| 1. |
- Enge, Maria, et al.
(författare)
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Malnutrition prevalence according to GLIM and its feasibility in geriatric patients : a prospective cross-sectional study
- 2024
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Ingår i: European Journal of Nutrition. - : Springer. - 1436-6207 .- 1436-6215. ; 63:3, s. 927-938
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Tidskriftsartikel (refereegranskat)abstract
- PurposeIn 2019, the Global Leadership Initiative on Malnutrition (GLIM) suggested a 2-step diagnostic format for malnutrition including screening and diagnosis. Prospective validation and feasibility studies, using the complete set of the five GLIM criteria, are needed. The aims of this study were to determine the prevalence of malnutrition, and investigate how the prevalence varied with mode of screening. Furthermore, we assessed the feasibility of GLIM in geriatric patients.MethodsConsecutive patients from two acute geriatric wards were included. For screening risk of malnutrition, the Mini Nutritional Assessment-Short Form (MNA-SF) or Malnutrition Screening Tool (MST) were used. In accordance with GLIM, a combination of phenotypic and etiologic criteria were required for the diagnosis of malnutrition. Feasibility was determined based on % data completeness, and above 80% completeness was considered feasible.ResultsOne hundred patients (mean age 82 years, 58% women) were included. After screening with MNA-SF malnutrition was confirmed by GLIM in 51%, as compared with 35% after screening with MST (p = 0.039). Corresponding prevalence was 58% with no prior screening. Using hand grip strength as a supportive measure for reduced muscle mass, 69% of the patients were malnourished. Feasibility varied between 70 and 100% for the different GLIM criteria, with calf circumference as a proxy for reduced muscle mass having the lowest feasibility.ConclusionIn acute geriatric patients, the prevalence of malnutrition according to GLIM varied depending on the screening tool used. In this setting, GLIM appears feasible, besides for the criterion of reduced muscle mass.
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| 2. |
- Kirvalidze, Mariam, et al.
(författare)
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Effectiveness of integrated person-centered interventions for older people's care : Review of Swedish experiences and experts' perspective
- 2024
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796.
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Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field. image
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| 3. |
- Al-Adili, Lina, et al.
(författare)
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Setting goals with patients at risk of malnutrition : A focus group study with clinical dietitians
- 2022
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 105:7, s. 2103-2109
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition.Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes.Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically oriented goals and patients' personal goals.Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. Practice implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.
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| 4. |
- Bostrom, Anne-Marie, et al.
(författare)
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Factors associated with evidence-based practice among registered nurses in Sweden : a national cross-sectional study
- 2013
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses' (RNs') practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation.Methods: A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models.Results: Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 - 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 - 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 - 2.0).Conclusions: To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors.
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| 5. |
- Bostrom, Anne-Marie, et al.
(författare)
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Factors in the psychosocial work environment of staff are associated with satisfaction with care among older persons receiving home care services
- 2022
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Ingår i: Health & Social Care in the Community. - : John Wiley & Sons. - 0966-0410 .- 1365-2524. ; 30:6, s. e6080-e6090
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Tidskriftsartikel (refereegranskat)abstract
- Older persons in Sweden are increasingly encouraged to continue living at home and, if necessary, be supported by home care services (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and well-being of older persons in residential care facilities, but few have examined such associations in HCS. This study examined associations between home care staff's perceptions of their psychosocial work environment and satisfaction with care among older people receiving HCS. The setting was 16 HCS work units. Two surveys were conducted, one on psychosocial working conditions of staff, one on satisfaction of older persons receiving HCS. For each work unit, data on individual satisfaction were matched to average values concerning psychosocial work conditions. Outcomes analysed with linear regressions were overall satisfaction and indices regarding assessment of performance of services, contact with staff and sense of security. The index for treatment by staff was analysed with ordered logistic regressions. Cluster correlated-standard error clustering on work units was used. Results showed that good working conditions were important for satisfaction with care, specifically overall satisfaction, treatment by staff and sense of security. The most important psychosocial work factors were work group climate, sense of mastery, job control, overall job strain, frustrated empathy, balancing competing needs, balancing emotional involvement and lack of recognition. Receiving more HCS hours was associated with stronger relationships between working conditions and satisfaction with care, especially with overall satisfaction and treatment by staff as outcomes. Managers and policymakers for home care need to acknowledge that the working conditions of home care staff are crucial for the satisfaction of older persons receiving HCS, particularly those receiving many HCS hours. Psychosocial work factors together with job strain factors are areas to focus on in order to improve working conditions for staff and outcomes for older persons.
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| 6. |
- Bostrom, I, et al.
