International Journal of Nursing Studies 37 (2000) 361368

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Ability for self-care among home dwelling elderly people in a health district in Sweden
Olle So derhamn a, b,*, Catharina Lindencrona a, Anna-Christina Ek b
b

Va nersborg University College of Health Sciences, P.O. Box 236, SE-462 23, Vanersborg, Sweden Department of Medicine and Care, Division of Nursing Science, Faculty of Health Sciences, SE-581 85, Linko ping, Sweden Received 11 November 1999; received in revised form 21 December 1999; accepted 14 January 2000

Abstract The aim of this study was to describe the ability for self-care among home dwelling elderly in the community in a health district in western Sweden. Two self-report instruments plus a number of self-care related questions were distributed by mail to an age stratied random sample and nally completed by a total of 125 subjects. Bivariate and multivariate statistical methods were used in the analyses. The results showed that self-care ability and self-care agency decreased for respondents 75+ years of age. Self-care ability was predicted by three productive means for self-care and four risk factors. 7 2000 Elsevier Science Ltd. All rights reserved.
Keywords: Ageing; Self-care ability; Self-care agency

1. Introduction Functional competence and ability for self-care are of importance for an independent life, both for individuals living in their own homes and those in institutional care. Self-care agency develops in everyday life through learning. Its operability and development can be aected by genetic and constitutional factors, culture, life experiences, and health state (Orem, 1995). The ability for self-care is high for many elderly persons, and most of them function well (Dean, 1986). An illustration of this is the fact that in Sweden a large majority of elderly people live in ordinary housing and only about 8% in residential or nursing homes (Hedin, 1993). The purpose of exercising the ability for selfcare, and to transform the capacity into self-care activity, is to maintain, restore or improve health and

* Corresponding author.

well-being. In Orem's self-care decit theory of nursing (Orem, 1995) self-care agency consists of self-care activity and self-care ability. Self-care ability can be considered as a necessary condition for the realization of self-care activities and presupposes them in time. Grounded in Po rn's theory of health and adaptedness (Po rn, 1984, 1993), a construct of self-care ability, closely linked to health, has been formulated (So derhamn et al., 1996a). Crucial components for the individual's state of health are the repertoire, the environment, and the goals. The repertoire appears as an act repertoire, a cognitive repertoire and a decision repertoire. It must be related to the environment and to some goal or goal prole. There must be some kind of equilibrium between the repertoire of the individual and his or her goal prole in a particular environment. In the case of equilibrium, when generalized adaptedness obtains, the repertoire is adequate with respect to the environment and the goal prole. The environment may be said to be appropri-

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ate in relation to the goal prole and the repertoire, and the goal prole may be said to be realistic in relation to the environment and the repertoire. From this perspective, a person is in good health if he has the repertoire which his generalized adaptedness requires. If his repertoire is inadequate, his health is less good, or he is ill to some extent (Po rn, 1984, 1993). Self-care ability can be characterized by the agent's intention to care for repertoire, environment and goals and her or his abilities to care for repertoire, environment and goals under prevailing circumstances. Repertoire, environment and goals are relative and dierent for dierent individuals (So derhamn et al., 1996a). For many individuals ageing causes changes in the repertoire, environment and/or goal proles. However, there are wide variations in the health of elderly people, which may be related to the conditions under which they have lived when they were younger. Often many elderly people can cope well with impairments and diseases, and only for people in their late seventies is there a growing need for help and support (Hedin, 1993). Some elderly people become recipients of health care when their self-care ability is less than required in daily living. It may be expected that there are dierences in health and also in self-care related variables between young elderly people just above 65 years of age, people in their late seventies and the oldest old. Knowledge of factors that inuence self-care ability, self-care agency and care of self among elderly people is of importance for health care professionals in order to identify individuals at risk and to plan care for this group, both on an individual and societal level. The aim of this study was to describe self-care ability among home dwelling elderly people in the community in a health district in western Sweden.

