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Self-perceived needs and nursing involvement with the elderley living at home Donaghue, Shirley June, 1930 1973

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SELF-PERCEIVED NEEDS AND NURSING INVOLVEMENT WITH THE ELDERLY LIVING AT HOME by SHIRLEY JUNE DONAGHUE B . A . , Univer s i ty of B r i t i s h Columbia, 1970 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n the School of Nursing We accept t h i s thes is as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1973 In p r e s e n t i n g t h i s t h e s i s in p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree t h a t permission for extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e s . I t i s understood that copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n permission. Department of The U n i v e r s i t y of B r i t i s h Columbia Vancouver 8, Canada i i ABSTRACT This study surveyed the s e l f perceptions of t h i r t y i n d i v i d u a l s over s i x t y - f i v e years of age, who l i v e d i n the Vancouver Quadra e l e c t o r a l d i s t r i c t , i n order to gather information about t h e i r needs. The study was designed to answer three questions. Do the e l d e r l y l i v i n g at home i n a s p e c i f i c geographical area of Vancouver perceive themselves as having needs i n the need areas defined by the l i t e r a t u r e , namely housing, health, independent l i v i n g , employment, economic security and i n t e r -personal relations? Do the e l d e r l y i n the selected sample perceive t h e i r needs as being met? Do the e l d e r l y i n the selected sample perceive nurses as involved i n helping them meet t h e i r needs? A semi-structured interview schedule was used to obtain information relevant to the research problem. The r e s u l t s of t h i s study indicated that more than ha l f the respondents, or 53 per cent, perceived needs i n the need areas defined by the l i t e r a t u r e . The majority of perceived needs, or ?6 per cent, were not met. None of the e l d e r l y whose needs were met perceived nurses as involved i n helping them meet these needs. Moreover, the majority of the study sample, or 87 per cent, did not perceive nurses as p o t e n t i a l l y helpful i n a s s i s t i n g them to meet t h e i r needs. The study recommends that nurses extend t h e i r current role and become a c t i v e l y involved i n assessing and meeting i v the needs of the e l d e r l y l i v i n g at home. 109 pages ACKNOWLEDGEMENTS I would l i k e to express my appreciation to the t h i r t y e l d e r l y individuals who participated i n t h i s study. I also wish to thank Professors Alice Baumgart, Helen Shore and Dr. G l o r i a Gutman fo r t h e i r advice and guidance. v TABLE OF CONTENTS Page ACKNOWLEDGEMENTS v LIST OF TABLES r v i i i CHAPTER I . INTRODUCTION TO THE STUDY 1 In t r o d u c t i o n 1 Statement of the Problem 3 S i g n i f i c a n c e of the Problem 4 Assumptions of the Study 5 D e f i n i t i o n s of Terms Used 6 L i m i t a t i o n s of the Study 6 I I . REVIEW OF THE LITERATURE 8 In t r o d u c t i o n . . . . . . . . . . . . . . . 8 The Advantages of Ma i n t a i n i n g the E l d e r l y at Home 9 Needs of the E l d e r l y L i v i n g at Home 15 " .-Nurse * s Role i n R e l a t i o n to the E l d e r l y L i v i n g a t Home 25 Summary . . . . . . . . . . . . . . . . . 32 I I I . THE RESEARCH DESIGN AND DEVELOPMENT OF THE STUDY 3^ Research Interview Schedule . . 3^ S e l e c t i o n of the Study Group . . . . . . . 37 The I n t e r v i e w i n g Procedure . 39 Summary . . . . . . 41 v i v i i CHAPTER Page IV. ANALYSIS OF THE DATA 42 Charac ter i s t i c s of the Study-Population 42 Areas of Need Perceived by the E l d e r l y L i v i n g at Home 44 Met and Unmet Needs ?6 Nursing Involvement i n Helping the E l d e r l y Meet Needs . . . . . 77 Summary 80 V. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS . . 82 Summary 82 Conclusions • • 84 Recommendations • • 88 BIBLIOGRAPHY 91 APPENDICES 96 A. Interview Schedule 97 B. Le t te r of Introduction 109 LIST OF TABLES TABLE Page 1. Se lec t ion of Sample Population . . . . . . . . 38 2. Age by Sex D i s t r i b u t i o n of Study Sample . . . 43 3 . Educat ional Charac ter i s t i c s of Study Sample Expressed i n Tota l Numbers and Percentages • • • • 43 4 . M a r i t a l Status by Sex of Study Sample . . . . 44 5 . Perceived Intens i ty of Needs of the Study Sample . . . . . . . 45 6. D i s t r i b u t i o n of Perceived Needs of Study Sample 46 7. Housing Needs of Study Sample . . . . . . . . 47 8. Length of Time Lived i n Place of Residence by Study Sample . . . . . . . . . 48 9. Number and Percentage of Study Sample Perceived Needs i n Itemized Areas Related to Health . . . . . 50 10. Respondents' Perception of Health i n Comparison with Own Age Group 53 11. Health Perceptions of Study Sample i n Relat ion to Number of Conditions Necess i tat ing Medical Treatment 54 12. Reasons for House Confinement of Study Sample i n Last Five Years 56 13. Degree of Task D i f f i c u l t y Experienced by Sample Populat ion 57 1 4 . A c t i v i t i e s Done Often and Occas ional ly by Numbers and Percentage of Study Sample . . . 59 15. A c t i v i t i e s Giv ing Highest Degree of Sa t i s f ac t ion as Selected by Number and Percentage of Study Population . . . . . . 62 16. Interest i n Re-employment Among Retired . . . 66 v i i i ix TABLE Page 1 7 ; Monthly Income by Number and Percentage of Study Sample 69 1 8 . Changes and Decisions Made by Por t ion of the Study Sample i n Last Five Years . . . . 73 1 9 . Responses of the Study Sample i n Respect to S a t i s f a c t i o n with Present L i f e . • . . . 75 2 0 . D i s t r i b u t i o n by Need Areas of Met and Unmet Needs of the Study Sample 77 2 1 . Means by Which Study Sample Perceived Needs Met 78 CHAPTER I INTRODUCTION TO THE STUDY I . INTRODUCTION In the twentieth century, rap id advances i n medical sc ience, together with genera l ly improved s o c i a l condi t ions , have resul ted i n a grea t ly increased l i f e span and an unpre-cedented number of o lder c i t i z e n s i n soc ie ty . In.Canada, as i n a l l the advanced countr ies , the number and proport ion of people l i v i n g to l a t e r ages i s growing s t e a d i l y . The F i n a l Report of the Specia l Committee of the Senate on Aging, presented i n Canada i n 1966, stated that the number of people over s i x t y - f i v e years of age i n the popula-1 t i o n was f ive times as many as i n 1901. The rate of increase also rose with age. The population seventy-five years and over i n age increased by s ix times the f igure recorded i n 1901. I t was estimated that by 1991t th i s f igure would increase two and one h a l f times. The Report emphasized that one of the most serious problems faced by society would be to help t h i s e l d e r l y popu-2 l a t i o n maintain a s a t i s f ac tory foothold i n the community. 1 F i n a l Report of the Specia l Committee of the Senate  on Aging, (Ottawa: Queen's P r i n t e r and Contol ler of S ta t ion-a r y , 1 9 6 6 )1 p . 1. 2 I b i d . , p . 4. 1 2 Studies ca r r i ed out i n other countries and reported by the Committee, demonstrated that the phys ica l and mental health of the e l d e r l y was preserved best when they were maintained 3 i n t h e i r own homes. Moreover, the e l d e r l y interviewed by the Committee expressed a desire to manage t h e i r own a f f a i r s 4 and l i v e i n t h e i r own homes as long as pos s ib l e . The Committee provided no simple answer to the ques-t i o n of whose r e s p o n s i b i l i t y i t i s to provide services and f a c i l i t i e s for t h i s growing populat ion of aged i n Canada. However, i n the Committee's op inion, many old people turn 5 to the publ ic health nurse for advice on t h e i r problems. While recogniz ing that the nurse 's primary r e s p o n s i b i l i t y i s for heal th guidance, the Committee stated that problems of heal th are d i f f i c u l t to separate from problems of f i n a n c i a l need,housing and l o n e l i n e s s . They recommended that a re-o r i e n t a t i o n of health agencies and nursing education should be attempted to provide the services needed by the aged i n 6 the community. In recent years, nursing l i t e r a t u r e also has empha-s ized the ob l i ga t ion and r e s p o n s i b i l i t y of the nursing pro-fes s ion to a s s i s t i n meeting the t o t a l needs of the aged 3 I b i d . , p . 30. 4 I b i d . , p . 5. 5 I b i d . , p. 145. 6 I b i d . , p . 116. 3 7 l i v i n g i n the community. However, the w r i t e r ' s experience while working with the e l d e r l y i n the community during grad-uate study, indicated that these p r i n c i p l e s were not ca r r i ed out i n actual p r a c t i c e . In v i s i t i n g several e l d e r l y people l i v i n g at home , the wr i te r repeatedly found that while medi-ca l needs frequently were met by.the nurse i n d a i l y contact , needs r e l a t i n g to problems i n l i v i n g e s s e n t i a l l y were ignored. Furthermore, research which explored the extent to which nurses i n Canada current ly are involved i n assessing and meeting the needs of the aged l i v i n g at home appeared to be l i m i t e d . I I . STATEMENT OF THE PROBLEM The purpose of t h i s exploratory study was to deter-mine se l f -perce ived need areas of a selected group of the e l d e r l y l i v i n g at home i n Vancouver and to determine whether the e l d e r l y perceived the nurse as a helping resource i n meeting needs. The study focused on answering three quest ions. (1) Do the e l d e r l y l i v i n g at home i n a s p e c i f i c geographical area of Vancouver, perceive themselves as having needs i n the Doris Schwartz, Barbara Henley, and Leonard Z e i t z , The E l d e r l y Ambulatory Pat ient : Nursing and Psychosocial  Needs (New York: The MacMillan Company, 1964), p . 4; see also Esther L u c i l e Brown, Nursing Reconsidered: A Study of  Change (Phi l ade lph ia : J . B. L ipp inco t t Company, 1 9 7 1 ) » p . 510. 4 need areas defined by the l i t e r a t u r e , namely housing, hea l th , independent l i v i n g , employment, economic secur i ty , and i n t e r -personal re l a t ions? (2) Do the e l d e r l y i n the selected sample perceive t h e i r needs as being met? (3) Do the e l d e r l y i n the se lected sample perceive nurses as involved i n helping them meet t h e i r needs? I I I . SIGNIFICANCE OF THE PROBLEM Various au thor i t i e s supported the view that nurses were i n a key p o s i t i o n to assess and a s s i s t i n meeting the 8 needs of the e l d e r l y l i v i n g at home. Yet few studies i n d i -cated e i ther the extent of nursing services made ava i lab le to the e l d e r l y i n t h e i r homes or whether the e l d e r l y per-ceived the nurse as a helping resource. This exploratory study'grew out of the w r i t e r ' s concern that so l i t t l e was known about the needs of the e l d e r l y l i v i n g at home i n Canada or the extent to which nurses were involved i n helping the e l d e r l y meet these needs. The study focused on the se l f -percept ions of the e l d e r l y i n d i v i d u a l i n r e l a t i o n to h i s needs. This method was i n keeping with opinions expressed i n separate studies 8 Doris Schwartz, Barbara Henley and Leonard Z e i t z , The E l d e r l y Ambulatory Patients Nursing and Psychosocial  Needs (New York; The MacMillan Company, 1964), p . 5; see also Esther L u c i l e Brown, Nursing Reconsideredt A Study of Change (Ph i l ade lph ia ! J . B. L i p p i n c o t t Company, 1 9 7 1 ) » P» 512; see also Gerald H. Bonham and Agnes B. Weston, "Growing Old i n Vancouver," On Growing O l d , V o l . VII , No. 4 (October, 1969). 1 - 8 . 5 undertaken by Shanas and Rosow. Shanas stated that the subject ive fee l ings of the i n d i v i d u a l were better indices frequently as to how he would funct ion than the re su l t s of 9 a phys i ca l examination, Rosow declared that two types of over-lappirig, but not corresponding needs existed among the e l d e r l y , namely the needs which the e l d e r l y r e a l l y have, and 10 those which profess ionals think they have, IV. ASSUMPTIONS OF THE STUDY The study was based on the assumption that : (1) Spec i -f i c needs of the aged group l i v i n g at home do e x i s t . This assumption was based on a review of l i t e r a t u r e that del ineated the needs of the e l d e r l y , (2) The e l d e r l y are able accurately to perceive and report t h e i r needs and to define i f nurses are involved i n meeting these needs. This assumption was i n keeping with the opinion of the Specia l Committee of the Senate on Aging i n Canada, who concluded that the e l d e r l y are the best reporters of t h e i r own needs and of how these 11 needs are met. 9 E t h e l Shanas and G. S t r e i b , Old People i n Three  I n d u s t r i a l Soc ie t ie s (New York: Atherton Press, 1968), p . 25. 10 I rv ing Rosow, S o c i a l Integrat ion of the Aged (New York: The Free Press, 1967), p . 1. 11 F i n a l Report of the Spec ia l Committee of the  Senate on Aging, op. c i t . , p . 159. V. DEFINITIONS OF TERMS USED 6 For the purpose of t h i s study the fo l lowing terms were def ined. Aged. E l d e r l y . Older, Old These terms were used interchangeably. S i x ty - f i ve years was chosen as a de l inea t ion of the aging process . This d e f i n i t i o n was i n keeping with the accepted age of retirement i n Canada. Nurses This term was used to re fer to any i n d i v i d u a l reg i s tered under the P r o v i n c i a l Registered Nurses* Act , whose involvement with the aged sample was on a profes s iona l ba s i s . Relat ives or fr iends of the aged who were nurses and as s i s ted i n meeting the needs of the aged i n a pr ivate capacity were not considered nurses i n the context of th i s study. L i v i n g at Home This term was used to re fer to a pr ivate place of res idence, maintained by the e l d e r l y themselves or by others , i n which no form of i n s t i t u t i o n a l care was of fered . Se l f -percept ion This term referred to the subjective awareness, impression and knowledge of the e l d e r l y i n d i v i d u a l . V I . LIMITATIONS OF THE STUDY There were recognized l i m i t a t i o n s to the study i (1) The sample was composed' of t h i r t y e l d e r l y i n d i v i d u a l s l i v i n g 7 at home i n the Vancouver Quadra e l e c t o r a l d i s t r i c t . There-fore , f indings appl ied only to the s p e c i f i c sample group and cannot be genera l ized . (2) The area from which the sample was drawn was composed of one-family res idences . No apart-ment dwellers or res idents of rooming or boarding houses were represented. CHAPTER II REVIEW OF THE LITERATURE I . INTRODUCTION P r i o r to World War I I , few studies r e l a t i n g to the aged and the needs of t h i s group had been carr ied out i n i n d u s t r i a l s o c i e t i e s . In B r i t a i n , for example, the f i r s t complete survey of the s o c i a l problems and needs of the aged 1 was presented i n 19^7. The Report of the F i r s t National  Conference on Ageing i n the United States of America was pub-l i s h e d i n 1951* The F i n a l Report of the Specia l Committee  of the Senate on Aging published i n 1966, was the f i r s t attempt i n Canada to examine the problems of the aged on a 3 nat iona l s ca le . Although the problems of aging have been present always i n the world, Loether stated i n 1967 that profes s iona l and publ ic awareness of these problems was 1 J . H . Sheldon, The S o c i a l Medicine of Old Age (Oxford Univer s i ty Press, 1948). 2 U. S. Department of Health, Education, and Welfare, Report of the F i r s t National^ Conference on Aging (Washington, D . C : U. S. Government P r i n t i n g Of f i ce , 1951). 3 F i n a l Report of the Specia l Committee of the Senate  on Aging (Ottawa: Queen's P r i n t e r and Cont ro l l e r of S ta t ion-ary, 1966) . 8 9 heightened only during the past two decades. This rapid growth of in tere s t was re f l ec ted i n the extensive amount of mater ia l r e l a t ed . to aging, published during t h i s pe r iod . Apart from the numerous works of i n d i v i d u a l authors, many reports and research studies by government and s o c i a l agencies were produced, as we l l as several handbooks on aging, which systematized the s o c i a l , psychologica l and 5 p h y s i o l o g i c a l knowledge of the f i e l d . Thus, the l i t e r a t u r e reviewed i n t h i s sec t ion w i l l be r e s t r i c t e d to three broad areas, namely theory and research r e l a t i n g to the importance of maintaining the e l d e r l y i n t h e i r homes? i d e n t i f i c a t i o n of s p e c i f i c needs of the e l d e r l y l i v i n g at home; and the nurseSs ro le i n r e l a t i o n to the e l d e r l y l i v i n g at home. I I . THE ADVANTAGES OF MAINTAINING THE ELDERLY AT HOME Numerous reports and studies indicated that the needs of the e l d e r l y are met most e f f e c t i v e l y when they can be maintained i n t h e i r own homes and within a f a m i l i a r 4 Herman J . Loether, Problems of Aging ( C a l i f o r n i a : Dickenson Publ i sh ing Company, I n c . , 196?), p . 2. 5 James E . B i r r e n (ed . ) , Handbook of Aging and the  Ind iv idua l ( I l l i n o i s : Un iver s i ty of Chicago Press,. 1959); Clark T i b b i t t s ( ed . ) , Handbook of Soc i a l Gerontology;  S o c i e t a l Aspects of Aging (Chicago: Univer s i ty of Chicago Press, I960); Richard H. Williams (ed . ) , Process of Aging,  S o c i a l and Psychologica l Perspectives (New York; Atherton Press, 1963). 10 6" environment. For example, the Report of the White House Conference on Aging, published i n 196l, s ta ted . that spec ia l emphasis should be given to the extension of services which 7 would permit the e l d e r l y to be cared for at home. The Report emphasized the b e n e f i c i a l aspects of home care and stated that the p r i o r i t y object ive of a l l s o c i a l services should be to enable o lder persons to remain i n , or return 8 to , t h e i r own homes as soon as pos s ib le . Moreover, the F i n a l Report of the Specia l Committee  of the Senate on Aging, presented i n 1966, stated that more than 90 per cent of the e l d e r l y i n Canada are not phys i -c a l l y or mentally incapaci tated to the extent that they 9 require i n s t i t u t i o n a l care . The Committee stressed the necess i ty for preventive and supportive services to enable t h i s great majority of e l d e r l y to remain at home. Research 6 Bernard Kutner, David Fanshel , A l i c e Togo and Thomas Langner, Five Hundred Over S ix ty (New York:. Wm. F. T e l l Co . , 1956); Bernard A. Stotsky, The E l d e r l y Pat ient (New York\ Green and Stra t ton , 1968); F i n a l Report of the Spec ia l  Committee of the Senate on Aging (Ottawa: Queen's P r i n t e r and Cont ro l l e r of Stat ionary, 1966); The Nation and Its  Older People: Report of the White House Conference on Aging (Washington, D . C : U . S . Government P r i n t i n g O f f i c e , 1961) . 7 The Nation and Its Older People: Report of the White  House Conference on Aging (Washington, D . C : U .S . Government P r i n t i n g O f f i c e , 1961), p . 153. 8 I b i d . , p . 174. 9 F i n a l Report of the Specia l Committee of the Senate  on Aging, op. c i t . , p . ?