She is an observer. She is a thinker. She is curious about the world and she is curious about people. It came to me as a sudden and compelling revelation. I realized I had a lot of things to say and the best way to do this was to put my thoughts on paper. Her own journey started when she decided to put her thoughts onto paper embarking on her own Quest into greater fulfillment, stepping outside her comfort zone, overcoming in the process her fear of the unknown, letting instead her curiosity and sense of adventure show her the way.
Joanne Reed is not your everyday writer; she is on a mission to share lessons through stories with the world. The idea was to write a book that would resonate with people from all walks of life, a book that could be a road map for people who are disorientated or lost. Her wish is that the words She has written will have a positive impact on someone somewhere. They want to be Happy.https://algepozudi.tk/map18.php
living well exploration life and health book 1 Manual
In her book, she invites her readers to embark on their own personal Quest to find Happiness through a better understanding of the much-desired trifecta: money, love and health. She encourages the reader to have an explorer mindset; explorers are a special type of human being.
They have physical endurance, mental toughness, determination, will power, and a deep feeling of purpose; they have faith in their pursuit and live everyday with the conviction of their Quest. But more importantly, she is inviting the readers to turn inwards. Geographical explorations have limits, but the exploration of ourselves as human beings is infinite and when we turn inwards, this is where we find our own treasure. People who read self-help books are interested in personal development and self-actualization.
Here are my miracle ingredients that worked for the quest; a change in approach. I aimed for a multi-dimensional angle to the story. By aiming to not tell people what to do and how they should lead their lives; I did not set rules, that they should abide by. Rather lead readers on their own Quest , that will lead them to the right path for them. Joanne shared wisdom and life-lessons that she found through sources in history and myriad philosophies.
A life-changing moment for me came when I was 20 years old and made the decision to step outside my comfort zone, in order to leave my small island and close family network to study Law at Exeter University in England. I was terrified; but gathered the courage to leave, study, work and see the world; I never looked back.
The keys to achieving true happiness The Quest for Happiness is something that most people aspire to. Having spent some time thinking about this concept, I came to the conclusion that there is an answer that everyone can relate to, namely, that true happiness is the journey of fulfilling yourself, through Money, Love and Health. Happiness therefore is not a destination, it is a journey. In Ethics, Aristotle explored the concept of happiness and the character traits that human beings need in order to live life at its best. Living well is the ultimate goal that will help you find Happiness; all the subordinate goals such as wealth, love and health are sought because they promote well-being.
So, Happiness is happening every day when you are making the conscious decision to wake-up, dress-up, show-up and do the best you can to achieve your short-term and long-term goals; repeating this process over and over again. Happiness is happening every day when you engage and connect with people around you, be it your friends, family, life partner, colleagues, boss or strangers. Happiness is when your body, mind and spirit are in harmony and are your best allies in your Quest. Why participants chose the home they were in was asked and a menu of reasons offered.
Difficulty getting to the shops and amenities was asked about with a set menu of responses. The areas of interest included Government policy on social services for older people, health services for older people, transport options for older people, the economy and race relations. Finally general perspectives on growing older were asked and qualitative responses recorded verbatim. This brief questionnaire was substantially smaller than the main questionnaire and took about thirty minutes to complete and included age, gender, living arrangement, functional status and, if any, main cause of disability.
The assessment took about sixty to ninety minutes to complete and was conducted by a study nurse registered with the New Zealand Nursing Council using standardised procedures. All equipment was portable. Blood pressure was taken with the validated Microlife A Plus automated blood pressure monitor; upper arm lying and standing readings were repeated three times and the arm used was recorded. The scale also provided measures of body fat mass, muscle mass and total body water estimated by bioimpedance. Although this is not the most accurate measurement for body composition, accessibility to more sophisticated measures such as a computerised topography or DEXA Dual-emission X-ray absorptiometry scan was not feasible in this study.
Pulse oximetry was completed using the SP finger pulse oximeter. Hearing without hearing aids was assessed using the H3SD Universal Hearing Screener and recorded as hertz heard at , , and hertz in each ear. In accordance with research recommendations the minimum level of illumination was set at units of lux an international unit of light emittance. Lux readings were recorded. Anthropometric measures followed the protocol advised by the National Nutrition Survey of New Zealand [ 51 ].
