Health as a movement between suffering of life and meaning in life for men who have experienced transitions in life.

BACKGROUND AND AIM: Previous studies show that life transitions can have negative effects on men's lives and lead to health problems and meaninglessness in life. This study aims to deepen the understanding of men's health by exploring the movement between suffering of life and meaning in life when experienced life transitions. THEORETICAL FRAMEWORK: The study is anchored in Eriksson's caritative caring theory. Core concepts are health and the movement between suffering of life and meaning in life. METHODOLOGY AND METHODS: The methodology is hermeneutical, and the study has a qualitative research design. Fifteen men from Norway participated in in-depth interviews in 2021. The interviews were analysed using reflexive thematic analysis. RESULTS: Four themes emerged in relation to the suffering of life; enduring separation from community, shame at being useless as a human being, grief over what has been lost in life, and being powerless and vulnerable in the face of a hopeless struggle. Three themes emerged in relation to meaning in life; realising what is most important in one's life gives strength, decision to live one's life brings joy in life and a positive attitude towards life gives freedom and awakens a new spark for life. CONCLUSION: Suffering of life emerges as a separation from relationships and society and as a perceived uselessness as a human being losing faith, control and feeling like a burden erodes dignity and trigger feelings of shame, guilt and degradation. Suffering of life manifests as loss of drive and spark for life. Life has meaning through finding the good in oneself, coming to know and believe in oneself and seeing new possibilities which bring about a spark for life, gratitude, dignity and freedom. Health exists in the movement between suffering of life and meaning in life, in pausing, recognising vulnerability, prioritising and reorienting oneself.

Rural former service members participate in meaningful occupations to 'fill the void' after military service.

INTRODUCTION: Over 50% of former service members report debilitating health conditions and difficulty adjusting to civilian life. Former service members living in rural areas are even more likely to experience poor health outcomes and have decreased access to specialist health-care services. Participation in meaningful occupations can support health and adjustment after military service. However, little is known about rural former service members' perspectives and experiences of participating in occupations after separating from military service. This study explored rural former service members' experiences of participating in occupations during their transition and their perceptions of how these experiences influenced their health and adjustment. METHODS: Purposive sampling was used to recruit 10 rural former Australian Defence Force members discharged from service between 1 July 2013 and 1 July 2018. Former service members participated in a series of semi-structured interviews. Interpretative phenomenological analysis was used to determine themes for individual participants and then overarching themes that characterised the experiences of the group. FINDINGS: A single overarching theme, 'It can't all be for nothing': Searching for ways to fill 'the void' through meaningful occupational participation, reflected rural former service members' experiences. The different ways that participants sought to fill 'the void' after military service were interpreted through two sub-themes: (1) 'You can't heal if you're still in a battlefield': Participating in occupations to re-establish safety and wellbeing, and (2) 'I was in a uniform and I could still do well': Participating in occupations to reconnect with self and continue the mission to serve. CONCLUSION: Rural former service members participated in various occupations to establish safety, wellbeing, and reconnection after transitioning from military service. The findings point to the need for further research to inform the development of consumer-led occupation-based interventions that are sensitive to individuals' service history, environmental context, and trauma recovery needs.

Experiences of moving an older parent into a care home or nursing home in the UK: a qualitative study.

The study explored the personal experiences of individuals making the decision to move an older parent into a residential care facility via retrospective narrative. It aimed to gain an understanding of how individuals experienced this transition, the emotions they felt at specific moments throughout the transition, and the perceived effect it had on their psychological wellbeing. 13 semi-structured video interviews were conducted online with individuals who had been active in the decision of moving an older parent into a care home or nursing home. The data was analysed using thematic analysis, along with relational analysis to explore relations between themes. Findings informed 8 different themes, which were subsumed under three meta-themes of The Decision Process, Conflicting Emotions and Reflective Evaluation. It was found that the decision was recalled as a complex and often stressful negotiation between multiple stakeholders, that emotions ranged from grief to guilt and relief, and that reflections emphasised the positive that had come out of the transition. The results from this study provide valuable insights into the uniqueness of this transition from the perspective of relatives and the range of emotions experienced at different stages of the transition.

Later-life transitions and changes in prescription medication use for pain and depression.

