Testing a causal model of hope and its antecedents among chronically ill older adults

Abstract

Most of the health care resources in this country go towards the treatment of chronic illness. Chronic illness is experienced by almost everyone as they age. Although there is abundant research to support the claim that those who can maintain hope when facing the challenge of chronic illness have better outcomes, there is little research into how hope can be maintained. The purpose of this study was to test a causal model of the role that hope and its antecedents play in assisting the chronically ill older adult to integrate the experience into life. A total of 103 community dwelling older adults with at least one chronic illness diagnosis participated in this study. Six instruments and a demographic questionnaire were used to measure the proposed variables: connectedness, energy, threat, meaning, growth, optimism, coping, hope and integration. Integration was conceptualized as a latent variable indicated by the presence of health promoting behaviors and self-transcendence. Hope was defined as the degree of active belief one has in achieving a desired goal. The psychometric properties of the instruments were examined for reliability and validity before data analysis proceeded. Factor analysis was used to create latent variables. Regression analysis was used to test the causal model, and partial correlation and regression analyses were used to test selected variables for activity as either a moderator or mediator. Residuals were analyzed for violation of regression assumptions, and where indicated, data were transformed to meet those assumptions. The causal model was respecified based on the results of data analysis. The findings support the importance of hope to integration of the chronic illness experience among the elderly. Hope acts as a mediator between the antecedent variables and integration. Meaning, optimism, threat, growth and connectedness directly impact hope. Specifically, a sense that one's life continues to have meaning is necessary to the maintenance of hope. Threat negatively impacts a sense of meaning. However, a perception of energy serves to reduce the level of threat. Nursing interventions aimed at strengthening hope are suggested based on the findings of the study.