prised 140 individuals in three dierent age cohorts were chosen in the fall of 1995. The individuals in these age cohorts were 6574 years of age, 7584 years, and 85+ years, respectively. A total number of 120 individuals completed and returned the distributed questionnaires after 3 months and two reminders. Two hundred and thirty-four persons returned a blank questionnaire, indicating that they did not wish to participate in the study. In order to investigate the study variables among the non-respondents, a random sample (n = 30) was selected from the non-respondents who had not actively refused to participate (n = 66). After one reminder and a period of 1 month, the non-respondents who could be traced in the telephone directories were phoned. The ve persons who nally completed the questionnaire were included in the study population (n = 125). 2.2. The questionnaire The self-report questionnaire distributed included two instruments, The Self-care Ability Scale for the Elderly and the Appraisal of Self-care Agency scale, and a number of open- and closed-ended questions representing dimensions of self-care in four sections. In a demographic section questions were asked about sex, age, civil status, and former profession. One section comprised questions on contacts with health care, received district nursing, social service or informal care, disease/handicap, perceived health, and need of help. Environment was highlighted with questions about type and quality of housing, cohabiting, contacts with important persons, and loneliness. The last section included questions about nancial position, feelings of helplessness, activity and anxiety about the end of life, quality of human contacts, satisfaction in life, and frequency of cogitation of one's own position in life. The Self-care Ability Scale for the Elderly (SASE) is a summated ve-point Likert scale based on Po rn's theory of health and adaptedness (Po rn, 1984, 1993) and designed to measure perceived self-care ability, i.e. the ability to maintain health and well-being (So derhamn et al., 1996a). Concurrent validity and construct validity have to a high degree been supported for the scale (So derhamn et al., 1996c). The Cronbach's alpha reliability coecient reported in the developmental phase was 0.68 (So derhamn et al., 1996a). Its 17 items reect areas that may be of concern for elderly people, such as activities of daily living, mastery, well-being, volition, determination, loneliness and dressing. Each item ranges from ``totally disagree'' to ``totally agree'' with scores from 1 to 5. The total score ranges between 17 and 85, where a higher value indicates high per-

2. Methods 2.1. Study group In a health district in western Sweden a total number of 420 home dwelling elderly persons (65+ years) in the community were selected to participate in this study. Since elderly people sometimes are regarded as a dicult group for questionnaires, it could be expected that many individuals would not like to participate. In order to enhance the amount of data from particularly the oldest old, an age stratied sampling with three age cohorts was chosen. In the health district in focus for the data collection about 31,000 persons above 65 years of age lived in towns (76.8%) or in rural areas (23.2%) (Statistics Sweden, 1996). Three random samples that each com-

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ceived self-care ability. Missing values in the selfreports were in the present study given a neutral score of 3 (``doubtful/it depends''). The self report form of the Appraisal of Self-care Agency scale (ASA-A) was designed and used to measure general self-care agency. The scale was developed by Dutch and American researchers (Evers, 1989) and is based on Orem's self-care decit theory (Orem, 1995). The Dutch version of the scale has been validated by Evers (1989), who found strong evidence for construct validity. A Swedish version (So derhamn et al., 1996b) was used in the present study. Aspects on validity of ASA-A has been shown in a Swedish sample (So derhamn et al., 1996c). The Cronbach's alpha reliability coecient was found to be 0.59 in the initial testing among elderly patients (So derhamn et al., 1996b). It is a Likert-type scale with 24 items ranging from ``totally disagree'', i.e. a score of 1, to ``totally agree'' or a score of 5. In the present study, a neutral score of 3 (``neither disagree nor agree'') was given to items with missing values. A total score is computed through summation of the scores for each individual item. A high total score means a higher degree of self-care agency. The total score can range from 24 to 120. 2.3. Statistics Non-parametric statistical tests used in handling the data were Pearson's w2-test with Yates's continuity correction for independent samples, Fisher's exact test (two-tailed probability), MannWhitney U test for independent samples (two-tailed probability), and KruskalWallis one-way analysis of variances (ANOVA). Parametric tests were Student's t-test for independent samples (two-tailed probability) and oneway ANOVA. Furthermore, a forward stepwise multiple regression analysis was performed in order to explore statistical relationships between self-care ability measured with SASE and possible explanatory variables. The same procedure was used for self-care agency measured with ASA-A. In these analyses, data from the questionnaire on the nominal scale level were coded into dummy variables. Interval data (age, SASE and ASA-A scores) were used as continous variables. The tested variables in the multiple regression analysis were those that reached a signicant Spearman rank correlation p < 0:05 with the dependent variable. A series of regression analyses, using the SASE scores as dependent variable, were then performed for sex, marital status, former profession, self-reported health, and each of the obtained predictors for self-care ability. It was hypothesized that female sex, being married and being a former professional or white collar worker inuenced self-