BACKGROUND: Over the past two decades, prescription medication use for pain and depression increased dramatically. Most studies consider the early life course, despite a similar increase among those in later life. In this paper, we examine whether and how later life transitions may relate to changes in medication use. METHODS: We draw on data from the Health and Retirement Study and fixed-effects models to examine whether work, family, and civic transitions in later life are related to changes in the usage of prescription pain and depression medication. RESULTS: Results show that individuals had higher odds of regularly using prescription pain and depression medications in periods when out of the labor market. Higher odds of depression medication use were also associated with periods of widowhood, and lower odds of use when frequently volunteering. Such relations persist adjusting for reported levels of pain and depression. CONCLUSION: Our findings call attention to the importance of social ties and the presence of actors that may regulate health behaviors, as well as a change in social context, that may shape medication use in later life.

The role of motherhood schemas and life transitions in reproductive intention formation.

OBJECTIVE: This study provides a theory-based snapshot of the processes involved in women's fertility intention formation and decisions regarding the timing of motherhood. BACKGROUND: The trend to defer childbearing is linked with both empowering and challenging outcomes for women. The cognitive-social (C-S) model suggests that deliberative thinking regarding reproduction occurs following fertility-relevant life transitions, which results in fluctuations in motherhood schemas and fertility intentions. This framework was applied to explore fertility intention formation. METHODS: Semi-structured interviews were conducted with twelve women who either had children or desired children. RESULTS: Two overarching themes central to the C-S model are discussed: (a) passive expectations and (b) deliberative intentions. Women's motherhood schemas were often underpinned by schematic structures (e.g. group norms and scripts) and material structures (e.g. observational influences). Life transitions and personal experiences tended to prompt deliberative thinking about motherhood plans. CONCLUSION: The results were generally consistent with the C-S model, but highlight complexities to consider when investigating fertility expectations and intentions.

An Evaluation of an ACT-Based "Aging Resiliently" Group.

OBJECTIVES: There were two quality improvement aims in this project: (1) to evaluate the outcomes of a six-week closed geriatric focused Acceptance and Commitment Therapy (ACT)-based group called "Aging Resiliently" offered in a primary care setting, and (2) to obtain feedback from group members in order to make relevant modifications to future groups. METHODS: Four cohorts of veterans ages 58 and older participated in the group (N = 17). Paired samples t-tests were computed to determine the significance of changes on pre- and post- self-report measures of depression, experiential avoidance, and life satisfaction. Veterans also provided feedback in the form of an open-ended feedback questionnaire. RESULTS: There were statistically significant improvements in depressive symptoms and satisfaction with life, but not in experiential avoidance. Two major themes emerged from the feedback questionnaire about what group members found to be the most helpful: (1) self-reflection/values, and (2) the social process of the group. CONCLUSIONS: At our institution, the Aging Resiliently group yielded meaningful outcomes for older veterans presenting with different problems related to aging. CLINICAL IMPLICATIONS: This Aging Resiliently group proved to be a potential effective, feasible, and acceptable psychotherapy for older veterans in our established local primary care setting.

Perceived Decisional Control as a Mediator between Moving to Assisted Living Due to Caregiver Burden and Relocation Adjustment.

OBJECTIVES: The rapid growth of the older population in the United States has led to increased utilization of assisted living facilities (ALFs), and it is important to understand what factors may facilitate better adjustment. This study examined the mediating role of perceived decisional control in the relationship between moving to assisted living (AL) to prevent/alleviate caregiver burden and post-relocation adjustment. METHODS: Participants were 91 newly-transitioned residents of ALFs in Alabama and Maryland. Data were gathered through in-person interviews and questionnaires. Mediation analyses were done using the PROCESS macro for SPSS, applying 5,000 bootstrap resamples with 95% bias-corrected confidence intervals estimated around the indirect effect. RESULTS: The effect of moving to AL to prevent/alleviate caregiver burden on post-relocation depression and socialization was indirect and dependent on the degree of perceived decisional control. CONCLUSIONS: Perceived decisional control may be a key factor in adjusting to AL, even when the move is catalyzed by such a complex and emotionally laden construct as caregiver burden. CLINICAL IMPLICATIONS: Greater perceived decisional control over potential relocation may facilitate better adjustment, and other parties involved in the decision-making process should strive to involve the older adult in question in this process to the greatest extent possible.

