How do older adults self-manage distress and does the Internet have a role? A Qualitative study

Problem

Anxiety and depression in older adults are common but under-recognised. Older adults are more likely to self-identify as ‘distressed’ rather than depressed or anxious and may feel responsible for addressing and self-managing their own mood problems. This qualitative study explores the self-management strategies ‘distressed’ older adults employ, with a particular focus on the role of the Internet for support. A Public and Patient Involvement and Engagement (PPIE) group provided input throughout the study.

Approach

University ethics approval obtained. Semi-structured interviews with eighteen older adults recruited from local community groups used to generate the data. Participants lived in urban and rural areas, and ages ranged between 65-91 years. Innovative ‘think-aloud’ methods (including ‘storyboards’ and extracts from online forums) generated discussion. Thematic analysis incorporating constant comparison methods used to analyse the data. Members of the PPIE group helped to develop the methods and gave their perspectives on the findings.

Findings

Respondents recognised the concept of ‘distress’ and described a preference to self-manage their mood independently from the healthcare system. Key self-management strategies included: individual activities such as reading, gardening and exercising, seeking social support from family and friends, engaging in community resources such as attending community groups and church. Male participants described attending community groups with the aim of learning a skill, women emphasised the social aspect of such groups. A small number of participants did describe consulting their GP when ‘distressed’, but reported being offered treatments they considered to be unacceptable e.g. medication and ‘talking therapies’. Respondents suggested that they might discuss their ‘distress’ face-to-face with friends who they trusted. All respondents had access to the Internet, which was seen as a source of health information once a GP had diagnosed a physical problem, but was rarely seen as a source of information for ‘distress’, or as a means of accessing social support. Many respondents stressed the importance of community computer groups to help older people learn how to maximise their use of the Internet.

Consequences

GPs need to be aware of the self-management strategies older adults with distress already employ in order to sign-post to additional and acceptable sources of information and support. Care is needed when sign-posting to online support as this might not be acceptable to older adults.