2006) Health means vital force – a phenomenological study on selfimage, ability and zest for life. Vard I Norden 79: 42–47.
Strandmark KM (2004) Ill health is powerlessness – a phenomenological study about
worthlessness, limitation and suffering. Scand J Caring Sci 18(2): 135-144.
Strauss A & Corbin J (1998) Basics of qualitative research: Techniques and procedures for
developing grounded theory. Thousand Oaks, CA. Sage Publications.
Suhonen R, Välimäki M & Leino-Kilpi H (2005) Individualised care, quality of life and
satisfaction with nursing care. J Adv Nurs 50(3): 283-92.
Suzuki M, Ohyama N, Yamada K & Kanamari M (2002) The relationship between fear of
falling, activities of daily living and quality of life among elderly individuals. Nurs
Health Sci 4: 155-61.
Svanborg A (1988) Practical and functional consequences of ageing. Gerontology 34
(suppl. 1): 11-15.
Šabovič M (2004) Sodobna načela internistične geriatrije. ISIS 13(8/9): 37-40.
Šelb-Šemrl J, Rok-Simon M, Kelšin N & Ivas N (2004) Staranje prebivalstva v Sloveniji:
Demografske spremembe in nekaj posledic za zdravstveno varstvo. Zdrav Vestn
73(5): 27-31.
Tannock C & Katona C (1995) Minor depression in the aged. Concepts, prevalence and
optimal management. Drugs Ageing 6: 278-292.
Teel CS & Leenerts MH (2005) Developing and testing self-care interventions for older
adults in caregiving roles. Nurs Res 54(3): 193-201.
Toljamo M & Hentinen M (2001) Adherence to self-care and social support. J Clin Nurs
10(5): 618-627.
Tomey AM & Alligood MR (2002) Nursing theorists and their work (5th ed.). St. Louis.
Mosby.
Toth M (2004a) Ekonomske dimenzije starosti. Ljubljana. Slovensko zdravniško društvo.
Toth M (2004b) Koriščenje zdravstvenih storitev po življenjskih obdobjih, zlasti po 65 letu
starosti. Zdrav Vestn 73(10): 731-735.
Toye C, White K & Rooksby K (2006) Fatigue in frail elderly people. Int J Palliat Nurs
12(5): 202-8.
Tschudin V (1999) Nurses methers. London. MacMillan Press.
Tschudin V (2004) Etika v zdravstveni negi: razmerja skrbi Ljubljana. Educy: Društvo
medicinskih sester in zdravstvenih tehnikov.
Topping A (2006) The quantitative – qualitative Continuum. In: Gerrisg K & Lacey A
(eds)The research process in nursing. Oxford, Malden, MA, Blackwell Publishing
157-158.
Tseng S Z & Wang R H (2001) Quality of life and related factors among elderly nursing
home residents in southern Taiwan. Public Health Nurs 18(5): 304-311.
99
Tudor-Locke CE & Myers AM (2001). Challenges and opportunities for measuring
physical activities in sedentary adults. Sports Med, 31(2): 91-100.
Uhlmann RF & Pearlman RA (1991) Perceived quality of life and preferences for lifesustaining treatment in older adults. Arch Intern Med 151(3): 495-497.
Uradni list Republike Slovenije (2000) Ljubljana: št. 49-2333.
Vallerand RJ, O´Connor BP & Blais MR (1989) Life satisfaction of elderly individuals in
regular community housing, in lowcost community housing, and high and low selfdetermination nursing homes. Int J Aging Hum Dev 28(4): 277-283.
Wenger GC & Burholt W (2003) Changes in levels of social isolation and loneliness
among Older People in a Rural Area – A 20-Year Longitudinal Study. Bangor
CSPRD, University of Wales.
Whedstone WR & Reid J (1991) Health promotion of older adults: perceived barriers. J
Adv Nurs 16(11): 1343-1349.