Exploring digital support for the student transition to university through questionable concepts.

New students face challenges when they make the transition from school to university. Existing digital technologies used during this transition can sometimes increase the stressors associated with change. In order to explore ways forward for technology design in this space, we developed a brochure of questionable concepts. The concepts were grounded in findings of our prior research, yet were also intended to act as provocations to promote discussion in workshops involving 32 first year university students. Our analysis of workshop discussions documents the diverse issues students face around social bonding, their home environment, and their academic performance. Our findings challenge assumptions made in prior work about the ease of transition to university. We demonstrate how questionable concepts can play an important role in prompting 'safe' conversations around stressful life events for adolescents.

Behavioral impact of national health campaigns on healthy lifestyle practices among young adults in Singapore: a cross-sectional study.

BACKGROUND: National health campaigns are often used to improve lifestyle behaviors in the general population. However, evidence specifically in the young adult population is scarce. Given the general deterioration of healthy lifestyle practices from adolescence to young adulthood, it is imperative to study this age group. This study aimed to investigate the behavioral impact of a national health campaign in Singapore on the lifestyle practices of young adults, and whether sex or full-time working and schooling status affected lifestyle practices. METHODS: A total of 594 Singaporean respondents aged 18-39 years old were interviewed via a cross-sectional study in December 2019. Lifestyle practices assessed were diet, exercise, alcohol consumption, current tobacco use, and participation in health screening programs. Other factors investigated included exposure to the national health campaign "War on Diabetes" (WoD), sex, ethnicity, and working/schooling status. Multivariable modified Breslow-Cox proportional hazards models were used to estimate prevalence risk ratios (PRRs) as measures for the associations in this study, after adjusting for potential confounders. RESULTS: Exposure to the WoD campaign had a significant association with meeting dietary recommendations (PRR = 1.6, 95% CI: 1.0-2.5, p = 0.037), participation in screening (PRR = 1.2, 95% CI: 1.0-1.5, p = 0.028), and current tobacco use (PRR = 0.5, 95% CI: 0.3-0.8, p = 0.003). Males were significantly more likely to meet exercise recommendations (PRR = 2.0, 95% CI: 1.5-2.7, p < 0.001), currently use tobacco (PRR = 3.9, 95% CI: 2.2-6.9, p < 0.001), and consume alcohol excessively (PRR = 1.5, 95% CI: 1.0-2.3, p = 0.046), as compared to females. Working young adults were significantly less likely to meet exercise recommendations (PRR = 0.7, 95% CI: 0.5-0.9, p = 0.019) but significantly more likely to be current tobacco users (PRR = 1.8, 95% CI: 1.1-3.1, p = 0.024), as compared to those who were in school. CONCLUSIONS: While this paper affirms that national health campaigns have significant beneficial associations in diet, health screenings and current tobacco use, policymakers should acknowledge that young adults are an age group with different influences that impact their healthy lifestyle habits. Specific interventions that target these subgroups may be required for better health outcomes. Future studies should evaluate other socio-environmental factors that could play a role in modifying the effect of health campaigns among young adults.

Pushed back, pulled forward: Exploring the impact of COVID-19 on young adults' life plans and future mobility.

The COVID-19 pandemic has caused unprecedented disruption to how people live, work and travel. There has been a recent outburst of research on the short-term impacts that the pandemic has had on travel behaviour. However, the long-term impact of the pandemic on travel behaviour is still uncertain and difficult to predict. In particular, young adults are facing some of the most significant disruptions from the pandemic; these disruptions are likely to have long-term impacts on their lives. This study aims to unpack the direct and indirect effects that COVID-19 may have on the travel behaviour of young adults. It does this through in-depth interviews with 26 young adults living in Melbourne and Victoria, Australia. Interviews suggest that while the pandemic has had significant impacts on the short-term travel behaviour of all young adults, the long-term impacts are more complex and mediated by how they are moving through key life milestones. Many respondents are relatively unimpacted by the pandemic. Others have faced a significant disruption to their lives. Those who had planned to live or work overseas have found their life plans 'accelerated', which may also accelerate their dependence on the car. In contrast, those who have lost work are facing a significant delay to their life plans. We propose a framework for how COVID-19 may directly and indirectly impact travel behaviour in the short- and long-term. The strongest impacts on mobility, through changes to life stage transitions, are indirect and unevenly spread across the population of young adults.