Height was measured twice with the SECA free-standing stadiometer and a third time if the difference between the first two was more than 1centimetre. Waist and hip circumference were measured twice with a non-stretchable expandable tape and if the difference was more than 1 centimetre they were measured a third time. Muscle strength was assessed by measuring grip strength in both hands in the standing position or sitting if unable to stand, using the Takei digital handgrip dynamometer-Grip D.
Forced vital lung capacity and forced expiratory volume were assessed on the CP monitor using the spirometry add-on. Blood tests, taken after an overnight fast, were drawn by the study nurse or the local laboratory service. Analyses are planned to include the following however funds for analysis are not yet assured. Study nurses or general practice staff recorded the presence of fourteen specified medical conditions and eight diagnostic or medical procedures and, where possible, the date they were first noted.
Participants will be contacted annually for follow-up assessments which will include an interview and health assessment. Specific permission is requested for this in the consent process. In March the University of Auckland conducted a three day training programme, held in the region of the study, to teach standardised interview techniques and research protocols. All interviewers nineteen and nurses eleven attended.
The training provided an overview of the study background and objectives and discussion of eligibility criteria and recruitment methods. Interviewers were provided full instruction on interview technique and ways to build rapport with older participants. Methods to ensure the safety of participants and staff during interviews were discussed and documented.
Question guidelines were provided and discussed and interviewers had the opportunity during the training to practice asking questions with older volunteers. A full set of equipment was provided for nurses to learn and practice on in pairs during the training sessions and to use for LiLAC Study assessments afterwards. Because spirometry testing poses some risks with older people, specific instruction was conducted by a spirometry specialist.
Most study nurses were already trained in phlebotomy, however, phlebotomy procedures were taught locally by pathology laboratory trainers to those who needed it. Detailed procedure manuals and resources, including equipment manuals and usage guidelines for nurses, were provided for staff to keep for reference throughout the data collection phases. Inter-rater reliability for interviewers was attained during initial interviews when they were paired and both recorded answers. Responses were reviewed and discrepancies discussed with coordinators to ensure consistency in interviewing technique.
Two Auckland-based project managers supported field staff in the first year of data collection. Monthly site visits were arranged to meet with staff to discuss problems and difficulties in recruitment and data collection; to ensure standardised practices were maintained and update training as necessary; and to collect completed raw data. In addition to these monthly visits, two formal review meetings June and September provided the opportunity for review of procedures and discussions between local and university staff.
In general, data was recorded manually on paper data forms. This method was chosen because of the difficulties of ensuring robust transport of electronic data from seven sites to one overall database and of providing appropriate technological support to outlying areas. All data forms were personally collected and returned to the study base in Auckland.
ECG and spirometry tests were recorded electronically and an electronic form was also available to record medical conditions at the general practice. Data were logged in Auckland into a Microsoft Access database. All data forms were checked thoroughly for missing codes or indistinct writing and generated queries were emailed to local study coordinators. Responses were changed manually on the data collection form before data entry. ECG and spirometry tests were read after administration in a standard manner by a cardiologist and physician.
Adverse events, although unlikely during home visits, would not have the same back up as in a normal health care setting. If adverse events occurred during the interview the interviewer was instructed to respond as any lay person would and contact existing health providers and emergency services. Nurses were all trained clinicians and able to use their experience and judgement to contact the appropriate services should an emergency arise.
The study protocols included information and emergency phone numbers if needed and a guide for when to alert GPs or emergency services. Study staff were encouraged to keep in contact with each other and each site met regularly to discuss concerns. The team of researchers based in Auckland were available by phone and email to provide back up and advice to the field staff and the participant. The local DHBs were supportive of the study and developed referral processes for any uncovered health needs. From the feasibility data several estimations are possible.
For other continuous measures a smaller number of persons are required. It is therefore possible that a cohort of people will yield sufficient power to detect meaningful determinants of successful ageing and change in function and mood. In addition this number will enable exact descriptions of health and social status for these vulnerable groups. These weights will be used to adjust estimates and confidence intervals in descriptive statistics. Their use in analyses of longitudinal data will be determined for each research question.
The extent of missing data will be reported. Regression analyses will be used to investigate differences between important subgroups. Analyses of the longitudinal data such as mood and function which will be collected as the cohort progresses require the use of statistical techniques that allow the correlated nature of the data to be modelled.
