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| 2. |
- Ekdahl, A. W., et al.
(författare)
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Frailty and comprehensive geriatric assessment organized as CGA-ward or CGA-consult for older adult patients in the acute care setting : a systematic review and meta-analysis
- 2015
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Ingår i: European Geriatric Medicine. - : Elsevier. - 1878-7649 .- 1878-7657. ; 6:6, s. 523-540
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Forskningsöversikt (refereegranskat)abstract
- Background: With worldwide population aging, increasing numbers of people need hospital care. Evidence suggests comprehensive geriatric assessment (CGA) is superior to usual care.Objective: To summarize the evidence for the effects of CGA in frail and moderately frail patients compared with usual care in acute care settings.Data sources: CINAHL, PsycInfo, Cochrane Library, EMBASE, and PubMed were searched in October 2011, January 2013, and February 2015.Study eligibility: Randomized controlled trials.Participants: Older adults aged ≥ 65 years who were admitted to hospital with a complex condition, divided into frail and moderately frail groups.Intervention: CGA.Control: Usual care.Outcomes: Change in housing, personal activities of daily living (PADL), instrumental activities of daily living (IADL), readmission, cognitive function, depression, quality-of-life care-giver burden, and mortality.Study appraisal and synthesis: The grading of recommendations assessment development and evaluation (GRADE) system to assess the quality of evidence and PRISMA-guidelines for meta-analyses and reviews. Continuous data were presented as standardized mean differences and dichotomous data were presented as risk differences.Results: Twenty-nine articles based on 17 unique studies (6005 patients in total). CGA was categorized as CGA-ward or CGA-consult. In the frail group, CGA-ward was superior to usual care for change in housing, PADL, and depression. CGA-consult was superior to usual care for PADL and IADL in the moderately frail group.Conclusion: There was a stronger effect for frail older adults and CGA-ward compared with usual care. This highlights the importance of detecting frailty. However, the degree of evidence was limited.
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- Wilhelmson, Katarina, 1958, et al.
(författare)
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Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings (CGA-Swed) : A Randomised Controlled Study
- 2020
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Ingår i: Geriatrics (Basel, Switzerland). - : MDPI AG. - 2308-3417 .- 0016-867X. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) for frail older people in Swedish acute hospital settings - the CGA-Swed study. In this study protocol, we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. The study is a randomised controlled trial with an intervention group receiving the CGA and a control group receiving medical assessment without the CGA. Follow-ups were conducted after 1, 6 and 12 months, with dependence in activities of daily living (ADL) as the primary outcome measure. The study group consisted of frail older people (75 years and older) in need of acute medical hospital care. The study design, randomisation and process evaluation carried out were intended to ensure the quality of the study. Baseline data show that the randomisation was successful and that the sample included frail older people with high dependence in ADL and with a high comorbidity. The CGA contributed to early recognition of frail older people's needs and ensured a care plan and follow-up. This study is expected to show positive effects on frail older people's dependence in ADL, life satisfaction and satisfaction with health and social care.
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- Cederfeldt, Marie, 1957, et al.
(författare)
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Mellanbedömarreliabilitet av instrumentet Executive Function Performance Test (EFPT)
- 2011
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Ingår i: Poster.
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Konferensbidrag (refereegranskat)abstract
- Bakgrund: Studier har visat att nedsatt exekutiv funktion är vanligt hos personer som fått stroke. Arbetsterapeuter som arbetar inom akutvården bedömer hur patienten klarar aktiviteter i det dagliga livet, men de flesta instrumenten som används är inom personlig vård. Instrument som bedömer mer komplexa aktiviteter har visat sig vara de mest effektiva avseende att upptäcka nedsatt exekutiv funktion. Eftersom instrumentet Assessment of Motor and Process Skills (AMPS) kan vara allt för omfattande att göra i den akuta fasen, skulle det kunna vara användbart att ha ett instrument som är mer lätthanterbart i det akuta skedet. Executive Function Performance Test (EFPT) är ett bedömningsinstrument som nyligen introducerats i Sverige. Studier saknas avseende validitet och reliabilitet utifrån Svenska förhållande. När ett nytt instrument skall användas är det viktigt att det har god validitet och reliabilitet. Syftet med denna studie var att utvärdera innehållsvaliditet och inter-bedömar validitet. Metoden innefattar en “forward” och en “backward” översättning av EFPT och en utvärdering av interbedömar reliabilitet genom att sjutton patienter från en stroke enhet har bedömts av två oberoende arbetsterapeuter. Studien är ett samarbete med kärnsjukhuset i Skövde. Resultatet håller på att analyseras och preliminära resultat kommer att presenteras på AT-forum.
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| 6. |
- Gosman-Hedström, Gunilla, 1947, et al.
