Health, coping and independent living in community-residing older care recipients

Background: Community health care is the arena in which most care-dependent older people receive professional nursing assistance. The main objective of home nursing care is to improve the patient’s quality of life and/or to maintain his/her independence. Aims: To describe the characteristics of people receiving home nursing care (HNC), and how the recipients define their health. To examine the mechanisms underlying the loss of independent living and the allocation of home nursing care, and whether home nurses give priority to the overall goals of HNC. Respondents/methods: 242 respondents were aged 75 years or older, receiving HNC. A survey with baselineand follow-up data (a 2-year period) was undertaken. Results: The oldest patients were the healthiest. Subjectively perceived health was more important in the perception of health than objective health measures. Strong perception of social support and a high self-rating of health predicted a longer period of independent living. Functional and cognitive decline and being male were the most important predictors of loss of independent living. Compensatory or complementary assistance from informal networks did not influence the period of independent living. Coping resources, measured as Sense of Coherence (SOC), did not prolong independent living. The allocation of home nursing care was mainly influenced by impaired functional health, and not influenced by subjective health measures. Conclusion: Older persons with a poor perception of subjective social and health conditions are vulnerable since these are not intercepted as a reason for care assistance. Implications: Nurses should emphasize the identification and treatment of subjective health problems. The salutogenic approach should be given stronger attention as a principle for nursing practice. More research should be done with regard to how the dimensions of sense of coherence influence health promotion. This includes both the individual patient, and how services are organized