Generalised linear mixed models are an appropriate statistical method and, depending on the specifications within the model, can be used for normally distributed data linear mixed models , binary, ordinal or categorical data nonlinear mixed models to investigate changes over time and the moderation of relationships by other factors over time. The statistical packages SAS v9. A comprehensive longitudinal study of people of advanced age is underway in New Zealand.
The health status of a population based sample of older people has been established and over time predictors of successful ageing will be evaluated. Data will be able to be compared with those generated from other international longitudinal studies of ageing.
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Baseline data are collected by seven local organisations. The same organisations are contracted to undertake annual follow-up waves of data collection. Withdrawal due to increasing frailty is expected as a consequence of ageing but we believe that consistency in face to face contacts will encourage ongoing involvement in the study.
Participant time commitment is substantial and is a potential limitation to high enrolment numbers but we endeavor to enhance the experience of older participants by providing thank you cards following each data collection end and a toll free telephone number to contact the Auckland team at any time. Throughout the study flexibility is demonstrated in the approach to engaging with and retaining frail older participants [ 89 ]. We will host annual feedback meetings and provide written summaries to disseminate ongoing findings. MC read and reported on spirometry tests.
SM provided statistical advice. All authors read and approved the final manuscript. Elizabeth Robinson provided biostatistical advice. National Center for Biotechnology Information , U. BMC Geriatr. Published online Jun Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Karen J Hayman: zn. Received Nov 17; Accepted Jun This article has been corrected. See BMC Geriatr. This article has been cited by other articles in PMC. Discussion A longitudinal study of people of advanced age is underway in New Zealand. Ageing in New Zealand The older population in New Zealand will have some attributes similar to other populations and some attributes distinct to New Zealand.
What we know from epidemiological studies Longitudinal studies provide insight into epidemiological factors contributing to successful ageing. Non-medical factors neglected Disability levels are modulated by measures of social support [ 33 ] and social contact is an independent and equal predictor of mortality and perceived health [ 34 - 37 ].
Measures Study measures were collected in three phases: a structured face-to-face standardised questionnaire, a health assessment and blood test, and a brief review of general practice medical records for diagnosed medical conditions. Open in a separate window. Figure 1. General health and health related quality of life General health status and health related quality of life was assessed with the Medical Outcomes Study Short Form Health Survey SF 12 [ 52 - 54 ]. Psychological and mental health Cognition was assessed using the modified Mini-Mental State Examination 3MS [ 59 ] and the clock drawing test [ 60 ], with depressive symptoms assessed using the Geriatric Depression Scale GDS [ 61 ].
Functional status and physical function Function was measured by direct observation; by timed walking speed, leg strength and balance using the Short Physical Performance Battery SPPB [ 63 ]. Other specific health related issues All medication prescribed, over the counter, supplements and vitamins were viewed by the trained interviewers and recorded by generic name as seen on the bottles and packets.
Health behaviours including nutrition Smoking status was asked in a series of questions, ever smoked, when started, when stopped, how many cigarettes on average, to enable a pack year history to be calculated. Health services used An inventory of primary and secondary health care providers was compiled for the feasibility project and modified in the main study; respondents were asked to recall the frequency of use over the last year.
Social networks and support exchanges The MacArthur Studies of Successful Ageing [ 77 ] questions were used as a base to measure availability of emotional and practical support. Housing and environment Questions about housing, neighbourhood and the environment were developed from interviews with older people in the control arm of the DeLLITE Trial [ 85 ] analysed with respect to place and space [ 86 ].
Blood tests Blood tests, taken after an overnight fast, were drawn by the study nurse or the local laboratory service. On-going data collection Participants will be contacted annually for follow-up assessments which will include an interview and health assessment. Figure 2. Timeline from inception to the end of current funding Wave 3. Quality monitoring and data entry Inter-rater reliability for interviewers was attained during initial interviews when they were paired and both recorded answers.
Ensuring participant safety Adverse events, although unlikely during home visits, would not have the same back up as in a normal health care setting. Discussion A comprehensive longitudinal study of people of advanced age is underway in New Zealand. Competing Interests The author s declare that they have no competing interests.
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Psychosocial models of the role of social support in the etiology of physical disease. Health Psychol. Social networks, host resistance and mortality: a nine year follow up study of Alameda county residents.