| 1. |
- Agerholm, Janne
(author)
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Analysing equity in outpatient care in Stockholm county and the impact of using different data sources
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Healthcare plays an important role in tackling inequalities in health by providing care to groups in need, and protecting lower income groups from further impoverishment due to ill health. Continually evaluating equity in healthcare is important as it changes with altered needs in the population and changes within the healthcare system itself. The aim of this thesis was to increase knowledge on equity in outpatient healthcare based upon data from Stockholm County in the period 2005-2013. The conclusions made are based upon the results from four different studies. In Study I, we investigated the non-response bias in a health survey with respect to socio-economic differences in healthcare utilisation by comparing data from a health survey with data of the general population in Stockholm County. In Study II, we investigated how the income gradient in healthcare utilisation changed when taking need into account, by comparing socioeconomic differences using register data on healthcare consumption and sociodemographic background characteristics, and linked survey data. In Study III, we compared socioeconomic differences in healthcare utilisation in Stockholm County before and after the introduction of a primary care reform in 2008 focusing on free choice of provider and free establishment for providers along with a change in reimbursement system from a need-weighted capitation based system to a system based primarily on fee-for-service. In Study IV, we investigated changes in resource allocation to primary care clinics in areas with different levels of median income over a period of nine year and whether the introduction of the 2008 primary care reform changed the trends in resource allocation. We also investigated whether a change in resource allocation was associated with changes in rates of ambulatory care sensitive conditions and emergency ward visits in areas with a decrease and increase of resources, respectively. The conclusions of this thesis is that although response rates in health surveys can be relatively low and differ between socioeconomic groups, relative differences in healthcare utilisation between different socioeconomic groups are representative of the source population and not biased, for most groups. Using health survey data to investigate equity in healthcare utilisation allows adjusting the analyses for healthcare needs. Using data where this is not possible is likely to underestimate socioeconomic differences. The 2008 primary care reform did not particularly benefit groups with higher healthcare needs, on the contrary there seems to be a decline in vertical equity in primary care in Stockholm from 2007 to 2011; especially among women with poor health and men with poor mental health as well as men living in disadvantaged areas. In addition, resources have been shifting from areas with populations with higher healthcare needs to areas with populations with lesser healthcare needs in this period (2005-2013). Further investigation is needed in order to fully understand the health effects of shifting resources from poorer to richer areas.
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| 2. |
- Agerholm, Janne, et al.
(author)
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Healthcare professionals' perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital : A qualitative comparative study of two Nordic capitals
- 2023
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In: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 23:1
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Journal article (peer-reviewed)abstract
- Background The handover of older adults with complex health and social care from hospital admissions to homebased healthcare requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals’ views is crucial to show what efforts are needed to manage patient handovers from hospitals to home care, and to identify strengths and weaknesses of the care systems in which they operate.Objective This is a comparative study aiming to examine healthcare professionals’ perceptions on barriers and facilitators for care coordination for older patients with complex health and social care needs being discharged from hospital in two capital cities Copenhagen (DK) and Stockholm (SE).Method Semi-structured interviews were conducted with 25 nurses and 2 assistant nurses involved in the coordination of the discharge process at hospitals or in the home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the participants’ contributions, responsibilities, and influence on decisions during the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed using thematic analysis.Results Main themes were communication ways, organisational structures, and supplementary work by staff. We found that there were differences in the organisational structure of the two care systems in relation to integration between different actors and differences in accessibility to patient information, which influenced the coordination. Municipal discharge coordinators visiting patients at the hospital before discharge and the follow-home nurse were seen as facilitators in Copenhagen. In Stockholm the shared information system with access to patient records were lifted as a facilitator for coordination. Difficulties accessing collaborators were experienced in both settings. We also found that participants in both settings to a high degree engage in work tasks outside of their responsibilities to ensure patient safety.Conclusions There are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs more smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there are more sector-overlapping work which might secure a safer transition from hospital to home. Participants in both settings initiated own actions to weigh out imperfections of the system.
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| 3. |
- Agerholm, Janne, et al.
(author)
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How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers' experiences in Region Stockholm
- 2023
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In: BMC Health Services Research. - 1472-6963. ; 23
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Journal article (peer-reviewed)abstract
- Background In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff.Method A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis.Results Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions.Conclusion Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.
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| 4. |
- Agerholm, Janne, et al.