• 11 c a r r i e d out by the Committee i n European countries supported t h e i r view that home care, with adequate s o c i a l and medical serv ices , proved a bet ter a l t e rna t ive for the e l d e r l y than 10 i n s t i t u t i o n a l care . The Committee stated that l i v i n g at home was an advantage to the i n d i v i d u a l himself as wel l as a f i n a n c i a l saving to the society at l a rge . The Committee claimed that experience demonstrated that the n o n - i n s t i t u -t i o n a l approach s i g n i f i c a n t l y reduces, prevents, or post-11 pones the pa tholog ica l aspects of the aging process . The re su l t s of a number of studies indicated that r e l o c a t i o n per se may have detrimental ef fects on the e l d e r l y . In one such study of a group of re located e l d e r l y persons, conducted by A l d r i c h and Mendkoff i n 1963, the death rate for people over seventy a f ter r e l o c a t i o n , was 12 three and one-half times the expected r a t e . A change i n s o c i a l environment rather than closeness to death seemed to be the re levant f a c t o r . Markus, Blenkner, Bloom and Downs also found that r e l o c a t i o n of the e l d e r l y resul ted i n increased morbidity and morta l i ty rates , even when r e l o c a t i o n was from one 10 I b i d . , p . 30. 11 I b i d . , p . 142 12 C. Knight A l d r i c h and Ethe l Mendkoff, "Relocat ion of the Aged and Disabled : A Mor ta l i ty Study," Middle Age and  Aging, ed . Bernice L . Neugarten (Chicago: The Univer s i ty of Chicago Press , 1968), pp. .401-8. 13 i n s t i t u t i o n to another. One of the c r u c i a l f indings i n the studies was the high death rate within the f i r s t three months fo l lowing r e l o c a t i o n . The psychologica l response to r e l o c a t i o n stress was more important i n r e l a t i o n to morta l i ty rates than phys ica l cond i t ion . Studies comparing i n s t i t u t i o n a l i z e d and n o n - i n s t i t u -t i o n a l i z e d groups resul ted i n unfavorable f indings i n r e l a -t i o n to i n s t i t u t i o n a l i z a t i o n . At the Eighth Internat ional Conference of Gerontology, Markus, Blenker and Downs re-14 ported on a mor ta l i ty study i n an i n s t i t u t i o n for the aged. When s u r v i v a l rates of matched i n s t i t u t i o n a l i z e d and non-i n s t i t u t i o n a l i z e d aged were compared, the authors found that the h a l f - l i f e of i n s t i t u t i o n a l i z e d males was 2 . 0 years and of females 2 . 8 years , whereas for contro l males h a l f - l i f e was 5 . 0 years and females 6 .7 years . S imi l a r di f ferences held for a l l ages. Another study by Comal l i , Kaus and Wapner, i n 1965» compared community-active older people with an i n s t i t u t i o n -13 E l l i o t Markus, Margaret Blenkner, Martin Bloom, and Thomas Downs, "The Impact of Relocat ion Upon M o r t a l i t y Rates of I n s t i t u t i o n a l i z e d Aged Persons," Journal of Geron-tology, V o l . XXVI, No. 4 (October, 1 9 7 1 ) . pp. 537 - 5 4 1 ; see also Markus, e t . a l . , "Relocat ion Stress and the Aged," I n t e r d i s c i p l i n a r y Topics i n Gerontology (Basel , Munchen, New Yorks S. Karger, 1 9 7 0 ) , V o l . VII , pp. 6 0 - 7 1 . 14 E l l i o t Markus, Margaret Blenkner and Thomas Downs, " M o r t a l i t y Experience i n an I n s t i t u t i o n for the Aged," Eighth Internat iona l Congress of Gerontology, Proceedings -V o l . I I , Abstracts of Volunteer Papers and Films (Washington, D . C . , 1 9 6 9 ) , P. 7 4 . 13 a l i z e d - a c t i v e group of the same ages and backgrounds to determine whether the cognit ive funct ioning of the i n s t i t u -t i o n a l i z e d group manifested greater regress ion than the non-15 i n s t i t u t i o n a l i z e d group. The study showed that the i n s t i -t u t i o n a l i z e d group exhibi ted greater regress ion than i t s community-active counterpart i n a manner analagous to the di f ference obtained when ch i ld ren were compared with adults or when schizophrenic pat ients were compared with normals. The inves t iga tors concluded that i n s t i t u t i o n a l i z a t i o n may be conceived as a condi t ion which induces and/or i s symptomatic of a formal developmental regress ion i n cognit ive processes. Several of the studies already mentioned, as wel l as numerous others , pointed out that older people themselves wish to remain independent and maintain t h e i r own way of l i f e 16 i n t h e i r own homes. In a survey of the problems of f ive hundred persons over the age of s ix ty years , Kutner, et a l . , found that the e l d e r l y placed a high premium on independence and pr ivacy , which frequently resul ted i n t h e i r i s o l a t i o n due to the deployment of s o c i e t y ' s resources to serve the most 15 Peter Comal l i , E . Kaus, P. Wapner, "Cognit ive Functioning i n Two Groups of Aged: One I n s t i t u t i o n a l i z e d , the Other L i v i n g i n the Community," Journal of Gerontology, V o l . XX, No. 1 (January, 1965), 16 F i n a l Report of the Specia l Committee of the Senate  on Aging, op. c i t . , p . 3? see also The Nation and Its Older  People, op. c i t . , p . 1 7 2 ; Loether, op. c i t . , p . 3 2 . 14 17 severely i l l , dependent, or d i s turbed . In a na t iona l survey of persons s i x t y - f i v e years and over, Shanas found that 83*3 per cent of t i i®i-resp v ondents pre-18 ferred to l i v e i n t h e i r own homes. Shanas stated that dependency and i n s t i t u t i o n a l i z a t i o n were the greatest fears of the e l d e r l y , A Spec ia l Committee on Aging i n the United States of America, found that o r d i n a r i l y o lder people prefer to l i v e 19 a lone. The Committee found that two out of three persons s i x t y - f i v e years and over maintained t h e i r own households and preferred t h i s arrangement to continue. Studies i n Canada reported s i m i l a r f i n d i n g s , A survey conducted i n Toronto showed that many older people re jec ted the idea of i n s t i t u t i o n a l care because there was no 20 guarantee of p r i v a c y . In a paper presented to the Canadian Conference on Aging, Zay stated that studies showed that the 17 Bernard Kutner, et a l . , Five Hundred Over S ixty (New York: Wm. F . T e l l Company, 1956), p . 113. 18 E t h e l Shanas, The Healthy of Older People: A S o c i a l  Survey (Cambridge: Harvard Univer s i ty Press, 1962), p . 103, 19 Development i n Aging: 1963 and 1964, Report No, 124 (Washington, D . C , : U . S . Government P r i n t i n g O f f i c e , 1965). p . 29 20 Problems of the Aged i n Our Community, Information Service S o c i a l Planning Council of Metropoli tan Toronto, 1963, P . 4. 15 e l d e r l y prefer to l i v e i n t h e i r own homes or where they had 21 spent most of t h e i r l i v e s . I I I . NEEDS OF THE ELDERLY LIVING AT HOME General Needs and Services The Spec ia l Committee on Aging i n Canada declared that o lder people are not a d i s t i n c t and;hanoge.no.us group and that t h e i r needs and in teres t s are very s i m i l a r to those of 22 the soc ie ty at l a r g e . The Committee emphasized the need of the e l d e r l y to maintain t h e i r independence as long as pos s ib l e . Housing, f inance, and health were seen as areas of major con-23 cern . Various services were suggested as e s sent i a l to the wel l being of the e l d e r l y l i v i n g at home. These services included medical , r e h a b i l i t a t i o n , home-nursing and homemaker serv ices , assistance with household chores, meal preparat ion and f r i e n d l y v i s i t o r serv ices , counse l l ing , information and r e f e r r a l services and recrea t iona l and s o c i a l centres i n 24 which educational and c u l t u r a l a c t i v i t i e s could be provided. 21 Nicholas Zay, L i v i n g Arrangements for the Aged (Ottawa: Queen's P r i n t e r and Cont ro l l e r of Stat ionary, 1965)* 22 F i n a l Report of the Specia l Committee of the Senate  on Aging, op. c i t . , p . 4. 23 I b i d . , p . 48. 24 I b i d . , p . 50; 16 The Report of the White House Conference on Aging i d e n t i f i e d s i m i l a r services which should be organized and co-ordinated i n order to meet the needs of the aged l i v i n g 25 at home. The Report stressed that spec ia l e f for t s should be made to obtain fac tua l data from the e l d e r l y about t h e i r i n t e r e s t s , needs, types of a c t i v i t i e s , and the type of ser-26 v ices required to meet t h e i r needs. A Report of the Committee on Labour and Publ ic Wel-fare , published i n the United States of America i n l Q 6 l , stated that the needs of the e l d e r l y l i v i n g at home were 27 complex and deeply i n t e r r e l a t e d . This Committee i d e n t i -f i e d the areas of need as medical , housing, employment, and economic. The Committee also saw continued i n t e l l e c t u a l s t imula t ion as a need and emphasized the fact that the aged's phys i ca l health and mental wel l being are re la ted to other factors such as income, a c t i v i t i e s , and the place accorded to 28 them by soc ie ty . Independent L i v i n g and Interpersonal Relat ionships Havighurst noted that the needs that are common to The Nation and Its Older People, op. c i t . , pp. 153-4. - s l b i d . , p . 172. 27 Act ion for the Aged and Aging A Report of the  Committee on Labor and Publ ic Welfare f United States Senate (Washington, D . C : U .S . Government P r i n t i n g O f f i c e , 1961), p . 9: 28 I b i d . , p . 81. 17 29 younger age groups are also common to the older person. He defined these needs as emotional s ecur i ty , s o c i a l recogni t ion a sense of worth or se l f - re spec t , and adequate food, c lo th ing she l t e r , and hea l th . T i b b i t t s and Donahue divided the needs of the aged into the broad areas of s ecur i ty , independence, p r ivacy , 30 s o c i a l contact and se l f -worth . These authors d i s t inguished between mater ia l and psychologica l s e c u r i t y . They defined mater ia l s ecur i ty as guaranteed s u f f i c i e n t income and adequat housing whereas psychologica l secur i ty re ferred to the i n d i -v i d u a l ' s knowledge of a cont inu i ty of l i f e experience with respect to such needs as adequate heal th and s a t i s f y i n g personal r e l a t i o n s h i p s . Loss of independence was sa id to threaten the aged's sense of i n d i v i d u a l i t y . The need for pr ivacy re ferred to the phys i ca l environment, which involves a quiet dwel l ing , a choice of residence and a s a t i s f ac tory l i v i n g space. T i b b i t t s and 'Donahue stated that the aged's need for s o c i a l contact f inds s a t i s f a c t i o n by both personal and impersonal means; The former meant contact through meaningful r e l a t i o n s while the l a t t e r meant contact with the l a rge r soc iety through the pub l i c media. Sel f-worth, the authors decided, i s re la ted to the perception a person has 29 Robert J . Havighurst, "Old Age:An American Problem, Journal of Gerontology, V o l . IV (October, 1949), pp, 298-304. 30 Clark T i b b i t t s and Wllma Donahue, Aging i n Today's  Society (New Jersey: P r e n t i c e - H a l l , I n c . , I960), pp. 319-20. 18 of h imsel f , which i n some respects , i s a r e f l e c t i o n of how others see him. Authors w r i t i n g l a t e r i n the decade presented s i m i l a r f indings i n r e l a t i o n to the needs of the e l d e r l y l i v i n g at homei Loether defined the major problems of aging i n the areas of in ter-persona l r e l a t i o n s , hea l th , housing, employ-ment, ret irement, e x p l o i t a t i o n of the aged and approaching 31 death. Loether saw these problem:areas as i n t e r r e l a t e d and as s i g n i f i c a n t i n creat ing needs among the e l d e r l y l i v i n g at home • Other studies supported t h i s statement. For example, a study by Blau found that retirement l e d to an a l t e r a t i o n i n se l f -concept , a change i n inter-personal r e l a t i o n s and sub-32 sequent s o c i a l i s o l a t i o n . An a d d i t i o n a l f ind ing of t h i s study was that o lder people who did not belong to community f r i endsh ip groups were more l i k e l y to see themselves as o ld than those who d id belong. However, a study by Lowenthal and Haven contradicted , 33 to some extent, these f i n d i n g s . Lowenthal and Haven found 3 1 Loether, op. c i t . , pp. 5-6 32 Zena S. Blau, "Changes i n Status and Age I d e n t i f i -c a t i o n , " American S o c i o l o g i c a l Review, V o l . XXI (January, 1956), pp. 198-203. 33 Marjorie F . Lowenthal and Clayton Haven, " Inter-ac t ion and Adaptation: Intimacy as a C r i t i c a l V a r i a b l e , " American S o c i o l o g i c a l Review, V o l . XXXIII, No. 1 (February, 1968), 390-410. 19 that maintenance of a stable confidante was more closely-associated with good mental hea l th , s a t i s f y i n g self-image, and high morale than was high s o c i a l i n t e r a c t i o n with others or high ro le status or s t a b i l i t y i n e i t h e r or both. This study found that the presence of a c.onfidate was of c r u c i a l s i gn i f i cance i n a s s i s t i n g the older person to adjust to the stresses of aging. Health The reported f indings of various studies defined heal th as a problem area creat ing needs among the e l d e r l y popula t ion . According to a National Health Survey carr ied out i n the United States of America, f o u r - f i f t h s of the pop-u l a t i o n s i x t y - f i v e years and over were a f f l i c t e d with one or more chronic diseases . The incidence of i l l n e s s was shown to increase s i g n i f i c a n t l y with age. The accompanying l i m i t a ' t i o n of a c t i v i t y associated with a chronic disease showed a corresponding increase with age. About 20 per cent of those reported as su f fer ing with a chronic disease, who were under s i x t y - f i v e years of age, experienced some l i m i t a t i o n of a c t i v i t y ; among those s i x t y - f i v e years of age and over, 56 35 per cent experienced l i m i t a t i o n of a c t i v i t y . However, a na t iona l survey by Shanas of the s e l f -34 U.S . Department of Health, Education, and Welfare, The Health Care of the Aged (Washington, D . C : U . S . Govern-ment P r i n t i n g O f f i c e , 1962), p . 17. 35 I b i d . , p . 20. 20 perceived health needs of persons s i x t y - f i v e years of age and 36 over, showed that state of heal th i s a r e l a t i v e matter. S i g n i f i c a n t l y , f o r t y - s i x per cent of the respondents i n the Shanas study saw themselves as being i n good heal th although a phys i ca l examination probably would reveal that many were i n poor hea l th . A further cross -nat iona l study of persons s i x t y - f i v e years and over i n B r i t a i n , the United States of America, and Denmark, by Shanas, et a l . , supported the. previous f indings i n regard to the s ign i f i cance of the e l d e r l y i n d i v i d u a l ' s subjective evaluat ion of t h e i r health 37 on t h e i r a t t i tudes toward l i f e . In t h i s study, f indings showed a strong r e l a t i o n s h i p between heal th assessment and fee l ings of lone l ines s and a l i e n a t i o n on the part of o ld people. People who saw themselves as s ick were more lone ly and a l ienated than those who saw themselves as w e l l . Shanas estimated that seven to eight per cent of the e l d e r l y are e i t h e r bedridden or housebound. Of the ambulatory aged, she estimated that approximately t h i r t y per cent have d i f f i c u l t y managing s t a i r s , ten per cent have d i f f i c u l t y bathing, e ight per cent have d i f f i c u l t y dress ing , and twenty per cent have d i f f i c u l t y cut t ing t h e i r t o e n a i l s . The amount of home care needs was shown to increase with age. 36 Shanas, op. c i t ; , p ; 3^i 37 E t h e l Shanas, et a l . , "The Psychology of H e a l t h , " Middle Age and Aging, ed. Bernice L . Neugarten (Chicago! The Univer s i ty of Chicago Press, 1968), pp. 212-20. 21 Housing Several studies indicated concern about the housing needs of the e l d e r l y . Data obtained by the C a l i f o r n i a State Department of S o c i a l Welfare from a survey of 250,000 Old Age Secur i ty r e c i p i e n t s showed that 6 l ,3 per cent of res-pondents l i v e d i n houses, 23.3 per cent i n apartments, 2.5 per cent i n hote l s , 4 per cent i n rooming houses and 0,9 per 38 cent i n i n s t i t u t i o n s . The C a l i f o r n i a data were sa id to be comparable fo r the nat ion as a whole. The survey showed that for many older people there was considerable d i s p a r i t y between t h e i r housing preferences and the actua l circumstances i n which they l i v e d . The housing problems of the aged derived b a s i c a l l y from economic problems. In a study of housing and community set t ings for the e l d e r l y , housing experts stated that c e r t a i n design features should be included i n a l l housing for the e l d e r l y to a s s i s t 39 i n meeting the unique needs of t h i s group. These experts recommended that adequate systems of temperature and climate contro l be i n s t a l l e d to supply the a d d i t i o n a l warmth required by the e l d e r l y i n t h e i r homes; that adequate sources of a r t i -f i c i a l l i g h t be ava i l ab le to provide the greater l i g h t i n t e n s i t y 38 C a l i f o r n i a Leg i s la ture Report of the Senate Sub- committee on Housing and Recreat ional Needs of E l d e r l y  C i t i zens (San Franc i sco ; Published by the Senate of the State of C a l i f o r n i a , 196l), pp; 30-32. 39 Walter K. V i v r e t t , "Housing and Community Sett ings for Older People , " Handbook of Soc i a l Gerontology; Soc i e t a l  Aspects of Aging, edi Clark T i b b i t t s (Chicago: The Univer s i ty of Chicago Press, i960), pp. 585-86. 22 required by the e l d e r l y j that s t r u c t u r a l a l t e ra t ions be made to keep noise and sound l e v e l s wi thin the acceptable range and that ampli fying systems be provided for door b e l l s , telephones and t e l e v i s i o n sets when d i f f i c u l t y i n hearing i s experienced by the e l d e r l y . These experts also recommended that safety devices should be b u i l t into housing uni t s of o lder persons; They claimed that most of the accidents the e l d e r l y have occur i n t h e i r own homes and that minor adjust-ments could eradicate many of these. They stated that sup-port bars should be placed i n s t ra teg ic places and that extra e f fo r t was necessary to protect the e l d e r l y l i v i n g at home from f a l l s , f i r e s and other hazards. However, Rosow claimed that only a small minori ty of 40 the e l d e r l y had housing needs. Rosow stated that l e s s than 15 per cent of e l d e r l y expressed d i s s a t i s f a c t i o n with t h e i r housing and that designers exaggerated t h i s problem, which b a s i c a l l y was the r e s u l t of low income. Employment Meaningful employment was seen by a number of wr i ters as a need of the e l d e r l y which remains l a r g e l y unmet. For example, the Report of the White House Conference on Aging stated that "there was general agreement that o lder workers i n the American economy are fac ing acute problems r e l a t i n g 40 I rv ing Rosow, S o c i a l Integrat ion of the Aged (New York: Free Press, 1967)I, p . 