William L (2004) The utility of self-care theory as a theoretical basis for self-neglect. J of
Adv Nurs 34(4): 545-551.
Woods N & Catanzaro M (eds.) (1988) Nursing Research: Theory and Practice. St Lous.
Mosby.
Yang Y & George LK (2005) Functional disability, disability transitions, and depressive
symptoms in late life. J Ageing Health 17(3): 263-292.
Zaletel M (1999) Kakovost življenja starostnikov in zdravstvena nega. Zdrav Var 38(1/2):
45-9.
Zasuszniewski JA (1996) Self-help and help-seeking behaviour patterns in healthy elders. J
Holist Nurs 14(3): 223-236.
Zika S & Chamberlain K (1992) On the relation between meaning in life and psychological
well-being. Brit J Psychol 83: 133-145.
Zupančič M (2004) Pozna odraslost. In: Marjanovič Umek L & Zupančič M (ur) Razvojna
psihologija. Ljubljana. Filozofska fakulteta Univerze v Ljubljani.
Železnik D & Batričević L (2003) Quality of life and self - care of older people in Slovenia
and Montenegro: Diploma assignment. Lovisenberg University College.
Železnik D (2005) Kakovost življenja starostnikov. In: Špelič M & Špur M (ur.) Paliativna
oskrba boljnikov:zbornik. Ljubljana. Zbornica zdravstvene nege Slovenije. 16-17.
100
APPENDIX 1
Interview instrument: Self-care, functional capacity, life satisfaction and self-esteem of
the home-dwelling elderly.
BACKGROUND DATA
1. Locality __________________________________________________________________
2. Place of residence
1 built-up area
2 rural area
3. Sex
7. Your main working experience
1 male
2 female
1 housekeeping
2 farming
3 work outside home
4. Your age in years
_______ years
8. Your way of living
1 alone
2 with a spouse/partner
3 with a spouse/partner and a child
4 with a child
5 with (an)other relative(s)
6 with a friend
5. Your marital status
9. Your dwelling
1 married / cohabiting
1 house
2 unmarried
2 apartment building
3 widowed
3 row house
4 divorced
4 old people’s home
5 assisted-living unit
6. Your education
1 circulating school or less
2 primary or junior secondary school
3 vocational school
4 matriculation examination
5 post-secondary education
101
TYPES OF SELF-CARE
10. I had to start working in early
Fully
Partly
Does not
disagree
disagree
apply
Partly agree
Fully agree
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
adolescence
11. I sacrificed my life to
housekeeping and child care
12. My life has been full of heavy
labour
13. I have always been the main
breadwinner in my family
14. I have always decided myself
how I live
15. Past events make me bitter
1
2
3
4
5
16. There are sad events in my
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
recent past
17. I still feel myself to be fairly
young
18. The problems of growing old
cause hardly any inconvenience in
my life
19. I consider myself relatively
healthy, although I have
medication
20. I am in an equally good bodily
condition as when I was younger
21. My life is dominated by various
pains, aches and other complaints
22. I want to be responsible for my
medication
23. I consult the health care
personnel as soon as I feel I need
help
24. My co-operation with doctors
and nurses is natural and equal
25. I know what illnesses I have,
and based on the information
provided by experts, I also know
how to best take care of them
26. I enjoy doing the daily chores
in the house
102
27. I obediently take the
Fully
Partly
Does not
disagree
disagree
apply
Partly agree
Fully agree
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
medicines the doctor has
prescribed me
28. I do not need to know what
illnesses my medicines are meant
for, as I trust in my doctor’s
expertise
29. I take medicines when I feel
like it
30. I use my own good ways to
take care of the illnesses
diagnosed by the doctor rather
than seek help
31. I believe that the treatments
prescribed to me help best
32. I know best myself what things
cause my problems
33. I can still take care of myself
1
2
3
4
5
34. I let other people take care of
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
the daily chores
35. I enjoy other people’s
company
