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Inner strength as a health resource among older women
Umeå University, Faculty of Medicine, Department of Nursing.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Long life does not inevitably mean more healthy years; older women have an increased risk of disabilities, diseases and adverse life events. Nevertheless, many older women experience health. This may be explained by possessing resources that promote health, despite adversities. Inner strength is seen as a resource as such. In this thesis inner strength is interpreted according to a theoretical model where inner strength comprises four interrelated and interacting dimensions: connectedness, creativity, flexibility and firmness, and being rated by the Inner Strength Scale (ISS).

Aim and methods The overall purpose of this thesis was to explore inner strength as a health resource among older women. In study I six focus group interviews were performed with older women (66-84 years; n = 29) and the interviews were analysed by a concept driven approach and by means of qualitative content analysis. Studies II–IV had a quantitative, cross-sectional design. A questionnaire was sent to all older women (65 years and older) living in Åland, an autonomous island community in the Baltic Sea, and 1555 (57%) women responded. The data was analysed using descriptive and inferential statistics.

Results In study I, exploring how inner strength and its dimensions can be identified in narratives of older women, connectedness was interpreted as a striving to be in communion, creativity as the ability to make the best of the situation, firmness as having a spirit of determination – “it is all up to you”, and flexibility as a balancing act. The results of study II showed that strong inner strength was associated with better mental health, but not physical health. In exploring factors associated with health-related quality of life, fewer symptoms of depressive disorders was the strongest explanatory variable, and together with not feeling lonely associated with better both physical health and mental health. Better physical health was also explained by not having a diagnosed disease, being of lower age and the opportunity to engage in meaningful leisure activities. Better mental health was additionally explained by having enough money for personal needs. In study III the result showed that non-depressed women were likely to have a strong inner strength, as well as never or seldom feeling lonely, taking fewer prescribed drugs, feeling needed and having the opportunity to engage in meaningful leisure activities. In study IV poorer mental health was associated with weaker inner strength in total, and in all four dimensions of inner strength. Symptoms of depressive disorders and feeling lonely were related to lower scores in three of the dimensions (except firmness and creativity, respectively) and poorer physical health was associated with lower scores in two of the dimensions (firmness and flexibility). Some other health threats were significantly associated with only one of the dimensions (connectedness or creativity), and others were not significantly associated at all.

Conclusion The results add nuance to the notion of inner strength and deepen empirical knowledge about the phenomenon. It is elucidated that the ISS can be used not only to rate inner strength but also to offer guidance as to the areas (i.e. dimensions) in which interventions may be profitable. It is further shown that inner strengths can be identified in narratives of older women. Mental ill health has shown to have overall the strongest association with weakened inner strength among community-dwelling older women. The causality can, though, not be studied due to the cross-sectional design; therefore, longitudinal studies are recommended. Notwithstanding that limitation, the findings can be used as a knowledge base in further research within this field.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2016. , 72 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1779
Keyword [en]
Connectedness, creativity, flexibility, firmness, inner strength, old age, women
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-116964ISBN: 978-91-7601-401-1 (print)OAI: oai:DiVA.org:umu-116964DiVA: diva2:903676
Public defence
2016-03-08, Vårdvetarhusets Aula, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-02-18 Created: 2016-02-16 Last updated: 2016-02-18Bibliographically approved
List of papers
1. Inner Strength as Identified in Narratives of Elderly Women A Focus Group Interview Study
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2015 (English)In: Advances in Nursing Science, ISSN 0161-9268, E-ISSN 1550-5014, Vol. 38, no 1, 7-19 p.Article in journal (Refereed) Published
Abstract [en]

By identifying sources of inner strength, health care personnel can be given valuable information about elderly people's capacities regardless of frailty. The focus of this interview-based study was to explore how inner strength and its dimensions can be identified in narratives of elderly women. The analysis was based on a theoretical model where inner strength is composed of 4 interacting dimensions of connectedness, creativity, firmness, and flexibility. Our findings add nuance to the notion of inner strength and deepen empirical knowledge about the concept.

Keyword
concept-driven approach, connectedness, content analysis, creativity, elderly women, firmness, exibility, focus groups, inner strength
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-100977 (URN)10.1097/ANS.0000000000000057 (DOI)000349468700004 ()25635502 (PubMedID)
Available from: 2015-03-16 Created: 2015-03-16 Last updated: 2017-12-04Bibliographically approved
2. Identifying variables in relation to health-related quality of life among community-dwelling older women: knowledgebase for health-promoting activities
Open this publication in new window or tab >>Identifying variables in relation to health-related quality of life among community-dwelling older women: knowledgebase for health-promoting activities
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2016 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 1, 20-26 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to explore health-related quality of life (HRQoL) and associated variables among all community-dwelling older women (565 years) (n¼2724) on A ° land, a Finnish self-governing island community. A total of 1023 women participated (mean age 72.96.8 years). Absence of depression, absence of diagnosed disease(s), having the opportunity to engage in meaningful leisure activities, and never or seldom feeling lonely explained, together with socioeconomic control variables (i.e. age, education and economic situation), 34.4% of the variation in physical health. Absence of depression, strong inner strength, and never or seldom feeling lonely explained, together with socio-economic control variables, 27.7% of the variation in mental health. HRQoL was rated as relatively good, although special attention should be paid to women aged 80þ years. To promote HRQoL, interventions aimed at preventing, detecting and treating depression should be prioritised. In addition, interventions aimed at reducing feelings of loneliness are also recommended in order to enhance overall HRQoL.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keyword
health-related quality of life, health promotion, nursing, old age, women
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-109722 (URN)10.1177/0107408315599691 (DOI)
Available from: 2015-10-05 Created: 2015-10-05 Last updated: 2017-12-01Bibliographically approved
3. Inner strength: associated with reduced prevalence of depression among older women
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2015 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 19, no 12, 1078-1083 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to explore if inner strength is independently associated with a reduced prevalence of depression after controlling for other known risk factors associated with depression.

Methods: A population-based cross-sectional study was performed, where all women living in Åland, a Finnish self-govern island community in the Baltic Sea, aged 65 years or older were sent a questionnaire including the Geriatric Depression Scale and the Inner Strength Scale along with several other questions related to depression. Factors associated with depression were analyzed by means of multivariate logistic regression.

Results: The results showed that 11.2% of the studied women (n = 1452) were depressed and that the prevalence increased with age and was as high as 20% in the oldest age group. Non-depressed women were more likely to never or seldom feel lonely, have a strong inner strength, take fewer prescription drugs, feeling needed, being able to engage in meaningful leisure activities, as well as cohabit.

Conclusion: Our results showed an association between stronger inner strength and being non-depressed. This can be interpreted to mean that inner strength might have a protective effect against depression. These findings are interesting from a health-promotion perspective, yet to verify these results, further longitudinal studies are required.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
Keyword
GDS-15, depression, inner strength, old age, women
National Category
Nursing Geriatrics Psychiatry
Identifiers
urn:nbn:se:umu:diva-108077 (URN)10.1080/13607863.2014.977775 (DOI)000360694500005 ()25402943 (PubMedID)
Available from: 2015-09-03 Created: 2015-09-03 Last updated: 2017-12-04Bibliographically approved
4. Inner strength and its relationship to healththreats in ageing – a cross-sectional studyamong community-dwelling older women
Open this publication in new window or tab >>Inner strength and its relationship to healththreats in ageing – a cross-sectional studyamong community-dwelling older women
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(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-116963 (URN)
Available from: 2016-02-16 Created: 2016-02-16 Last updated: 2016-02-17

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