6; 23 41 to t h e i r employment s e c u r i t y . " The Report noted that employment i s important to the older person, not only for se l f - support and independence but for hea l th fu l l i v i n g and s e l f - r e spec t ; While poor hea l th , obsolescence of s k i l l and age d i s c r imina t ion were given as reasons for o lder people l eav ing the labour force , studies showed that o lder workers 42 often performed as wel l as, or bet ter than, younger people. A study by Morse and Weiss, i n which a random sample of employed men were asked i f they would continue to work i f they i n h e r i t e d enough money to l i v e comfortably without work-ing , found that 80 per cent of the men, inc lud ing people s i x t y -43 f ive years and over, sa id that they would continue to work. Reasons given for continuing to work ranged from enjoyment of the type of work to keeping occupied and j u s t i f y i n g one's ex i s tence ; Morse and Weiss concluded that men would work even without economic necess i ty and that work maintains the i n d i v i d u a l ' s sense of we l l -be ing . In a study of personal adjustment, Thompson, S t re ib and Kosa found that among persons s i x ty years and over, the major determinants of l e v e l of morale were work status , 41 The Nation and Its Older People, op. c i t . , p ; 142. 42 B. V. H. Schneider, The Older Worker (Berkeley: U n i v e r s i t y of C a l i f o r n i a Press^ 1962), p . 19. 43 Nancy S. Morse and Robert Weiss, "The Function and Meaning of Work and the Job , " American S o c i o l o g i c a l Review, V o l ; XX (January, 1955), p . 19o\ 24 socioeconomic status and h e a l t h . S l i g h t l y more than h a l f of t h i s sample was composed of r e t i r e d people. S i g n i f i c a n t di f ferences were found i n the morale l e v e l s of the r e t i r e d and the unemployed. Among the r e t i r e d persons 62 per cent scored low on morale whereas among the employed persons, 38 45 per cent scored lowi Employment or meaningful a c t i v i t y i n retirement also 46 was del ineated as a need of the e l d e r l y by Bernard Stotsky. Stotsky claimed that a pos i t ive r e l a t i o n s h i p exis ted between good heal th and p a r t i c i p a t i o n i n some form of s o c i a l a c t i v i t y . Stotsky saw common problems among the e l d e r l y at home as a r i s i n g from such things as inadequate income, unemployment, widowhood, poor housing, l i v i n g arrangements, boredom and 47 excessive l e i su re and long term i l l n e s s . The c r i t i c a l needs of the aged, Stotsky stated, were for f i n a n c i a l independence, adequate housing, opportunit ies for work and productive use of l e i su re time, protect ive services and f i r s t 48 class medical and nursing care to preserve hea l th . 44 Wayne E . Thompson, Gordon S t re ib and John Kosa, "The E f f e c t of Retirement on Personal Adjustment: A Panel A n a l y s i s , " Journal of Gerontology, V o l . XV (December, i 9 6 0 ) , p. 1 6 5 - 6 9 ; • 45 I b i d i , pi 167. 46 Bernard Ai Stotsky, The E l d e r l y Pat ient (New York: Grume and Stra t ton , 1968), p . 73. 47 I b i d . , p . 72. 48 I b i d . , p . 2; 2 5 IV. NURSE'S ROLE IN RELATION TO ELDERLY LIVING AT HOME In 1964, a study by Schwartz, Henley and Z e i t z , i d e n t i -f i e d nursing and s o c i a l service needs of the c h r o n i c a l l y i l l 49 e l d e r l y ambulatory pat ient l i v i n g at home. More than h a l f t h e i r study sample had problems of d ie t and indicated a need fo r heal th education and assistance with medication regimeni Other nursing areas of need were i d e n t i f i e d as assistance with a c t i v i t i e s of d a i l y l i v i n g , sk in care, physiotherapy, housekeeping and marketing. S o c i a l service needs were i d e n t i f i e d i n the areas re l a ted to l i v i n g arrange-ments, use of free time, vocat iona l adjustment, f i n a n c i a l adjustment, adjustment to i l l n e s s , and family r e l a t i o n s h i p and morale. Schwartz, et a l . , accepted the fo l lowing d e f i n i t i o n of the ro le of the nurse, by Henderson, to guide the planning and implementation of t h e i r research study: The unique funct ion of the nurse i s to a s s i s t the i n d i v i d u a l , s i ck 'or w e l l , i n the performance of those a c t i v i t i e s contr ibut ing to health or i t s recovery (or to peaceful death) that he would per-form unaided i f he had the necessary strength, w i l l or knowledgei And to do t h i s i n such a way as to help him gain independence as r a p i d l y as p o s s i b l e . 5 ° 49 Doris Schwartz, Barbara Henley and Leonard Z e i t z , The E l d e r l y Ambulatory Pat ient : Nursing and Psychosocial Needs (New York: The MacMillan Company, 1964), pp. 179-199. 50 I b i d . , p . 178. 26 These researchers considered that nurs ing i s one of the d i s c i p l i n e s e s sent i a l to planning and implementing compre-51 hensive care of ambulatory pa t i ent s . Their study showed that by using adequate too l s , nurses were able to assess the needs of e l d e r l y people and to provide both themselves and other profes s iona l groups with a common core of observations that are e s sent i a l i f profes s iona l a c t i v i t y i s to r e s u l t i n e f fec t ive care of the e l d e r l y at home. In descr ib ing the prac t i ce of community health nurs-ing , Freeman defined an t i c ipa tory guidance, such as preparing a g e r i a t r i c pat ient for problems associated with the aging process , as a s p e c i f i c funct ion of the community health nurse, by v i r tue of her expertise i n publ ic health p r a c t i c e , as wel l 52 as i n nurs ing ; Other wri ters s i m i l a r l y have i d e n t i f i e d the e l d e r l y l i v i n g at home as an at r i s k group i n need of a d d i t i o n a l pre-ventive and supportive nurs ing care . The Specia l Committee of the Senate on Aging recommended that l o c a l heal th agencies keep a record of a l l persons s i x t y - f i v e years and over and that pub l i c health nurses or s o c i a l workers v i s i t these people 53 p e r i o d i c a l l y i f v i s i t s are needed or de s i red . The Committee 51 I b i d ; , Preface VI I . 52 Ruth B. Freeman, Community Health Nursing Pract ice (Toronto: W. B. Saunders Company, 1970), p . 34. 53 F i n a l Report of the Specia l Committee of the Senate  on Aging, op. c i t . , p i 30. 2? stated that procedures should reach out to o ld people rather than expecting the e l d e r l y to come to the agency. They saw counse l l ing as a service which should be more ava i lab le i n heal th agencies, whether advice was needed on p r a c t i c a l matters such as budgeting or more medical ly or iented subjects 54 such as bereavement or phys ica l i l l n e s s . The Committee emphasized the ro le of the publ ic heal th nurse, and health agencies i n general , i n provid ing or co-ord inat ing services for the e l d e r l y l i v i n g at home. In r e f e r -ence to the publ ic heal th nurse, the Committee noted that the number of v i s i t s to the e l d e r l y had increased; However, the Committee stated that a great deal more could be done to meet 55 the o ld person's s o c i a l and medical needs; They stressed the fact that heal th i s in t imate ly re la ted to matters of employment, housing and recrea t ion and that these matters a f fect the e l d e r l y i n d i v i d u a l ' s fee l ings of usefulness, wel l 56 being and mental hea l th . The necess i ty for teamwork i n car ing fo r the older person at home also was emphasized by the Committee, who noted that education of the heal th pro-fess ions , i n the past, had not prepared t h e i r members for 57 t h i s r o l e . 54 I b i d . , p . 145. 55 I b i d . , p i 116 56 I b i d . , p . 99. 57 I b i d . , p . 120. 28 While working i n a c l i n i c designed to help the aged with t h e i r medical problems, Latimer found that a s i g n i f i -cant por t ion of her time was spent i n meeting the p a t i e n t ' s 58 non-medical needs. She found that the most valued aspect of c l i n i c conferences to the pat ient was the opportunity to t a lk f r e e l y to a sympathetic l i s t e n e r . Latimer stated that the e l d e r l y depend on the nurse, not so much for medical knowledge, but as a f r i end and advi ser ; In an a r t i c l e d i scuss ing health programmes for the e l d e r l y at home, Archer drew a t tent ion to the r e s p o n s i b i l i t y of nurses working with t h i s group to be more than just aware 59 of the need to co-ordinate and integrate se rv ices . She emphasized the p o t e n t i a l influence of the nurse 's ro le i n e f f ec t ing change. She noted that nurses, as a group, were the l a rge s t number of any p r a c t i t i o n e r s working with the e l d e r l y and urged that nurs ing forsake i t s t r a d i t i o n a l geron-t o l o g i c nurs ing care i n order to b u i l d new and bet ter ways to 60 meet the expanding needs of the aged popula t ion . Archer stressed the complexity of the process involved i n provid ing complete care for the aged. She also noted that the need for 58 Ann Latimer, "Nursing C l i n i c for the Aged," American Journal of Nursing, V61, 63 (October, 1965), p . 116-17. 59' Sara Katherine Archer, "Health Maintenance Programs for Older A d u l t s , " Nursing C l i n i c s of North America, V o l . IIIi, No. 4 (December, 1968), p . 729-741. 60 I b i d ; , p . 738 29 nurses to f i l l pos i t ions as co-ordinators and l i a s o n persons i n the f i e l d of aging i s current ly fa r from met. A paper submitted to the Eighth Internat ional Congress of Gerontology, by Schwenger and Sayers, discussed the ro le of the pub l i c health nurse i n the in tegra t ion of community ser-61 v ices to the aged i n Canada. Schwenger and Sayers stated that a survey of Ontario heal th departments indicated that l e s s than one per cent of those s i x t y - f i v e years of age and over received home v i s i t s from a publ ic health nurse i n 1965. A s i m i l a r survey i n Edinburgh, Scotland, reported by Schwenger and Sayers, showed that 38 per cent of o ld people needed the services of a health v i s i t o r but only 2.5 per cent received one • In order to a scer ta in the importance of a publ ic heal th nurse ' s services among the e l d e r l y i n Ontar io , Schwenger and Sayers ca r r i ed out a survey on the health and l i v i n g condit ions of 600 o ld age pensioners who were seventy years and over. Results indicated that the publ ic health nurse can and should play an increas ing and cent ra l ro le i n the in tegra t ion of community serv ices . The authors concluded that the publ ic health nurse should act as an assessor of needs, heal th counsel lor and primary co-ordinator of other 61 C. W. Schwenger and L . A . Sayers, "The Role of the Publ ic Health Nurse i n the Integrat ion of Community Resources to the Aged," Eighth Internat ional Congress of Gerontology, Proceedings - Volume I I , Abstracts of Volunteer Papers and Films (Washington, D . C , 1969), p . 96. 30 agencies and i n d i v i d u a l s provid ing home services to the aged. The authors also recommended that a r e g i s t e r be kept by-heal th departments of a l l o ld age pensioners and that v i s i t s be made by the publ ic health nurse p e r i o d i c a l l y to those who needed or desired same. In d i scuss ing the profess ional ro le i n community nurs ing , Brown made the statement that the existence of v i s i t i n g nurse serv ices , home-care programmes and s i m i l a r serv ices , l ed the l a i t y to bel ieve that the aged can be cared 62 for at home. However, Brown continued, " i t must be stated c a t e g o r i c a l l y . . • that these services reach only a very 63 small proport ion of persons needing them". Brown claimed that many of the neediest never heard of ava i lab le se rv ices . She emphasized the urgency and the opportunity, at the present time, for health professions to develop a va r i e ty 64 of models to provide comprehensive home-care se rv ice s . Commenting upon the operation of the San Francisco Home Health Service , Brown stated that p r i o r to the appoint-ment of a home health aide f i e l d supervisor , publ ic health nurses were used to assess needs and supervise but the co-62 Esther L u c i l e Brown, Nursing Reconsidered; A Study  of Change (Phi l ade lphia : J . B. L i p p i n c o t t Company, 1971), P» 63 I b i d . 64 . I b i d . , p . 510. 31 65 ord inat ion of services proved t o t a l l y inadequate. The s ign i f i cance of changes i n community nursing p r a c t i c e , Brown claimed, can be evaluated only i n the l i g h t of the predomin-66 ant status of nurs ing . Brown stated that 60 per cent of a l l nurses are occupied p r i m a r i l y i n carry ing out task-oriented functions i n hosp i ta l s while only 10 per cent of a l l nurses are employed i n the p o t e n t i a l l y vast f i e l d of community 6? nurs ing . Moreover, Brown claimed, most of these nurses i n the community perform only routine and narrowly t echnica l tasks . S imi l a r f indings were reported by the National Commi-ss ion for the Study of Nursing and Nursing Education i n the 68 United States of America. The Commission noted that two out of three nurses were engaged i n hosp i t a l set t ings and that the remainder were spread t h i n l y over a l l other areas of nurs ing p r a c t i c e . In Canada, Mussallem quoted s i m i l a r f igures i n 69 r e l a t i o n to the deployment of nursing personnel . Less 65 I b i d , , p . 506, 66 I b i d . , p . 484. 67 I b i d . 68 An Abstract for Act ion (New Yorks McGraw-Hill Book Company, 1970), p . 9 2 . 69 Helen K. Mussallem, "The Expanding Role s Where Do We Go From Here?" The Canadian Nurse, V o l . 67, No. 9 , (September, 1971), p . 32 . 32 than 7 per cent of nurses i n Canada, Mussallem stated, are engaged i n publ ic heal th p r a c t i c e . Moreover, she claimed, only 5 per cent of the health d o l l a r i s used i n preventive se rv ice s , V. SUMMARY This chapter presented the review of the l i t e r a t u r e which was d iv ided into three sect ions . The f i r s t sect ion reviewed the l i t e r a t u r e that focused on the reasons for maintaining the e l d e r l y i n t h e i r own homes. I t was found that the phys ica l and mental health of the e l d e r l y i s pre-served best when they are maintained at home. It was found that the e l d e r l y themselves prefer t h i s way of l i f e to i n s t i -t u t i o n a l i z a t i o n . The l i t e r a t u r e also suggested that t h i s arrangement was economically advantageous to the soc ie ty . The second sect ion reviewed the l i t e r a t u r e which i d e n t i f i e d the needs of the aged l i v i n g at home. Because the a u t h o r i t i e s quoted had d i f f e rent or ientat ions to t h e i r sub-jec t , varying emphasis was given to ce r t a in aspects of need. However, i t was found that there was general concensus i n r e l a t i o n to the broad areas i n which needs were def ined. These areas were found to include interpersonal r e l a t i o n s , hea l th , housing, economic secur i ty and independent l i v i n g . The t h i r d sect ion reviewed the l i t e r a t u r e which examined the nurse 's ro le i n r e l a t i o n to the aged l i v i n g at home. I t was found that the l i t e r a t u r e i n t h i s area was 33 l i m i t e d . Several authors recommended extension of the current nurse ' s ro le i n order to meet the needs of the e l d e r l y l i v i n g at home. The po tent i a l ro le of the nurse as an assessor of needs and a co-ordinator of services was s t ressed . However, there was l i t t l e evidence i n the l i t e r a -ture to indicate s i g n i f i c a n t advances i n t h i s d i r e c t i o n . References to the deployment of nursing personnel i n the community suggested one reason for the evident lack of involvement of the nursing profess ion with the aged l i v i n g at home. The paucity of studies that examined the e l d e r l y person's perception of need and/or the extent to which nurses were involved i n helping the e l d e r l y i n d i v i d u a l meet h i s needs seemed to j u s t i f y a study i n these areas. CHAPTER III THE RESEARCH DESIGN AND DEVELOPMENT OP THE STUDY The descr ip t ive survey method of research was used i n the study, which was conducted i n Vancouver, B r i t i s h Columbia. The interview method was used to obtain the information needed by the study. This method seemed to be the most appropriate to use i n view of the sample population and the nature of the information required . T h i r t y e l d e r l y people were interviewed i n t h e i r usual place of res idence. A l l people interviewed were over s i x ty-f ive years of age and l i v e d i n a private home, e i t h e r t h e i r own or one belonging to a r e l a t i v e • I . RESEARCH INTERVIEW SCHEDULE A semi-structured interview schedule was used to obtain information pert inent to the research problem. Because the interview schedule designed by Schwartz, at a l . , seemed to cover the need areas defined by the l i t e r a t u r e , t h i s t o o l , with minor modi f icat ions , was chosen for use i n 1 the present study. The modified interview schedule i s 1 Doris Schwartz, Barbara Henley and Leonard Z e i t z , The E l d e r l y Ambulatory Pat ient ; Nursing and Psychosocial Needs (New York: The MacMillan Company, 1964), pp. 299-333 34 shown i n Appendix A. I n i t i a l questions were designed to determine demo-graphic c h a r a c t e r i s t i c s of the sample. This i d e n t i f y i n g information included age, sex, years of school ing, , mar i ta l s tatus , and b i r thplace of respondents. Anonymity of the subjects was preserved by use of study numbers i n place of name s. The remaining questions were designed to gather data to answer the f i r s t question asked by the study r e l a t i n g to perceived need areas. These questions were grouped into s ix sect ions i n the Schwartz, et a l . , interview schedule and l a b e l l e d l i v i n g arrangements, adjustment to i l l n e s s , use of l e i s u r e time, vocat ional adjustment, f inances, and i n t e r -2 personal re l a t ionsh ips and morale. These categories were considered to correspond with the need areas defined by the l i t e r a t u r e , namely housing, hea l th , independent l i v i n g , employment, economic secur i ty , and interpersonal r e l a t i o n s . The l i t e r a t u r e - d e f i n e d need areas were inserted beside the o r i g i n a l sect ion headings. The summary sheet of the schedule was designed to tabulate data r e l a t i n g to perceived needs and to c o l l e c t data to answer the second and t h i r d questions asked by the study. Data r e l a t i n g to perceived needs and i n t e n s i t y of perceived need i n each of the above s ix categories were c o l l e c t e d by the f i r s t question on the summary sheet. Data 2 I b i d . 