| 1. |
- Westgård, Theresa, et al.
(författare)
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Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital : a feasibility study
- 2018
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Ingår i: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.Methods: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.Result: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].Conclusion: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.Trial registration: Clinical Trials ID: NCT02773914. Registered 16 May 2016.
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| 2. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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From Intervention Trial to Full-scale Implementation Research: Positive Tendencies for Frailty and Self-rated Health in Frail Older People.
- 2018
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Ingår i: International Journal of Geriatrics and Gerontology. - 2577-0748. ; 2018:2
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Tidskriftsartikel (refereegranskat)abstract
- A continuum of care for frail older people was created to link the chain between the hospital, and discharge to the person’s home. Despite earlier positive findings, it remains unclear if the benefits are sustainable in a real-life context. The present longitudinal study aimed at evaluate the effects of the implementation of a full-scale process program for frail older people in a real-life context regarding levels of frailty, self-rated health and activities of daily living up to one year later. The sample consisted of a total of 143 frail people aged 75 years and older, divided in the two groups: 77 participants from the full-scale process program and 66 historical controls. The findings showed that at the six months follow-up, the participants partaking in the full-scale process program had a significantly higher odds of displaying decreased frailty (p=0.015), and at twelve months, this sample had a significant lower likelihood of reporting decreased self-rated health (p=0.023). Thus, the findings showed positive results on frailty level and self-rated health when implementing the intervention in real life, indicating that a person-centred, multi-professional team with a case manager is beneficial for frail older people.
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| 3. |
- 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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| 4. |
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| 5. |
- Westgård, Theresa, et al.
(författare)
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Feeling respected as a person: a qualitative analysis of frail older people's experiences on an acute geriatric ward practicing a Comprehensive Geriatric Assessment
- 2019
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Ingår i: Geriatrics. - : MDPI AG. - 0016-867X .- 2308-3417. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Comprehensive geriatric assessment (CGA) practices multidimensional, interdisciplinary, and diagnostic processes as a means to identify care needs, plan care, and improve outcomes of frail older people. Conventional content analysis was used to analyze frail older people’s experiences of receiving CGA. Through a secondary analysis, interviews and transcripts were revisited in an attempt to discover the meaning behind the participants’ implied, ambiguous, and verbalized thoughts that were not illuminated in the primary study. Feeling “respected as a person” is the phenomenon participants described on a CGA acute geriatric ward, achieved by having a reciprocal relationship with the ward staff, enabling their participation in decisions when engaged in communication and understanding. However, when a person was too ill to participate, then care was person-supportive care. CGA, when delivered by staff practicing person-centered care, can keep the frail older person in focus despite them being a patient. If a person-centered care approach does not work because the person is too ill, then person-supportive care is delivered. However, when staff and/or organizational practices do not implement a person-centered care approach, this can hinder patients feeling “respected as a person”.
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| 6. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Erfarenheter av självbestämmande hos personer som nyligen utvecklat ett beroende i dagliga aktiviteter
- 2013
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Ingår i: AT-Forum (Arbetsterapeuternas nationella konferens). Stockholm, 24-25 april 2013 (Muntlig presentation).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Övergången från att vara oberoende till att utveckla sårbarhet och beroende av annan person i dagliga aktiviteter kan vara fylld med utmaningar. I takt med att en person utvecklar ett beroende, kan möjligheten till självbestämmande i dagliga aktiviteter försämras vilket kan upplevas stressande för den äldre personen. Äldre som är beroende uttrycker ett behov att kunna fortsätta vara delaktiga i beslutsfattande som rör dagliga aktiviteter. För att äldre ska kunna bibehålla god hälsa och välbefinnande är det viktigt att de involveras och tillåts att ta beslut som rör deras dagliga aktiviteter. Hälso- och sjukvårdspersonal är medvetna om vikten av äldres rätt till självbestämmande, dock påvisar studier att professionella efterfrågar mera kunskap om äldres erfarenheter för att kunna stödja de äldre till ökat självbestämmande. Syfte: Att undersöka erfarenheter av självbestämmande vid övergången från oberoende till beroende av annan person i daglig aktivitet hos personer 80 år och äldre. Tillvägagångssätt och analys: En explorativ design baserad på Grounded Theory beskriven av Charmaz används i studien. Semistrukturerade intevjuer kommer att genomföras på ca 15 personer i åldern 80 år och äldre som börjat uppleva svårigheter i dagliga aktiviteter eller som utvecklat ett beroende i minst en Instrumentell Daglig Aktivitet (I-ADL) och/eller minst en Personlig Daglig Aktivitet (P-ADL) enligt ADL-trappan. Insamlad data kommer att analyseras med Grounded Theory. Både intervjuer och analys av data har påbörjats. Resultat/förväntat resultat: Studien förväntas ge en förståelse för hur personer vilka är 80 år och äldre erfar sitt självbestämmande vid övergången från oberoende till beroende av annan person i daglig aktivitet. Slutsatser: Förväntat resultat kommer att leda till ökad kunskap om hur personal inom hälso- och sjukvården kan stödja äldre personer som är i övergången till att utveckla ett beroende i dagliga aktiviteter till ökat självbestämmande.