36. I have close and warm
relations with my children and/or
the other people who are close to
me
37. My days are filled with things
that I find meaningful and
stimulating
38. Even as I am growing older, I
feel I am getting ahead in life
39. I am confident about the future
and trust that people will take care
of me
40. As I am growing older, I
inevitably spend less time in other
people’s company
41. I just have to adjust to the idea
of growing old
103
42. As I am growing older, I have
Fully
Partly
Does not
disagree
disagree
apply
Partly agree
Fully agree
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Partly agree
Fully agree
to give up the things I am no
longer able to do
43. In old age I must let other
people take care of my needs
44. I must accept the things that
will be brought along by the future
45. I take care of my own needs
and do not need help from
anybody
46. I am dependent on the help
given by my family and friends
47. It is important for me not be a
burden on anybody
48. I am going to continue living at
home, no matter how sick I may
become
49. I have a few interpersonal
relations that help me to cope
50. I feel I am no good for
anything any more
51. I am afraid of the future
SELF-CARE ORIENTATION
Fully
Partly
Does not
disagree
disagree
apply
1
2
3
4
5
53. I feel I was rejected as a child
1
2
3
4
5
54. I had a carefree youth and
1
2
3
4
5
1
2
3
4
5
52. I feel I was accepted and
loved as a child
freely grew to be independent
55. I had many responsibilities
when I was young, and I did not
have time for myself
56. Adulthood was mentally the
1
2
3
4
5
most strenuous time in my life
57. I enjoy life in old age
1
2
3
4
5
58. I suffer from the uncertainty of 1
2
3
4
5
life in old age
104
59. I have had to be content with
Fully
Partly
Does not
disagree
disagree
apply
Partly agree
Fully agree
1
2
3
4
5
1
2
3
4
5
61. I have had hardships in my life 1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
65. Growing old causes me to feel 1
2
3
4
5
Strongly
Slightly
Neither
Slightly agree
disagree
disagree
agree nor
my lot in life
60. I have had things in my life
that have helped me to carry on
that have exhausted my resources
62. Taking care of my own wellbeing has always been one of the
most important things in my life
63. I have not had the time or the
opportunity to think about myself
and my own well-being
64. Old age is a good time in my
life
bitter and sad
LIFE SATISFACTION
Strongly
agree
disagree
66. In most ways my life is close to 1
2
3
4
5
2
3
4
5
my ideal
67. The conditions of my life are
1
excellent
68. I am satisfied with my life
1
2
3
4
5
69. So far I have achieved the
1
2
3
4
5
1
2
3
4
5
Strongly
Slightly
Neither
Slightly agree
Strongly
disagree
disagree
agree nor
important things I want in life
70. If I could live my life over, I
would change almost nothing
SELF-ESTEEM
agree
disagree
71. On the whole, I am satisfied
1
2
3
4
5
72. At times I think I am no good at 1
2
3
4
5
with myself
all
105
73. I feel that I have a number of
1
2
3
4
5
74. I am able to do things as well as 1
2
3
4
5
2
3
4
5
good qualities
most other people
75. I feel I do not have much to be
1
proud of
76. I certainly feel useless at times
1
2
3
4
5
77. I feel that I am a person of
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
80. I take a positive attitude toward 1
2
3
4
5
worth, at least on an equal plane
with others
78. I wish I could have more
respect for myself
79. All in all, I am inclined to feel
that I am a failure
myself
FUNCTIONAL ABILITY
I can manage
I can manage
I cannot manage
independently without
independently, but with
independently
difficulties
difficulties
81. Washing
1
2
3
82. Dressing
1
2
3
83. Getting out of bed
1
2
3
84. Toiletry
1
2
3
85. Moving indoors
1
2
3
86. Moving outdoors
1
2
3
87. Preparing a meal
1
2
3
88. Light housework
1
2
3
89. Managing tasks that
1
2
3
1
2
3
1
2
3
require dexterity (e.g.
taking the correct dose of
medicine)
90. Taking a bath or
having a shower
91. Shopping
106
Appendix 2
Table 16. Life experiences, background (N=20).
