| 1. |
- Andersson, Edith, et al.
(författare)
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Acute confusional episodes in elderly orthopaedic patients: the patients' actions and speech.
- 2002
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Ingår i: International Journal of Nursing Studies. - 1873-491X. ; 39:3, s. 303-317
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to illuminate the pattern of confusional episodes with regard to the content of elderly patients' actions and speech. Fifty-one (11.2%) out of 457 people admitted to an orthopaedic clinic developed acute confusional state. Non-participant direct observations and daily clinical bedside follow-up observations were made during the confusional episodes, focusing on the patients' speech, actions and reactions with reference to situation, the surroundings, and the nurses' actions, including their verbal communication with the patient. The texts were analysed using manifest and latent content analysis and revealed disturbances in motor activity, speech and mood. 'Struggling to understand and to gain control when in a state of confusion and viewing oneself as being confused' was the main theme illuminated in the texts. In the struggle to achieve understanding and take control over themselves and what was currently taking place, the patients used a variety of strategies. They attempted to find clarity, to make a sensible story out of the present and to impute meaning to the present by using their life story. The findings indicated that the patients had a drive to achieve control when they were confused and that they were both aware and unaware of their state and tended to oscillate between being in a confused state and viewing their confusion from an outside perspective. The findings indicated that possibly the best approach is to support their inner drive to gain control. This means moving between confirmation of their emotional state and their perceptions and trying to introduce 'reality' when they realize their state of confusion. Thus the nurse--patient relationship perhaps needs to hold a balance between confirmation and introducing in reality.
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| 2. |
- Andersson, Edith, et al.
(författare)
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Acute confusional state in elderly orthopaedic patients: factors of importance for detection in nursing care
- 2001
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Ingår i: International Journal of Geriatric Psychiatry. - 1099-1166. ; 16:1, s. 7-17
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aims of this study were to identify factors of significance in the development of acute confusional state (ACS) and the differences between patients who developed ACS and those who did not. METHOD AND RESULTS: Assessment, observations and interviews with 505 patients admitted to an orthopaedic clinic revealed that 51 patients developed ACS during their in-hospital stay. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthros or gonarthros (3.6%). The highest hazard ratio for ACS was several other physical diseases 15.94 (CI: 4.60-55.31 and p-value <0.00001) and the lowest was age 1.10 (CI: 1.04-1.15 and p-value <0.0002). The ACS lasted from 1 to 9 days, and patients had one (N=42), two (N=8) or three episodes (N=1) of confusion during their stay on the ward. More patients who developed ACS before surgery had two or more confusional episodes and emergency patients developed ACS more rapidly. The ACS lasted longer in patients with a higher score on the OBS scale at admittance and with rapid development of ACS. CONCLUSIONS: Acuteness in the situation seems an important risk indication for ACS in the elderly. Awareness of factors associated with the development of ACS makes it possible to more systematically identify those at risk, for instance by systematic assessment in the first interview with the patient on admission to hospital.
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| 3. |
- Andersson, Edith, et al.
(författare)
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Nurses' experiences of the encounter with elderly patients in acute confusional state in orthopaedic care.
- 2003
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Ingår i: International Journal of Nursing Studies. - 1873-491X. ; 40:4, s. 437-448
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to illuminate nurses’ experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n=26) or licensed practical nurses (n=22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses’ actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses’ experiences showed that the nurses found it difficult to reach the patients’ reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients’ situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients’ irritation and anger. The results were more successful when the strategies were derived from the nurses’ interpretation of the patients’ situation and the nurses paid attention to the patients and confirmed them.
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| 4. |
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| 5. |
- Andersson, Edith, et al.
(författare)
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The meaning of acute confusional state from the perspective of elderly patients.
- 2002
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 17:7, s. 652-663
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to illuminate lived experience of having been in an acute confusional state (ACS) as narrated by elderly patients in orthopaedic care. METHOD: Qualitative study with phenomenological hermeneutic method for analysing the data based on narrative interviews. Fifty patients (67-96 years of age) who developed ACS during hospitalisation and in all cases the ACS ceased during their stay on the ward were interviewed once lucid again regarding the course of the event, their experiences, memories and interpretation of what had happened during the ACS. RESULTS: The meaning of the patients' lived experiences of being and having been confused was interpreted as 'Being trapped in incomprehensible experiences and a turmoil of past and present and here and there', comprising the themes trying to get a grip on the experience of the confusion, encountering past, present and the realm of the imagination as reality during the period of confusion and confronting the idea of having been confused. Contradictory to earlier research the patients remembered and could tell in great detail about their ACS. While confused, the confusional state means that impressions of all kinds invade the mind of the person and are experienced as reality, making him/her a victim of these impressions rather than the one who controls what comes into his/her mind. While in the middle of these experiences the person simultaneously senses that the impressions are unreal, thus indicating that he/she is in some sort of borderland between understanding and not understanding. The things that come into the mind of the person can either be frightening or neutral or enjoyable scenarios that seem to be mainly familiar but can also be unknown. These scenarios seem to be a mixture of past and present, of events and people while they seem to float from location to location. CONCLUSIONS: The findings indicates that what takes place during the ACS is not nonsense but probably a mix of the patient's life history, their present situation and above all a form of communication concerning their emotional state and inner experiences in this new situation. The findings also indicated that one possible approach to the patients is to confirm and support the patients in narrating their experiences both during the confusion and also after the ACS had ceased.
