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Mental health promotion among community-dwelling seniors with multimorbidity: perspectives of seniors, district nurses and home care assistants
Sophiahemmet University. Karolinska Institutet.ORCID iD: 0000-0002-5923-8764
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The prevalence of mental illness is increasing among the older population in Sweden. One of the most vulnerable groups for mental health problems is older persons with multimorbidity, i.e. seniors with multiple chronic conditions. Many of them remain in their own homes with a comprehensive and complex need of support and healthcare, mainly provided by home care assistants (HCAs) and district nurses (DNs). However, the detection of mental health problems for adequate treatment or to promote mental health among community-dwelling seniors with multimorbidity, calls for skills and competences in this area.This thesis aimed to gain a deeper understanding of how mental health may be promoted among community-dwelling seniors with multiple chronic conditions. Four studies have been included in this thesis (I-IV). All studies had a qualitative descriptive design with either a phenomenographic approach or latent and manifest qualitative content analysis technique. The aim of study I was to describe the variations in how community-dwelling seniors with multimorbidity perceived the concept of mental health and what may influence it. The findings showed the participants conceptualised mental health as having both positive and negative facets. The participants further conceived that social contact, physical activity and optimism may improve mental health, while social isolation, ageing, and chronic pain may worsen it. Study II aimed to describe the experience of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity, and what these seniors believed to be important for achieving a dialogue that may promote their mental health. The main finding was the necessity of being seen as a unique individual by an accessible and competent person. Further, the participants missed having friends and relatives to talk to and they especially lacked healthcare or social service providers for health-promoting dialogues that may promote mental health. The aim of study III was to describe DNs’ perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity. Findings revealed that the DNs’ focus was on assessment, collaboration and social support as a way of detecting mental health problems and promoting mental health. Study IV described HCAs’ perspectives on detecting mental health problems and promoting mental health among the seniors in focus. The findings revealed that continuity of care and the seniors’ own thoughts and perceptions were regarded as essential for the detection of mental health problems. Further, observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health.Conclusions: The results of this thesis are based on interviews and show that: 1) Seniors with multimorbidity should have an opportunity to describe how multiple chronic conditions may affect their life situation; 2) An optimal level of care can be achieved through continuity, involvement, and by providing a health-promoting dialogue based on the person’s wishes and needs; 3) Even if DNs seemed engaged in primary mental healthcare, there were no expressed goals set in the improvement of mental health, and it seemed that these DNs could not bear the primary responsibility for early detection of mental health problems and early interventions to improve mental health; 4) HCAs had knowledge about risk factors for mental health problems and it appears that they were dependent on care managers’ decision-making in granted support, as well as supervision from DNs in the detection of mental health problems and to promote mental health.In summary, the finding in the present thesis demonstrates that managing mental health problems is still an ongoing challenge for those organisations providing continuity in home care and home healthcare for homebound elderly persons with complex chronic conditions. The finding in the thesis also shows that DNs and HCAs seem to be dependent on each other in this area. Mental health promotion was expressed as an important assignment among DNs and HCAs, even though they describe different prerequisites and factors which could be seen as barriers in the detection of common mental health problems such as depression, anxiety and sleep problems. These personnel further described difficulties in collaboration and transmission of information between care- and healthcare providers from the community and primary care context. Social and physical interventions - as well as social contacts and social support to break social isolation - seemed important according to all the informants, with their different perspectives of how mental health may be promoted.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2015. , 95 p.
Keyword [en]
Ageing, Care of older people, District nurse, Home care assistants, Mental health, Mental health promotion, Municipal care, Nursing, Older people, Primary healthcare, Sweden
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:shh:diva-2002ISBN: 978-91-7676-076-5 (print)OAI: oai:DiVA.org:shh-2002DiVA: diva2:876070
Public defence
2015-12-11, Erforssalen, Sophiahemmet Högskola, Valhallavägen 91, Ingång R, Stockholm, 13:00
Opponent
Supervisors
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-06-09Bibliographically approved
List of papers
1. How community-dwelling seniors with multimorbidity conceive the concept of mental health and factors that may influence it: a phenomenographic study
Open this publication in new window or tab >>How community-dwelling seniors with multimorbidity conceive the concept of mental health and factors that may influence it: a phenomenographic study
2012 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7, 19716- p.Article in journal (Refereed) Published
Abstract [en]