Life experiences background
remarks
yes
no
I had to start working in early adolescence
19
1
I sacrificed my life to housekeeping and child care
8
0
My life has been full of heavy labour
12
0
There are sad events in my recent past
9
0
Table 17. Life experiences, experience of health and ageing (N=20).
Life experiences of health and ageing
Remarks
yes
no
7
2
I consider myself relatively healthy, although I have medication
10
0
My life is dominated by various pains, aches and other complaints
8
0
The problems of growing old cause hardly any inconvenience in
my life
Table 18. Self-care (N=20).
Self-care
Remarks
yes
no
I want to be responsible for my medication
7
0
My cooperation with doctors and nurses is natural and
6
1
9
0
11
0
12
2
equal
I know what illnesses I have, and based on the
information provided by experts, I also know how to take
care of them in the best way possible
I obediently take the medicines the doctor has
prescribed me
I can still take care of myself
Table 19. Orientation towards the future, attitudes towards other people (N=20).
Orientation towards the future and its attitudes towards
other people
I have close and warm relations with my children and/or
Remarks
yes
no
7
0
the other people who are close to me
107
Table 20. Orientation towards the future and ageing (N=20).
Orientation towards the future and ageing
Remarks
yes
no
Even as I am growing older, I feel I am getting ahead in life
3
4
I just have to adjust to the idea of growing old
6
1
I must accept the things that will be brought along by the
6
1
It is important for me not to be a burden to anybody
14
0
I am going to continue living at home, no matter how sick I
10
0
6
5
future
may become
I am afraid of the future
Table 21. Internal self-care (N=20).
Internal self-care
Remarks
yes
no
I feel I was accepted and loved as a child
10
0
I had a carefree youth and grew freely to be independent
4
3
I enjoy life in old age
6
2
Old age is a good time in my life
7
2
Table 22. External self-care (N=20).
External self-care
I had many responsibilities when I was young, and I did not
Remarks
yes
no
8
0
14
0
have time for myself
I have had to be content with my lot in life
108
Table 23. Life satisfaction.
Life satisfaction
Remarks
positive remarks
negative remarks
I am satisfied with my life
17
2
So far I have got the important things I wanted in my life
7
1
If I could live my life over, I would change almost nothing
5
6
Table 24. Self-esteem.
Self-esteem
Remarks
positive remarks
negative remarks
On the whole, I am satisfied with myself
15
2
I feel that I have a number of good qualities
7
0
I am able to do things as well as most other people
8
1
I feel that I am a person of worth, at least I have equal
16
0
10
0
footing with others
I take a positive attitude toward myself
Table 25. Functional ability.
Functional ability
Remarks
positive remarks
negative remarks
Washing
13
6
Dressing
12
6
Getting out of bed
13
5
Visiting the toilet
13
5
Moving indoors
13
5
Moving outdoors
13
5
Preparing a meal
11
7
Light housework
12
7
Managing tasks that require dexterity (e.g. making the
14
2
correct dose of medicine)
Taking a bath or having a shower
11
3
Shopping
7
13
109
D954etukansi.kesken.fm Page 2 Wednesday, October 24, 2007 3:08 PM
ACTA UNIVERSITATIS OULUENSIS
SERIES D MEDICA
939.
Hirsso, Päivi (2007) Alopecia; its prevalence and association with cardiovascular
diseases, risk factors and quality of life—cross-sectional population-based studies
940.
Tuohimäki, Carita (2007) The use of coercion in the Finnish civil psychiatric
inpatients. A part of the Nordic project Paternalism and Autonomy
941.
Karvonen, Juha T. (2007) Somatization in young adults. The Northern Finland
1966 Birth Cohort Study
942.
