Influences of Faith on Rural Appalachian Older Adult Health: An Ethnonursing Study.

INTRODUCTION: Rural Appalachian older adults (RAOAs) constitute a vulnerable population and experience significant health disparities. The combination of age, poverty, rural residence, health care provider shortages, and limited transportation increases risks for poor health outcomes. Spirituality enhances older adult health; however, little is known about spirituality-health linkages of RAOAs. Therefore, the purpose of this study was to discover the influences of spirituality on RAOA health. METHODOLOGY: Culture Care Theory and ethnonursing method guided analysis of 32 RAOA interviews in community settings in East Tennessee. RESULTS: "Faith" is an integral component of RAOA culture and health. Three themes were extrapolated: (a) Relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and [the need to] (c) "Open the door" for spiritual care. DISCUSSION: Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults.

Holistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities.

Although resident wellness is increasingly a priority in senior living communities, there are few programs that promote holistic wellness in later life. A total of 79 residents (ages 71 to 97; M = 84.27, SD = 6.46) from eight senior living communities completed a pilot study of a novel, staff-led wellness coaching program consisting of resident-driven goals and individual and group coaching sessions. Participants completed surveys at three time points (pre-program, post-program, and 1-month follow-up). Repeated measures ANOVAs revealed positive changes in resident health satisfaction, physical quality of life (QOL), psychological QOL, loneliness, relatedness, competence, and sense of purpose. Some of these results (i.e., psychological QOL, loneliness) persisted at follow-up. Residents reported high satisfaction with the program. These findings have implications for the application of holistic wellness frameworks in later life, as well as the development and implementation of wellness coaching programs with older adults.

Profile of informal rural Appalachian caregivers of patients with chronic illnesses.

PURPOSE: Caring for a family member with chronic illness increases cardiovascular disease (CVD) risk by 82%, and rurality imparts additional CVD disparities. The purpose of this study was to describe a profile of rural caregivers of patients with chronic illnesses to determine the prevalence of CVD risk factors, and psychosocial and socioeconomic burden, as well as to compare these variables across gender. METHODS: Baseline data from a trial of CVD risk reduction in rural caregivers of patients with chronic illnesses were used. We measured depression and anxiety with the PHQ-9 and Brief Symptom Inventory; social, economic, and environmental factors using the MOS-Social Support and Economic and Environmental surveys; body mass index (BMI); blood pressure (BP); and lipid profile. RESULTS: Of 181 caregivers (age 53±14 years, 80% female), 69% were married; 88% were caring for a family member, including 46% caring for a spouse and 18% for a parent. A total of 51% were anxious, 25% depressed, and 25% reported lack of social support. Most (51%) caregivers had one or more types of CVD; and 49% were smokers. By examination, 76% had elevated BP; 35% had total cholesterol >200; 50% low-density lipoprotein >100; 56% triglycerides >150; and 79% high-density lipoprotein <60. Based on BMI, 91.5% were overweight or obese. Gender comparisons revealed that women reported higher levels of depressive symptoms than men. CONCLUSIONS: Rural caregivers, regardless of gender, are at increased risk of CVD and struggle with factors that make caregiving burdensome and contribute to their own poor cardiac health.

Defining malaria risks among forest workers in Aceh, Indonesia: a formative assessment.

BACKGROUND: Following a dramatic decline of malaria cases in Aceh province, geographically-based reactive case detection (RACD) was recently evaluated as a tool to improve surveillance with the goal of malaria elimination. While RACD detected few cases in households surrounding index cases, engaging in forest work was identified as a risk factor for malaria and infections from Plasmodium knowlesi-a non-human primate malaria parasite-were more common than expected. This qualitative formative assessment was conducted to improve understanding of malaria risk from forest work and identify strategies for targeted surveillance among forest workers, including adapting reactive case detection. METHODS: Between June and August, 2016, five focus groups and 18 in-depth interviews with forest workers and key informants were conducted in each of four subdistricts in Aceh Besar and Aceh Jaya districts. Themes included: types of forest activities, mobility of workers, interactions with non-human primates, malaria prevention and treatment-seeking behaviours, and willingness to participate in malaria surveys at forest work sites and using peer-referral. RESULTS: Reported forest activities included mining, logging, and agriculture in the deep forest and along the forest fringe. Forest workers, particularly miners and loggers, described often spending weeks to months at work sites in makeshift housing, rarely utilizing mosquito prevention and, upon fever, self-medicating and seeking care from traditional healers or pharmacies rather than health facilities. Non-human primates are frequently observed near work sites, and most forest work locations are within a day's journey of health clinics. Employers and workers expressed interest in undertaking malaria testing and in participating in survey recruitment by peer-referral and at work sites. CONCLUSIONS: Diverse groups of forest workers in Aceh are potentially exposed to malaria through forest work. Passive surveillance and household-based screening may under-estimate malaria burden due to extended stays in the forest and health-seeking behaviours. Adapting active surveillance to specifically target forest workers through work-site screening and/or peer-referral appears promising for addressing currently undetected infections.

Impact of Savoring Ability on the Relationship Between Older Adults' Activity Engagement and Well-Being.

The relationship between activity engagement and well-being can vary based on individual characteristics, and it is important to identify moderating factors to support the development and implementation of aging services. The current study examined whether the relationship between activity engagement and well-being depends on older adults' savoring ability, that is, the ability to attend to positive experiences and to engage in emotion regulation strategies to enhance positive feelings during those experiences. A total of 5,128 older adults (Mage = 83.86 years) completed measures of activity engagement, savoring, and well-being (i.e., life satisfaction, depression, loneliness, purpose, and health). Multilevel modeling analyses revealed that activity engagement and savoring independently predicted better functioning across all well-being measures. However, savoring moderated the relationship between activity engagement and four well-being measures (life satisfaction, depression, loneliness, and purpose). Findings suggest that older adults with low activity engagement may particularly benefit from savoring-skills training to enhance their psychological well-being.

Factors associated with the performance and cost-effectiveness of using lymphatic filariasis transmission assessment surveys for monitoring soil-transmitted helminths: a case study in Kenya.

Transmission assessment surveys (TAS) for lymphatic filariasis have been proposed as a platform to assess the impact of mass drug administration (MDA) on soil-transmitted helminths (STHs). This study used computer simulation and field data from pre- and post-MDA settings across Kenya to evaluate the performance and cost-effectiveness of the TAS design for STH assessment compared with alternative survey designs. Variations in the TAS design and different sample sizes and diagnostic methods were also evaluated. The district-level TAS design correctly classified more districts compared with standard STH designs in pre-MDA settings. Aggregating districts into larger evaluation units in a TAS design decreased performance, whereas age group sampled and sample size had minimal impact. The low diagnostic sensitivity of Kato-Katz and mini-FLOTAC methods was found to increase misclassification. We recommend using a district-level TAS among children 8-10 years of age to assess STH but suggest that key consideration is given to evaluation unit size.