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| 7. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Impact on Participation and Autonomy – test of validity and reliability for older persons
- 2014
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Ingår i: Health Psychology Research. - : Open Medical Publishing. - 2420-8124. ; 2:3, s. 68-73
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Tidskriftsartikel (refereegranskat)abstract
- In research and health care it is important to measure older person’s self-determination in order to improve their possibilities to decide for themselves in daily life. The questionnaire Impact on Participation and Autonomy (IPA) assesses self-determination, but is not constructed for older persons. The aim of this study was to examine the validity and reliability of the IPA-S questionnaire for persons aged 70 years and older. The study was performed in two steps; first a validity test of the Swedish version of the questionnaire, IPA-S, followed by a reliability test-retest of an adjusted version. The validity was tested with focus groups and individual interviews on persons aged 77-88 years, and the reliability on persons aged 70-99 years. The validity test result showed that IPA-S is valid for older persons but it was too extensive and the phrasing of the items needed adjustments. The reliability test-retest on the adjusted questionnaire, IPA-for Older persons (IPA-O), showed that 15 of 22 items had high agreement. IPA-O can be used to measure older persons’ right to self-determination in their care and rehabilitation.
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| 8. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Risk for depression affects older people's possibilities to exercise self-determination in using time, social relationships and living life as one wants : A cross-sectional study with frail older people
- 2018
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Ingår i: Health Psychology Research. - : Pagepress Publications. - 2420-8124 .- 2281-2075. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Exercising self-determination in daily life is highly valued by older people. However, being in the hands of other people may challenge the older people's possibilities to exercise self-determination in their daily life. Among frail older people living in Sweden, risk for depression is highly predominant. There is a knowledge gap regarding if, and how having a risk of depression affects older people's self-determination. The objective was, therefore, to explore if, and in that case how, frail older people's self-determination is affected by the risk of depression. In this cross-sectional, secondary data analysis, with 161 communitydwelling frail older people, simple logistic regression models were performed to explore the association between self-determination, the risk of depression and demographic variables. The findings showed that risk for depression and reduced self-determination were significantly associated in the dimensions: use of time (P=0.020), social relationship (P=0.003), help and support others (P=0.033), and the overall self-determination item (P=0.000). Risk for depression significantly affected self-determination in use of time (OR=3.04, P=0.014), social relationship (OR=2.53, P=0.011), and overall self-determination (OR=6.17, P=0.000). This point out an increased need of strengthening healthcare professionals' perspectives, and attitudes towards a self-determined, friendly, and person-centred dialogue.
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| 9. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Validitet och reliabilitet av frågeformuläret Inverkan på Delaktighet och Autonomi för äldre personer
- 2013
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Ingår i: Posterpresentation AT-Forum Stockholmsmässan 24-25/4-2013.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Frågeformuläret Inverkan på Delaktighet och Autonomi (IPA) har konstruerats för att mäta en persons upplevda delaktighet och självbestämmande/beslutande autonomi. Eftersom validiteten och reliabiliteten av IPA är testade på personer under 75 års ålder, behövs ytterligare studier riktade mot äldre. Syfte: Att undersöka validiteten och reliabiliteten av frågeformuläret IPA för personer i åldern 70 år och äldre. Metod: Studien utfördes i två steg som figuren visar; först ett validitetstest av den svenska versionen av IPA och därefter ett test-retest reliabilitetstest av det reviderade frågeformuläret. I test-retesten användes Svenssons program, ett statistiskt program som är lämpligt vid analys av ordinaldata. Resultat: Deltagarna ansåg att frågorna var viktiga men omfattande. När de besvarade frågorna framkom att de fokuserade på enbart utförandet av aktiviteterna. Revideringen resulterade i 22 frågor om upplevd delaktighet och självbestämmande. Test-retesten visade att den procentuella överensstämmelsen varierade, 15 frågor hade hög reliabilitet (70 % eller över). Slutsatser: IPA-Ä är valit och reliabelt för den äldre populationen. IPA-Ä kan användas som ett utvärderingsinstrument för att säkerställa äldre personers rätt till självbestämmande och delaktighet. IPA-Ä rekommenderas som ett utvärderingsinstrument vid geriatrisk rehabilitering.
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| 10. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Governing or being governed: Older persons' experiences of self-determination
- 2014
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Ingår i: Age Well - 22nd Nordic Congress of Gerontology, 25-28 maj, Göteborg, Sverige.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: In Sweden it is a legal right for older persons to exercise self-determination. Exercising self-determination is also important for older persons’ health and well-being. Health professionals are in general aware of the importance, but research shows that older persons’ self-determination is not fully respected within the health care sector. Research on self-determination from the perspective of older persons who are in the beginning to develop dependence in daily activities is limited. In order to deepen the knowledge of older persons own experiences in this process, further studies are needed. Aim: The aim of this study was to explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older. Method: Qualitative interviews with 11 persons aged 84-95 years who were in the beginning to experience difficulties in daily activities were performed in accordance with the constructivist grounded theory method. Results: The core category, shifting between governing oneself or being governed by others, illustrates the complexity and the shifting of the experiences during the development of dependence. The categories struggling against the aging body, guarding one’s own independence and transferring the performance highlights different ways of governing in one’s life, whereas exercising self-determination is in the hands of others is a result of the increasing dependence. Conclusions: For community-dwelling older persons, the social context and the ageing body may influence the possibilities to exercise self-determination in daily life. Professionals and health care providers should enable and encourage older persons to exercise self-determination related their own healthcare.
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