Pastoral Support for Late-Life Sexuality

SUMMARY

As more persons live longer and enjoy relatively good physical health, new ethical questions arise. One set of questions regards the continuation of sexual life among older persons, especially among older unmarried persons. Women live many years longer than their spouses and often were of a younger age than the spouses. The Judeo-Christian tradition affirms the vitality of sex as a basic part of God's gift of physical creation. A large majority of older people view sexual expression as important and many see it as crucial to a good relationship with a partner. These issues are raised for the awareness of pastoral counselors to understand and be responsive to the varied sexual alternatives m the later years m order to offer practical help to older persons.     

Aging stereotypes and active lifestyle: Personal correlates of stereotype internalization and relationships with level of physical activity among older adults

ObjectivesThe goal of this study was to identify the personal correlates (openness to experience and implicit theories of ability) of internalization of aging stereotypes and its relationships with physical activity.DesignCross-sectional survey.MethodOne hundred and ninety-two older adults (78 men and 114 women) from 60 to 93 years (M_age = 73.44, SD = 7.34) completed a series of questionnaires measuring openness to experience, implicit theories of ability, stereotypes about older people and physical activity, attitude toward own aging, physical self-worth, physical activity level, self-rated health and education level.ResultsThe main results showed that (a) openness to experience positively predicted physical activity level through incremental theories, endorsement of aging stereotypes relative to benefits, attitude toward own aging, and physical self-worth; and (b) entity theories negatively predicted physical activity level through endorsement of aging stereotypes relative to risks, attitude toward own aging, and physical self-worth.ConclusionThe present study indicates that openness to experience and implicit theories of ability are correlates of endorsement of aging stereotypes and suggests that endorsement may be an important factor of engagement in physical activity in older adults.     

Grounding theory in self-referent thinking: conceptualizing motivation for older adult physical activity

Objectives: The aim of this study was to enrich current theoretical understanding of the kinds of thoughts older people have about physical activity by answering the broad research question: How well does the lay thinking of older adults about their involvement in physical activity fit current theory?Design: In order to enrich current theory, individual beliefs and experiences with physical activity were explored. An interpretive design employed content analysis of in-depth interviews.Methods: Forty-one adults aged 55 to 92 were interviewed for 60 to 90 minutes about their involvement in physical activities and their reasons for participation (or not). The inductive approach was used to extract positive and negative meanings, and generate conceptual themes within each individual interview. Each meaning segment was then matched, if possible, to elements on a theoretical template that used key constructs from major health behavior theories.Results: The main finding was that no new conceptual themes were found but interesting patterns of responses emerged by activity level. In thinking about their physical activity, inactive respondents generally had more negative thoughts than positive ones; their explanations showed contradictions and poor logic at times, lending support for Weinstein's notion of haphazard or faulty thinking. An unexpected finding was that active people also expressed a full array of barriers, but they seemed to counter every negative thought with strong positive dialogue and every barrier with a solution.Conclusions: Active older people were clear about their motives to be active. They felt personally capable, had steadfast goals, anticipated positive outcomes, and showed an overarching commitment to active living despite life distractions. While current behavioral theory was supported, qualitative evidence of haphazard thinking suggests that human nature has observable foibles and complexity.     

What do targeting positive views on ageing add to a physical activity intervention in older adults? Results from a randomised controlled trial

Objective: Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention.

Design: Randomised controlled trial with three groups aged 65+: Intervention for physical activity with ‘views-on-ageing’-component (n?=?101; IGVoA), and without ‘views-on-ageing’-component (n?=?30; IG), and active control intervention for volunteering (n?=?103; CG).

Main outcome measures: Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5?months after the intervention.

Results: Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable.

Conclusion: A ‘views-on-ageing’-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.     

