Gabriela Maldonado-Guzmán, Flor Esthela Carbajal-Mata, Patricia Rivera-Vázquez, Rosa Idalia Castro-García
Facultad de Enfermería “Victoria”, Universidad Autónoma de Tamaulipas, Ciudad Victoria, Tamaulipas, México,
Correspondence: Flor Esthela Carbajal-Mata
Received: October 22nd 2013
Judged: February 7th 2014
Accepted: July 7th 2014
Introduction: Mutual aid groups composed of older adults are an educational tool effectively managed by nurses.
Objective: To know the perception of older adults about the benefits of joining a group of self-care practices to improve their quality of life.
Methods: A quantitative and qualitative study was performed; the level of independence and depression in older adults who joined a support group was evaluated.
Results: At the end of their participation in the support group, 69.2 % of older adults had mild dependence, 23.1 % independence and 7.7 % total dependence; 92.3 % managed to be or remain self-sufficient and expressed satisfaction with the new knowledge. No older adult presented greater depression risk by the end of the strategy. No relationship between gender and level of chi-square test independence was found (chi-square test= 1.733, df = 2, 0.420 > a, a = 0.05) between sex and level of depression (chi-square test= 1.733, df = 1, 0.188 > a, to be found = 0.05) or between depression and level of independence (chi-square test= 0.482, df = 2, 0786 > a, a = 0.05). The more referred benefits were in the areas of self-image and self-perception.
Conclusions: Adherence to recommendations made within the support group was achieved due to benefits perceived by older adults. In the future more nurses involved in the organization and functionality of such strategies will be required.
Keywords: Aged; Self-help groups; Nursing services; Self concept
The aging of the world population in developed and developing countries is an indicator of improved health in the globe. The number of people aged 60 or more worldwide has doubled since 1980 and is expected to reach 2 billion by 2050.1 This whole phenomenon is due to increased life expectancy and declining fertility rates, which has resulted in the rapid increase in this age group compared to others.2
The aging population can be considered a success of public health policy and economic development, but it is also a challenge to society, which must adapt to maximally improve the health and functional capacity of older adults as well as their social participation and safety.2 This is why at the beginning of this new century the training of nurses able to provide the necessary care is required. Attention, prevention, and care for chronic diseases and the design of environments adapted to older adults are qualities and skills for professionals to develop to support the older adult.1
To fulfill the activities proposed by the World Health Organization, the nursing professional uses a versatile tool: self-help groups. These groups are composed of people who share a problem and who meet voluntarily and periodically3 to overcome it and to achieve social and personal changes, which favor changes in the behavior of its members through educational and recreational activities.4 An important feature of the support group is the interaction of both nurses providing information, support, and services, and group members through the exchange of experiences and interaction with their peers, strengthening their own identities.4
In the health sector, self-help groups run by nurses are an invaluable educational tool. These groups are composed of people who voluntarily decide to meet periodically to overcome the problems or situations they have in common and thus achieve personal or social changes.3
In these groups, individuals provide each other with information, exchange experiences, provide emotional support, do social activities, and offer services and resources. At the same time, its members sensitize the population and, at times, create social pressure, with an emphasis on personal interaction and individual accountability. They also promote values through which members can strengthen their own identities.3,4
The use of group techniques to achieve changes in attitudes and behavior modification is applicable in the present concept of health, which is considered both preventative and curative.5 Therefore, these techniques are the fundamental basis of the integration of groups of people, in which interpersonal influence provides mutual assistance and positive behavioral role models.5 From this perspective, the use of the group as an instrument of change, socialization, support, and welcome is feasible in social and health or hospital contexts.
Support groups are convened to create a welcoming environment in which members’ resources are managed to cope with change. Membership in these groups gives new links and social relations to their members, so that concrete resources are replaced or their deficiencies are compensated with psychosocial provisions by interacting with people who have common problems, deficiencies, or experiences.
This research aimed to establish a self-care practices group for older adults, to improve the quality of life in areas such as nutrition, exercise, and self-esteem, and to learn the perception they have of these groups led by nurses.
To conduct this research, a study of quantitative and qualitative design was performed in which the in-depth interview was used as research technique. This research considered the provisions of the Ley General de Salud en Materia de Investigación.
The sample was composed of 28 participants of both sexes, from 60 to 83 years old. Inclusion criteria were preserved cognitive and physical abilities, voluntary participation, willingness to learn, and residence in the area of influence. Individuals with diseases that contraindicate physical activity or those unable to independently perform basic activities were excluded.
The following were considered as exclusion criteria for this study: the decision to withdraw from the support group, not completing at least 80% of the program sessions, not completing at least 80% of the questions on the questionnaires, and change of residence.
To determine the level of independence of older adults, Barthel and physical fitness scales were applied, to determine whether their participation in the intervention was possible. Older adults participated in the implementation of a self-care program run by nurses, which consisted of 12 educational and exercise sessions in a span of three months.