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| 6. |
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| 7. |
- Andersson, Ingalill, et al.
(författare)
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Vitamin and mineral status in elderly patients with chronic obstructive pulmonary disease
- 2007
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Ingår i: Clinical Respiratory Journal. - : Blackwell Publishing. - 1752-6981 .- 1752-699X. ; 1:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Eating problems are common in patients with chronic obstructive pulmonary disease (COPD), and intake of micronutrients might be lower than recommended. Objective: To study dietary intake, serum and urinary concentration of trace elements and vitamins in elderly underweight patients with established severe COPD. Methods: Outpatients at a university clinic for lung medicine, with COPD, 70-85 years old, with no other serious disease, and with a body mass index (BMI) of similar to 20 kg/m(2) and an FEV(1) of < 50 % predicted were recruited. Body composition and bone density were evaluated with dual energy X-ray absorptiometry. Dietary intake was studied by a trained dietitian using diet-history interview. Blood and urine samples were analysed for various vitamins and trace elements. Results: Seventeen of 30 recruited patients took part. Osteoporosis or osteopaenia was found in 16 patients. Dietary intake of energy and macronutrients was in line with recommendations for healthy individuals. Intake of protein did not meet recommendations for COPD patients. Intake of polyunsaturated fatty acids was lower than recommended and intake of saturated fatty acids was higher than recommended. Mean intake of vitamin D and folic acid was far below recommendations. Serum concentrations for folic acid and methylmalonate and plasma concentrations for homocysteine were below normal in several patients. Conclusion: Intake of vitamin D and calcium is often low in older COPD patients, which might contribute to osteoporosis. Low intake of folic acid might also be a problem. The results support prophylaxis with calcium, vitamin D and folic acid.
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| 8. |
- Andersson, Magdalena, et al.
(författare)
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Health care consumption and place of death among old people with public home care or in special accommodation in their last year of life.
- 2007
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Ingår i: Aging clinical and experimental research. - 1720-8319. ; 19:3, s. 228-239
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Developing care for older people in the last phase of life requires knowledge about the type and extent of care and factors associated with the place of death. The aim of this study was to examine age, living conditions, dependency, care and service among old people during their last year of life, but also their place of death and factors predicting it. METHODS: The sample (n=1198) was drawn from the care and services part of the Swedish National Study on Ageing and Care (SNAC). Criteria for inclusion were being 75+ years, dying in 2001-2004, and having public care and services at home or in special accommodation. RESULTS: In the last year of life, 82% of persons living at home and 51% living in special accommodation were hospitalized; median stays were 10 and 6.7 days respectively. Those living at home were younger and less dependent in ADL than those living in special accommodation. Those living at home and those having several hospital stays more often died in hospital. In the total sample, more visits to physicians in outpatient care predicted dying in hospital, whereas living in special accommodation and PADL dependency predicted dying outside hospital. CONCLUSIONS: Old people in their last year of life consumed a considerable amount of both municipal care and outpatient and in-hospital medical care, especially those living at home, which in several cases ended with death in hospital. (Aging Clin Exp Res 2007; 19: 228-239) ©2007, Editrice Kurtis
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| 9. |
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| 10. |
- Andersson, Magdalena, et al.
(författare)
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Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life.
- 2008
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 1873-491X .- 0020-7489. ; 45:6, s. 818-828
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Tidskriftsartikel (refereegranskat)abstract
- Background: Old people's life situation when receiving municipal help and care in their last period of life is sparsely investigated from their own perspective. Objective: The aim of this study was to investigate the experiences of aspects that bring about a good life in the last phase of life among people (75 + years) receiving municipal care. Participants: Older people living in a municipality in Southern Sweden being 75 years or older, receiving help and/or care from the municipality, and having a life-threatening disease and/or receiving palliative care were asked to participate. In all 17 people, 10 women and 7 men, aged 78-100 years were included. Methods: Qualitative interviews, with the emphasis on their present life situation especially what brought about a good life, were performed. The interviews were analysed using qualitative content analysis. Results: The experience was interpreted to be Turning inwards to come to peace with the past, the present and approaching death while being trapped by health complaints. Six categories embraced the experience of aspects that constitute a good life in the last phase of life: Maintaining dignity, Enjoying small things, Feelings of "being at home", Being in the hands of others, trying to adjust, Still being important for other people and Completing life while facing death. Conclusion: This study confirm theories suggesting that the last phase of life in old age meant focusing inwards, reflecting on the entire life as a way of completing it as well as enjoying small things and also viewing oneself in the perspective of contributing to the future. It also indicated that this phase of life meant being trapped by health complaints and functional limitations. The struggle to maintaining dignity as opposed to being in the hands of others implies that the concept of palliative care may be useful as a framework for providing nursing care to very old people, especially at the end of life.
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