Protecting strategies used by sufferers of catastrophic illnesses and injuries

Caring for Patients with Functional Impairment in Middle Age: Perspectives from Primary Care Providers and Geriatricians

BACKGROUND

The prevalence of functional impairment is increasing among middle-aged adults and is associated with adverse health outcomes. Primary care providers (PCPs) and geriatricians may have important insights about optimal approaches to caring for these patients, but little is known about their perspectives.

OBJECTIVE

To examine PCPs' and geriatricians' perspectives on clinical needs and optimal approaches to care for middle-aged patients with functional impairment.

DESIGN

Qualitative study using semi-structured interviews.

PARTICIPANTS

PCPs and geriatricians from outpatient practices in the San Francisco Bay area.

APPROACH

Interviews focused on characteristics and care needs of middle-aged patients with functional impairment and models of care to address these needs. We analyzed interviews using hybrid deductive-inductive qualitative thematic analysis.

KEY RESULTS

Clinicians (14 PCPs, 15 geriatricians) described distinct characteristics of functional impairment in middle-aged versus older adults, such as different rates of onset, but similar clinical needs. Despite these similar needs, clinicians identified age-specific barriers to delivering optimal care to middle-aged patients. These included system-level challenges such as limited access to insurance and social services; practice- and clinician-level barriers including inadequate clinician training; and patient-level factors including less access to family caregivers and perceptions of stigma. To overcome these challenges, clinicians suggested clinical approaches including addressing health-related social needs within healthcare systems; implementing practice-based models that are multi-disciplinary, team-based, and coordinated; training clinicians to effectively manage functional impairment; and expanding community-based services and supports to help patients navigate the medical system. Identified needs, challenges, and solutions were generally similar across geriatricians and PCPs.

CONCLUSIONS

Clinicians face challenges in delivering optimal care to middle-aged patients who have functional impairments similar to their older counterparts but lack access to services and supports available to older people. These findings suggest the importance of increasing access to care models that address functional impairment regardless of age.

When Functional Impairment Develops Early: Perspectives from Middle-Aged Adults

BACKGROUND

Difficulty performing basic daily activities such as bathing and dressing ("functional impairment") affects more than 15% of middle-aged people, and this proportion is increasing. Little is known about the experiences and needs of individuals who develop functional impairment in middle age.

OBJECTIVE

To examine the experiences and needs of adults who developed functional impairment in middle age.

DESIGN

Qualitative study using semi-structured interviews.

PARTICIPANTS

Forty patients aged 50-64 years who developed functional impairment in middle age, recruited from four primary care clinics in San Francisco.

APPROACH

Interviews included open-ended questions about participants' daily life, ability to perform activities of daily living (ADLs), and needs related to functional impairment. We analyzed interviews using qualitative thematic analysis.

KEY RESULTS

Interviews revealed several themes related to the psychosocial and physical impacts of developing functional impairment in middle age. Participants noted that losses associated with functional impairment, such as loss of independence, control, and social roles, caused conflict in their sense of identity. To cope with these losses, participants used strategies including acceptance, social comparison, adjusting standards, and engaging in valued life activities. Participants reflected on the intersection of their functional impairment with the aging process, noting that their impairments seemed premature compared to the more "natural" aging process in older adults. In terms of physical impacts, participants described how a lack of accommodations in the built environment exacerbated their impairments. While participants used behavioral strategies to overcome these challenges, unmet needs remained, resulting in downstream physical and psychological impacts including safety risks, falls, frustration, and fear.

CONCLUSIONS

Unmet psychosocial and physical needs were common among middle-aged adults with functional impairment and led to negative downstream effects. Eliciting and addressing unmet needs may help mitigate downstream health consequences for this growing population, optimizing function and quality of life.

National study of behavioral and life changes since September 11

Since the terrorist attacks of September 11, 2001 (9-11), terrorism poses a continuous threat to those living in the United States. A substantial number of people may have experienced behavioral and life changes since the attacks, with possible implications for public health. This study investigated behavioral and life changes American people have experienced since the attacks. Using random-digit dialing that included unpublished numbers and new listings, a nationally representative cross-sectional sample of 807 U.S. adults ages 18 or older was interviewed. Logistic regression analyses indicated that gender, age, race/ethnicity, and employment status were significant predictors for experiencing different outcome variables. The qualitative data obtained from an open-ended question regarding life changes were analyzed and synthesized. The 9-11 events have considerably affected Americans' lifestyles and behavior, which may have various implications for public health policy makers and educators.

Boosting Strategies: Enhancing the Self-Esteem of Individuals With Catastrophic Illnesses and Injuries

This qualitative study used grounded theory methods to determine how individuals were able to live with catastrophic illnesses and injuries. Twenty-eight participants were interviewed for stories of how they endured their circumstances. Although several strategies were used, this article describes a strategy entitled "boosting," which outlines the affected individuals' efforts to improve their self-esteem, which helped them bear their circumstances. Boosting has some relationship to social comparison theory. Implications for nurses and the importance of awareness of this communication need for patients are discussed.