36 to answer the second and t h i r d questions asked by the study were gathered by the second question on the summary sheet. Certa in questions i n the body of the schedule allowed a consistency check of answers obtained by the summary sheet i n r e l a t i o n to the t h i r d question asked by the study. Data gathered by questions 3 - 6 on the summary sheet re la ted to the e l d e r l y i n d i v i d u a l ' s perception of the nurse as a potent-i a l resource for profess ional he lp . The i n c l u s i o n of these questions was supported by the review of the l i t e r a t u r e , which suggested that nurses would be seen as hospital-based or 3 involved only i n routine and technica l procedures. ! The summary sheet of the Schwartz, et a l . , interview schedule was revi sed to meet the s p e c i f i c requirements of t h i s study i n provid ing opportunity for subjective assessment of needs and need re so lu t ion by the e l d e r l y . The interview schedule was pretested on f ive e l d e r l y i n d i v i d u a l s l i v i n g i n t h e i r own homes to e s t ab l i sh whether the schedule e l i c i t e d answers to the questions asked by the study. The e l d e r l y people used i n the pretest l i v e d outside the boundaries of the p o l l i n g d i v i s i o n used to se lect the sample populat ion . A l l the pretest sample were re ferred by f r iends to the wr i te r , who was unacquainted with the group p r i o r to the pre te s t . Minor changes were made i n the t o o l 3 Esther Luc i l e Brown, Nursing Reconsidered; A Study  of Change (Phi l ade lph ia : J . B. L ipp inco t t Company, 1971)t P« 484. fo l lowing pre te s t . Question l b , r e l a t i n g to length of time l i v e d i n present res idence, was added. Length of time i n same residence seemed to be an ind ica to r of the cont inu i ty of l i f e experience, a factor associated with psychologica l 4 secur i ty by T i b b i t t s and Donahue. This fac tor appeared to inf luence the a v a i l a b i l i t y of help from neighbours and the perception of need by the e l d e r l y . I I . SELECTION OF THE STUDY GROUP The l i s t of e lec tors for urban p o l l i n g d i v i s i o n No. 153 of the Vancouver Quadra e l e c t o r a l d i s t r i c t was obtained. This e l e c t o r a l d i v i s i o n was considered to be representative of a suburban area with the standard health services a v a i l -ab le . No knowm survey of community needs i n the area had been undertaken. The e l e c t o r a l l i s t contained a t o t a l of fo r ty- four i n d i v i d u a l s who were c l a s s i f i e d as r e t i r e d or widowed, or were without a l i s t e d employment c l a s s i f i c a t i o n . Of these for ty- four i n d i v i d u a l s , t h i r t y people, or 68 per cent of those p o t e n t i a l l y q u a l i f i e d , were included i n the f i n a l sample• These people were included i n the study group on the basis of the pre-determined c r i t e r i a , namely wi l l ingness to p a r t i c i p a t e , over s i x t y - f i v e years of age, and res ident i n a 4 Clark T i b b i t t s and Wilma Donahue, Aging i n Today's  Society (New Jerseys P r e n t i c e - H a l l , Inc . , I960), p . 319. 38 pr ivate home i n which no form of i n s t i t u t i o n a l care was o f fered . Reasons for f a i l u r e to include the remaining four-teen i n d i v i d u a l s were as fo l lows . Six people were too young to meet the age c r i t e r i o n . Three people were away on h o l i -days. Four people were u n w i l l i n g to p a r t i c i p a t e . One person was unable to be contacted on three d i f f e rent occasions. This information i s shown i n Table 1. The study sample represented 82 per cent of the e l i g i b l e populat ion. Table 1 Se lec t ion of Sample Population L i s t e d as r e t i r e d , widowed, or employment un l i s t ed on r o l l . 44 Too young to meet age c r i t e r i o n . . . . . . . . 6 Away on hol idays 3 Unable to make contact . . . . . . . . . . . . 1 Unwi l l ing to par t i c ipa te 4 Actual sample population . . 3 0 I n i t i a l Contact with the Study Group The po ten t i a l ava i lab le sample populat ion was contac-ted personal ly at t h e i r homes by the w r i t e r . No p r i o r contact by mail or telephone was attempted as previous studies using s i m i l a r populations found that the e l d e r l y responded better 5 and pa r t i c ipa ted more when approached i n person. A l l con-5 Doris Schwartz, Barbara Henley and Leonard Z e i t z , The E l d e r l y Ambulatory Pat ient : Nursing and Psychosocial  Needs (New York: The MacMillan Company, 1964); see also Dieter Meiners and Joanne Moore, "Home Services for the Aged," (Unpublished M.A. thes i s , Univer s i ty of B r i t i s h Columbia, 1967). 39 tacts were made i n dayl ight hours to avoid any refusals by the e l d e r l y to answer the door to a stranger at n i g h t . Af ter introducing her se l f by name and as a graduate student i n the u n i v e r s i t y nursing programme, the wr i ter b r i e f l y described the study and requested the e l d e r l y i n d i v i d -u a l ' s p a r t i c i p a t i o n , provided the i n d i v i d u a l met the c r i t e r i a for i n c l u s i o n i n the study. The wri ter ca r r i ed a l e t t e r signed by the Chairman of the thes i s Committee i d e n t i f y i n g her as a bona f ide stu-dent engaged i n an academic p u r s u i t . This l e t t e r i s shown i n Appendix B. However, no one i n the proposed study group examined t h i s l e t t e r or requested any form of corroborat ion of the w r i t e r ' s stated purpose. I I I . THE INTERVIEWING PROCEDURE The majority of those approached par t i c ipa ted without reservat ion i n the study. With two exceptions, a l l i n t e r -views were conducted at the time the i n i t i a l contact with the e l d e r l y i n d i v i d u a l was made. A sui table time was arranged with the two people for whom t h i s procedure was not convenient. In s ixteen cases, two people from the same household were included i n the study sample. In these instances, interviews were conducted consecutively during the same v i s i t . In one such household, both respondents were present during the t o t a l interview process . Upon completion of the interview, the wr i te r allowed time to answer any questions concerning the interview, the 40 research purpose or re la ted mater i a l . The interview was terminated by an expression of appreciat ion for the e l d e r l y i n d i v i d u a l ' s p a r t i c i p a t i o n . S e l f - d i s c i p l i n e was necessary at times to guard against the "he lp ing" impulses described by Blenkner and 6 Wasser and Schwartz, et a l . These authors claimed that the t r a d i t i o n a l techniques developed by the helping professions for t a l k i n g with people frequently are antagonis t ic to the goals of a structured research interview. At the same time, the wr i ter found that cont ro l l ed use of s o c i a l v i s i t i n g and communication techniques establ i shed rapport and seemed to motivate the e l d e r l y to p a r t i c i p a t e . The wri ter attempted to achieve a balanced use of s e l f i n order to stimulate p a r t i c i p a t i o n yet minimize anxiety and procure sound data. The Responses of the Study Group The majority of the e l d e r l y who par t i c ipa ted i n the study i n i t i a l l y indicated that they wished to be he lp fu l to the wr i te r i n completing thes i s requirements. Fol lowing completion of the interview schedule, many of the sample populat ion indicated strong in te re s t i n the schedule's con-tent . There was general acknowledgement of the need for more information regarding the problems of the e l d e r l y , e spec i a l ly 6 Margaret Blenkner and Edna Wasser, Serving the Aging:  Part I I . Methodological Supplement (New York, 1964), p . 7; see also Doris Schwartz, et a l . , The E l d e r l y Ambulatory  Pa t ient : Nursing and Psychosocial~Needs (New York: The MacMillan Company, 1964), p . 15. 41 those l i v i n g i n les s secure circumstances than the sample popula t ion . Recognition was given by many to a need for information about ava i lab le services i n the area. The interview schedule maintained the focus of the interview on the research task. However, another element frequently was apparent i n the interview and became more apparent on completion of the task. Almost a l l the respon-dents and two of the people who did not q u a l i f y for the study, seemed very anxious to detain the w r i t e r . The interview schedule took t h i r t y minutes to complete. However, the wr i t e r frequently wasi.in the respondent's home for at l ea s t one hour. Upon completion of the interview, most of the e l d e r l y people offered refreshments and indicated a desire to prolong contact , t a l k i n g f r e e l y of t h e i r l i v e s and current a c t i v i t i e s . The widowed respondents p a r t i c u l a r l y seemed eager to discuss i n d e t a i l the los s of t h e i r spouse and the resu l tant changes i n t h e i r l i v e s . IV. SUMMARY The descr ip t ive method of research was used for t h i s study. The interview method was used to obtain the necessary information for the study. An adapted interview schedule was used as the data gathering t o o l . The s e l ec t ion of the study group was descr ibed. Deta i l s of the interviewing procedure were o u t l i n e d . Responses of the study group were discussed. CHAPTER IV ANALYSIS OF THE DATA Responses to each sect ion of the interview schedule were examined to provide information regarding the need c h a r a c t e r i s t i c s of the study sample i n the areas of housing, hea l th , independent l i v i n g , employment, economic secur i ty , and interpersonal r e l a t i o n s . One or more need i n each area was counted as one. Descr ipt ive analys i s of the data was planned around answering the three questions asked by the study. Supplemen-tary data were analyzed to determine whether the nurse was perceived as a poss ible resource person i n the need areas and who the e l d e r l y pereeived as t h e i r preferred source of profes s iona l he lp . Data i n r e l a t i o n to perceived needs and charac ter i s -t i c s of sex, age, years of school ing , mar i ta l status and place of b i r t h , were tabulated and tested by the ch i square method for s i g n i f i c a n t d i f ferences . I . CHARACTERISTICS OF THE STUDY POPULATION The sample population consisted of eleven males and nineteen females. Thus 37 per cent of the sample populat ion were males and 63 per cent were females. The range i n age 42 was from s i x t y - f i v e to e ighty-four as shown i n Table 2. Table 2 Age by Sex D i s t r i b u t i o n of Study Sample Age Male Female Tota l Percentage 65-69 years 3 8 11 37 70-74 years 4 8 12 40 75-79 years 4 2 6 20 80-84 years 0 1 1 3 Tota l 11 19 30 100 Only one person i n the sample population had less than e ight years of school ing . Years of schooling ranged from l e s s than eight to more than college graduation as shown i n Table 3. Table 3 Educat ional Charac ter i s t i c s of Study Sample Expressed i n Tota l Numbers and Percentages Years of Schooling Number Percentage Less than 8 1 3 8 but l e s s than 12 14 47 12 but l e s s than col lege grad. 9 30 College graduation 6 20 Tota l 30 100 44 The majority of the sample population were born i n Canada as i l l u s t r a t e d by the fo l lowing data: -Bir thplace Canada Scotland England Norway Tota l Number 21 2 6 1 . 30 Percentage 70 7 20 3 100 Four people were s ingle i n the sample populat ion, s ixteen were married, - nine were widowed and one was d ivorced . This information i s shown i n Table 4. Table 4 M a r i t a l Status by Sex of .Study Sample Status Number Male Female Single 4 2 2 Married 16 8 8 Widowed 9 1 8 Divorced 1 0 1 Tota l 30 11 19 I I . AREAS OF NEED PERCEIVED BY THE ELDERLY LIVING AT HOME Data c o l l e c t e d by means of the interview schedule showed that s ixteen people, or 53 per cent of the study sample perceived needs i n one or more areas defined by the l i t e r a t u r e . Fourteen people, or 47 per cent of the study sample did not perceive.needs i n the areas defined by the l i t e r a t u r e . The 45 majority of perceived needs i n both the study by Schwartz, et a l . , and the present study, were i d e n t i f i e d i n the areas of housing, hea l th , independent l i v i n g and interpersonal re-1 l a t i o n s . In the present study, needs i n the areas of employ-ment and economic secur i ty , although, present, were not prom-inent , as indicated i n Table 5» Table 5 Perceived Intens i ty of Needs of the Study Sample Area of Need Intens i ty of Need S l i g h t Moderate Serious C r i t i c a l Tota l Housing 8 3 0 0 1 «! 11 Health 6 4 1 0 11 Independent l i v i n g 6 2 1 0 9 Employment 1 0 0 0 1 Economic secur i ty 2 0 0 0 2 Interpersonal r e l a t i o n s 5 2 1 0 8 Tota l 28 11 3 0 42 From these data i t was concluded that the majority of the e l d e r l y l i v i n g at home, i n a s p e c i f i c geographical area of Vancouver, perceived themselves as having needs i n the need 1 Doris Schwartz, Barbara Henley and Leonard Z e i t z , The E l d e r l y Ambulatory Pat ient : Nursing and Psychosocial Needs.(New York: The MacMillan Company, 1964), pp. 75-99* 46 areas defined by the l i t e r a t u r e . The frequency d i s t r i b u t i o n of needs among the sample populat ion i s shown i n Table 6. Table 6 D i s t r i b u t i o n of Perceived Needs of Study Sample Needs Number Percentage No needs 14 47 One area of need 3 10 Two areas of need 4 1 3 Three areas of need 6 20 Four areas of need 2 7 Five areas of need 1 3 Tota l 30 100 Data i n r e l a t i o n to perceived needs and charac ter i s -t i c s of sex, age, school ing , mar i ta l status and b i r thplace were tabulated. Due to small numbers i n study sample, tables were condensed. The c h i square binomial te s t was used to determine the s igni f icance of dif ference between respondents with perceived needs and respondents with no perceived needs i n r e l a t i o n to the v i t a l s t a t i s t i c s mentioned above. No s i g n i f i c a n t dif ference was found at the .05 l e v e l of s ign-f i cance . Housing In r e l a t i o n to needs i n the area of housing 21 people, or 70 per cent of the study sample^did not perceive any needs. Nine people, or 30 per cent of the study sample, perceived a need for household, help with cleaning or garden-47 ing , as reported i n Table 7. Table 7 Housing Needs of Study Sample Area of Need Number Percentage No needs perceived 21 70 Assistance with house cleaning 5 16 Assistance with gardening 2 7 Assistance with c leaning and gardening 2 7 Tota l 30 100 The need for housekeeping assistance among the e l d e r l y l i v i n g at home, was consistent with f indings i n other 2 s tudies . Lack of need i n r e l a t i o n to other aspects of housing was incons i s tent with these other s tudies ' f ind ings . I t was f e l t that t h i s dif ference may r e s u l t from the nature of the present study sample, which contained no apartment or boarding house dwel lers . The majority of the study sample also owned the houses i n which they l i v e d and were a stable populat ion. At the same time, these f indings were not incons i s tent with re su l t s of a study by Rosow who claimed that les s than 5 per cent of the aged spontaneously 2 Doris Schwartz, Barbara Henley and Leonard Z e i t z , The E l d e r l y Ambulatory Pat ient : Nursing and Psychosocial Needs (New York: The MacMillan Company, 1964), p . 202; see also Die ter Meiners and Joanne Moore, "Home Services for the Aged," (Unpublished M.A, the s i s , Univer s i ty of B r i t i s h Columbia, 1967), p . 42. 48 3 mention housing as a problem. The majority, or 90 per cent of .the study sample, l i v e d i n t h e i r own homes. Three people, or 10 per cent of the sample, l i v e d with r e l a t i v e s . Most people had l i v e d i n t h e i r present place of residence for several years, as ind ica ted i n Table 8. Table 8 Length of Time Lived i n Present Place of Residence by Study Sample . Years at Present Residence Number Percentage 4 or le s s 3 10 5 - 9 1 3 2 0 - 2 9 9 30 3 0 - 3 9 12 40 4 0 - 4 9 3 10 6 0 . - 6 9 2 7 Tota l 30 100 These fac tors , concerning permanence of residence and ownership of place of residence, seemed to make unnecessary several questions on the interview schedule re la ted to s a t i s -f a c t i o n with housing condi t ions . None of the respondents were d i s s a t i s f i e d with the condi t ion of t h e i r phys ica l housing. However, ten people, or 33 per cent of the populat ion, 3 I rv ing Rosow, Soc i a l Integrat ion of the Aged (New York: The Free Press, 1967), p . 5. 49 had thought of moving i n the l a s t year . The reason given by seven of the respondents re la ted to the large s ize of t h e i r present home. Three people l i v i n g with r e l a t i v e s stated they would prefer a place of t h e i r own. None of these three people had taken any ac t ion i n t h i s regard. Three of the other seven people, had invest igated apartment l i v i n g . At the time of the interview these people were not considering moving. In the area of household chores, twenty-six people, or 87 per cent of study sample, d i d , or a s s i s ted with , the housework. Eighteen of these people, or 69 per cent of those doing housework, had no d i f f i c u l t y with chores. Seven people, or 27 per cent, had minor d i f f i c u l t y . One person, or 4 per cent, had help two days per month. One other i n d i v i d u a l who had no d i f f i c u l t y with house-keeping, had help once a month. Twenty-one people, or 70 per cent of the study sample, were s a t i s f i e d with the way the house was kept. Nine people, or 30 per cent of the sample, were d i s s a t i s f i e d because they could no longer maintain house as neat ly as they would l i k e . No respondent needed any add i t iona l form of household equip-ment. Health In summarizing needs i n the area of hea l th , nine-teen people, or 63 per cent of the study sample, d id not spontaneously perceive needs i n t h i s area . However, when asked i f help was needed i n completing s p e c i f i c a c t i v i t i e s 50 or i n obtaining ce r t a in services associated with heal th needs, the study sample indicated a need fo r assistance i n every area except one, as shown i n Table 9. Table 9 Number and Percentage of Study Sample Perce iv ing Needs i n Itemized Areas Related to Health Area of Possible Need Number Perce iv ing Need i n Area Percentage Preparing meals or d i e t 2 7 Medications, dress ings , in j ec t ions 0 0 Shopping, t r a v e l l i n g 3 10 T o i l e t , cosmetic care, dress ing 2 7 Housekeeping 11 37 Gardening 12 40 Upkeep of house, appliances 10 33 Occupational therapy, medical care or s o c i a l services 3 10 Someone with whom to t a lk 6ver medical or personal problems 4 13 Obtaining information about ava i l ab le services i n area 8 27 In other words, while respondents perceived that they needed help i n ce r t a in hea l th-re la ted a c t i v i t i e s , t h i s ass istance was not always perceived as cons t i tu t ing a need i n the area of hea l th . Thus, the number of respondents who reported that they needed help to perform s p e c i f i c hea l th-re la ted functions was greater than when these same respond-ents were asked i f they perceived any needs i n the area of h e a l t h . A poss ible explanation for f indings of t h i s nature was suggested by Rosow, who claimed that o lder people simply accept increas ing d i s a b i l i t y as normal as long as they can 4-get around and funct ion adequately. One person, or 3 per cent of the populat ion, thought a nurse could current ly provide help i n the area of hea l th . This i n d i v i d u a l saw.the nurse as someone to t a lk to regarding problems. Twenty-nine people, or 97 per cent of the study sample, d id not perceive the nurse as being able to help them apart from g i v i n g bedside care when necessary. These f i n d -ings r e f l e c t e d claims by Brown and other nursing au thor i t i e s i n respect to the predominant status of community nursing i n which nurses perform only routine and narrowly t echn ica l 5 tasks . There was no comparable increase i n the number of respondents who perceived the nurse as h e l p f u l to them as a r e s u l t of l i s t i n g s p e c i f i c hea l th-re la ted a c t i v i t i e s i n which the interviewees perceived a need for as s i s tance . One person 4 • Rosow, op. c i t . , p . 