Physical activity and posttraumatic growth: A systematic review of quantitative and qualitative studies

ObjectivesThis systematic review aimed to examine the relationships between physical activity and posttraumatic growth (PTG) following a highly stressful life event.DesignA systematic review was conducted to identify eligible articles. A meta-analysis was conducted for quantitative studies and a meta-ethnographic synthesis was conducted for qualitative studies.MethodAfter systematic searches of five databases and literature screening, 20 quantitative studies and 12 qualitative studies were included in the final review. A meta-analysis of 14 quantitative studies was conducted to examine association between leisure-time physical activity and PTG. A meta-ethnographic synthesis of 10 qualitative studies was conducted to examine the relationship between physical activity and the experience of PTG.ResultsThe meta-analysis revealed a positive, yet small, association between leisure-time physical activity and PTG (average correlation = 0.120; 95% confidence interval: 0.071 to 0.168; p < 0.001). The effect sizes did not differ by measurements of PTG and participants’ age and gender but were smaller in studies with a binary variable of physical activity, a sample of participants with moderate or advanced diseases, and a longer period since the stressful event. The meta-ethnographic synthesis identified potential processes linking physical activity and PTG, including perceptions of self, social experiences, philosophical re-evaluation, and health effects.ConclusionsThis review suggest physical activity is a behavioral factor that may facilitate PTG. It highlights methodological considerations for further research.     

From pleasure and pride to the fear of decline: Exploring the emotions in older women's physical activity narratives

ObjectivesThe purpose of this study was to explore the emotion narratives in older women's ageing body and physical activity-related stories.MethodThe study was informed by narrative inquiry. We conducted two semi-structured interviews with 21 women aged 65 to 94 and asked them about their physical activity engagement, and body perceptions, experiences, and management strategies. Using thematic narrative analysis, we analysed the content of participants’ stories pertaining to physical activity, the core patterns within them, and considered the cultural context in which they were embedded.ResultsEmotion narratives of anxiety/fear, shame, guilt, pride, and pleasure permeated the women's stories. Participants feared physical and cognitive decline, and engaged in physical activity to stave off the ageing process. Body-related shame and guilt transected their stories; they were frustrated by their inabilities to engage in certain activities and with their move away from the healthy and physically fit cultural ideal. To negotiate this body-related anxiety/fear, shame, and guilt, the women drew attention to their accomplishments in the physical domain with pride, reinforcing their efforts to take personal responsibility for their health. Participants were also physically active for pleasure, gaining satisfaction from the social connections and mindfulness derived from being active, and through their participation in challenging yet rewarding activities.ConclusionsThe findings are novel as they highlight the importance of cultural age and body norms coupled with complex emotional experiences in shaping later life physical activity experiences, and draw attention to the usefulness of stories to explore emotions in the physical domain.     

The Paradoxes of Humor and the Burdens of Despair

SUMMARY

People today often express considerable despair about old age and the aging process. Older adults who experience frequent losses of connections with important persons can feel considerable despair in old age. Nevertheless, many older people retain hope in the face of situations that elicit despair and demonstrate what gerontologists call the “paradox of well being” in later life. Often, their hope is expressed in humor. This paper traces the connections among humor, hope, and religious faith in older adults. It argues that even persons who suffer from dementia can continue to express what Viktor Frankl called the “defiant power of the human spirit” through their humor.     

Distinguishing between self-control and perceived control over the environment to understand disadvantaged neighbourhood health and lifestyle outcomes

Abstract

Objective: The current study aimed to test whether and how self-control and perceived control play a role in health outcomes and lifestyle differences between disadvantaged and non-disadvantaged neighbourhoods.

Design: Cross-sectional survey data including demographics was collected from 3758 participants. Main outcome measures: With the survey, self-control, perceived control, health status and lifestyle variables were assessed.

Results: Participants in disadvantaged neighbourhoods reported poorer general health, as well as unhealthier lifestyles compared to participants in non-disadvantaged neighbourhoods. Self-control was likewise positively associated with health and lifestyle variables. However, self-control did not differ between participants from different neighbourhoods. Perceived control over the environment mediated between type of neighbourhood and health, with participants from a disadvantaged neighbourhood reporting a lower sense of perceived control, which in turn was associated with poorer self-reported general health and less healthy lifestyle choices.

Conclusion: This reveals that perceived control over one’s life and the environment is more important than self-control when explaining health differences between neighbourhoods.     

Mental health and quality of life in non-binary transgender adults: a case control study

Abstract

Background: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking.