The first four sessions addressed aspects relating to food, food groups, and food accessibility; at the end of these sessions they were given a brochure with information on the healthy plate and healthy eating tips. The following four sessions were of physical activity, for which they were asked in advance to wear comfortable clothes and were explained the importance of physical activity, such as disease prevention and the creation of emotional and physical well-being. At the end of the first session they were given printed information with drawings clearly visible so they could arrive at the following session directly to warm-ups and then walking. These sessions concluded with a tango dance, suggested by a member of the group.
For the last block of four sessions, a psychologist was invited, who scheduled a discussion and activities on self-esteem in which she used relaxation techniques, occupational therapy, and group dynamics to improve the mood of the older adults, to whom she assigned various activities such as board games, crafts, and sessions for sharing experiences and expressing feelings.
After the strategy two surveys were applied in order to find out the levels of independence according to the Barthel Scale and the Yesavage Geriatric Depression Scale. Data were analyzed using SPSS version 18 with descriptive statistics, chi-squared for correlation between variables, and McNemar test to determine changes.
After the survey interviews were conducted randomly with members of the group, which were transcribed and interpreted following techniques from qualitative research analysis. Participants were informed of the purpose of the study and were assured anonymity and confidentiality. The interview aimed to deepen group impact and adherence for the older adults. Once the information was collected, the most relevant categories and subcategories were identified.
Integration and participation of older adults
The questionnaire on aptitude for physical activity recorded that 89% of participants were female, 85.7% had no heart problems, and 39.3% had no bone pain; even though 32.1% reported contraindication to exercise, their motivation to participate, after reassessment, allowed the adult to join the group. With the Barthel Scale it was identified that 82% were self-sufficient to perform activities of daily living.
After the intervention, the group was consolidated into the Unidad de Atención Integral de Enfermería in the Facultad de Enfermería “Victoria” of Ciudad Victoria, Tamaulipas. It was found that 14.3% had at least some health disorder that affected their physical performance.
Results in older adults after the program
Regarding the level of independence, it was noted at the end of participation in the support group that 69.2% had a mild level of dependence, while 23.1% achieved independent status. Only 7.7% of seniors remained in the totally dependent category. In summary, 92.3% managed to be or to remain self-sufficient.
None of the older adults showed risk depression at the end of participation in the support group. Although they had concerns, they resolved them to a greater or lesser extent. In analyzing the results of the Yesavage Scale, it was found that one person expressed a moderate degree of depression, while the rest were able to obtain and maintain a mild degree of depression.
Upon applying the chi-squared test there was no relationship between sex and level of independence (chi-squared = 1.733, df = 2, 0.420 > a, a = 0.05), between sex and level of depression (chi-squared = 1.733, df = 1, 0.188 > a, a = 0.05), or between depression and level of independence (chi-squared = 0.482, df = 2, 0.786 > a, a = 0.05). Regarding this last comparison, the results of the Kendall Tau-b (-0.092) indicated that there was minimal relationship between these two criteria, and besides its behavior was reversed, that is, with greater independence, lower levels of depression.
Older adults’ responses about the program
To find out the perception of the older adults regarding the activities, six members of the group were interviewed. Various categories were obtained; the most important and direct quote responses are summarized in Table I.
|Table I. Main responses older adult members of a self-help group|
|Gratitude||Another experience is the support that my peers gave me.
I am very grateful that they care about people like us.
I was very grateful that young people, like you, would want to make a group of grandparents like us to help us.
I thank you for paying attention to old folks like me.
|Physical activity||The main activity that I liked was the exercise before classes.
I felt that it removed my stress.
I think it improved my workouts...Now I walk more than before and I understand better how to care for myself and what should I ask the doctor when I go to the clinic, because before I felt embarrassed.
|Self-image||I felt that I had a lot of energy and desire to do things in my house.
I started to pay attention to my personal appearance...Yes, that I noticed.
|Loneliness||Don't forget us!|
|Relationship with the
|The attention they gave me in all these hours that we were coming to the course, to the group, and that they treated all my peers very well
Because in addition to learning with you... the stuff about care and exercise from the teacher, for us older people, it was very nice.
|Self-perception||That we can be better and better, even though age does not stop and you get older and you're always falling apart because of age... that cannot be stopped.
I met more people who, like me, we also need to do more for ourselves.