care ability in a positive way when considered separately. Furthermore, it was hypothesized that experiencing good health was connected to a high degree of self-care ability. It was also a hypothesis that the predictors of self-care ability, when taken separately one by one, were going to inuence self-care ability in the same way as when they were considered together. A series of regression analyses between ASA-A as dependent variable and the above used demographic variables, self-reported health and the obtained predictors for self-care agency were also performed. Here, the hypotheses were that female sex, being married and being a former professional or white collar worker gave a high degree of self-care agency when considered separately. It was also hypothesized that experiencing good health was connected to a high degree of self-care agency. The last hypothesis was that, when taken separately, the predictors for self-care agency were going to inuence the ASA-A scores in the same way as in the multivariate equation. In the regression analyses a weighted least square method was used so the obtained data in the dierent age cohorts represented the age distribution of the elderly inhabitants in that particular health district, i.e. 51.7% being 6574 years of age, 36.5% 7584 years, and 11.8% 85+ years (Statistics Sweden, 1996). Reliability of the self appraisals with SASE and ASA-A was measured as internal consistency with Cronbach's alpha coecients (Cronbach, 1951). 2.4. Ethical considerations The study was designed and implemented according to common principles in clinical research (Beauchamp and Childress, 1994). It was approved by the Research Ethics Committee of western Sweden (Medical Faculty, Gothenburg University).

3. Results 3.1. Respondents and non-respondents Thirteen elderly persons could not be found, and nine persons were deceased, leaving an eective study sample of 398 individuals. Among them 31.4% n 125 participated in the study. Reported reasons for not participating (n = 273) were bad health and/or being old (n = 42) or low motivation (n = 26). When lling in the questionnaire, 28 respondents had been supported by a spouse, a child, a caregiver or someone else for reasons of fatigue or bad health (n = 7), poor vision (n = 5), low motivation or lack of interest n 3, and need of explication (n = 11). The charac-

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teristics of the respondents in the study are displayed in Table 1. Analysis of non-respondents showed that in the random sample of 30 non-respondents, 25 (83.3%) did not return the questionnaire. Three non-respondents (10.0%) were deceased, 13 (43.3%) could not be found, and nine (30.0%) did not wish to take part in the study. Five persons (16.7%) agreed to participate in the analysis. No dierences in sex or age were found between the sample selected for this analysis (n = 30) and the other non-respondents (n = 270). Furthermore, there were no dierences in ASA-A scores between the ve respondents in this analysis and the other 120 respondents. The respondents in this analysis were, however, older ( p < 0.05) and scored less on SASE ( p < 0.05). A comparison within the appropriate age cohorts did not reveal any dierences in obtained ASA-A and SASE scores. No dierences were found between respondents and non-respondents concerning age, sex, marital status or former profession in the youngest and oldest age cohorts. In the intermediate age cohort the non-respondents were older ( p < 0.05) and more frequently single ( p < 0.05) than the respondents. 3.2. Self-care related variables and scores Self-reported health among the 125 respondents in the three age cohorts and signicant dierences between the groups concerning health related variables and self-care related scores are shown in Table 2. Among the studied repertoire variables, there were no dierences between the age cohorts in reported freTable 1 Characteristics of respondents in the three age cohorts Age cohort 1 Demograc variables Age (years) Mean SD Sex [no. (%)] Female Male Marital status [no. (%)] Single Married Missing Former profession [no. (%)] Professional/white collar worker Blue collar worker/housewife Missing 6574 years n1=53 68.8 3.0 23 (43.4) 30 (56.6) 24 (45.3) 29 (54.7) 0 (0) 19 (35.8) 29 (54.7) 5 (9.4)

quencies of being handicapped/having a chronic disease, contacts with health care within the last year, and contacts with a district nurse. More respondents in the oldest age cohort received help than respondents in the youngest ( p < 0.0001) and intermediate age cohorts ( p < 0.05). No dierences in reported frequencies were found between the age cohorts in connection with the variables perceived helplessness, being active, and cogitation about life. There were some dierences in the environment between the three age groups with a higher reported frequency of contacts with social service and institutional living in the two oldest age cohorts. The economic and material conditions were reported to be satisfying for signicant more respondents among the youngest respondents than among the ones in the 75 84 years age span ( p < 0.01). The intermediate group also diered signicantly from the oldest old p < 0:05: Most people in the three age cohorts reported that they had a satisfactory living, that they had daily contacts with other people and also that they had close contacts with other people. Twenty-one percent of the oldest old reported that they felt lonely, and there were no signicant dierences found between the age cohorts. The oldest respondents were also cohabiting to a lesser extent than the elderly in the youngest age cohort ( p < 0.005) and in the intermediate age cohort ( p < 0.001). There were no dierences between the age cohorts concerning the two goal variables. Seventy-ve percent or more of the respondents felt satised with their lives and 1119% feared the end of life. There were no signicant dierences in SASE and