Participation in occupations, health and adjustment during the transition from military service: A cross-sectional study.

Participation in meaningful occupations is central to health, well-being, and adjustment during the transition from military service. The aim of the present study was to identify what occupations transitioning Australian Defence Force members participate in for the purpose of improving their health and well-being. A secondary aim was to identify if participation in various occupations was associated with better self-reported health and/or adjustment outcomes. One hundred and ninety-eight former Australian Defence Force members discharged on or after January 1, 2004 responded to a cross-sectional survey measuring adjustment, physical and mental health, and participation in occupations. Occupations were coded using the Time Use Classification system developed by the Australian Bureau of Statistics. An easier adjustment was reported by former service members who participated in employment-related activities, domestic activities, voluntary work and care activities, and social and community interaction (MD = -0.63 to -0.45, d = .37 to .52). Participation in employment-related activities, social and community interaction, and sport and outdoor activity was associated with better physical health (MD = 3.20 to 3.73, d = .34 to .40). Participation in employment-related activities was also associated with better mental health (MD = -3.75, d = .54). This research indicates that participation in occupation is a factor that may be utilized with former service members to positively influence health and adjustment during military transitions. Given differences in participation and outcomes among different sub-groups, it is recommended that occupation-based programs be tailored to individual preferences and transition needs.

Self-esteem change during the transition from university to work.

OBJECTIVE: The current study examined whether the transition from university to work, a major developmental milestone in young adulthood, was related to stability and change in self-esteem. METHOD: Self-esteem was assessed in the last year of their master's program (T1) of 163 27-year old students and 14 months later, when they had graduated and half of them had started a full-time job (T2). Daily diaries were used to assess the occurrence of achievement- and affiliation-related experiences on 14 consecutive days at T1 and T2. We compared the full-time job beginners and a comparison group without a full-time job with regard to their mean-level change, rank-order stability and correlated change of self-esteem and daily experiences. RESULTS: First, job beginners increased in self-esteem, but the difference to the mean-level change of the comparison group was only small. Second, self-esteem was less stable among job beginners than among the comparison group. Third, the changes in achievement-related daily experiences and self-esteem correlated positively in the job-beginner group but not in the comparison group. CONCLUSIONS: The findings underline the role of daily experiences during life transitions for individual differences in self-esteem change. The discussion calls for accounting for unique transition experiences to advance theory and research on self-esteem development.

Parent-adolescent relationship quality as a predictor of leaving home.

INTRODUCTION: Leaving home is a significant life transition that effects both emerging adults and their families. The age of leaving home has been increasing across industrialized societies, and children remain dependent on their parents for a longer time. The present study investigated the association between parent-adolescent relationships and timing of leaving home over a timespan of six years: From middle adolescence to emerging adulthood. METHODS: Data came from three cohorts of two longitudinal studies in the Netherlands (N = 1100). At the start of the study, participants had a mean age of 16.41 (SD=.71), and approximately half of them (n = 547) were male. Adolescents completed questionnaires on parent-adolescent relationship quality. The impact of positive and negative relationship characteristics on timing of leaving home were examined separately for mothers and fathers. RESULTS: Survival analysis results showed that higher levels of mother's and father's warmth, and higher levels of power attributed to father, but not mother, predicted later timing of leaving home. Higher levels of parental autonomy support predicted earlier timing of leaving home. Conflict with parents was not associated with timing of leaving home, except in the father-daughter relationship. Only, the effect of parental warmth on timing of leaving home remained robust when controlling for age, gender, education level, and SES. CONCLUSIONS: Our findings indicate that certain parent-adolescent relationship characteristics contribute to the increase in age of leaving home. Parents may be able to prepare their children for a self-sufficient living by balancing warmth and autonomy support they provide during adolescence.

Multiple and multidimensional life transitions in the context of life-limiting health conditions: longitudinal study focussing on perspectives of young adults, families and professionals.