Older adults before and during participation
The results before beginning the self-help program for the older adults were similar to those reported in other studies, in which the magnitude and amount of physical activity depended directly on the health and emotional status of the individuals.6 While some research has shown that a significant percentage of older adults have difficulties in implementing activities, this intervention identified that age and limitations were no obstacles to the active integration of a healthy group of older adults.6,7
Condition of older adults at end of program participation
The program’s benefits were numerous, and knowledge and attitudes were reinforced in personal life. One aspect that impacted the older adults positively was to discover and express their own needs, which allowed those who were confined to their homes due to health problems to leave the isolation and monotony; joining the group encouraged them and gave them strength to attend and share with others.8
Experience with this group and that obtained from previous research on these issues indicate that health, solidarity, and participation in society increase to the extent that self-help groups are encouraged and supported.8,9
Perceptions of older adults
Feeling like part of a group gave seniors a sense of security that they projected to their homes and community. Meeting people who faced situations more difficult than their own gave them emotional well-being, which motivated them to keep going, to not be intimidated by the problems, and to think that things or ways of addressing things can change.4 In addition to this, there were positive experiences related to proper health maintenance. Older adults with higher levels of physical activity, both in frequency and in daily duration, tend to have a better quality of life.10
As for the obtained and perceived benefits, most seniors focused on image and family relations. The quality of life and weekly physical activity were significantly related to autonomy and weekly physical activity, that is, the more physical activity per week, the higher levels of autonomy.4,10
Participation in recreational physical activity programs increases levels of mobility, independence, and self-esteem, and contributes to the appreciation of life. Furthermore, the relationship between autonomy and social support is significant: the greater autonomy, the better the social support relationships.10
Older adults expressed their acceptance of the work of the nurse by asking for more support and companionship to perform intervention activities, and that they did not want to be alone or forgotten. One respondent said, "do not forget us!” At the same time, it was observed that the older adults considered the nurse as a social support.
The above proved the loneliness of older adults, and the wide field of knowledge application and generation through the qualitative approach, with which needs were identified that require immediate attention.10 The discipline of nursing can intervene directly, proposing aid programs aimed at understanding this age group.4,10,11
The perception of the older adults of the benefits, barriers, and social support that stimulate or limit physical activity showed gender differences. Emotional support to do the activity was higher in men, as they have fewer activities at home. Health and recreation was the main reason for physical activity in both sexes.11
In terms of self-perception, once the intervention activities were conducted in the support group, significant improvement in the behavior of the older adult could be seen, as well as in their mood and image. Older adults are aware of their limitations; however, being in these activities helped them to socialize and feel better. Regarding the reason for physical activity, both men and women agreed on health, consistent with the results of the study on physical activity and emotional state.12
Expressions such as "seeing life differently" or "laughing at ourselves" indicate that the older adults enjoyed performing the physical and recreational activities proposed by the support group led by the nurse. Benefits such as decreased pain and increased joy and energy improved the older adults’ self-perception.10,12
The family relationships of the older adults also improved, as reflected in phrases such as "they were more interested in me" or "I look happier to them". Depression was more pronounced in women than in men, due to family, community, and society attitudes such as rejection, overprotection, or abuse;13 however, both men and women were classified as having mild depression, whose development is fostered by social problems that they are living (abuse and neglect).10,14
Regarding the desire to learn, the older adults had interest in acquiring or developing recreational, leisure, and craft skills. In the support group it was possible to create a lifestyle good for one’s health, significant learning was obtained on the stage of life that they are living, motivating and enjoyable activities for daily living were found, and emotional bonds were built between participants.15
One issue addressed in the talks with the older adults was family care; although at first there was difficulty in talking about it, at the end of the session some concerns were discussed. Neglect, improper care, and lack of understanding by both family and society, were the most common complaints. Family should address intangible aspects such as affection, since aging creates a series of demands for care and affection from families.8,16 In addition to financial support, older adults require cognitive and emotional support to facilitate adjustment to this stage of life, considering the changes in social and familial roles.15,16
Regarding support for their peers, older adults said that it is necessary to do awareness activities about not leaving seniors alone or abandoned. Help groups are organizations of people who share psychological, physical, or existential problems, whose members meet in order to expand their knowledge and learn from the experiences of others, with the desire to improve their quality of life.9
The most advanced stage of adulthood brings many changes, including the loss of some capabilities and, therefore, of functional autonomy, a fact that leads to the need to increase physical protection by family or health staff. However, although the arrival of older adulthood announces the decline of certain skills, it is true that there are other options to improve the quality of life such as joining support groups, dynamic organizations with great initiative potential to influence improving the quality of life in areas such as nutrition, exercise, and self-esteem, so the use and reinforcement of this strategy are encouraged.
The integration of an organized group of older adults greatly favored self-care in physical, emotional, and family issues, and nurses played a key role in promoting health. This investigation observed the concern felt by the participants due to loneliness, both their own and that of their peers; after exposure of the main situations facing them, the group found emotional support, companionship, solidarity, responsibility, and willingness.
It was also found that participation in organized groups allowed the older adults to improve mood, create new links, generate feelings of self-esteem, encourage initiative, open the opportunity to participate in new activities, share experiences with people of the same age, participate in an environment of healthy recreation, and strengthen the intention to adopt preventative health measures.
For all these benefits it is necessary for more health professionals, especially in the area of nursing, to take responsibility for organizing and maintaining working self-help groups, which will impact the health of older adults, life expectancy, decreased hospital admissions, the household economy, and the social sphere in general. Family members or primary caregivers of older adults also need to join the self-help groups.
The authors declared that there is no personal or institutional conflict of interest of a professional, financial, or commercial nature, during the planning, execution, writing of this article.