Fifty-eight percent of the older adult (65 years of age or older) population is comprised of couples living together at home with chronic illness (Administration on Aging, 2016; US Census Bureau, 2017). They face multiple health challenges related to aging and the management of health within a continuously changing health care system (Elhauge, 2010; Vassilaki et al., 2015). Decreased quality of life, higher out-of-pocket expenses and a higher risk of developing dementia are added threats to the aging experience (Kayser, Watson, & Andrade, 2007; Kiecolt-Glaser & Newton, 2001; Lyons, Zarit, Sayer, & Whitlatch, 2002; Vassilaki et al., 2015). The resources available to support the older adult couple to manage these challenges at home has implications beyond the couple, but for the family, the community and for society (Hudson, 2014; Hoppmann, Michalowski, & Gerstorf, 2016; Sugar, Riekse, Holstege, & Faber, 2014). To date, there is insufficient knowledge of how to leverage the strengths of being a couple to address the couple’s health concerns and their required caregiving supports while aging within their community.
Therefore,the purpose of this exploratory study was to better understand the OA couple’s experience, as a couple, living at home with chronic illness by answering the following research questions: (a) What is the life pattern manifested by older adult couples living with chronic illness at home?, and (b) Are there common themes across the life patterns of older adult couples living with chronic illness at home? The study provided a necessary first step in informing the development of effective strategies to support this population and facilitate their ability to remain in their homes and communities while aging (Colby & Ortman, 2014; Kane, 2015; Vassilaki et al., 2015).
Methods:
This qualitative study used Margaret Newman’s Theory of Health as Expanding Consciousness (HEC) to guide the methodological design and the interpretative lens for data analysis (Newman, 1979, 1990, 2008). The theory views health as an evolving life pattern, encompassing disease and non-disease, characterized by meaning. Newman’s HEC was selected as the framework to guide this study because of its alignment with nursing’s paradigm and the opportunity to capture new insights to address the research questions through the older adult couple’s perspective that other method designs could not.
Newman’s hermeneutic-dialectic phenomenological design captured rich data through two home interviews with 14 married older adult couples. It was through the mutual process, between the researcher and participants, where reality was explored, reflected on, and a consensus was reached regarding a common understanding that may enhance awareness and meaning (Gadamer, 1976, 1989; van Manen, 1997). The interviews were conducted jointly to capture the data within the context of being a couple to support the interpretative analysis and its meaning.
Results:
During in-depth data analysis three themes emerged, (1) an unfolding pattern of living meaningfully as the couple, (2) interconnectedness strengthening the bond within the couple’s relationship that promotes self-growth, and (3) a resonating process between spouses promoting opportunity toward transformative change to enhance mutual well-being and health. Conceptual models were proposed illustrating a range of influencing processes which facilitate mutual caregiving while the older adult couples moved through life-aging transitions.
Conclusion:
The study discovered an emerging pattern of living meaningfully across the older adult couples within the context of moving through life transitions, where a broader conceptualization of health beyond the focus on illness was required to sustain health, functionality, and well-being. Significant implications were found for viewing the older adult couples as a family unit, where mutual caregiving is a characteristic may be leveraged as a supportive factor for the couple. The proposed models illustrate the processes by which the couples may navigate through life transitions within the context of aging dynamics. Nursing may be able to emphasize the strengthens of being an older adult couple through a mutual caregiving lens as leverage towards more creative and effective interventions to support the couples in sustaining health, well-being and meaning as they age together at home.