| 1. |
- Burstrom, Bo, et al.
(författare)
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The aftermath of COVID-19 : Mortality impact of the pandemic on older persons in Sweden and other Nordic countries, 2020-2023
- 2024
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905.
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The COVID-19 pandemic hit Sweden harder than the other Nordic countries in the early phase, especially among older persons. We compared the impact of the COVID-19 pandemic on mortality especially among older persons during the period 2020-2022 in Sweden, Denmark, Finland and Norway, using four different outcome measures.Methods: We compared publicly available information on reported cases and deaths in COVID-19 from the World Health Organization COVID-19 Dashboard, age-specific mortality rates, life expectancy at age 65 years and excess mortality from Nordic Statistics database and national statistics and health agencies in Sweden, Denmark, Finland and Norway.Results: The pandemic peaked earlier in Sweden than in Denmark, Finland and Norway, where cases and deaths increased more during 2021 and 2022, also reflected in age-specific death rates among persons aged 70+ years. COVID-19 mortality was highest in Sweden, followed by Finland, Denmark and Norway. Life expectancy declined during 2020 in Sweden but more during 2021 and 2022 in Denmark, Finland and Norway. Excess mortality during 2020-2022 was nearly twice as high in Finland as in the other countries.Conclusions: COVID-19 mortality was higher in Sweden than in Denmark, Finland and Norway. Life expectancy declined during 2020 in Sweden, was partly regained in 2021 and 2022, while it declined during 2021 and 2022 in Denmark, Norway and Finland. However, excess mortality during 2020-2022 was similar in Sweden, Denmark and Norway and twice as high in Finland. Different mortality outcomes reflect the complexity of the mortality impact of COVID-19.
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| 2. |
- Doheny, Megan, et al.
(författare)
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Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County : an interrupted time series analysis
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits.Design Interrupted time series analysis from 2000 to 2015.Setting Stockholm County.Participants All inhabitants 65+ years in Stockholm County on 31 December of each study year.Intervention IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County.Outcome Rates of hospital-based ED visits.Results IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65–79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years.Conclusion The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.
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| 3. |
- Doheny, Megan, et al.
(författare)
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Socio-demographic differences in polypharmacy and potentially inappropriate drug use among older people with different care needs and in care settings in Stockholm, Sweden
- 2023
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:1, s. 11-20
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting.Methods: Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015. A logistic regression analysis was used to estimate socio-demographic differences in polypharmacy and PIM, adjusting for education, age group, sex, country of birth, living alone, morbidity and dementia by care setting based on area and by care need (i.e. independent, home help or institutionalised).Results: The prevalence of polypharmacy and PIM was greater among home-help users (60.4% and 11.5% respectively) and institutional residents (74.4% and 11.9%, respectively). However, there were greater socio-demographic differences among the independent, with those with lower education, older age and females having higher odds of polypharmacy and PIM. Morbidity was a driver of polypharmacy (odds ratio (OR)=1.19, confidence interval (CI) 1.16–1.22) among home-help users. Dementia diagnosis was associated with reduced odds of polypharmacy and PIM among those in institutions (OR=0.78, CI 0.71–0.87 and OR 0.52, CI 0.45–0.59, respectively) and of PIM among home-help users (OR=0.53, 95% CI 0.42–0.67).Conclusions: Polypharmacy and PIM were associated with care needs, most prevalent among home-help users and institutional residents, but socio-demographic differences were most prominent among those living independently, suggesting that municipal care might reduce differences between socio-demographic groups. Care setting had little effect on inappropriate drug use, indicating that national guidelines are followed.
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| 4. |
- Doheny, Megan, et al.
(författare)
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Socio-demographic differences in the frequent use of emergency department care by older persons : a population-based study in Stockholm County
- 2019
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, the number of older people using emergency department (ED) care is rising. Among older persons an ED visit is a stressful event, which potentially could have been prevented or treated at other levels of care. Frequent ED use (> 4 visits a year) by older persons might reflect issues in the organisation of health care system to address their needs. We aimed to explore socio-demographic differences among older people seeking ED care in terms age and gender, and to investigate the association between income and frequent ED use. Methods: A population-based study analysing the utilisation of ED care by (N = 356,375) individuals aged 65+ years. We linked register data on socio-demographic characteristics from 2013 to health care utilisation data in 2014. Multivariable logistic regression was used to estimate the income differences in the frequent use of ED care, adjusting for living situation, country of birth, residential area, age in years, multi-morbidity and the use of other health care services. Results: Those 65+ years accounted for (27%) of all ED visits in Stockholm County in 2014. In the study population (2.5%) were identified as frequent ED users, who were predominantly in the lower income groups, living alone or in an institution, had more multi-morbidity, and utilised more of other health care services. The lowest income groups had a three-fold greater odds of being a frequent ED user than those in the highest income group. In the adjusted models, the odds were reduced by 12-44% for those in the lowest income groups. However, age and gender differences were observed with men 65-79 years (OR 1.75 CI: 1.51-2.03) and women 80+ years (OR 150, CI 1.19-1.87) in the lowest income groups having a higher odds of frequent ED use. Conclusion: This study observed that ED visits by older persons are driven by a need of care, and those that frequently visit hospital-based EDs are a socially disadvantaged group, which suggests that the organisation of care for older people should be reviewed in order to better meet their needs in other levels of care.