BACKGROUND: There is a dearth of literature that investigates life transitions of young adults (YAs) with life-limiting conditions, families and professionals. The scant literature that is available has methodological limitations, including not listening to the voice of YAs, collecting data retrospectively, at one time point, from one group's perspective and single case studies. The aim of this study was to address the gaps found in our literature review and provide a clearer understanding of the multiple and multi-dimensional life transitions experienced by YAs and significant others, over a period of time. METHODS: This qualitative study used a longitudinal design and data were collected using semi-structured interviews over a 6-month period at 3 time points. Participants included 12 YAs with life-limiting conditions and their nominated significant others (10 family members and 11 professionals). Data were analysed using a thematic analysis approach. RESULTS: Life transitions of YA and significant others are complex; they experience multiple and multi-dimensional transitions across several domains. The findings challenge the notion that all life transitions are triggered by health transitions of YAs, and has highlighted environmental factors (attitudinal and systemic) that can be changed to facilitate smoother transitions in various aspects of their lives. CONCLUSIONS: This study makes a unique and significant contribution to literature. It provides evidence and rich narratives for policy makers and service providers to change policies and practices that are in line with the needs of YAs with life-limiting conditions as they transition to adulthood. Families and professionals have specific training needs that have not yet been met fully.

Navigating emotions and relationship dynamics: family life review as a clinical tool for older adults during a relocation transition into an assisted living facility.

OBJECTIVE: Relocation for the purpose of receiving care may be one of the more challenging transitions for older adults. The purpose of this study was to facilitate a family life review (FLR) session aimed at enhancing family relationships and assisting older adults in coping with the challenges associated with a relocation. METHODS: Fourteen dyads comprised of older adults who relocated to an assisted living facility (ALF) and a chosen family member or friend participated in a FLR session and semi-structured follow up interview. Data were analyzed using the constant comparative method and triangulated with descriptive statistics. RESULTS: Emergent themes suggested participating in FLR influenced families by raising emotions, systemically thinking, and navigating the relocation. FLR facilitated positive connections, enhanced existing relationships, and promoted self-acceptance. Families indicated mutual storytelling was enjoyable and reminded them of the urgency to share their story. FLR allowed dyads to reflect and thus prompted a renewed perspective on some of the more challenging components of the relocation transition. CONCLUSION: Study findings provide insight into how families organize individual and interpersonal narratives and use these narratives during transitional times. FLR can aid families in making a smoother and fulfilling move to an ALF and other late life transitions.

Life transitions of adolescents and young adults with life-limiting conditions.

AIMS: A systematic review was conducted to appraise and classify evidence related to the life transitions of adolescents and young adults with life-limiting conditions. METHODS: The databases searched were MEDLINE, CINAHL, PsycINFO, CancerLit, and AMED. Methodological quality was assessed using an established tool and the final articles included in the study were rated as moderate to high quality. Articles were then assessed based on the insight that they provided into life transitions for adolescents and young adults. RESULTS: Eighteen studies were included in the final review, with two major life transitions identified as pertinent: 'illness transition' and 'developmental transition'. These concurrent transitions were found to be relevant to adolescents and young adults with life-limiting conditions, generating complex needs. Sub-themes within the transitions were also identified. Furthermore, the illness transition was found to also impact significant others, namely family members, having physical, mental and emotional health implications and requiring them to make adaptations. CONCLUSIONS: Future research is needed to focus on adolescent and young adult perspectives to bring further insight into these key transitions, since such perspectives are currently underrepresented. Attention to the impact of the illness on the whole family would be useful to expand findings from this review.

Childhood sleeping difficulties and depression in adulthood: the 1970 British Cohort Study.

Sleeping difficulties in childhood have been associated with an increased risk of depression in adult life, but existing studies have not accounted for comorbid maternal sleeping difficulties and depression. This study aimed to determine the association between childhood sleeping difficulties and depression in adulthood after adjusting for the potential confounding influences of maternal depression and sleeping difficulties. Data from the British Cohort Study 1970, a prospective birth cohort with 30 years of follow-up (1975-2005) were used. At 5 years of age, 7437 parents of participants recorded information on whether their child had sleeping difficulties, the frequency of bed-wetting, nightmares, maternal depression and sleep difficulties. At 34 years of age, participants reported whether or not they had received medical treatment for depression in the past year. Parental reports of severe sleeping difficulties at 5 years were associated with an increased risk of depression at age 34 years [odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.2, 3.2] whereas moderate sleeping difficulties were not (OR = 1.1, 95% CI = 0.9, 1.3). In conclusion, severe sleeping problems in childhood may be associated with increased susceptibility to depression in adult life.