4. 5 > • Esther L u c i l e Brown, Nursing Reconsidered: A Study of Change (Phi l ade lph ia : J . D. L i p p i n c o t t Company, 1971), p. 504; see also C. W, Schwenger and L . A . Sayers, "The Role of the Publ ic Health Nurse i n the Integrat ion of Community Resources to the Aged," Eighth Internat ional Congress of  Gerontology. Proceedings - Volume I I , Abstracts of Volunteer Papers and Films (Washington, D . C , 1969), p . 96. 52 continued to say a nurse could he lp . Five people, or. 17 per cent of the populat ion, were uncer ta in . Twenty-four people, or 80 per cent of the sample study^ did not think a nurse could help them complete the a c t i v i t i e s or obtain needed se rv ice s . The study supported Shanas' f indings about the r e l a t i o n s h i p between perceived state s,of health and the way an 6 i n d i v i d u a l funct ions . Twenty-eight people, or 93 per cent of the sample populat ion, saw themselves as not having too much trouble with i l l n e s s e s i n t h e i r l i f e t i m e . Two people, or 7 per cent of the population saw themselves as having a l o t of trouble with i l l n e s s e s . These two people were among the three people with the highest number of needs, having f ive and four needs r e s p e c t i v e l y . When asked to compare t h e i r present state of health with others i n t h e i r age group, these two people rated them-selves i n poor and f a i r health r e s p e c t i v e l y . Twenty-one respondents, or 70 per cent of the sample study, rated t h e i r heal th as very good. Six people, or 20 per cent of the study sample, saw t h e i r ' h e a l t h as good. Two people, or 7 per cent of the study sample, saw t h e i r health as f a i r . One person, or 3 per cent of the study sample rated h i s state of health as poor i n comparison with h i s own age group. This i n f o r -. 6 E t h e l Shanas, The Health of Older People: A Soc i a l  Survey (Cambridge: Harvard Univer s i ty Press , 1962), p . 34. 53 mation i s shown i n Table 10. Table 10 Respondents* Perception of Health i n Comparison with Own Age Group Health Rating Male Female Number Percentage Very good 8 13 21 70 Good 2 4 6 20 F a i r 1 1 2 ... 7 Poor 0 1 1 3 Tota l 11 19 30 100 The i n d i v i d u a l r a t ing health as poor in•comparison with h i s own age group, had the highest number of needs i n the sample group. This i n d i v i d u a l also had more than one medical condi t ion for which regular medical treatment was rece ived . The two people with the next highest number of needs rated t h e i r health re spec t ive ly as f a i r and very good. Neither of these people had condit ions neces s i t a t ing regular medical treatment. Twenty-one people, or 70 per cent of the sample study, had no condi t ion neces s i ta t ing regular medical treatment. This f igure was not consistent with the f indings of the study by the United States Department of Heal th , Educat ion, and Welfare, reported i n the review of the l i t e r a ' ture, which stated that 70 per cent of the aged suffered with 54 7 some form of chronic disease. These r e su l t s may be explained by the f indings of Shanas, who showed that perceived state of heal th i s a r e l a t i v e matter not always consistent with the 8 f indings of a phys ica l examination. The breakdown of medical condit ions for which treatment was received i n r e l a t i o n to perception of heal th i s shown i n Table 11. Table 11 Health Perceptions of Study Sample i n Rela t ion to Number of Conditions Necess i tat ing Medical Treatment Perceived Health No Medical Condit ion One Medical Condition One or More Medical Conditions Tota l Very good 18 2 1 21 Good 1 4. 1 6 F a i r 1 1 0 2 Poor 0 0 1 1 Tota l 20 7 3 30 The condit ions for which the study sample received regular medical treatment are indicated below: Condit ion Number A r t h r i t i s and diabetes 1 A r t h r i t i s and ulcerated l e g 1 7 United States Department of Health, Education, and Welfare, The Health Care of the Aged (Washington, D . C : United States Government P r i n t i n g O f f i c e , 1962), p . 17 8 Shanas, op. c i t . , p . 34 Condit ion ' Number A r t h r i t i s 3 Hypertension 1 Hypertension, u l c e r , C . V . A . 1 Diabetes 1 Parkinson's Disease 1 Tota l 9 Only one person saw hi s condi t ion as a b ig problem. Seven people saw t h e i r condit ions as some problem. One saw h i s condi t ion as no problem because h i s diabetes was c o n t r o l -led and caused him no inconvenience. A l l nine i n d i v i d u a l s considered t h e i r medical condi-t i o n had changed t h e i r l i v e s . Six people saw the change as of l i t t l e importance. Two people saw the change as f a i r l y important. One person saw the change as very important. No one had any d i f f i c u l t y fo l lowing phys ic i an ' s orders or required more information-concerning h i s cond i t ion . Three people, or 10 per cent of the populat ion, worried about t h e i r hea l th . Two of these people perceived themselves as i n poor and f a i r health r e spec t ive ly . These people had no medical condi t ion requ i r ing regu lar treatment. The t h i r d person rated himself i n good heal th but worried about future funct ioning of a fractured elbow. Two of the three people f e l t they could discuss fears with t h e i r phys ic ian but would not bother him. Two of the three sa id they would discuss fears with a nurse. However, both people stated they did not think a nurse could help them. Nine people, or 30 per cent of the study sample, 56 were housebound i n the preceeding f ive years . The reasons for t h e i r confinements are shown i n Table 1 2 . Table 12 Reasons for House Confinement of Study Sample i n Last Five Years Condit ion Number Percentage Acute i l l n e s s 3 ! 1 0 Acute incidents i n chronic i l l n e s s 3 10 Chronic d i s a b i l i t y 1 3 Trauma 2 7 9 30 A l l nine people used help i n t h i s per iod . One person required p r i m a r i l y nurs ing he lp . Two people required p r i m a r i l y house-keeping he lp . Six people required both nurs ing and house-keeping he lp . Four people used someone i n the household for he lp . Five people used household help together with someone from outside the household. In r e l a t i o n to outside help , four people required profess ional he lp . Five people required non-profess ional he lp . Seven people, or 2 3 per cent of the study sample, were not sure they could get assistance at night i f needed. For f ive of these people, t h i s s i t u a t i o n represented a change over the l a s t few years . One person was not concerned about t h i s need. Two people were fr ightened about the s i tu^ a t i o n . Two people accepted the s i t u a t i o n as unavoidable. In r e l a t i o n to capaci ty , twenty-four people, or 80 57 per cent of the study sample, walked without as s i s tance . Six:;people, or 20 per cent of the study sample, used a crutch or cane. No one used a wheelchair or walker or wore any kind of brace. The majority of people managed to t r a v e l without any problems. Twenty-one people, or 70 per cent of the study sample, never had any d i f f i c u l t y t r a v e l l i n g . Seven people, or 23 per cent of the study sample, had occasional d i f f i c u l t y . Two people, or 7 per cent of the study sample, often had d i f f i c u l t y t r a v e l l i n g . The degree of d i f f i c u l t y experienced by the study group i s shown i n Table 13. Table 13 Degree of Task D i f f i c u l t y Experienced by Sample Population A c t i v i t y Don't Know E a s i l y With D i f f i c u l t y Not at A l l Tota l Climb a curb 0 28 2 0 30 Climb s t a i r s 0 26 4 • 0 30 Go down s t a i r s 0 23 6 1 30 Use a bus 1 25 3 1 30 Use a car 0 29 1 0 30 Five people, or 17 per cent of the study sample, had been v i s i t e d by a nurse since ret irement . A l l f ive perceived the nurse as h e l p f u l . However, a l l f ive p r i m a r i l y perceived the nurse 's funct ion as g iv ing bedside care . No one current ly had a nurse v i s i t i n g . Independent L i v i n g In summarizing the perceived needs i n r e l a t i o n to independent l i v i n g , the majority of the study sample were, s a t i s f i e d with t h e i r way of l i f e . Nine people, or 30 per cent of the study group, perceived needs i n t h i s area and would l i k e to spend time d i f f e r e n t l y . Seven of these people., or 24 per cent of the t o t a l populat ion, would l i k e more s o c i a l contacts . One of these people, or 3 per cent of the study sample, would l i k e to be more independent of re la t ives . . One person, or 3 per cent of the study sample, would l i k e to d i e . However, twenty-one people, or 70 per cent of the study sample, would not l i k e to spend t h e i r time any d i f f e r e n t l y and perceived no needs i n t h i s area . The sample populat ion par t i c ipa ted i n a wide v a r i e t y of a c t i v i t i e s , as shown i n Table 14. Every member of the study sample watched t e l e v i s i o n . The same number said they s i t and chat. Most people, 90 per cent of the study sample, read magazines or books. Almost everyone, 97 per cent of the study sample, went to the movies, concerts , or sports events. The majority of people, 83 per cent, regularly;- took walks. Twenty-four people, or 80 per cent of the populat ion, went to church. The same number took regular vacat ions . Twenty people, or 67 per cent of the populat ion, pract i sed hobbies. The same number attended meetings, and played cards regular ly , - - Twenty-one people, or 70 per cent of the study sample, sat q u i e t l y at times 59 and did nothing. Table 14 A c t i v i t i e s Done Often and Occas ional ly by Numbers and Percentage of Study Sample A c t i v i t y Done Often Done Occas ional ly Number Percentage Take walks 12 13 25 83 L i s t e n to T . V . or radio ' 17 13 30 100 Play cards 15 5 20 67 : Go to church 4 20 24 80 Go to movies, sports or concerts 13 16 29 97 Prac t i ce hobbies 12 .8 20 67 Go to meetings 12 8 20 67 S i t and chat 11 19 30 100 Read magazines and books 16 11 27 90 Take vacations 4 20 24 80 S i t q u i e t l y by s e l f and do nothing 5 16 21 70 Other 3 1 4 13 _ I f done at a l l , watching t e l e v i s i o n , reading, p lay ing cards, and going to the movies, were seen most c h a r a c t e r i s t i c -a l l y as part of the d a i l y rou t ine . Going to church, taking vacat ions , s i t t i n g chat t ing or s i t t i n g q u i e t l y by oneself doing nothing, were the major sources of d iver s ion done o c c a s i o n a l l y . These f ind ings , i n r e l a t i o n to the a c t i v i t i e s of the e l d e r l y , were s i m i l a r to those found by Schwartz, et 60 9 a l . However, the percentage of the study sample p a r t i c i p a -t i n g i n a c t i v i t i e s was much higher than i n the study by-Schwartz, et a l . The sample group's economic secur i ty , l e v e l of school ing , and prolonged membership i n one community, may be factors a f f ec t ing these f ind ings . The study sample's high a c t i v i t y l e v e l also may be re la ted to t h e i r actual and/or perceived state of good hea l th . Stotsky claimed that a p o s i t i v e r e l a t i o n s h i p existed between good health and p a r t i -10 c i p a t i o n i n some form of s o c i a l a c t i v i t y . The proport ion of respondents belonging to organi-zat ions also was higher than that reported by Schwartz, et 11 a l . Twenty i n d i v i d u a l s , or 67 per cent of the populat ion, attended meetings of the fo l lowing organizat ions : Organizat ion Number attending meetings Senior Citizen^.'? Assoc ia t ion 8 • Church , 9 Volunteer groups 3 Masons 4 A. Adult Education Assoc ia t ion 1 Bowling club 1 Tota l 26 Two of these people belonged to both a church organizat ion 9 Schwartz, et a l . , op. c i t . , p . 92. 10 Bernard A . Stotsky, The E l d e r l y Patient (New York: Grume and S t ra t ton , 1968), p . 73* 11 Schwartz, et a l . , op. c i t . , p . 96. and the Senior C i t i zens * As soc i a t ion . One person belonged to the Senior C i t i z e n s ' Assoc ia t ion and a Volunteer group. Two people belonged to a Volunteer group and the Masons. The study sample was heterogeneous i n respect to choosing an a c t i v i t y which gave the highest degree of s a t i s f a c t i o n to them. S i t t i n g and chatt ing and v i s i t i n g with f r iends and r e l a t i v e s was considered most frequently to give the most s a t i s f a c t i o n . Since t h i s a c t i v i t y was mentioned by the whole study sample as an a c t i v i t y engaged i n at l ea s t occas iona l ly , t h i s f ind ing i s reassuring i n respect to the e l d e r l y person's meaningful use of t ime. However, only one person mentioned watching t e l e v i s i o n as h i s most s a t i s f y i n g a c t i v i t y . Yet, t h i s a c t i v i t y most frequently was engaged i n by the t o t a l population of the sample. With one exception, these f indings were s i m i l a r 12 to r e su l t s reported by Schwartz, et a l . Whereas a l l the present study sample.mentioned an a c t i v i t y that gave s a t i s f a c t i o n , 13 per cent of the Schwartz, et a l . , study sample answered ,the question negat ive ly . Information about s a t i s f a c t i o n i n r e l a t i o n to various a c t i v i t i e s i s 12 I b i d . , p . 98. given i n Table 15. Table 15 A c t i v i t i e s Giving Highest Degree of S a t i s f a c t i o n as Selected by Number and Percentage of Study Populat ion, A c t i v i t y Number Choosing Percentage S i t t i n g , chat t ing and v i s i t i n g with r e l a t i v e s and f r iends 9 30 Senior C i t i z e n s * Assoc ia t ion 2 7 Volunteer groups 2 7 Working around house 1 3 Sport ing a c t i v i t i e s 2 7 T r a v e l l i n g 2 7 Gardening 3 10 Reading 2 7 Bridge 3 1° Craftwork 2 7 Ta lk ing , p lay ing with pets 1 3 Watching t e l e v i s i o n 1 3 Tota l 30 100 Twenty-three, or 77 per cent of people who l i k e d to spend time outside the house at a p a r t i c u l a r p lace , usua l ly went there because they talked to acquaintances and f r i e n d s . Most people, 70 per cent of the study sample, spent time at the l i b r a r y . Eighteen people, or 60 per cent of the study 63 sample, spent time at c lubs . Thirteen people, or 43 per cent of the.study sample, spent time with r e l a t i v e s and f r i e n d s . The majority of people preferred to s i t and chat with neighbours and fr iends as opposed to household members. Four people, 13 per cent of the study sample, l i k e d to s i t and chat with household members. Twenty-one people, 70 per cent of the study sample, l i k e d to chat to neighbours, acquaintances and f r i e n d s . Five people, or 17 per cent of the study sample, preferred to chat mainly with f r i e n d s . The majority of people who l i k e d to take vacat ions , t r a v e l l e d widely . F i f teen people, or 50 per cent of the populat ion, l i k e d to t r a v e l abroad. Nine people, or 30 per cent of the study sample, l i k e d to t r a v e l around Canada. People who l i k e d to s i t q u i e t l y by themselves and do nothing usua l ly reminisced, an a c t i v i t y regarded as e s sent i a l to the achievement of the developmental tasks of l a t e r matur-13 i t y , postulated by Havighurst . Thir teen people, or 43 per cent of the study sample, sat and thought about the past . Nine people, or 30 per cent of the populat ion, never sat q u i e t l y doing nothing. Five people, or 17 per cent of the study sample, sat and planned for the future . One person, or 3 per cent of the study sample, sat and wished for death. This i n d i v i d u a l was i n the 80-84 years age group, l i v e d with 13 Robert J . Havighurst, Developmental Tasks and  Education (New York: David McKay Company, I n c . , 1964), pp. 9 2 - 9 8 . 64 r e l a t i v e s , and perceived needs i n four areas. Two people, or 7 per cent of the study sample, sat and wished t h e i r l i f e s i tua t ions were d i f f e r e n t . Both these people l i v e d with r e l a t i v e s and perceived needs i n three or more areas* Three people, or 10 per cent of the study sample, had thought about moving where they could get more care or compan-ionship i n the l a s t year . Two of these people were i n the 70-74 years age group and had thought about eptering a nursing home. One person was i n the 80-84 years age group and had thought of enter ing an old age i n s t i t u t i o n . Two of the three l i v e d with r e l a t i v e s . A l l three were the highest need respondents of the study sample. None of the three had done anything about arranging to move. These same three people, or 10 per cent of the study sample, found time.hung heavi ly on t h e i r hands. Twenty-seven people, or 90 per cent of the study sample, found time passed q u i c k l y . Only two people, or 7 per cent of the study sample, f e l t d i f f e r e n t l y than they had i n the past about doing things with people or a lone. Both people were females i n the 70-74 years age group who used to prefer to do things with other people, but now preferred to be alone. One of these two people was the highest need respondent, perce iv ing her-s e l f with needs i n every area except one. The other person had needs i n three areas. Employment Only one person, or 3 per cent of the study sample, ind ica ted a need i n the area of employment. This i n d i v i d u a l 65 had r e t i r e d le s s than one year and stated that he missed the s o c i a l involvement of h i s previous employment. Twenty-nine people, or 97 per cent of the study sample, perceived no needs i n the area of employment. Research noted i n the review of l i t e r a t u r e found that men would continue to work even without economic necess i ty and that work maintains the 14 i n d i v i d u a l ' s sense of wel l -be ing . The present study-sample, ind ica ted l i t t l e desire for re-employment. This r e su l t may be explained by the high a c t i v i t y l e v e l of the study sample which i n turn may compensate for lack of employment. Of the study sample, th i r t een people, or 43 per cent were housewives, who had not worked for a sa lary since marriage, many years p rev ious ly . The remaining seventeen people, 57 per cent of the study sample, were r e t i r e d from employment. Eleven of these people, or 37 per cent of the study sample, r e t i r e d more than f ive years ago. The remain-ing s ix people, 20 per cent of the sample, r e t i r e d more recent-l y as shown by the fo l lowing data: Years r e t i r e d Number Percentage' Less than 1 year ago 1 3 1 - 2 years ago 3 10 - . 