Age cohort 2 7584 years n2=44 78.3 3.1 17 (38.6) 27 (61.4) 13 (29.5) 30 (68.2) 1 (2.3) 11 (25.0) 28 (63.6) 5 (11.4)

Age cohort 3 85+ years n3=28 88.2 1.9 14 (50.0) 14 (50.0) 21 (75.0) 7 (25.0) 0 (0) 8 (28.6) 15 (53.6) 5 (17.9)

O. So derhamn et al. / International Journal of Nursing Studies 37 (2000) 361368 Table 2 Self-reported health, health related variables, and self-care related scores among the respondents in the three age cohorts Age cohort 1 6574 years n1=53 Experiencing good health [no. (%)] Repertoire variable [no. (%)] Receiving help Environmental variables [no. (%)] Contacts with social service Living in institution Cohabiting Satisfactory economic/material conditions SASE [mean score] SD Cronbach's alpha ASA-A [mean score] SD Cronbach's alpha 43 (81.1) 8 (15.1) 4 (7.5) 0 (0) 34 (64.2) 51 (96.2) 73.89 7.74 0.79 94.19 8.29 0.72 Age cohort 2 7584 years n2=44 28 (63.6) 14 (31.8) 6 (13.6) 2 (4.5) 32 (72.7) 33 (75.0) 66.55 12.49 0.89 86.91 9.93 0.75 Age cohort 3 85+ years n3=28 21 (75.0) 17 (60.7) 12 (42.9) 9 (32.1) 8 (28.6) 27 (96.4) 61.14 13.95 0.89 85.96 14.13 0.86

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p-Value

n.s. < 0.0005 < 0.0005 < 0.0001 < 0.001 < 0.005 < 0.0001 < 0.0005

ASA-A scores between the intermediate and oldest age cohorts. 3.3. Prediction of self-care ability and self-care agency The Cronbach's alpha coecients were in the total sample for SASE and ASA-A 0.88 and 0.80, respectively. The result of the stepwise multiple regression analysis for SASE revealed three factors that had a positive inuence on self-care ability and four factors with a negative inuence. The most prominent positive factor was self-care agency measured by ASA-A. The result of this analysis is displayed in Table 3. The stepwise multiple regression analysis with ASAA as dependent variable revealed that predictors for self-care agency measured by ASA-A were being active (beta=0.19, p < 0.05) and SASE score beta
Table 3 Standardized regression coecients for predicting self-care ability measured by SASE in a stepwise multiple regression analysis (n = 125) Variables ASA-A Being active Feeling satised Close contacts with other people Perceived helplessness Age Receiving help Constant: 62.05 ( p < 0.0001) R 2=0.70 (Adjusted R 2=0.68) Beta 0.29 0.25 0.23 0.15 0.16 0.20 0.24 p-value < 0.0001 < 0.0005 < 0.0005 < 0.05 < 0.05 < 0.001 < 0.0005

0:56, p < 0:0001: The constant in this equation was 51.03 p < 0:0001 and 46% of the variances were explained with this solution. Some demographic variables, self-reported health and the predictors for self-care ability as independent variables in a series of regression analyses with selfcare ability, measured by SASE, as dependent variable are presented in Table 4. Taken separately, the three factors that had a positive inuence on self-care ability in the multiple regression analysis showed a positive linear relationship
Table 4 Standardized regression coecients for some demograc variables, self-reported health and the predictors for self-care ability in a series of regression analyses with SASE scores as dependent variable (n = 125) Variables Demograc variables Sex Female sex Marital status Being married Former profession Professionals/white collar workers Experiencing good health Predictors for self-care ability ASA-A Being active Feeling satised Close contacts with other people Perceived helplessness Age Receiving help Beta p-Value R2

0.02 n.s. 0.10 n.s.

