Life-stories, engagement and health problems of elderly persons in northern areas, with consequences for care services

The project was granted with funds from the Strategic University College Programs (SHP) based upon an application submitted 02/21/2007. The research questions are related to a central and highly relevant issue within the national priority area "caring for the elderly with particular focus on dementia" (Report no. 25 (2005-2006): Long term care. Future challenges. Care plan 2015), especially the impact of culture upon the health of the ethnic diverse population in Northern Norway. Life histories are investigated to understand how ethnicity is related to activity, health and aspects of care. Main objective: To examine how ethnicity affects engagement in life among elderly with health problems in Troms and Finnmark using life history research, and to examine the implications for nursing and care services. Secondary objectives: 1) To use life stories told by the elderly and their family members to investigate how the development of activities, reflections and values throughout life is affected by current health problems, including dementia, and to identify the implications for nursing and care. 2) To use fieldwork and interviews to examine how knowledge about the life of patients in nursing homes is relevant to nursing and care, especially for people who are affected by dementia disease. 3) How use of life stories that focus on ethnicity can reveal reflections, values and experiences in elderly Sami with health problems, including dementia. Of particular interest is the use of knowledge from early life of patients in nursing homes and home care services. So far, especially the results from the publication of the first five articles in the project have evoked both local, national and international attention. The results are transferable to similar areas within the field of caregiving. The life history and the narrative perspectives have been fruitful regarding the project issues. Results from the sub-projects have been published in both scholarly and popular science settings, e.g. at various conferences in Norway and abroad. So far, the project has resulted in seven published scientific articles. Both published articles and anticipated publications will have a major impact locally, nationally and internationally due to the transferability of findings to the life story research and narrative research in general, but also specifically in relation to: a) research on people with dementia disease, b) the relationship between informal carers and nursing staff in the municipal health services directed towards people with dementia disease (patients with Kven, Sami and Norwegian ethnic background) c) opportunities to maintain previous activities for people with dementia disease in nursing homes. We also expect that future publications from the project will have great transfer value locally, nationally and internationally.

This is an interdisiciplinary health science project. The general objective of meaningful activity in older age is sought contextualized through life stories. This makes it possible to integrate perspectives on aging, gender, ethnicity and involvement in life, in elderly afflicted with health impairments, including dementia, and with consequences for health care. Two of the projects use life story methodology, the third project studies the use of previous life knowledge in nursing homes, by means of fiel d methodology. The lifetime of the elderly of Troms and Finnmark has had a special character. It was marked by several tragedies, the most devastating was the 1944 scorched earth warfare. For all ethnic groups, the late arrival of modernity in the regio n meant wide-ranging cultural and social changes through a short span of time. A culturally responsive approach to the elderly of the North implies a focus on ethnicity. Sámi language and cultural expressions were officially suppressed since the 19th cent ury, and today, ethnic identity may not be readily perceptible for persons who lack the insiders knowledge. Bilingual patients afflicted with dementia often have severe difficulties in their language choice and language separatiion, and the subsidiary la nguage may disappear while the language major may be unsullied. A growing multicultural aging population in the North of Norway is a challenge to Norwegian health care environments. Knowledge of earlier life is recognized as important in care of the elde rly, in nursing, pshysiotherapy and occupational therapy, especially regarding elderly suffering from dementia. More research is needed on the health care approaches to earlier life, its limits and possibilities. As old age often is conceived as a potent ial time for self-reflection and creation of personal coherence, a life-story approach in health science may contribute to individualized understanding. A hermeneutic, Ricoeur-inspired methodology is suggested