(författare)
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Sex ratio of multiple sclerosis in the National Swedish MS Register (SMSreg)
- 2013
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Ingår i: Multiple sclerosis (Houndmills, Basingstoke, England). - : SAGE Publications. - 1477-0970 .- 1352-4585. ; 19:1, s. 46-52
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Tidskriftsartikel (refereegranskat)abstract
- Sex ratio in multiple sclerosis has been reported from several geographical areas. The disease is more common in women. In Europe the female-to-male ratio varies from 1.1 to 3.4. A recent study from Canada has reported a significant increase, with time, in female-to-male ratio in multiple sclerosis over the last 100 years. Objective: The aim of this study was to analyse any change in sex ratio in multiple sclerosis in the Swedish population. Methods: Data from the Swedish MS Register and data from the Swedish National Statistics Office were used to estimate sex ratio by year of birth and year of onset. Results: In the analysis of sex ratio by year of birth there were 8834 patients (6271 women and 2563 men) born between 1931 and 1985. The mean women-to-men ratio was 2.62. No clear trend was noted for the women-to-men ratio by year of birth (Spearman’s rho = 0.345, p = 0.298, n = 11). The number of patients analysed by year of onset was 9098 during the time period 1946 until 2005. The mean women-to-men ratio was 2.57. No significant change in women-to-men ratio (Spearman’s rho = −0.007, p = 0.983, n = 12) with time was observed. Conclusion: There is no evidence for an increasing women-to-men ratio with time amongst Swedish multiple sclerosis patients.
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| 7. |
- Gronstedt, Helena, et al.
(författare)
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Effect of Sit-to-Stand Exercises Combined With Protein-Rich Oral Supplementation in Older Persons : The Older Person's Exercise and Nutrition Study
- 2020
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Ingår i: Journal of the American Medical Directors Association. - : ELSEVIER SCIENCE INC. - 1525-8610 .- 1538-9375. ; 21:9, s. 1229-1237
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Nursing home (NH) residents are often undernourished and physically inactive, which contributes to sarcopenia and frailty. The Older Person's Exercise and Nutrition Study aimed to investigate the effects of sit-to-stand exercises (STS) integrated into daily care, combined with a protein-rich oral nutritional supplement (ONS), on physical function, nutritional status, body composition, health-related quality of life, and resource use. Design: Residents in 8 NHs were randomized by NH units into an intervention group (IG) or a control group (CG) (n = 60/group). The IG was a combination of STS (4 times/day) and ONS (2 bottles/day providing 600 kcal and 36 g protein) for 12 weeks. Setting and Participants: The participants resided in NH units (dementia and somatic care), were >= 75 years of age, and able to rise from a seated position. Methods: The 30-second Chair Stand Test was the primary outcome. Secondary outcomes were balance, walking speed, dependence in activities of daily living, nutritional status and body composition, health-related quality of life, and resource use. Results: Altogether, 102 residents (age 86 +/- 5 years, 62% female) completed the study. No improvement in the physical function assessments was observed in the IG, whereas body weight increased significantly (2.05 +/- 3.5 kg, P = .013) vs the CG. Twenty-one (of 52) participants with high adherence to the intervention (ie, at least 40% compliance to the combined intervention) increased their fat free mass (2.12 kg (0.13, 4.26 interquartile range), P = .007 vs CG). Logistic regression analyses indicated that the odds ratio for maintained/improved 30-second Chair Stand Test was 3.5 (confidence interval 1.1, 10.9, P = .034) among the participants with high adherence compared with the CG. Conclusions/Implications: Twelve-week intervention of daily STS combined with ONS in NH residents did not improve physical function, but increased body weight. Subgroup analyses indicated that high adherence to the combined intervention was associated with maintained or improved physical function and a gain of fat free mass. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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| 8. |
- Hagg, Sara, et al.