Aim: To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth.

Method: A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures.

Results: Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups.

Conclusion: There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.     

Mental Health and Spirituality in Later Life: Pastoral Approaches

SUMMARY

This chapter proposes a perspective on providing pastoral care for people at risk of, or who have mental health problems in later life. Two major areas of mental health, depression and dementia are explored, examining their impact on older people and strategies to identify risk in depression, and signs indicating need for pastoral intervention in depression and/or dementia. The work from two studies that examine issues for meaning of people, the first for older people living independently and the second in residential care, form the basis of the material presented in this chapter. It is maintained that pastoral interventions may greatly improve quality of life for these people, their families and carers.¹     

Physical activity in employees with differing occupational stress and mental health profiles: A latent profile analysis

ObjectivesTo examine whether employees with differing occupational stress and mental health profiles differ in their self-reported levels of physical activity.DesignCross-sectional survey data.MethodThe sample consisted of 2660 Swedish health care workers and social insurance officers (85% women, M = 46.3 years). Latent profile analysis was performed to identify classes. Between-class-differences in physical activity were tested via χ²-tests and multinominal logistic regression analyses using sex, age, BMI, marital status, children at home, caregiving, and smoking as covariates.ResultsLatent profile analysis resulted in a six-profile solution. Two pairs of classes had equal stress levels, one pair with high stress, one pair with moderate stress. Within each pair, one group showed some resilience (i.e. only moderate mental health problems despite high stress or good mental health despite moderate stress), whereas the other did not. The other two classes were characterized by either low stress and good mental health or moderate-to-high stress and elevated mental health problems. Participants who were resilient to high or moderate stress were more active than participants of the corresponding non-resilient classes. Participants with low stress and good mental health reported the highest physical activity levels, participants with high stress and high mental health problems reported the lowest physical activity levels.ConclusionsThe findings suggest that physical activity is associated with resilience to occupational stress, and that beyond primary prevention efforts to make work less stressful regular physical activity should be a target variable for health professionals working in the occupational setting.     

A ‘new life’ story or ‘delaying the inevitable’? Exploring older people's narratives during exercise uptake

ObjectivesThe purpose of this study was to examine narratives of ageing in a clinical population embarking on a physical activity/exercise programme, exploring if and how their narratives changed throughout their experiences.DesignThe study employed a longitudinal narrative approach.MethodParticipants were six sedentary individuals aged between 78 and 89 years who were enrolled on an exercise programme for older adults. During the course of the 32-week programme participants took part in multiple interviews focused on their attitudes towards physical activity and their physical self-perceptions and identity. A structural narrative analysis was used to focus on the progression of the plot outlined in each participant's story.ResultsOur results suggested the emergence of two comparative narratives, with each demonstrated in the stories told by three participants. The first narrative is one of decelerated decline, in which the exercise programme is assimilated or fitted into the existing life narrative, but little is made of the personal meaning of being active. In the second narrative, participation in exercise prompted participants to re-story their ageing narratives, changing from initially accepting the decline they associated with an ageing body, to the prospect of gaining some control. While this increased sense of control may intuitively seem positive, participants initially described a number of existential challenges and dilemmas as well as their resolution of these.ConclusionParticipants' emergent stories highlighted that while older adults may perceive exercise positively, their existing narratives of decline may be resistant to change. Where changes do occur, it is important for health professionals to recognize the associated difficulties with gaining increased responsibility for health.     

The physical activity experiences of men with serious mental illness: Three short stories

ObjectivesAlthough a considerable amount of research has explored the effects of physical activity on mental health, the voices of people with mental illness have been largely excluded from published reports. Through this study we aim to foreground service users’ voices in order to shed light on the personal and subjective nature of the relationship between physical activity and serious mental illness (SMI).MethodsAn interpretive case study approach was used to explore in depth the physical activity experiences of three men with SMI. Creative analytic practice was used to write three creative non-fictions which, as first-person narratives, foreground the participants’ voices.ResultsWe present three short stories in an effort to communicate participants’ personal and subjective experiences of physical activity in an accessible, engaging, and evocative manner. We hope to: (i) provide potentially motivating physical activity success stories for others who live with SMI; (ii) increase awareness among mental health professionals of the possibilities of physical activity; and (iii) provide an empathetic understanding of possibilities and problems of living with SMI which may help challenge the stigma surrounding mental illness.ConclusionsFor us, the stories communicate the diversity and difference inherent in the ways men with SMI experience physical activity. We reflect on how the short story form allows these differences to be preserved and respected. We resist making further interpretations of the stories preferring instead to encourage the reader to form her or his own conclusions.     

