News
December 2010
Home Alone: Making It Work for Older Women
Eileen J. Porter, PhD, RN, FGSA
"Most [of us] nurses have a connection through our own lives to the population that eventually becomes our population of interest," says Eileen Porter, PhD, RN, FGSA. For her, it was her grandmother's generation in a small town in west central Kansas that left its mark on her life and her research.
Growing up in a rural setting, she saw her grandparents and their friends almost every day—at church, in the neighborhood, frequently in their homes. "Most of my longer-lasting relationships as a child were developed with people older than me," says Porter. "I formed bonds with these people. I can still remember their names; I can still see their faces."
Today, Porter says, she carries them with her.
Porter, who joined the UW–Madison School of Nursing in fall of 2010, explores the health-related experiences of older women in their 80s and 90s who live at home, alone—many having outlived their spouses—and now face numerous challenges in their lives. "Home is the place where these women want to be, where they can best be themselves," says Porter. "They are not passive recipients of services; they still want to remain in charge of their lives."
Although the variations of daily risks for older women living at home alone are incalculable, says Porter, they all have implications for interventions. "We must ascertain what the person is really trying to do … how that person is trying to live her life."
Porter's latest research, funded by the National Institute on Aging and published in July of 2010 in the Journal of Nursing Scholarship, focuses on the intentions of older, homebound women to prevent falling again. Thirty-six women, ages 85 to 98, each had fallen at least once at home, making them more aware of reasons for the fall, including not using a walker, bending over and losing balance, and not turning on a light to see the room clearly.
"But few scholars have linked reasons that these women offer for particular falls to their intentions to prevent another fall," says Porter. Exploring and understanding their intentions to prevent future falls— from arranging the furniture to changing patterns of reliance on walking devices to changing a health habit, such as resuming an exercise class—is key to reducing the risk of falling again.
"As a care provider, you may think that you not only know the problem, but that you've got the solution," says Porter. "This is not effective. Our interventions, whatever they are, must be based on understanding the person's intentions."
Porter's descriptive research method, built on the philosophical framework of German philosopher Edmund Husserl, holds that "you are never done; you can always learn more," says Porter. "My hope is to try to describe the data—so meaningful to me as I sat with these women—so that practitioners say, ‘How might I change my practice now to be more aware and to reflect that understanding.'"
Funded by the National Institute of Nursing Research, another area of Porter's research looks at older widows' experiences in home care. Porter's findings could help reconfigure the standards of home care by redefining the roles of the caregiver and care receiver.
"Receiving home care is really not an accurate description," says Porter. "These women are positioning themselves as partners in negotiating health care services in order to live alone. They prioritize what they think needs to be done and mobilize helpers to assist them with tasks; they negotiate reliance on some helpers while protecting others from task overload. Home care providers need to focus on clients' reasons for what they propose; intentions are likely to emerge."
More than a decade of research at the University of Missouri–Columbia studying the experiences of older rural women in Missouri has prepared Porter for her role at the School of Nursing. At the UW–Madison, she anticipates further studies on reducing older women's risks at home, including being able to get help quickly or to be found after a fall or other crisis.
"Fear of falling and not being found is quite an issue," says Porter. "Some older women carry a telephone or subscribe to a personal emergency response system so that they can reach help. Others don't want access to such devices, preferring to contact help ‘on my own' or to wait for someone to find them.
"The challenge we face is to enable older women who live alone to be as alone as they need to be, but to have and to reach the help they need to continue sustaining themselves at home."