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| 5. |
- Doheny, Megan
(författare)
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Socio-economic differences in the healthcare utilisation of older persons in Sweden
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The global population is ageing and this demographic change has important implications for the provision of healthcare and social care. Older people often have multiple and complex health problems and a range of different care needs. Equity in healthcare is a cornerstone of the Swedish system, making it crucial to examine whether socio-economic differences are visible in different aspects of healthcare utilisation, especially given the changes in organisation of healthcare and social care for older people. The overall aim of this thesis is to assess socio-economic differences in the utilisation of healthcare and prescription drugs among older persons in Sweden in light of recent changes to the healthcare and social care system. In study I, socio-demographic differences among older people seeking emergency department (ED) care were explored in terms of age and sex, the association between income groups and frequent ED use was also investigated. This study included persons 65 years and older (N=356,375), and followed their utilisation of ED care in 2014. Frequent ED users were mostly in low income groups living alone or in institutional care. Men 65-79 years and women 80 years and older in low income groups were found to be more frequent ED users. In study II, the impact of the introduction of an integrated care system in Norrtälje Municipality on subsequent changes in the trend of the rate of ED visits were investigated. An interrupted time series analysis was performed, using data from 2000-2015, in order to assess whether the introduction of integrated care in 2006 in Norrtälje Municipality changed the pattern of ED care utilisation among inhabitants 65 years and older, and were further stratified by socio-demographic group. Overall, there was a modest decrease in the rate of ED visits after the introduction of integrated care. In study III, the socio-demographic differences in polypharmacy and potentially inappropriate medication (PIM) use among older people with different care needs in a standard vs integrated care setting was examined. Care needs were defined based on exposure to social care services in 2014 and subsequent prescription drug utilisation was measured in 2015. Polypharmacy and PIM were more prevalent among home-help users and institutional care residents. However, socio-demographic differences, including education level and age, were more noticeable among those living independently. There were slight differences in inappropriate drug use between care settings. In study IV, the association between income groups and inpatient care expenditure, as well as the impact of demographic factors, health status, and healthcare and social care utilisation in the last year of life was investigated. We included 13,538 individuals who died during 2015 and retrospectively measured the inpatient care costs accrued over their last year of life. Higher income groups incurred higher inpatient care costs at the 75th and 95th percentile compared to lower income groups. Older age and more months in institutional care were associated with lower in a patient care expenditure. In conclusion, socio-economic differences were observed among older people in the utilisation of ED care, drug prescription and inpatient care expenditure in the last year of life. This thesis indicates that there are differences in the healthcare utilisation among older people who have a greater need of care. The introduction of integrated care model in Norrtälje in 2006 did not produce the expected change though the full impact of integrated care remains difficult to evaluate. However, the approach could, when fully implemented, potentially provide higher quality care for older people with complex needs.
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| 6. |
- Doheny, Megan, et al.
(författare)
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Socioeconomic differences in inpatient care expenditure in the last year of life among older people : a retrospective population-based study in Stockholm County
- 2022
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate the association between inpatient care expenditure (ICE) and income group and the effect of demographic factors, health status, healthcare and social care utilisation on ICE in the last year of life.Design Retrospective population-based study.Setting Stockholm County.Participants Decedents ≥65 years in 2015 (N=13 538).Outcome ICE was calculated individually for the month of, and 12 months preceding death using healthcare register data from 2014 and 2015. ICE included the costs of admission and treatment in inpatient care adjusted for the price level in 2018.Results There were difference between income groups and ICE incurred at the 75th percentile, while a social gradient was found at the 95th percentile where the highest income group incurred higher ICE (SEK45 307, 95% CI SEK12 055 to SEK79 559) compared with the lowest income groups. Incurring higher ICE at the 95th percentile was driven by greater morbidity (SEK20 333, 95% CI SEK12 673 to SEK29 993) and emergency department care visits (SEK77 995, 95% CI SEK64 442 to SEK79 549), while lower ICE across the distribution was associated with older age and residing in institutional care.Conclusion Gaining insight into patterns of healthcare expenditure in the last year of life has important implications for policy, particularly as socioeconomic differences were visible in ICE at a time of greater care need for all. Future policies should focus on engaging in advanced care planning and strengthening the coordination of care for older people.
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| 7. |
- 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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