2 - 5 years ago 2 7 More than 5 years ago 11 37 Tota l 17 57 14 Nancy S. Morse and Robert Weiss, "The Function and Meaning of Work and the Job," American S o c i o l o g i c a l Review, V o l . XX (January, 1 9 5 5 ) . p . 1 9 ^ 66 The major reason given for r e t i r i n g was employer's dec i s ion because of age. E ight people, or 47 per cent of the r e t i r e d populat ion, gave t h i s reason. Pour people stated that they "wanted to enjoy l e i s u r e " . Two people claimed that " d i s a b i l -i t y i n t e r f e r e d " . Three people re spec t ive ly gave as reasons for r e t i r i n g , "work too strenuous", "own dec i s ion , f e l t o ld enough to q u i t " and " i l l n e s s i n the f a m i l y " . L i t t l e in te re s t was shown by the study sample re-garding working again i f jobs were a v a i l a b l e . One person, 3 per cent of the populat ion, was poss ib ly interes ted i n work-ing f u l l t ime. Interest in.re-employment i s i l l u s t r a t e d i n Table 16, Schwartz, et a l , , found s i m i l a r d i s i n t e r e s t i n re-employment among a predominantly b lue-co l l a red r e t i r e d sample. Neither of these two s tudies ' f indings were consistent with the Report of the White House Conference on Aging, which stated that o lder people face acute problems re la ted to employ-ment, which i s needed for independence, hea l thfu l l i v i n g and 16 s e l f - r e spec t . 15 Table 16 Interest i n Re-employment Among Ret ired Type of Employment Number Enthus ia s t i c Number Interested Number Dis-interes ted • - • i Tota l F u l l time employment 0 1 29 30 Part time employment 3 10 17 30 15 Schwartz, et a l . , op. c i t . , p . 72. 16 The Nation and Its Older People; Report of the White  House Conference on Aging (Washington, D . C : U .S . P r i n t i n g Off ice for the Government, 196l) , p . 142. 6? None of the study sample had looked for work i n the preceding year . One occas iona l ly worked i f needed by ex-employer. The sample was weighted i n the d i r e c t i o n of pro-f e s s iona l and housewife job categories as evidenced by the fo l lowing datas Previous work category Number Percentage Profess ional 12 40 Technical 2 7 Unsk i l l ed 1 3 Housewife 15 50 Tota l ~W 100 The majority of people, 84 per cent, had been happy i n t h e i r jobs, inc lud ing a l l but one of the housewives. Four people, 13 per cent of the study sample, worked because the job had to be done. One person, 3 per cent of the study sample,, was discontented with employment. In reference to the longest job held i n h i s working l i f e , each respondent was asked what things he l i k e d about his work. Twelve people, 40 per cent of the study sample, l i k e d t h e i r job because i t was i n t e r e s t i n g work. Four people, 13 per cent of the populat ion, l i k e d t h e i r job because they had f r iends at work. Two people, inc lud ing the discontented housewife, l i k e d nothing about t h e i r jobs. Twelve people, or 40 per cent of the study sample, predominantly housewives, regarded t h e i r work as a natura l way of l i f e and did not think about i t . 68 Economic Secur i ty There was l i t t l e evidence of perceived needs i n the area of economic s e c u r i t y . The majority of the study sample saw themselves as f i n a n c i a l l y comfortable. Two people, 7 per cent of the sample populat ion, perceived a need i n t h i s area . However, t h e i r need was perceived more i n r e l a t i o n to a poss ib le future need than a present one. Many i n d i v i d u a l s had two sources of income and many previous ly had held high paying profes s iona l jobs. The majority were married with two incomes to susta in them and most l i v e d i n t h e i r own homes. These factors poss ib ly expla in dif ferences i n respect to income and finances between the study sample and other 17 s tud ie s ' f indings i n these areas. The monthly income of the study sample ranged from $100 - |349. Seventeen people, or 57 per cent of the study sample, had an income above #250 per month, more than a " h e a l t h f u l " budget for a couple, as defined by the Bureau of 18 Labor S t a t i s t i c s i n 1958. Information re la ted to income 17 Wayne E . Thompson, Gordon Stre ib and John Kosa, "The E f f e c t of Retirement on Personal Adjustments A. Panel A n a l y s i s , " Journal of Gerontology, V o l . XV (December, i960), p. 168; see also Bernard Kutner, David Fanshel , A l i c e Togo and Thomas Langner, Five Hundred Over S ixty (New Yorks Wm. F . Tell,Company, 1956), p . 115. 18 Schwartz, et a l . , op. c i t . , p . 70. 69 of the study i s shown i n Table 17. l iable 17 Monthly Income by Number and Percentage Of the Study Sample Monthly Income Number Percentage $100 - $149 4 13 C150 - 199 6 20 200 - 249 3 10 250 - 299 10 33 300 - 349 7 24 Tota l 30 100 Only two people, 7 per cent of the study sample, thought they had any d i f f i c u l t y managing on t h e i r incomes. When questioned "where do you f e e l the pinch most * \ the respondents mentioned the purchase of luxury items such as co lor t e l e v i s i o n or expensive t i cke t s to shows. When asked to rate themselves f i n a n c i a l l y as "comfortable", "have enough to get by on" or "do not have enough to get by on" , these two people stated they had enough to get by on. The majority of the study sample, twenty people, or 67 per cent, thought they had enough to get by on. Ten people, 33 per cent of the populat ion, placed themselves as comfortable. No one i n the study sample thought they did not have enough to get by on. When asked about t h e i r expectations ^regarding t h e i r f i n a n c i a l s i t u a t i o n , twenty people, or 67 per cent of the 70 study sample, expected t h e i r f i n a n c i a l s i t u a t i o n to stay the same over the next f ive years . Nine people, JO per cent of the study sample, d id not know what t h e i r s i t u a t i o n would be i n f ive years . One person, 3 per cent of the study sample, expected h i s f i n a n c i a l s i t u a t i o n to get worse. Interpersonal Relations In r e l a t i o n to needs and interpersonal r e l a t i o n s h i p s , e ight people, or 27 per cent of the study sample, perceived a need i n t h i s area. Twenty-two people, or 73 per cent of. the sample, d id not perceive any needs i n t h i s area . Most of the sample e i ther l i v e d with family members or could r e l y on f r iends and r e l a t i v e s i n times of need. The majority of the populat ion had frequent contact with f r iends and r e l a t i v e s and were s a t i s f i e d with t h e i r present l i f e . Almost three-quarters of the study sample l i v e d with other people i n the house. Twenty-two people, or 73 per cent of the populat ion, had family members i n the home. E ight men and eight women, 5^ per cent of the populat ion, l i v e d with t h e i r spouses. The remaining s ix people, 19 per cent of the populat ion, l i v e d with t h e i r respective sons, daughters, or s i s t e r s . A l l twenty-two people could get he lp , i f needed, from the i n d i v i d u a l s with whom they l i v e d . F i f teen people, or 50 per cent of the study sample,- could expect to be looked a f t e r by those with whom they l i v e d . Seven people, or 23 per cent of the study sample, could expect the i n d i v i d u a l s with whom they l i v e d to get a id i f necessary to care for them. E ight people, or 27 per cent of the study sample, l i v e d 71 alone. However, none of these people were without close f r iends or r e l a t i v e s whom they saw frequent ly . A l l e ight people could expect help from r e l a t i v e s amd fr iends i f needed. The majority of the study sample also could r e l y on neighbours for help when necessary i n r e l a t i o n to shop-p ing , preparat ion of meals, or get t ing some form of emergency ass i s tance . Every member of the study sample had fr iends or r e l a t i v e s whom they had seen at l eas t once i n the past s ix months. Nineteen people, or 64 per cent of the study sample, had seen t h e i r f r iends several times i n t h i s per iod . Ten people, or 33 per cent of the study sample, had seen t h e i r f r iends weekly. One person, or 3 per cent of the study-sample, had seen his f r i end once i n the l a s t s ix months. Every member of the study sample also had seen r e l a t i v e s , other than those with whom they l i v e d , at l ea s t once i n the l a s t s ix months. Two people, or 7 per cent of the study sample, had seen t h e i r r e l a t i v e s once i n the l a s t s ix months. Twenty-four people, or 80 per cent of the sample, had seen r e l a t i v e s several times. Ten people, or 13 per cent of the study sample, had seen r e l a t i v e s weekly i n the l a s t s ix months. The s o c i a l contacts of the study sample were s i g n i f i c a n t l y higher than those found by Schwar.tz, et a l . , whose sample had only sparse or occasional ' contact . 19 Schwartz, et a l . , op. c i t . , p . 89 . 72 These researchers bel ieved that people who lack community t i e s lack a valuable bulwark against psychosocial prob-20 lems • During the l a s t month, f ive people, or 17 per cent of the study sample, had f e l t lone ly of ten. Two people, or 7 per cent of the study sample, had f e l t l o n e l y , but not o f ten . These people stated that lone l ines s was experienced as only a passing f e e l i n g . Twenty-three people, or 77 per cent of the study sample, had not f e l t l one ly i n the past month. The majority of the sample did not see the previous f ive years as a period of great change and d e c i s i o n . Twenty-three people, or 77 per cent of the study sample, exper i -enced no sense of unexpected or traumatic change. These people knew cer t a in changes, such as retirement, had occurred. However, these respondents did not perceive such expected adjustments as denoting a period of change and d e c i s i o n . Seven people, or 23 per cent of the populat ion, d id f e e l that the l a s t f ive years had been a period of change and b i g dec i s ions . Six of these seven people per-ceived they had needs i n three or more areas. The most important changes or decisions- these seven people made, involved some measure of los s and adjustment to 20 I b i d . 73 l o s s , as indicated i n Table 18. Table 18 Changes and Decisions Made by Port ion of the Study Sample i n Last Five Years (N=7) Changes and Decisions Made Number Making Change Percentage Adjustment to l i v i n g alone fo l lowing death of spouse 3 • 10 Acceptance of dependency i n l i v i n g with r e l a t i v e s 2 7 Move from eastern Canada, los s of family home 1 3 Business sold followed by retirement 1 3 Tota l 7 23 When asked "are you s a t i s f i e d with the above change or d e c i s i o n s " , s ix people, or 20 per cent of the population i n quest ion, gave a " q u a l i f i e d yes" answer. One person, or 3 per cent of the population i n quest ion, was not s a t i s f i e d with the change. The reasons for q u a l i f y i n g these answers, or g i v i n g a negative response, were as fo l lows : Reason D i f f i c u l t to adjust to loss of a spouse and l i v i n g alone Unable to exercise any choice, due to age and helplessness , r e l i a n t on r e l a t i v e s No fr iends i n B r i t i s h Columbia, unfami l iar with the area Work as a source of s a t i s f a c t i o n that has not been replaced Tota l Number Percentage 10 2 1 1 T 7 3 3 23 74 When asked what changes they ant ic ipated having to make i n the next year, twenty people, or 67 per cent of the study sample, d id not think they would have to make any important changes i n the next year . E ight people, or 27per cent of the study sample, did not know i f any important changes would have to be made. Two people,, or .6 per cent of the populat ion, thought they would have to make important changes. The poss ible causes of future changes are given i n the fo l lowing data: Poss ible Causes Necess i tat ing Change Number May get i l l 2 Increasing age, may need help 2 Home too b i g , ge t t ing d i f f i c u l t to look a f te r 2 Desire to t r a v e l , may s e l l home 1 May become increas ing ly incapaci tated and need f u l l - t i m e nursing home care 2 Probably w i l l die 1 Tota l ;10 Three of these ten people had discussed the matter of pos s ib l changes with other people. One person had discussed the sub-ject with a r e l a t i v e . Two people discussed the subject with a f r i e n d . Seven people had not discussed the matter with anyone. Two people would l i k e to discuss the matter fur ther . Two people would not l i k e to discuss the matter. Six people d id not. know i f there was any point i n d i scuss ing the subject When asked with whom they would discuss the subject , g iven the desire and choice, four of the ten people, or 14 pe cent of the study sample, mentioned a f r i e n d . One person, 3 per 'cent of the sample, mentioned a r e l a t i v e . Two people, 7 75 per cent of the study sample, chose t h e i r p h y s i c i a n . One person, or 3 per cent of the sample, did not know with whom they would choose to discuss the subject . I t was s i g n i f i c a n t i n terms of the present study, that none of the e l d e r l y per-ceived the nurse i n t h i s confidante r o l e . When asked how s a t i s f i e d they f e l t with l i f e at present, twenty-two people, or 73 per cent of the study sample, were quite s a t i s f i e d , the highest l e v e l of s a t i s -f a c t i o n allowed by the schedule. The percentage f igure was 21 higher than apparent i n s i m i l a r studies of the aged. These responses may be explained by the di f ferences between the samples, i n r e l a t i o n to economic secur i ty , housing secur i ty , a c t i v i t y l e v e l and s o c i a l contacts . The nature of the s a t i s -f a c t i o n responses are demonstrated i n Table 19. Table 19 Responses of the Study Sample i n Respect to Sa t i s f ac t ion with Present L i f e Level of Sa t i s f ac t ion Number Percentage Quite s a t i s f i e d 22 73 F a i r l y s a t i s f i e d 5 17 Somewhat d i s s a t i s f i e d 1 3 Usual ly d i s s a t i s f i e d 2 7 Tota l r 30 100 21 Schwartz, et a l . , op. c i t . , p . 99; see also Meiners, et a l . , op. c i t . , p . 42. When asked i f things had turned out more or l e s s the way they had hoped, seventeen people, or 57 per cent of the study sample, r e p l i e d i n the a f f i rmat ive . Nine people, or 30 per cent of the populat ion, r e p l i e d i n the negat ive. Four people, or 13 per cent of the study sample, could not express an op in ion . Of the t h i r t e e n people i n the l a t t e r two categories , eleven people, or 37 per cent of the study sample, accepted and were resigned to the dif ference between t h e i r expectations and r e a l i t y . One person, or 3 per cent of the populat ion, was pleased with the way things had evolved. One person, or 3 per cent of the study sample was displeased, I I I . MET AND UNMET NEEDS Information i n respect to met and unmet needs was provided by the summary sheet of the interview schedule. At the completion of each sec t ion , respondents who per-ceived needs i n the spec i f i ed area were asked i f these needs were being met. Sixteen people, or 53 per cent of the study sample perceived forty-two examples of need. Thir ty- two, or 76 per cent of the perceived needs were not being met. Ten need s i t u a t i o n s , or 24 per cent of per-ceived needs, were being met. The d i s t r i b u t i o n of the met 77 and unmet needs of the study sample are shown i n Table 20. Table 20 D i s t r i b u t i o n by Need Areas of Met and Unmet Needs of the Study Sample Area of Need Number of Need S i tuat ions Unresolved • Number of Need S i tuat ions Resolved Tota l Housing 9 2 11 Health 7 4 11 Independent l i v i n g 7 2 9 Employment 0 1 1 Economic secur i ty 2 0 2 Interpersonal r e l a t i o n s 7 1 8 Tota l 32 10 42 A l l respondents, who indicated that perceived needs were not being met, accepted t h e i r need s i t u a t i o n as unavoidable. These data showed that the majority of the e l d e r l y with needs i n the se lected sample do not perceive t h e i r needs as being me t . IV. NURSING. INVOLVEMENT IN HELPING THE ELDERLY MEET MEEDS Information c o l l e c t e d by the summary sheet of the interview schedule answered the t h i r d question asked by the study. Add i t iona l information was gathered by the summary sheet i n respect to which profes s iona l group was perceived by the study sample as p o t e n t i a l l y most he lp fu l to them i n 78 meeting needs. Data showed that none of the study sample, who per-ceived needs as being met, saw the nurse as involved i n help-ing them meet t h e i r needs. The previous sect ion of Chapter Four ind ica ted that, the s ixteen e l d e r l y who per ceived need areas saw ten need s i tua t ions , or 24 per cent of perceived needs, as being met. In r e l a t i o n tp these resolved needs, the sample populat ion perceived the majority of need s i tua -t ions to be resolved by t h e i r own ac t ions . Seven need s i t u -a t ions , or 70 per cent of resolved needs, were perceived by the e l d e r l y to be resolved through s e l f - a c t i o n . In 20 per cent of resolved need s i tua t ions , the study sample perceived r e l a t i v e s to be involved i n helping them meet t h e i r needs. In 10 per cent of the resolved need s i t u a t i o n s , s o c i a l work-ers were perceived as helping the e l d e r l y meet t h e i r needs. The manner i n which the study sample perceived t h e i r need s i tua t ions to be resolved i s shown i n Table 21. Table 21 £Means by Which Study Sample Perceived Needs Met Area of Met Need Resolved by S e l f Resolved by Relat ive Resolved by S o c i a l Worker Tota l Housing 1 1 0 2 Health 2 1 1 4 Independent l i v i n g 2 0 0 ' 2 Employment 1 0 0 1 Economic secur i ty 0 0 0 0 Interpersonal r e l a t i o n s 1 0 0 1 Tota l 7 2 1 10 . 7 9 The t o t a l study sample also was questioned about t h e i r perception of the nurse 's ro le i n r e l a t i o n to the needs of the e l d e r l y l i v i n g at home. A l l respondents were asked whether they thought a nurse could help them or a s s i s t them to get help should needs occur i n any of the areas discussed during the interview. Twenty-six people, or 87 per cent of the study sample, d id not think a nurse could help unless bedside care was necessary. Given these condi t ions , none of these respondents would contact a nurse p r i o r to consul ta t ion with a phys i c i an . Four people, or 13 per cent of the study sample, were- uncertain whether a nurse could help to meet po ten t i a l needs. Two of these people thought a nurse may be able to advise them where.to get necessary he lp . The other two people thought a nurse may be a he lpfu l person with whom to discuss personal problems. However, these two people perceived the s o c i a l worker to be more he lp fu l i n t h i s r o l e . As mentioned prev ious ly , these f indings re f l ec ted readings i n the review of l i t e r a t u r e re la ted to the urgent need to expand the concept 22 of community nursing and the current nurse 's r o l e . The majority of the populat ion, twenty-five people, or 83 per cent knew where to get i n touch with a nursing s e r v i c e . However, a l l of these people, with one exception, 22 Brown, op. c i t . , p . 