(författare)
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‘Mastering an unpredictable everyday life after stroke’– older women’s experiences of caring and living with their partners
- 2012
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 26:3, s. 587-597
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The shift from older persons living in institutions to living in the community naturally affects both the older persons and their partners. The informal care is often taken for granted, and the research that focuses on the diversity of older female carers needs is scarce. Aim: To explore and learn from the older women how they experience their life situation and formal support as carers of their partners after stroke and to suggest clinical implications. Method: The design of the study is qualitative being based on the focus group method. Sixteen carers, median age 74 years (range 67–83), participated in four focus group discussions, which each met once for not more than 2 hours. Findings: The discussions resulted in one comprehensive theme; ‘Mastering an uncertain and unpredictable everyday life’. Three subthemes emerged from the material: ‘Living with another man’ where the carers discussed not only the marked change in their partner’s personality, but also the loss of a life-companion and their mutual intellectual contact; ‘Fear of it happening again’, comprising the carers’ experiences of fear and confinement, of always having to be ready to help and of being trapped at home; ‘Ongoing negotiation’, referring to the carers’ struggling and negotiating not only with their partners, but also with themselves and formal care for time to themselves. Conclusion: This study helps us to understand how these older women tried to master an uncertain and unpredictable life. Their life had changed radically; now they were always on call to help their partners and felt tied to home. The results draw attention to the carers’ need for time to themselves, a greater knowledge of stroke and continuous support from formal care.
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| 7. |
- Dahlin-Ivanoff, Synneve, 1950
(författare)
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Development and evaluation of a health education programme for elderly persons with age-related macular degeneration
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to develop and evaluate a health education programme for elderly persons with age-related macular degeneration (AMD). I. In order to plan the programme focus group methodology was used with the aim to learn how persons with the diagnosis AMD perceived and described their disease and how the disease had changed their daily occupations. The participants perceived insecurity in performing daily occupations. They used a number of strategies to continue to perform daily occupations. The participants expressed uncertainty about and a desire to know more about the disease and its consequences both at micro and macro level.II. A cross-sectional population study was performed with the purpose of describing disability in activities of daily living and its relation to visual impairment, focusing on AMD. Especially people with AMD were found to be more dependent on help in both personal and instrumental activities of daily living. The proportion of participants with disability in ADL and the relative risk of developing ADL dependence increased with the decrease in visual acuity (VA). The relationship between ADL and VA was, however, weak, implying that people adapt to the consequences of the disease, though to different degrees. III. Focus group methodology was used to improve the programme. The results indicated that the participants were, on the whole, pleased with the content of the programme, but they did not understand all the information provided. Social support, regained hope and meeting others with the same disease were reported as positive aspects of the programme. The role of the group leader and the composition of the groups were considered important. Several suggestions for improving the programme were put forward.IV. A non-parametric statistical method was used to develop an evaluative instrument that could measure and detect (in)security as an early signs of occupational dysfunction. The study showed that the instrument had a high level of test-retest stability and was responsive. V. A randomised study showed that the programme was effective as the participants in the health education programme developed a significantly higher level of security, according to the instrument developed in study IV, than found in the individual intervention group. The health education programme slow down the progression of decline in daily occupation
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| 8. |
- Ekerstad, Niklas, et al.
(författare)
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Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care
- 2017
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Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 12, s. 1239-1248
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Tidskriftsartikel (refereegranskat)abstract
- Background: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. Results: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P amp;lt; 0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P amp;lt; 0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170). Conclusion: Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.
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| 9. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Shifting between self-governing and being governed: a qualitative study of older persons’ self-determination
- 2014
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older persons’ right to exercise self-determination in daily life is supported by several laws. Research shows that older persons’ self-determination is not fully respected within the healthcare sector. In order to enable and enhance older persons’ self-determination, extensive knowledge of older persons’ self-determination is needed. Aim: To explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older. Methods: Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons aged 84–95 years who were beginning to develop dependence in daily activities. Results: The data analysis revealed the core category, “Self-determination - shifting between self-governing and being governed”. The core category comprised three categories: “Struggling against the aging body”, “Decision-making is relational”, and “Guarding one’s own independence”. Self-determination in daily activities was related to a shifting, which was two-fold, and varied between self-governing and being governed by the aging body, or by others. Conclusions: The findings imply a need to adopt a person-centered approach where the older persons’ own preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.
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| 10. |
- Ekström, Henrik, et al.
(författare)
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Effects of Walking Speed and Results of Timed Get-Up-and-Go Tests on Quality of Life and Social Participation in Elderly Individuals With a History of Osteoporosis-Related Fractures
- 2011
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Ingår i: Journal of aging and health. - : SAGE Publications. - 0898-2643 .- 1552-6887. ; 23:8, s. 1379-1399
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the relationships between physical performance, quality of life (QoL), and social participation among elderly men and women with a history of osteoporosis-related fractures. METHOD: The study was a population-based cross-sectional study including 155 participants aged 60 to 93 years from the Swedish longitudinal investigation, "Good Aging in Skåne." The participants had suffered fracture of the vertebrae, hip, pelvis, or ankle. Physical performance was expressed as walking speed (WS) and timed get-up-and-go (TUG). QoL was measured as using the Health Related Quality of Life (HRQoL) and Life Satisfaction (LS) scales. Social participation was defined as taking part in social, cultural, and leisure activities. RESULTS: Lower WS and/or TUG were associated with lower HRQoL, lower LS, and a reduction in social participation, after adjustment for confounding factors. DISCUSSION: Measurements of WS and TUG could be used to determine QoL and social participation in elderly people having sustained fractures.
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