Poutanen, Raija (2007) Boys and girls as health-promoting actors—determinants
of oral health-related lifestyle among 11- to 12-year-old schoolchildren
943.
Arpiainen, Satu (2007) Transcriptional regulation of the hepatic cytochrome P450
2a5 gene
944.
Päiväläinen-Jalonen, Satu (2007) Expression and stability of myelin-associated
elements
945.
Tiainen, Johanna (2007) Bioresorbable plain and ciprofloxacin-releasing selfreinforced PLGA 80/20 implants' suitability for craniofacial surgery. Histological
and mechanical assessment
946.
Aaltonen, Vesa (2007) PKC and neurofibromin in the molecular pathology of
urinary bladder carcinoma. The effect of PKC inhibitors on carcinoma cell
junctions, movement and death
947.
Kuvaja, Paula (2007) The prognostic role of matrix metalloproteinases MMP-2
and -9 and their tissue inhibitors TIMP-1 and -2 in primary breast carcinoma
948.
Siira, Virva (2007) Vulnerability signs of mental disorders in adoptees with genetic
liability to schizophrenia and their controls measured with Minnesota Multiphasic
Personality Inventory
949.
Komulainen, Silja (2007) Effect of antihypertensive drugs on blood pressure
during exposure to cold. Experimental study in normotensive and hypertensive
subjects
950.
Anttonen, Vuokko (2007) Laser fluorescence in detecting and monitoring the
progression of occlusal dental caries lesions and for screening persons with
unfavourable dietary habits
951.
Torppa, Kaarina (2007) Managerialismi suomalaisen julkisen erikoissairaanhoidon
johtamisessa. Tutkimus yksityissektorin johtamisoppien soveltamisesta neljässä
yliopistollisessa sairaanhoitopiirissä ja arvio managerialismin soveltuvuudesta
julkisen erikoissairaanhoidon uudistamiseen
Book orders:
OULU UNIVERSITY PRESS
P.O. Box 8200, FI-90014
University of Oulu, Finland
Distributed by
OULU UNIVERSITY LIBRARY
P.O. Box 7500, FI-90014
University of Oulu, Finland
D954etukansi.kesken.fm Page 1 Wednesday, October 24, 2007 3:08 PM
D 954
OULU 2007
UNIVERSITY OF OULU P.O. Box 7500 FI-90014 UNIVERSITY OF OULU FINLAND
U N I V E R S I TAT I S
S E R I E S
SCIENTIAE RERUM NATURALIUM
Professor Mikko Siponen
HUMANIORA
TECHNICA
Professor Harri Mantila
Professor Juha Kostamovaara
MEDICA
ACTA
U N I V E R S I T AT I S O U L U E N S I S
Danica Železnik
E D I T O R S
Danica Železnik
A
B
C
D
E
F
G
O U L U E N S I S
ACTA
A C TA
D 954
SELF-CARE OF THE HOMEDWELLING ELDERLY PEOPLE
LIVING IN SLOVENIA
Professor Olli Vuolteenaho
SCIENTIAE RERUM SOCIALIUM
Senior Assistant Timo Latomaa
SCRIPTA ACADEMICA
Communications Officer Elna Stjerna
OECONOMICA
Senior Lecturer Seppo Eriksson
EDITOR IN CHIEF
Professor Olli Vuolteenaho
EDITORIAL SECRETARY
Publications Editor Kirsti Nurkkala
ISBN 978-951-42-8636-0 (Paperback)
ISBN 978-951-42-8637-7 (PDF)
ISSN 0355-3221 (Print)
ISSN 1796-2234 (Online)
FACULTY OF MEDICINE,
DEPARTMENT OF NURSING SCIENCE AND HEALTH ADMINISTRATION,
UNIVERSITY OF OULU;
FACULTY OF HEALTH SCIENCES,
UNIVERSITY OF MARIBOR
D
MEDICA