The Developmental Transition From Living With to Dying From Cancer: Hospice Decision Making.

Despite increasing utilization of hospice care, older adults with cancer enroll in hospice for shorter periods of time than those with other life-limiting illnesses. How older adults with cancer and their family members consider hospice is unknown. The purpose of this study was to compare decision making in late-stage cancer in people who enrolled in hospice with those who declined. Concepts from the Carroll and Johnson (1990) decision-making framework guided the development of a hospice decision-making model. The study design was exploratory-descriptive, cross-sectional, and used a two-group comparison. Qualitative and quantitative data were collected in the same interview. Open-ended questions were used to explore the illness trajectory and decision-making process. The interrelationships between functional ability, quality of life, and social support with hospice decision making were assessed using the Katz, QLQ-30, and Lubben Social Network Scales. Study participants included 42 older adults with cancer who had been offered hospice enrollment (24 non-hospice and 18 hospice) and 38 caregivers (15 non-hospice and 23 hospice); N = 80. The decisional model illustrates that the recognition of advanced cancer and information and communication needs were experienced similarly by both groups. There was interaction between the decisional stages: formulation of awareness and generation of alternatives that informed the evaluation of hospice but these stages were different in the hospice and non-hospice groups. The hospice enrollment decision represents a critical developmental juncture, which is accompanied by a transformed identity and substantive cognitive shift. Increased attention to the psychosocial and emotional issues that accompany this transition are important for quality end-of-life care.

Moving in together in later life: Making spaces into places as a joint endeavor.

BACKGROUND AND OBJECTIVES: We focus on the linkages between relocation, new forms of partner cohabitation, and retirement. What are the patterns and trajectories of moving in with a partner in retirement? How do older adults experience different transitions, place attachment, and placemaking when they move in with a partner? RESEARCH DESIGN AND METHODS: In this qualitative study, 50 persons between 60 and 75 years old were interviewed in Sweden and Germany. For this paper, we focused on nine participants who experienced a relocation with a partner in retirement. Interviews were transcribed and analyzed using a strategy derived from social constructivist Grounded Theory and thematic analysis. RESULTS: Research participants described experiences of several relocations and cohabitation trajectories. In particular, we identified two patterns of relocating with a partner in retirement: moving into a new place with a partner and moving into a partner's pre-existing home, the latter proving more challenging for forming place attachment and for the couple relationship. Relocation experiences appeared to form a joint process in which relationships and retirement were renegotiated. DISCUSSION AND IMPLICATIONS: Using cross-cultural data, this novel study shows an unexpected diversity in housing and cohabitation trajectories among older adults. More research is needed to understand what "aging in the right place" with "the right person" really means and the role of life course trajectories and couple negotiations in such processes. Future research should focus on what comes before and after relocation rather than solely studying the decision-making process that leads up to a move.

Mental Health, Declining Physical Activity and Social Connection during Transitions into Fatherhood in the UK.

This paper addresses an under-explored area of sociologically oriented health research, namely, the mental health and physical activity (PA) experiences of new fathers. Drawing upon responses to an online qualitative survey from 32 fathers, aged 18 or over, and living in the UK, we show how the decline in these fathers' overall PA was associated with poor mental health and the changing constraints that characterised their increasingly complex networks of interdependence. These constraints corresponded with shifts in fathers' PA engagement from team sports towards individualised, flexible, and more recreationally oriented lifestyle activities like running and the gym. Fathers' engagement in these activities appeared to exacerbate the complex feelings of guilt and isolation that they already encountered as new fathers. These experiences were simultaneously associated with feelings of shame associated with being insufficiently active and fearing judgement about their engagement in fathering responsibilities. The paper has important policy implications, highlighting the need for tailored support for new fathers in the perinatal period, and implications for practice, suggesting that co-produced community-based PA programmes are potentially effective settings for engaging new fathers in PA and promoting their mental health.