0 0.01

0.17 n.s. 0.03 0.52 < 0.0001 0.27 0.66 0.56 0.46 0.18 0.50 0.43 0.52 < 0.0001 < 0.0001 < 0.0001 < 0.05 < 0.0001 < 0.0001 < 0.0001 0.44 0.32 0.21 0.03 0.25 0.18 0.27

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with the SASE scores. For the negative inuencing factors, a negative linear relationship was found between three of the factors, i.e. perceived helplessness, age, and receiving help. Close contacts with other people showed in this analysis a positive linear relationship. Experiencing good health was related to a higher selfcare ability. In Table 5 the results are shown of the same type of analysis with ASA-A as dependent variable. Experiencing good health, being active, and the SASE scores were all related to a higher self-care agency.

4. Discussion 4.1. Methodological considerations The percentage of male respondents were higher in comparison with the same age groups in the underlying population. This may indicate that the male elderly people in our sample were more eager to communicate facts on their lives. However, the presented results provided no signicance for sex as a variable for prediction of self-care ability. Although a substantial part of the elderly who received the questionnaire did not wish to participate in the study, a sucient sample was obtained in this relation-searching study. The ve subjects in the analysis of the non-respondents were older than the other respondents, and that they scored less on SASE but not on ASA-A could be expected when regarding the other obtained results. There was, however, a dierence in mean age at p < 0.05 between respondents and non-respondents in the intermediate age cohort, which should be observed. The dierence in marital status in the same group at p < 0.05 could be explained by the
Table 5 Standardized regression coecients for some demograc variables, self-reported health and the predictors for self-care agency in a series of regression analyses with ASA-A scores as dependent variable (n = 125) Variables Beta p-value R2

fact that approximately one third of the non-respondents had not answered this question. Since no other dierences between respondents and non-respondents could be revealed and the weighted least square procedure was used in the regression analyses, it should be possible to generalize the presented results to a substantial part of the cultural and geographical group studied. However, since it was not possible to determine if the individuals who did not answer diered in any way, some caution in the interpretation of the results must be done, especially for the age group between 80 and 84 years of age. It is also evident that non lucid elderly could not take part in this study, because a necessary prerequisite was sucient cognitive abilities. It has been shown in other studies that a high rate of dementia and other psychiatric disorders are present especially among the oldest old (Skoog, 1993). This may be one obvious reason for not responding. Other methods for data collection may have been more succesful. But in order to get population based randomized data, the way of using a mailed questionnaire and an age stratied sample seemed fruitful within the limits of available resources. 4.2. Self-care related variables and scores The reliability of SASE and ASA-A scores was found sucient with Cronbach's alpha coecients between 0.72 and 0.89 in all study groups (Streiner and Norman, 1995). There were signicant dierences in both SASE and ASA-A scores between the two youngest age cohorts. No dierences were found between the respondents in the intermediate and the oldest cohort. This may indicate that a decline in self-care ability and self-care agency mainly takes place among the younger elderly around 75 years of age and that persons who have an age of 85+ years have reached a more stable level of self-care ability and self-care agency. In their oldest years they may have adapted themselves to their actual life situation and level of health. Respondents in the youngest cohort were born in the 1920s. Subjects born during that period can be characterized as belonging to an advantaged age cohort. Although born in the beginning of a depression, as adults they benetted from the postwar auence and built a society characterized by extensive economic and social resources. Later life, understood as a later but continuous part of the human life course (Maddox, 1994), may explain that respondents in the intermediate and oldest cohorts show less prerequisites for experiencing health and well-being, due to worse economic and social conditions earlier in life as compared to the youngest cohort. In order to better clarify the importance of age for self-care ability and self-care

Demograc variables Sex Female sex 0.04 Marital status Being married 0.07 Former profession Professionals/white collar workers 0.07 Experiencing health 0.37 Predictors for self-care agency Being active 0.49 SASE 0.66

n.s. n.s.