Are action planning and physical activity mediators of the intention-habit relationship?

ObjectivesPhysical activity is associated with many health benefits that are important for older adults. These health benefits can only be obtained and preserved when physical activity is maintained over a long period of time. Habit formation has been proposed as a way to ensure long-term maintenance of physical activity. Intention, action planning, and physical activity are suggested to be determinants of physical activity habits. However, how they determine physical activity habits in older adults is largely unknown. This study examined whether the relationship between intention and habit is mediated by action planning and/or physical activity.DesignA four-wave prospective design was used.MethodsTwo independent studies were conducted in 469 (Study 1; M_age = 63.07, SD_age = 7.61) and 322 (Study 2; M_age = 64.31, SD_age = 9.39) older adults. Study 2 was conducted with the aim of replicating findings of Study 1. In both studies the older adults completed questionnaires on intention, physical activity, and habit at baseline, action planning at three months, physical activity at six months, and habit at twelve months.ResultsStructural equation modeling analyses showed significant intention-physical activity-habit paths, nonsignificant intention-action planning-habit paths, and nonsignificant intention-action planning-physical activity-habit paths in both studies.ConclusionsThe relationship between physical activity habit and intention was mediated by physical activity. Intention was neither associated with habit via action planning as a single mediator, nor via action planning and physical activity as sequential mediators. Possible conditions under which intention-action planning-habit paths and intention-action planning-physical activity-habit paths exist are discussed.     

Motives for and barriers to physical activity participation in middle-aged Chinese women

ObjectivesThis study examined differences in motives for and in barriers to physical activity participation in middle-aged Chinese women between activity levels and motivational styles.DesignCross-sectional study.MethodsChinese middle-aged women (N=360) completed a battery of questionnaires about level of physical activity, reasons for and barriers to physical activity participation, and general motivational style.ResultsEighty percent of the women were classified into precontemplation, contemplation, or preparation stages of physical activity, indicating the majority were not physically active enough to achieve health benefits. Fitness–health, enjoyment–interest and appearance were found to be the most important motives for, and lack of time, resources or skills and family or friend support the most important barriers to participation. Women in the later stages of physical activity behavior were more likely to exhibit greater motive strengths and to perceive fewer barriers compared to those in the earlier stages. Among a number of motivational style results, women in the later stages were found to be more arousal-seeking and to rate challenge of activities and improving competence higher than women in the earlier stages. Also, having a mastery motivational style and a higher income were strong predictors of physical activity participation in these middle-aged women.ConclusionThe findings of the present study extend the literature by providing insights into how women's motives for and barriers to physical activity participation are related to their activity levels and motivational styles. The implications of the results for physical activity promotion and provision with regard to benefiting women's health are discussed.     

‘Just Because I Can't Remember …’ Religiousness in Older People with Dementia

SUMMARY

This paper reports part of a pilot study that used spiritual reminiscence techniques to explore issues of religiosity, church attendance and meaning in life of a group of older people with dementia. The study used small groups, individual interviews and participant observation to examine the experience of dementia and the search for meaning used by people with dementia. There were 22 participants from three aged care facilities involved in the project. The majority of participants had been long-term church attendees and could describe how their religion and relationship with God had impacted on their lives. They had few fears for the future and derived considerable meaning in life from their relationships with family. Participants were able to describe early memories and also remember things happening recently in their aged care facility. This would seem to be the opposite of community expectations (and sometimes staff expectations) of older people with dementia.     