(författare)
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Age, Frailty, and Comorbidity as Prognostic Factors for Short-Term Outcomes in Patients With Coronavirus Disease 2019 in Geriatric Care
- 2020
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Ingår i: Journal of the American Medical Directors Association. - : ELSEVIER SCIENCE INC. - 1525-8610 .- 1538-9375. ; 21:11, s. 1555-1559
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To analyze whether frailty and comorbidities are associated with in-hospital mortality and discharge to home in older adults hospitalized for coronavirus disease 2019 (COVID-19). Design: Single-center observational study. Setting and Participants: Patients admitted to geriatric care in a large hospital in Sweden between March 1 and June 11, 2020; 250 were treated for COVID-19 and 717 for other diagnoses. Methods: COVID-19 diagnosis was clinically confirmed by positive reverse transcription polymerase chain reaction test or, if negative, by other methods. Patient data were extracted from electronic medical records, which included Clinical Frailty Scale (CFS), and were further used for assessments of the Hospital Frailty Risk Score (HFRS) and the Charlson Comorbidity Index (CCI). In-hospital mortality and home discharge were followed up for up to 25 and 28 days, respectively. Multivariate Cox regression models adjusted for age and sex were used. Results: Among the patients with COVID-19, in-hospital mortality rate was 24% and home discharge rate was 44%. Higher age was associated with in-hospital mortality (hazard ratio [HR] 1.05 per each year, 95% confidence interval [CI] 1.01.1.08) and lower probability of home discharge (HR 0.97, 95% CI 0.95.0.99). CFS (>5) and CCI, but not HFRS, were predictive of in-hospital mortality (HR 1.93, 95% CI 1.02.3.65 and HR 1.27, 95% CI 1.02.1.58, respectively). Patients with CFS >5 had a lower probability of being discharged home (HR 0.38, 95% CI 0.25.0.58). CCI and HFRS were not associated with home discharge. In general, effects were more pronounced in men. Acute kidney injury was associated with in-hospital mortality and hypertension with discharge to home. Other comorbidities (diabetes, cardiovascular disease, lung diseases, chronic kidney disease and dementia) were not associated with either outcome. Conclusions and Implications: Of all geriatric patients with COVID-19, 3 out of 4 survived during the study period. Our results indicate that in addition to age, the level of frailty is a useful predictor of short-term COVID-19 outcomes in geriatric patients. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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| 9. |
- Karlsson, Emelie S., et al.
(författare)
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Response and Adherence of Nursing Home Residents to a Nutrition/Exercise Intervention
- 2021
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 22:9, s. 1939-1945.e3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Interindividual response variability to nutrition and exercise interventions is extensive in older adults. A group of nursing home (NH) residents participated in a combined intervention. The objective of this post-hoc analysis was to identify factors associated with intervention response measured by change in physical function and body composition. Design: Post-hoc analyses in the Older Person's Exercise and Nutrition study, a 2-arm randomized trial. The primary outcomes were 30-second Chair Stand Test and composite scores combining physical function and fat-free mass. A secondary outcome was intervention adherence. A 12-week intervention of sit-to-stand exercises and protein-rich nutritional supplements did not improve chair-stand capacity vs control on intention-to-treat basis. Setting and Participants: Residents >75 years of age from dementia and somatic units in eight NHs in Sweden. Methods: Logistic regressions were performed to define factors associated with response (maintenance/ improvement) or nonresponse (deterioration) in 30-second Chair Stand Test, and with intervention adherence. Linear regressions were performed to explore factors associated with response in composite scores. Results: Mean age of participants (n = 52 intervention, n = 49 control) was 85.8 years. Sarcopenia was occurring in 74%. Sarcopenia at baseline (P = .005) and high adherence to nutritional supplements (P = .002) increased the odds of response. Higher independence in daily activities increased the odds of adherence to sit-to-stand exercises (P =.027) and the combined intervention (P = .020). Allocation to the intervention group and higher self-perceived health were associated with higher composite scores. Conclusions and Implications: NH residents with baseline sarcopenia, better self-perceived health, and high adherence to nutritional supplements benefitted most from a combined nutrition and exercise intervention regarding chair-stand capacity and composite scores of function and fat-free mass. Adherence was related to higher grade of independence. Understanding factors associated with response and adherence to an intervention will help target susceptible residents in most need of support and to optimize the outcome.
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| 10. |
- Kåreholt, Ingemar, 1960-, et al.
(författare)
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Staffs' Psychosocial Work Environment in Relation to Recipient Satisfaction in Home Care Services
- 2022
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Ingår i: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 6:Supplement 1, s. 702-702
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Tidskriftsartikel (refereegranskat)abstract
- In accordance with ‘aging in place’ policy, older persons in Sweden are increasingly encouraged to continue living at home and if necessary be supported by home care service (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and the wellbeing of the older persons in nursing homes, but few have examined such associations in HCS. The setting was 16 HCS work units. Two surveys were sent, one to staff on psychosocial working conditions, one to care recipients on care satisfaction. For each work unit, data on individual recipient satisfaction was matched to average values on psychosocial work conditions. Outcomes analyzed with linear regressions were overall recipient satisfaction, based on one question, and indexes on: assessment of implementation of services, contact with staff, and sense of security. Index on treatment by staff was analyzed with ordered logistic regressions due to skewed distribution. We used cluster correlated standard errors (clustering on work units). Results showed that good working conditions are important for recipient satisfaction, specifically overall recipient satisfaction, treatment by staff, and sense of security. Psychosocial work factors most important were work group climate, overall job strain, sense of mastery, job control, frustrated empathy, balancing competing needs, balancing emotional involvement, and lack of recognition. Having more home help hours was associated to stronger relation between working conditions and recipient satisfaction, especially with overall recipient satisfaction and treatment by staff as outcomes.
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