0 0

n.s. 0 < 0.0001 0.13 < 0.0001 0.24 < 0.0001 0.44

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agency, longitudinal studies of dierent cohorts of elderly are needed. Decrease of self-care agency with advanced age is consistent with Orem's self-care decit theory (Orem, 1995). Since self-care ability is viewed as a prerequisite for self-care activity, it is reasonable that self-care ability also decreases with advanced age. A decrease in self-care ability and self-care agency could also be explained as signs of disengagement. Following Tornstam's reformulation of the disengagement theory (Tornstam, 1989, 1996) other signs that point towards gero-transcendence can be seen in the results. Many respondents in the three age cohorts were cogitating about life, and only a few feared the end of life. Not fearing death is also a condition for the old individual in order to be able to reach the stage of ego-integrity in Erikson's developmental theory (Erikson, 1997). Another condition is that despair does not interfere. Most respondents in this study reported that they felt satised with their lives. To further elucidate issues on self-care ability and self-care agency for elderly in connection with concepts as wisdom and gero-transcendence, studies within another meta-theoretical framework than the one used in this study must be done. Among the health related repertoire variables in the three age cohorts the variable ``receiving help'' from informal caregivers was the only variable that diered signicantly between the age cohorts. This indicates that the amount of informal care increased with advanced age. 4.3. Predicition of self-care ability and self-care agency Informal care was also found to be a predictor for self-care ability. None of the four environmental variables that signicantly diered between the age cohorts ``contacts with social service'', ``living in institution'', ``cohabiting'', and ``satisfactory economic/material conditions'' contributed in the equation. The dierences between the age cohorts for at least the three rst variables could be expected. Predictors for self-care ability that contributed negatively are considered as risk factors. The repertoire variable ``receiving help'' along with age, ``close contacts with other people'', and ``perceived helplessness'' comprised the risk factors for low self-care ability scores. Three risk factors showed negative inuence on the self-care ability score when they were analysed separately. But ``close contacts with other people'' had a positive inuence when considered separately. It can be argued that received help from informal caregivers may be both a consequence and a reason for low selfcare ability among elderly. Many elderly are recipients of informal care, both in Sweden and in other

countries, which has been shown in other studies (Arber and Ginn, 1990; Johansson, 1991). It should be of interest to determine if this type of care is a reason or a consequence for a low self-care ability. Informal care to aged people is to a great extent provided by other elderly or by younger women (Arber and Ginn, 1990) and an increased self-care ability among the recipients of this care may lighten a sometimes heavy social burden for these groups. A more careful investigation of the nature of ``close contacts with other people'' must be done in further studies in order to obtain knowledge about both the positive and negative inuence on self-care ability among the elderly. The variables that had a positive inuence on selfcare ability, i.e. the ASA-A scores, ``being active'' and ``feeling satised'', can all be considered as productive means (von Wright, 1996) for self care, i.e. they produce health and well-being. It was shown that self-care ability together with ``being active'' explained self-care agency. This is consistent with the proposition that self-care ability is a necessary condition for self-care activity (So derhamn et al., 1996a). That being active also has a positive inuence on self-care agency is logical, since self-care agency, measured by ASA-A, to a high degree reects self-care activity. 4.4. Implications for health care The ability for self-care among the elderly home dwelling persons in this study was predicted by three productive means for self care, i.e. self-care agency, being active and feeling satised, and four risk factors, i.e. receiving help, age, perceived helplessness, and close contacts with other people. Self-care ability, measured by SASE and considered as the necessary means for self-care activities has in this study proved to be signicantly connected to self-reported health. Valid assessment of self-care agency, level of activity, perceived satisfaction, and the four risk factors for low self-care ability are of importance for health care professionals in order to be able to plan, implement and initiate proper measures within repertoire care, environmental care, and goal care for elderly people. The results indicate that elderly people should not receive excessive help, and, therefore, an accurate assessment of the help needed must take place. Furthermore, actual self-care activities in the generic sense and also physical activities should be supported. In order to enhance self-care ability among elderly people it is suggested that assets and limitations of the elderly individual must be made conscious and also accepted. Mastery of feelings of dissatisfaction and helplessness should be a target for health care professionals in

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order to promote health and well-being. Self-awareness may here be a crucial component. Although developing and maintaining self-awareness is a lifelong process, certain self-care activities can be of importance. Value clarication, assessment of coping skills, awareness of feelings, and awareness of thought and action patterns are areas that should be emphasized (Hill and Smith, 1985).

5. Conclusions The results of this study showed that self-care ability and self-care agency decreased for respondents 75+ years of age. Self-care ability was predicted by three productive means for self-care, i.e. self-care agency, being active and feeling satised, and four risk factors receiving help, age, perceived helplessness and close contacts with other people. Self-care agency was predicted by self-care ability and being active. In order to enhance self-care ability among elderly people, valid assessment of inuencing factors is recommended, as well as support of self-care activities and physical activities. Furthermore, developing self-awareness through value clarication, assessment of coping skills and awareness of feelings, thoughts and action patterns is suggested. The value of such actions must be evaluated in further studies.

Acknowledgements We are grateful to all respondents. We also gratefully acknowledge the valuable discussions and the statistical advice given by Olle Eriksson, Department of Mathematics, Linko ping University. The study was lvsborg County Council, supported by grants from A Sweden.

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