The effect of video observation on warmth and competence ratings of individuals with a disability

ObjectivesThis study examined whether a video featuring an adult with a physical disability engaging in either sport, exercise, or an activity of daily living (ADL) can mitigate negative stereotypes of disability held by people without a disability.DesignThis study used a pre-post design, involving three participant groups.MethodsParticipants (n = 212) read a vignette describing an adult with a disability (target). Consistent with the stereotype content model, participants judged the target's warmth and competence. One week later, participants viewed a video of the target participating in sport, exercise, or an ADL and judged the target's warmth and competence.ResultsJudgements of competence but not warmth changed over time. The greatest increases occurred in the sport condition. At follow-up, the typical high warmth low competence stereotype of disability was reversed; the character was judged as being more competent than warm especially in the sport condition.ConclusionVideos of adults with a disability engaging in physical activity, particularly sport, have potential to mitigate negative stereotypes of disability.     

A test of the impact of pain on automatic motivational processes in people with knee osteoarthritis

ObjectivePeople with osteoarthritis are likely to be physically inactive and current socio-cognitive approaches to changing physical activity in this patient population are generally ineffective. We assessed prospective associations between physical activity and the automatic processes of habit automaticity, automatic evaluations, and automatic self-schema in people with knee osteoarthritis.DesignOne-week prospective.Method253 adults (aged 46–82 years, 72% female, 28% male) with knee osteoarthritis self-reported their physical activity behaviour of the past week, habit automaticity for physical activity and completed two implicit association tests to assess automatic evaluations of physical activity (relative to sedentary behaviour) and automatic self-schema for physical activity. One week later, participants self-reported physical activity and pain while walking over the prior week. Linear regression models assessed associations of each automatic process with subsequent physical activity and the moderation effect of pain and each automatic process on subsequent physical activity, controlling for covariates.ResultsWe did not find evidence of a statistical relationship between physical activity with automatic evaluations, automatic self-schema, or habit automaticity. The inclusion of pain while walking did not moderate the relationship between any automatic process and physical activity.ConclusionAlthough previous research on healthy, young adults suggests that automatic processes affect physical activity behaviour, we did not find evidence to confirm whether a similar relationship exists for older adults with knee osteoarthritis. Replication and extension work testing these research questions is needed to ensure the findings are not a result of measurement and design features of the study.     

Predicting physical activity in adolescents: The role of compensatory health beliefs within the Health Action Process Approach

Objective: Compensatory health beliefs (CHBs), defined as beliefs that healthy behaviours can compensate for unhealthy behaviours, may be one possible factor hindering people in adopting a healthier lifestyle. This study examined the contribution of CHBs to the prediction of adolescents’ physical activity within the theoretical framework of the Health Action Process Approach (HAPA).

Design: The study followed a prospective survey design with assessments at baseline (T1) and two weeks later (T2).

Method: Questionnaire data on physical activity, HAPA variables and CHBs were obtained twice from 430 adolescents of four different Swiss schools. Multilevel modelling was applied.

Results: CHBs added significantly to the prediction of intentions and change in intentions, in that higher CHBs were associated with lower intentions to be physically active at T2 and a reduction in intentions from T1 to T2. No effect of CHBs emerged for the prediction of self-reported levels of physical activity at T2 and change in physical activity from T1 to T2.

Conclusion: Findings emphasise the relevance of examining CHBs in the context of an established health behaviour change model and suggest that CHBs are of particular importance in the process of intention formation.     

Women's disclosure of sexual abuse

Abstract

In this qualitative study of women who have experienced nonconsensual sexual activity, participants were asked to write accounts of their experiences focusing on what motivated them to confide in someone, to whom they confided, what the outcome was, and how it effected them. Participants had to be female and 18 years of age or older, and they had to have been sexually abused at some point in their lives. A total of 10 women participated. Nine of the women wrote about an abusive experience that happened to them as a child, and one wrote about an experience that occurred in adulthood. The participants wrote that they were able to disclose their past sexually abusive experience because they felt safe with the person to whom they confided, they felt they needed help, and the opportunity presented itself. They were more likely to disclose to non-family members than family members, and the majority of the people they disclosed to had a positive reaction. Consequently, most of the women in this study were positively affected by their disclosure. Findings of this study are similar to those of other studies on disclosure and sexual abuse.