484; see also Schwenger and Sayers, op. c i t . , p, 96, 80 stated they would not contact a nurse d i r e c t l y but i n i t i a l l y would consult with a phys i c i an . Five people, 17 per cent of the study sample, d id not know where to obtain a nurse 's a s s i s tance . When asked which profess ional group or person they would contact f i r s t regarding problems or needs i n the areas discussed, the majority of respondents mentioned the phys ic ian as t h e i r preferred source of he lp . Twenty-two people ^ or 73 per cent of the study sample, stated they would discuss prob-lems with t h e i r respective phys ic ians . However, several of these respondents also indicated t h e i r reluctance to waste t h e i r phys i c i an ' s valuable time with personal problems. Three people, or 10 per cent of the study sample, said they would contact d i r e c t l y a service agency which deal t with t h e i r s p e c i f i c need. Five people, or 17 per cent of the study sample, stated they would seek the advice of a f r i end or r e l a t i v e as to whom they should contact . L i t t l e more than h a l f of the study sample knew the heal th and service agencies ava i lab le to a s s i s t them i n the area . Sixteen people, or 53 per cent, thought they knew most of the ava i l ab le se rv ice s . Fourteen people, or 47 per cent of the study sample, d id not think they had adequate knowledge of ava i lab le se rv ice s . V. SUMMARY The data obtained by the interview schedule were presented. A desc r ip t ion of the study populat ion i n terms 81 of v i t a l s t a t i s t i c s was g iven. Data c o l l e c t e d by each sect-ion of the interview schedule and the summary sheet were descr ibed . The data answered three questions asked by the study. Data showed that 53 per cent of the study sample (perceived needs i n one or more of the need areas defined by the l i t e r -ature , namely housing, hea l th , independent l i v i n g , employment, economic secur i ty , and inter-persona l r e l a t i o n s . Data showed that the majority of perceived needs were not met. Forty-two instances of perceived need were i d e n t i -f i e d by the study sample. Thir ty-two, or 76 per centtof these perceived needs were not met. Data showed that none of the study populat ion, who perceived needs as being met, saw nurses as involved i n he lp ing them meet these needs. Moreover, supplementary data showed that 87 per cent of the t o t a l study sample d id not perceive nurses as being p o t e n t i a l l y able to help them meet needs i n the defined areas of need. Twenty-two people, or 73 per cent of the study sample, nominated the phys ic ian as t h e i r preferred source of profess ional he lp . A l i t t l e less than h a l f the study sample, 47 per cent, d id not think they had adequate knowledge regarding ava i lab le services i n the area . CHAPTER V SUMMARY, CONCLUSIONS AND RECOMMENDATIONS I . SUMMARY The purpose of t h i s study was to gather information about the perceptions of the e l d e r l y l i v i n g at home i n r e l a -t i o n to t h e i r needs. The nature of the study was d e s c r i p t i v e . The study was designed to answer three quest ions; l i Do the e l d e r l y l i v i n g at home i n a s p e c i f i c geographical area of Vancouver perceive themselves as having needs i n the need areas defined by the l i t e r a t u r e , namely housing, hea l th , independent l i v i n g , employment, economic s ecur i ty and interpersonal re la t ions? 2, Do the e l d e r l y i n the selected sample perceive t h e i r needs as being met? 3 . Do the e l d e r l y i n the selected sample perceive nurses as involved i n helping them meet t h e i r needs? A review of the l i t e r a t u r e re la ted to aging was under-taken i n three areas i The f i r s t sect ion focused on reasons for maintaining the e l d e r l y i n t h e i r own homes. The second sect ion focused on s p e c i f i c needs of the e l d e r l y l i v i n g at homei The t h i r d sect ion focused on the nurse 's ro le i n r e l a t i o n to the e l d e r l y l i v i n g at home. This review showed that the phys ica l and mental health of the e l d e r l y i s best 82 83 preserved when they are maintained i n t h e i r homes. General broad areas of need were i d e n t i f i e d i n r e l a t i o n to housing, hea l th , independent l i v i n g , employment, economic secur i ty and interpersonal r e l a t i o n s . Systematic studies of the nurse 's ro le i n r e l a t i o n to the e l d e r l y l i v i n g at home were l i m i t e d . The p o t e n t i a l ro le of the nurse as an assessor of needs and a co-ordinator of services was s tressed. A semi-structured interview schedule was used to obtain information pert inent to the research problem. The interview schedule was d iv ided into sections which corres-ponded with s ix areas of need defined by the l i t e r a t u r e . A summary sheet allowed for d e f i n i t i o n by the respondents of perceived needs i n these areas, the degree to which these needs were met and the extent to which nurses were involved i n helping them meet these needs. The study populat ion was drawn from the l i s t of e l ec tor s fo r urban p o l l i n g d i v i s i o n No. 153 of the Vancouver Quadra e l e c t o r a l d i s t r i c t . T h i r t y i n d i v i d u a l s were included i n the study sample on the basis of the pre-determined c r i t e r i a , namely wi l l ingness to p a r t i c i p a t e , over s i x t y - f i v e years of age and res ident i n a pr ivate home i n which no form of i n s t i -t u t i o n a l care was o f fered . Descr ipt ive analys i s of the data gathered by the interview schedule was ca r r i ed out. Tables were constructed and presented. The ch i square tes t was used to determine the s ign i f i cance of di f ferences between respondents who perceived needs and respondents with no perceived needs i n r e l a t i o n to 84 sex, age, years of school ing , mar i ta l status and place of b i r t h . No s i g n i f i c a n t di f ferences were found at the .05 l e v e l of s i g n i f i c a n c e . Analys i s of data focused on answering the three questions asked by the study, I t was found that the majority of the study sample, 53 per cent, perceived needs i n one or more of the areas defined by the l i t e r a t u r e . Data showed that the majority of perceived needs, 76 per cent, were not met. The e l d e r l y who saw t h e i r needs as being met d id not perceive nurses as involved i n helping them meet these needs. The majority of the t o t a l study sample, 87 per cent, d id not perceive nurses as p o t e n t i a l l y he lp fu l i n a s s i s t i n g them to meet needs i n the defined need areas, I I . CONCLUSIONS On the basis of these f ind ings , c e r t a in conclusions were drawn. 1. The e l d e r l y may not be the best i d e n t i f i e r s and reporters of t h e i r own needs and may require help i n def ining s p e c i f i c need areas. (a) An assumption of the study, based on the l i t e r -ature, was that the e l d e r l y are able accurately to perceive and report t h e i r needs. This assump-t i o n , to some extent, was found to be i n c o r r e c t . In some cases, respondents indicated that they needed help i n ce r t a in areas.' However, these same respondents d id not report a perceived need i n these areas. A poss ible explanation for 85 t h i s response may be that the study sample did not perceive "help" or "ass is tance" to const i tute a "need". At the same time, the e l d e r l y may corre late growing o ld with having d e f i c i t s , which are not perceived as needs. On the other hand, r e su l t s may be an a r t i f a c t of the technique used. A l t e r n a t i v e l y , c u l t u r a l factors may encourage a reluctance among the e l d e r l y to state needs insofar as d e f i n i t i o n of a need may be interpreted as the difference be-tween dependence and independence. This factor may be s i g n i f i c a n t i n respect to the study sample's perception of the nurse as he lp fu l only i n circumstances i n which the respondent was placed i n a dependent r o l e . Moreover, the majority of the study sample answered negat ively questions re la ted to a need for company or the need for someone with whom to discuss problems. Yet almost every re-spondent seemed eager to detain the interviewer and express hi s fee l ings i n regard to present l i f e s ty le and problems. The d i s p a r i t y be-tween the study sample's recognized needs and demonstrated behaviour led to the conclusion that the majority of respondents under- ident i -f i ed some areas of need. The behaviour of the study sample implied that most respondents had an unperceived need for someone to f i l l the confidante role described i n the l i t e r a t u r e . 2. Profess ionals are able accurately to define need areas i n r e l a t i o n to the e l d e r l y l i v i n g at home. (a) Results suggested that profess ionals are more able to define relevant need areas than some author i t i e s a l low. For example, Rosow claimed the perception of experts, i n r e l a t i o n to the 1 needs of the e l d e r l y , was warped. However, the perceived needs of the study group corre-sponded with the need areas defined i n the l i t e r a t u r e • (b) At the same time, re su l t s indicated that u n i -form needs of the e l d e r l y were d i f f i c u l t to determine other than i n broad areas. In comparison with s i m i l a r populat ions, the study sample seemed able to cope with problem s i t u -at ions , such as retirement, for example, very 2 e f f e c t i v e l y . These f indings suggested that 1 I rv ing Rosow, Soc i a l Integrat ion of the Aged (New York: The Free Press, 1967), p . 2, 2 Doris Schwartz, Barbara Henley and Leonard Z e i t z , The E l d e r l y Ambulatory Pat ient : Nursing and Psychosocial  Needs (New York: The MacMillan Company, 1964);. see also Bernard Kutner, David Fanshel , A l i c e Togo and Thomas Langner, Five Hundred Over S ixty (New York: Wm. F,. T e l l ' Company, 1956) * 8 7 p r i o r to general ized programme planning, assessment of needs, i n r e l a t i o n to s p e c i f i c groups of the e l d e r l y l i v i n g at home, would be necessary. Results supported opinions ex-pressed by Lane, who claimed that no other age group manifested i n d i v i d u a l di f ferences as much 3 as the e l d e r l y . Lane further stated that genera-l i z a t i o n s about the aged were d i f f i c u l t to make and seldom true . Findings of the present study implied that var i ab le s , such as adequate income, ownership of home and long standing residence i n a stable community, may be more s i g n i f i c a n t fac tors , i n the varying degrees of need exper-ienced by the e l d e r l y l i v i n g at home, than has been establ i shed to date. 3« xThe exis tent system of health care i s not appropriate to meeting the needs of the e l d e r l y l i v i n g at home. Although the majority of the study sample perceived needs, few a c t i v e l y sought access to serv ices , a c o r o l l a r y of the present de l ivery system. Results suggested that the patterns of health care de l ivery should be adapted to enable health profess ionals to 3 Harr ie t C. Lane, "Phys io log i ca l Changes i n Aging and Implicat ions for Nursing P r a c t i c e , " The Older Persons  Implicat ions for Nursing Prac t i ce , Carolyn Bingham Davis, ed, (Georgetown: Univer s i ty School of Nursing, 1 9 6 7 ) , P» 6. 88 seek out the e l d e r l y l i v i n g at home and f a c i l i t a t e the meeting of t h e i r needs. 4. Nurses should extend t h e i r ro le i n r e l a t i o n to the e l d e r l y l i v i n g at home. I f nurses are to assume the ro le s proposed i n the l i t e r a t u r e , f indings suggested they must become more a c t i v e l y involved with the e l d e r l y l i v i n g at home. The study indicated an i n t e r - r e l a t e d aspect of t h i s problem, insofar as the perception of the e l d e r l y themselves, i n respect to the nurse 's a b i l i t y to f u l f i l l t h i s proposed r o l e , must be a l t e r e d . I I I . RECOMMENDATIONS This study gathered information about the needs of the e l d e r l y l i v i n g at home and the extent to which nurses were involved i n meeting these needs. Su f f i c i en t evidence was ava i lab le to suggest that : (1) the e l d e r l y l i v i n g at home do not spontaneously perceive a l l t h e i r needs or seek help i n meeting these needs; (2) the degree of need which the e l d e r l y l i v i n g at home verba l ly acknowledge may be influenced by such factors as the c u l t u r a l s t igmat izat ion or dependency connotation attached to words l i k e "need"; (3) the degree of need experienced by the e l d e r l y l i v i n g at home may depend 4 V i r g i n i a Henderson, The Nature of Nursing (New York: The MacMillan Company, 1966); see also F i n a l Report of the  Spec ia l Committee of the Senate on Aging (Ottawa: Queen's P r i n t e r and Cont ro l l e r of Stat ionary, 1966). 89 more on such factors as ownership of home or establ i shed residence i n a stable community than has been establ i shed to date; (4) health profess ionals should i n i t i a t e and develop d i f f e rent approaches to the de l ivery of health care i f the needs of the e l d e r l y l i v i n g at home are to be met: and (5) nurses should become a c t i v e l y involved with the e l d e r l y l i v i n g at home i f the perception of the e l d e r l y , i n re-l a t i o n to the nurse, i s to be a l tered and the proposed ro le of the nurse, as a preferred source of profess ional help, i s to be achieved. On the basis of t h i s evidence, the fo l lowing recommen-dations were made. 1. More extensive research be undertaken to e s t ab l i sh the r e l a t i v e s igni f icance of f ac tor s , such as community re l a t ionsh ip s and s t a b i l i t y , i n minimizing needs among the e l d e r l y l i v i n g at home, 2. Methodological research be undertaken to e s t ab l i sh whether obtained re su l t s were an a r t i f a c t of the technique used i n respect to the r e l a t i v e ef fects of using words such as "he lp" and "need" . 3. The health care de l ivery system be adapted to enable profess ionals to seek out the e l d e r l y l i v i n g at home and a s s i s t them i n def in ing and meeting t h e i r needs. 4. The nursing profess ion promote community education programmes aimed at a l t e r i n g the perception and a t t i tudes of the e l d e r l y i n r e l a t i o n to the extended community role of the nurse and her a b i l i t y to help them meet t h e i r needs. 5. The nursing profess ion explore means to achieve a more co l laborat ive r e l a t ionsh ip between family-physicians and community nurses i n order to provide e f fec t ive supportive and preventive services for the e l d e r l y l i v i n g at home. Nursing education be structured to systemat ica l ly examine the expanded ro le of the nurse i n r e l a t i o n to the problems of the e l d e r l y i n the community and to i n i t i a t e and develop programmes to support t h i s concept. BIBLIOGRAPHY 9 1 Bibl iography A. BOOKS B i r r e n , James B. ( ed , ) . Handbook of Aging and the I n d i v i d u a l . I l l i n o i s : Univer s i ty of Chicago Press, 1959, , The Psychology of Aging. New Jersey: Pren-t i c e - H a l l , I n c . , 1964. Brown, Esther L u c i l e . Nursing Reconsidered: A. Study of Change. P h i l a d e l p h i a : J . B. L i p p m c o t t Company, 1971. Davis , Carolyn Bingham, ( e d . ) . The Older Person: Implications  for Nursing P r a c t i c e . Georgetown: Univer s i ty School of Nursing, 1967. Freeman, Ruth B. Community Health Nursing P r a c t i c e . Toronto: W. B. Saunders Company, 1970. Henderson, V i r g i n i a . The Nature of Nursing. New York: The MacMillan Company, 1966. K a l i s h , Richard A. ( ed , ) . The Dependencies of Old People. Michigan: Ins t i tute of Gerontology,Publ icat ions , 1969. Kutner, Bernard, David Fanshel, A l i c e Togo and Thomas Langner, Five Hundred Over S ix ty . New York: Wm. F . T e l l Company, 1956. Loether, Herman J . Problems of Aging. C a l i f o r n i a : Dicken-son Publ i sh ing Company, I n c . , 1967. Meiners, Dieter and Joanne Moore. Home Services for the Aged. Unpublished M.A. Thesis , Univer s i ty of B r i t i s h Columbia, 1967 Neugarten, Bernice L . ( ed . ) . Middle Age and Aging. Chicago: The Univer s i ty of Chicago Press, 1968. Rosow, I r v i n g . Soc i a l Integrat ion of the Aged. New York: The Free Press, 1967. Schneider, B. V. H. The Older Worker. Berkeley: Univer s i ty of C a l i f o r n i a Press, 1962. Schwartz, Dor i s , Barbara Henley and Leonard Z e i t z . The E l d e r l y  Ambulatory Pa t i ent : Nursing and Psychosocial Needs. New York: The MacMillan Company, 1964. 92 93 Shanas, E t h e l , et a l . Old People i n Three Indus t r i a l  S o c i e t i e s . New Yorks Atherton Press, 1968. Shanas, E t h e l . The Health of Older People; A Soc ia l Survey. Cambridge: Harvard Univer s i ty Press, 1962. Sheldon, J . H. The S o c i a l Medicine of Old Age. Oxford: Univer s i ty Press, 1948. Stotsky, Bernard A . The E l d e r l y Pa t i ent . New York: Grune and S t ra t ton , 1968. T i b b i t t s , C la rk . Handbook of Soc i a l Gerontology: Soc i e t a l  Aspects of Aging. Chicago: Univer s i ty of Chicago Press, I960. Tibbi t t s , . . -Clark , and Wilma Donahue. Aging i n Today's Society, New Jersey: P r e n t i c e - H a l l , I n c . , I960. Wil l iams , Richard H . , et a l . Processes of Aging: Soc i a l and Psychologica l Perspect ives . New York: Atherton Press, 1963. B. PERIODICALS Archer , Sara Katherine. "Health Maintenance Programmes for Older A d u l t s , " The Nursing C l i n i c s of North  America, XII (December, 1968), 729-741. Blau, Zena S. "Changes i n Status and Age I d e n t i f i c a t i o n , " American S o c i o l o g i c a l Review, XXI (January, 1956), 198-203. Bonham, Gerald H. and Agnes B. Weston. "Growing Old i n Vancouver," On Growing Old . VII (October, 1969), 1-8. Comal l i , Peter , et a l . "Cognit ive Functioning i n Two Groups of Aged: One I n s t i t u t i o n a l i z e d , the Other L i v i n g i n the Community," Journal of Gerontology, XX (January, 1965), 14-18. Havighurst , Robert J . "Old Age: An American Problem," Journal of Gerontology. IV (October, 1949), 298-304. Latimer, Ann, "Nursing C l i n i c for the Aged," American Journal of Nursing, CIII (October, 1965), 116-117. Lowenthal, Marjorie F . and Clayton Haven. " Interac t ion and Adaptation: Intimacy as a C r i t i c a l V a r i a b l e , " American S o c i o l o g i c a l Review, XXXIII (February, 1968), 390-410. 94 Markus, E l l i o t , et a l . " M o r t a l i t y Experience i n an I n s t i t u t i o n for the Aged," Eighth Internat ional  Congress of Gerontology - Abstracts of Volunteer  Papers and Fi lms , II (1969). 