Multimorbidity, that is, the coexistence of chronic diseases, is associated with mental health issues among elderly people. In Sweden, seniors with multimorbidity often live at home and receive care from nursing aides and district nurses. The aim of this study was to describe the variation in how community-dwelling seniors with multimorbidity perceive the concept of mental health and what may influence it. Thirteen semi-structured interviews were analysed using a phenomenographic approach. Six qualitatively different ways of understanding the concept of mental health and factors that may influence it, reflecting key variations of meaning, were identified. The discerned categories were: mental health is dependent on desirable feelings and social contacts, mental health is dependent on undesirable feelings and social isolation, mental health is dependent on power of the mind and ability to control thoughts, mental health is dependent on powerlessness of the mind and inability to control thoughts, mental health is dependent on active behaviour and a healthy lifestyle, and mental health is dependent on passive behaviour and physical inactivity. According to the respondents' view, the concept of mental health can be defined as how an individual feels, thinks, and acts and also includes a positive as well as a negative aspect. Social contacts, physical activity, and optimism may improve mental health while social isolation, ageing, and chronic pain may worsen it. Findings highlight the importance of individually definitions of mental health and that community-dwelling seniors with multimorbidity may describe how multiple chronic conditions can affect their life situation. It is essential to organize the health care system to provide individual health promotion dialogues, and future research should address the prerequisites for conducting mental health promotion dialogues.

Keyword
Aged, Care of older people, Mental health promotion, Municipal care, Nursing, Phenomenography, Primary health care
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:shh:diva-1998 (URN)10.3402/qhw.v7i0.19716 (DOI)000312271000001 ()23237629 (PubMedID)
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-01-20Bibliographically approved
2. Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity
Open this publication in new window or tab >>Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity
2014 (English)In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 7, 189-199 p.Article in journal (Refereed) Published
Abstract [en]

Mental health promotion needs to be studied more deeply within the context of primary care, because persons with multiple chronic conditions are at risk of developing poor mental health. In order to make progress in the understanding of mental health promotion, the aim of this study was to describe the experiences of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity - what these seniors believe is important for achieving a dialogue that may promote their mental health. Seven interviews with six women and one man, aged 83-96 years, were analyzed using qualitative content analysis. The results were summarized into nine subcategories and three categories. The underlying meaning of the text was formulated into an overarching theme that embraced every category, "perceived and well-managed as a unique individual". These seniors with multimorbidity missed someone to talk to about their mental health, and needed partners that were accessible for health dialogues that could promote mental health. The participants missed friends and relatives to talk to and they (crucially) lacked health care or social service providers for health-promoting dialogues that may promote mental health. An optimal level of care can be achieved through involvement, continuity, and by providing a health-promoting dialogue based on seniors' needs and wishes, with the remembrance that general health promotion also may promote mental health. Implications for clinical practice and further research are discussed.

Keyword
Aged, Care of older people, Mental health-promotion, Municipal care
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:shh:diva-1999 (URN)10.2147/JMDH.S59307 (DOI)24812516 (PubMedID)
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-01-20Bibliographically approved
3. District nurses' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity
Open this publication in new window or tab >>District nurses' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 17-18, 2590-2599 p.Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES:

To describe district nurses' perspectives on detecting mental health problems and promoting mental health among homebound older people with multimorbidity.

BACKGROUND:

Mental health problems among older people with multiple chronic conditions, that is, multimorbidity, are challenging issues. These patients' homes often serve as arenas in which district nurses can promote health. Mental health promotion must be studied in greater depth within primary care because older people with multimorbidity are particularly prone to developing poor mental health, which can go undetected and untreated.

DESIGN:

A descriptive, qualitative study using semi-structured interviews and content analysis.

METHODS:

Twenty-five district nurses completed individual or focus group interviews. Data were analysed using qualitative content analysis.

RESULTS:

Most district nurses stated that detecting mental health problems and promoting mental health were important tasks but that they typically focused on more practical home health care tasks. The findings revealed that district nurses focused on assessment, collaboration and social support as means of detecting mental health problems and promoting mental health.

CONCLUSIONS:

The district nurses described various factors and actions that appeared to be important prerequisites for their involvement in primary mental health care. Nevertheless, there were no established goals for mental health promotion, and district nurses often seemed to depend on their collaboration with other actors. Our findings indicated that district nurses cannot bear the primary responsibility for the early detection of mental health problems and early interventions to promote mental health within this population.

RELEVANCE TO CLINICAL PRACTICE:

The findings of this study indicated that workforce training and collaboration between different care providers are important elements in the future development of this field. Early detection and early treatment of mental health-related issues should also be stated as explicit objectives in the provision of care to community-dwelling older people with multimorbidity.

Keyword
Sweden; Ageing; District nurse; Mental health; Mental health promotion; Municipal care
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:shh:diva-2000 (URN)
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-10-24Bibliographically approved
4. Home care assistants' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity
Open this publication in new window or tab >>Home care assistants' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity
2016 (English)In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 9, 83-95 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients’ mental health status.

Aim: To describe HCAs’ perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity.

Methods: We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs.

Results: Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors’ own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health. Conclusion: The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers’ decisions to support the needed care, to schedule assignments related to the detection of mental health problems, and to promote mental health.

Keyword
Home care assistants, Mental health promotion, Municipal care, Older people, Sweden
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:shh:diva-2001 (URN)
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-06-10Bibliographically approved

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