74. Markus, E l l i o t . "The Impact of Relocat ion Upon M o r t a l i t y Rates of I n s t i t u t i o n a l i z e d Aged Persons," Journal  of Gerontology. XXVI (October, 1971), 537-WT. . "Relocat ion Stress and the Aged," Inter-d i s c i p l i n a r y Topics i n Gerontology, VII (1970), 60-71. Morse, Nancy S. and Robert Weiss. "The Function and Meaning of Work and the Job," American S o c i o l o g i c a l Review, XX (January, 1955), 198-199. Mussallem, Helen K. "The Expanding Role: Where Do We Go From Here?" The Canadian Nurse, CVII (September, 1971), 31-35. Schwenger, C. W. and L . A . Sayers. "The Role of the Publ ic Health Nurse i n the Integrat ion of Community Resources to the Aged," E ighth Internat ional Congress of . Gerontology - Abstracts of Volunteer Papers and F i lms . II (1969), 96. Thompson, Wayne E . , Gordon S tre ib and John Kosa. "The E f f e c t of Retirement on Personal Adjustment: A Panel A n a l y s i s , " Journal of Gerontology, XV (December, i960), 165-169. C. GOVERNMENT REPORTS Act ion fo r the Aged and Aging - A Report of the Committee  on Labor and Publ ic Welfare United States Senate. Washington: U .S . Government P r i n t i n g O f f i c e , 1961. An Abstract for Act ion - National Commission for the Study  of Nursing and Nursing Educat ion. New York: McGraw-Hill Book Company, 1970. B r i t i s h Columbia Department of Health Services and Hospi ta l Insurance. Annual Report of the Health Branch, 1968. V i c t o r i a : Queen's P r i n t e r , 1969. Developments i n Agings 1963 and 1964. Report No. 124. Washington: U i S . Government P r i n t i n g Of f i ce , 1965. F i n a l Report of the Spec ia l Committee of the Senate on Aging. Ottawa: Queen's P r i n t e r and Cont ro l l e r of Stat ionary, 1966. L i v i n g Arrangements for the Aged. A Paper presented at the Canadian Conference on Aging. Ottawa: Queen's P r i n t e r and Cont ro l l e r of Stat ionary, 1965. The Nation and Its Older People: Report of the White House  Conference on Aging. Washington: U.S . Government P r i n t i n g Of f i ce , 196l. Senate of the State of C a l i f o r n i a . C a l i f o r n i a Leg i s la ture  Report of the Senate Subcommittee on Housing and  Recreat ional Needs of the E l d e r l y C i t i z e n s . San Francisco : 1961. Problems of the Aged i n Our Community. Information Service S o c i a l Planning Council of Metropol i tan Toronto, 1963. United States Department of Health, Education, and Welfare. The Health Care of the Aged. Washington: U .S . Government P r i n t i n g Of f i ce , 1962. United States Department of Health, Education, and Welfare. Report of the F i r s t National Conference on Aging. Washington: U.S . Government P r i n t i n g Of f i ce , 1951. APPENDIX A INTERVIEW SCHEDULE 9 6 SELF-PERCEIVED NEEDS AND NURSING INVOLVEMENT WITH THE ELDERLY LIVING AT HOME Ident i fy ing Information Study No; 1. Sex Male _ Female 2. Age 65 - 69 _ 70 - 74 _ 75 - 79 _ 8o - 84 _ 85 - 89 _ 90 & over Years of Schooling Less than 8 8 but l e s s than 12 12 but l e s s than col lege gca d . College graduation and over M a r i t a l Status a . single_ b . married c . widowed d . divorced e. separated Birthplace a . Canada b . Gr . B r i t a i n c . Europe d . Other 1. L i v i n g Arrangements (housing) (a) Are you now l i v i n g i n an apartment or a pr ivate home? Private house_ Apartment Furnished room _ Boarding room Home of r e l a t i v e Other 1. (b) How long have you l i v e d here? years 2. Do you f i n d i t genera l ly sa t i s fac tory? ( I f any answer except yes, ask) What don't you l i k e about i t ? Yes Qual i f ied yes No Qual i f ied no 3. How about such(other) things as: Heat Pr ivacy , quiet 97 98 V e n t i l a t i o n . Bathroom f a c i l i t i e s Space The neighbourhood L ight 4. Are your s leeping arrangements a l l r ight? Yes No 5 i (Ask everyone but dwellers i n a pr ivate house) Do you f e e l your b u i l d i n g i s kept clean enough? Yes No 6; Do you have a telephone? ( I f no, ask a) Yes No a. Do you ever f e e l you need one? Yes No 7. a . Do you l i v e on the ground f l o o r Yes No b. Does your b u i l d i n g have an e levator you can use? ( I f no, ask c & d) Yes No c . How many f l i g h t s of s t a i r s do you walk? One Two Three More than 3 d. How do you f e e l about th i s ? ( C i r c l e c loses t to p a t i e n t ' s react ion) No problem Minor nuisance D i f f i c u l t for reasons of health D i f f i c u l t for other reasons 8. During the l a s t year have you a c t u a l l y thought about moving? No . Yes ( I f yes ask a, b, and c) a i For what reasons? b . Have you done anything about i t yet? No Yes c. What problems are you running into? 9. I ' d l i k e to ask some questions about your housekeeping. During the l a s t month who d id most of the housework? Yourse l f Spouse Other r e l a t i v e i n household Yourse l f sharing equal ly with someone else Relat ive or f r i e n d outside of household Paid help Other 10. I f interviewee does most of housekeeping or shares the job, ask) a i Is there any part of the housework tha t ' s d i f f i c u l t f o r you i n any way? ( I f yes, say) T e l l me about i t . b . Then you would say that , a l l i n a l l , you do the work with (Offer appropriate category) No d i f f i c u l t y Minor d i f f i c u l t y Some r e a l d i f f i c u l t y Serious d i f f i c u l t y 9 9 11. What kind of household equipment do you need ( i s needed) that you don't have now? None Kind 12. What kind of household help do you need ( i s needed) that you don't now have? None Kind 13. During the l a s t month were things around your household kept the way you would l i k e them to be?(If any answer except yes, ask) Why i s that? Yes Qualified yes No Qualified no Complete Questions No. 1, No. 2 on summary sheet i n r e l a t i o n to met and unmet housing needs,. I I . Adjustment to I l l n e s s (health) 1. During your l i f e t i m e do you think you have had a great deal of trouble because of being sick. or Not much ? 2. When you think about a l l the people you know i n your own age group, how do you think your health compares with theirs? a. Very good b. Good c. F a i r d. Poor 3. Do you have any condition for which you receive regular medical treatment? Check appropriate category of reply • (check as many as apply) Yes No a. Symptoms or l i m i t a t i o n s b. Disease en t i t y (ies) Is::this (repeat patient's wording) a. A big problem to you b. Some problem to you c. No problem to you Why? 4. What did the doctor t e l l you to do for your (repeat i n t e r -viewee's response to question No. 3) a. Is there anything about t h i s that you f i n d d i f f i c u l t to follow? Anything you don't quite understand? No Yes _ _ _ _ _ _ 5. Is there anything you want to know about your condition that you haven't been told? No _. Yes 6, During the l a s t month have you been worried about your health? ( i f yes ask a. and b.) No Yes a. Can you t e l l me what worried you? b. Do you f e e l you can discuss t h i s with your doctor? No Qualified no Yes Qualified yes (Other than 'yes* ask c") 100 c. Would you l i k e to discuss i t with some health profess ional such as a nurse? No Qual i f ied no yes Qual i f ied yes 7. I f you had to spend some time i n bed because of i l l n e s s , i s there one you could count on to give help? No Probably Yes Perhaps Don't know ( I f probably or perhaps, ask) Who i s that? Someone i n household Someone outside of household Profess ional help Other 8. Do you think your (repeat interviewee's response to No. 3) has changed your d a i l y l i f e ? No Yes I f 'yes ' how important have these changes been? a . Of no importance b . Of l i t t l e importance c . F a i r l y important d . Very important I f ' a * asks What makes you think that? 9 . Are you supposed to have a spec ia l d iet? Yes No ( I f yes complete the next 2 questions) 10. Why are you on th i s d ie t? a . Don't know b . Doctor ' s order c . Needed to contro l disease d . Needed to contro l symptoms e. Other ( spec i f iy ) Verbatum 11. Are you having any spec ia l trouble keeping to your diet? Yes No 12. In the l a s t 5 years have you been housebound because of any sickness or in jury? Yes No a. What was the i l l n e s s or in jury? Acute i l l n e s s Acute incidence i n chronic i l l n e s s More or l e s s chronic d i s -a b i l i t y . Injury b . Did you have your meals i n bed? Yes No c . Did you need any help you did not get? Yes No d . Did you use anyone for help? Yes No ( I f no, ask) Why not? D idn ' t need No one ava i lab le Didn ' t l i k e to ask Other ( I f yes ask a. and b.) 101 a. Who? Someone i n household Nonprofessional outside household Profess ional help Other b . What kind of help? Pr imar i ly nursing Pr imar i ly housekeeping Both Other 1 3 * Is there someone on whom you can c a l l i f you need help at night? Poss ib ly Yes No Does t h i s represent a change i n the l a s t few years? Yes No 1 4 . How do you f e e l about having (or not having) someone to c a l l on? 15. Walking Status (check as many as apply) Check one a . Walk alone without a crutch or cane b » . N e e d the help of crutches or cane _ c . Need the help of a wheelchair or walker d . Need another person to help you walk e. Need another person to help you move i n a wheelchair . . • f . Do you wear any kind of brace o r s p l i n t 1 6 . Ambulation and Travel Do you have any spec ia l d i f f i c u l t y t r a v e l l i n g ? . Often Occas ional ly Never I f other than 'never ' what kind? Verbatum 1 7 . Can you Don't know E a s i l y With d i f f i c u l t y Not at a l l a . Climb a curb '  b . Climb s t a i r s c. Go down s t a i r s d . Use a bus e. Use a car 18. Since you r e t i r e d , have you ever had a nurse v i s i t i n g you pro fe s s iona l ly at home? Yes No Uncertain I f yes, was she able to help? Yes No Uncertain I f yes, what d id she do or say that helped? Verbatim Is a nurse coming i n now? Yes No What for? 1 9 . Do you think there are any ways a nurse could help you now? Yes No Uncertain I f yes, or uncerta in , i n what ways? 102 20. Do you think you need help with (offer a l l of the not mentioned by interviewee) . C i r c l e appropriate a . preparing meals or d ie t b . medications dressings, in j ec t ions c . shopping, t r a v e l l i n g d . t o i l e t , cosmetic care or dress ing e. housekeeping f . gardening g . upkeep of house, r epa i r household appliances h . obta ining physiotherapy, occupational therapy or medical care or s o c i a l services i . «p:eE:s8fiaJL Or mSQieal^proble^jfisl/- do you need some one to t a lk things over with? j . obta ining information about ava i lab le services i n t h i s area 21. Do you think a nurse could help you with (repeat item mentioned by interviewee as unmet need) or a s s i s t you to obtain t h i s help? Yes No Uncertain fo l lowing i tem. Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Complete questions No. 1, No. 2., i n r e l a t i o n to met and unmet health needs. I I I . Use of Leisure Time (independent l i v i n g ) 1. Now I am interes ted i n knowing how you spend your spare t ime. T e l l me a l i t t l e about what you general ly do. 2. Do you also (offer a l l of the fo l lowing not yet mentioned by p a t i e n t ) . Probes: About how often do you do th i s ? Do you spend a l o t of your time on th i s or just a l i t t l e now and then?.Do you usua l ly do t h i s with others or by your-se l f ? Do you enjoy th i s ? Why or why not? Often occa- never Alone with Comments s i o n a l l y others Take walks L i s t e n to Play cards Go to church Go to movies, concerts , e t c . Pract ice . : . hobbies Go to meetings What organizations? With people i n household? Neighbours? Friends S i t by your- What do you usua l ly think s e l f and do nothing about? Read magazines, How often? newspapers, books Which ones? Take Vacations What do you do? Other Describe: 103 3. Is there some p a r t i c u l a r place outside of your home where you l i k e to spend time? ( I f yes, ask a and b) None a . What sort of place? Club L ibrary Park bensch Restaurant Bar Home of f r i end or r e l a t i v e Stores House stoop Others b . Do you usual ly t a lk to f r iends or acquaintances there? No acquaintances there Acquaintances there 4. Of a l l the a c t i v i t i e s . y o u ' v e mentioned ( r e c a l l them one by one) what gives you the most sa t i s f ac t ion? In what way? 5. Sometimes people consider l i v i n g some place else where they can get more care or companionship. During the past year have you ever thought of such a thing? No Yes ( I f yes, ask a, b, and c) a . What sort of place have you thought about? . Home of r e l a t i v e or f r i end Move to a d i f f e rent climate Dwelling near a r e l a t i v e or f r i end Old age i n s t i t u t i o n Nursing home Hospi ta l Other b . Have you done anything about th i s? No Yes c. Is t h i s something you're interes ted i n get t ing more information about? No Yes 6. In general do you f i n d that time hangs heavi ly or seems to pass quickly? 7. Now th ink ing back over your l i f e , would you say that i n the past you usua l ly preferred to do things with others _ or to keep to yourse l f? Do you s t i l l f e e l that way today? Yes No 8. Would you l i k e to spend your time d i f f e r e n t l y i n any way? ( I f yes, ask how?) Yes No Complete questions No. 1, No. 2 on summary sheet i n r e l a t i o n to met and unmet needs of independent l i v i n g . IV. Vocat ional Adjustment (employment) 1. When d id you l a s t work f u l l time? Less than one year ago One to two years ago More than f ive years ago Housewife 2. Why did you r e t i r e (cut down on your work)? Work too strenuous Work d i s t a s t e f u l 104 Symptom or d i s a b i l i t y in ter fered Employer's dec i s ion because of age Wanted to enjoy l e i su re S o c i a l pressure Unable to f ind work Other 3 . a . I f a f u l l time job were ava i lab le to you, how would you f e e l about working these days? What makes you f e e l t h i s way? Enthus ia s t i c Poss ib ly interes ted Di s interes ted ( I f poss ib ly in teres ted , ask b) b . How about a part-time job? Enthus ia s t i c Poss ib ly interes ted Dis interes ted 4 . Have you looked for a (another) job wi th in the past year? No Yes _ ( I f yes) What d i f f i c u l t i e s d id you run into? 5 . a . What was the longest job you held? Profes s iona l , t e c h n i c a l , Sales , Nondomestic serv ice , U n s k i l l e d , Domestic serv ice , Housewife b . For how many years? c . How did you f e e l about that job? 6. What were some of the things you l i k e d about that job? Way of making a l i v i n g or supplement income Good pay F i l l e d time Interes t ing work Made me f e e l important Had fr iends on the job B e n i f i t s (besides pay) Made me f e e l f i t Freedom from supervis ion Nothing Hadn't thought about i t Other Which of these reasons i s most important to you? Complete questions No. 1, No. 2 on summary sheet i n re-l a t i o n to met and unmet employment needs. V. Finances (economic secur i ty) 1. By the way, what i s your monthly income approximately? $100 - 149 159 - 249 250 - 299 300 - 349 350 - 399 400 - 500 Not acertainable 105 2 . Do you have any d i f f i c u l t y managing your income? No Yes _ I f yes - where do you f e e l the pinch most? 3 . Where would you put yoursel f? Am comfortable Have enough to get by on Do not have enough to get by on 4. Is there anything you r e a l l y need these days that you . have delayed buying because you can' t af ford i t ? No Yes ( I f yes ask) What i s that? 5 . Do you expect t h i s s i t u a t i o n to stay the same, get bet ter or worse i n the next f ive years? ( I f bet ter or worse, ask) Why do you think so? Same Better Worse Complete questions No. 1 , No. 2 On summary sheet i n r e l a t i o n to met and unmet economic needs. V I . Interpersonal Relations and Morale 1 . Who l i v e s with you now? I f no one, ask question 2 , Person Relat ionship Sex Age I f you needed help In what way because of sickness or other reason, could t h i s person help  1 2 4 5 6 7 8 9 i o 2 , Do you have other close f r iends or r e l a t i v e s whom you see? Yes No (I f none ask question No. 3 ) . About how old i s she (he)? Where does she (he) l i v e ? Have you seen or heard from her (him) i n the l a s t 6 months? About how often? Relat ionship Approx. Place of Seen or Hear from to interviewee age residence not at once several weekly d a i l y a l l times  1 2 3 :  4 5 6 ; 7 -8 • 9 — — 10 • 106 3. During t h i s l a s t month have you f e l t at any time that you minded being alone? ( I f yes, ask) : Do you often f e e l th i s way, or was t h i s just a passing feel ing? No Yes, often Yes, not often 4, Have the past f ive years been a time of changes and b ig decis ions i n your l i f e ? ( I f yes, ask a. and b.) Yes No _ a. What was the most important change (or decis ion) you had to make? b . Are you s a t i s f i e d with t h i s change (or decis ion)? I f any answer except yes, ask) T e l l me why not? Yes Qual i f ied yes No Qual i f ied no 5. Looking ahead, do you think you w i l l have to make any important changes i n your l i f e i n the next year or so? ( I f yes, ask a and b ) . Yes No Don't know a. What i s that? b . Have you discussed t h i s with anyone? ( I f yes, ask) Who i s that? Yes No Relat ive Friend Doctor Nurse Soc i a l worker Other c . Would you l i k e to discuss t h i s (further) with someone? No Yes Don't know d. With whom would you choose to discuss i t ? Relat ive Friend Doctor Nurse Soc ia l worker 0 Other Don't know 6, A l l i n a l l , how s a t i s f i e d do you f e e l about your way of l i f e these days? Then you'd say you f e e l (of fer statement c loses t to p a t i e n t ' s own fee l ing) Quite s a t i s f i e d F a i r l y s a t i s f i e d _Sometimes d i s s a t i s f i e d Usual ly d i s s a t i s f i e d 7. Have things turned out for you more or les s the way you'd hoped? Yes No Don't know I f 'no* does the dif ference make you f e e l Pleased Displeased Resigned Complete questions No. 1, No. 2 on summary sheet i n r e l a t i o n to met and unmet personal needs 107 SUMMARY SHEET 1. a . Now i n respect to (repeat category just completed) do you think you have any unmet needs i n t h i s area? b. How serious are these needs? Area of Unmet Need '3.. ' . Intensity of needs No Needs S l i gh t Moderate Serious C r i t -^ i c a l 1. L i v i n g arrangements (housing)  2. Adjustments to i l l n e s s (health)  3. Use of l e i s u r e time (Independent l i v i n g )  4. Vocat ional adjustment (employment)  5» Finances (economic secur i ty)  6 . Interpersonal r e l a t i o n s  2, Are you doing anything about meeting these needs? Would you t e l l me how you met these needs? Did you meet the needs by your own act ions or with the help of some-one else? Would you t e l l me who helped you? Was a nurse involved any way at a l l i n helping you to meet t h i s need? Means by Which Need S i tua t ion Resolved Area of Met Need i. .-Need Nurse Other Involved Need S i tua t ion S i tua t ion involved In Meeting Accepted, Resolved In meeting Need Health S.S. Un resolved By Own Needs Act ion Direct I n d i r . Fr iend R e l . Pro 1.Housing 2. Health _ _ _ 3. Independent L i v i n g  4. Employment  5. Economic Secur i ty 6. Interpersonal Relat ions 3:. When you think about a l l the things we've ta lked about today (repeat a l l categories) do you think a nurse could help you or a s s i s t you to get help to meet any needs i n these areas? Yes No Uncertain I f ' yes ' or ' uncer t a in ' ask i n what ways? 4. Who would be your preferred source of profes s iona l help? 5« Would you know how to get i n touch with a nurse i f you wanted one to help you? Yes No 6. Do you think that health and other service agencies are ava i l ab le i n t h i s area to help people? Yes No APPENDIX B LETTER OF INTRODUCTION 108 

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