(author)
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Impact of Integrated Care on the Rate of Hospitalization for Ambulatory Care Sensitive Conditions among Older Adults in Stockholm County : An Interrupted Time Series Analysis
- 2021
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In: International Journal of Integrated Care. - : Ubiquity Press, Ltd.. - 1568-4156. ; 21:2
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Journal article (peer-reviewed)abstract
- Introduction: Reducing avoidable hospital admissions is often viewed as a possible positive consequence of introducing integrated care (IC). The aim of this study was to investigate the impact of implementing IC in Norrtälje on the rate of admissions for ambulatory care sensitive conditions (ACSC).Method: Using interrupted time series analyses we investigated the effect of implementing IC in Norrtälje municipality in the northern part of Stockholm county, Sweden. The time period included 48 time points, from year 2000 to year 2011 with measurements before and after introducing IC in Norrtälje in 2006. In order to control for other extraneous events that could affect the outcome measure, but not related to the introduction of IC, we included a control population from Stockholm municipality.Results: After introducing IC in Norrtälje the rate of admissions for ACSC decreased. This decrease was greater in Norrtälje than in the matched control population, however the difference between the two areas was not statistically significant (p = 0.08).Conclusion: Introducing IC in Norrtälje may have had positive impact on admissions for ACSC for older people living in Norrtälje; however, the interpretation of the impact of IC on admissions for ACSC is complicated by intervening policy changes in health and social care during the study period.
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| 5. |
- Agerholm, Janne, et al.
(author)
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Patient-reported outcomes among patients undergoing total hip replacement in an integrated care system and in a standard care system in Region Stockholm, Sweden
- 2022
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Coordination, cooperation and efficient use of resources is vital for the health- and social care sector if it is to meet the needs of an aging population. Integrated care is a patient-centred approach to provision of care aiming to improve quality of care and overcome fragmented care through co-productive partnerships and may positively affect quality of care and health outcomes, especially among those in need of highly coordinated care services.Aim: To compare patient-reported outcomes (PROs) among patients undergoing total hip replacement (THR) in the integrated care system in Norrtälje Municipality and in the standard care system in other municipalities in Region Stockholm, Sweden.Methods: Swedish Hip Arthroplasty Register PRO data during 2008–2015 were compared 1 year after THR among patients (≥50 years) in integrated care (n = 407) and standard care (n = 3501) systems using linear (EQ VAS score), logistic (EQ-5D-3L dimensions) and negative binomial (hip pain VAS score) regressions. Analyses were adjusted for the preoperative factors age, sex, BMI, ASA class and type of incision.Results: 1-year postoperatively, patients in the integrated care system did not report their health significantly different from patients receiving standard care. Exceptions: Female patients in integrated care reported less problems with self-care (OR:0.52; 0.29–0.96) and patients above 70 years reported more problems with mobility (OR: 1.37; 1.01–1.87).Conclusion: No significant differences were found between the two care systems for postoperative PROs. A longer follow-up time and analyses by socioeconomic groups would be valuable.
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| 6. |
- Agerholm, Janne, et al.
(author)
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The organisation and responsibility for care for older people in Denmark, Finland and Sweden : outline and comparison of care systems
- 2024
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 52:2, s. 119-122
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Journal article (peer-reviewed)abstract
- Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden.Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion, rehabilitation, and social care were presented in relation to policy guidance, funding and organisation.Results: In all three countries, the state issues policy and to some extent co-funds the largely decentralised systems; in Denmark and Sweden the regions and municipalities organise the provision of care services – a system that is also about to be implemented in Finland to improve care coordination and make access more equal. Care for older citizens focuses to a large extent on enabling them to live independently in their own homes.Conclusions: Decentralised care systems are challenged by considerable local variations, possibly jeopardising care equity. State-level decision and policy makers need to be aware of these challenges and monitor developments to prevent further health and social care disparities in the ageing population.
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| 7. |
- Burstrom, Bo, et al.
(author)
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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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In: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905.
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Journal article (peer-reviewed)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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| 8. |
- Doheny, Megan, et al.
(author)
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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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In: BMJ Open. - : BMJ. - 2044-6055. ; 10:6
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Journal article (peer-reviewed)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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| 9. |
- Doheny, Megan, et al.
(author)
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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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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:1, s. 11-20
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Journal article (peer-reviewed)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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| 10. |
- Doheny, Megan, et al.
(author)
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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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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19
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Journal article (peer-reviewed)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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| 11. |
- Doheny, Megan, et al.
(author)
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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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In: BMJ Open. - : BMJ. - 2044-6055. ; 12:7
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Journal article (peer-reviewed)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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| 12. |
- Kirvalidze, Mariam, et al.
(author)
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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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In: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796.
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Journal article (peer-reviewed)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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| 13. |
- Kåreholt, Ingemar, 1960-, et al.
(author)
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History of Job Strain And Risk of Late-Life Dependency : A Nationwide Swedish Registerbased Study
- 2022
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In: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 6:Supplement 1, s. 502-503
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Journal article (peer-reviewed)abstract
- There is substantial evidence that work plays a significant role in post-retirement health. Yet little is known about its role in when late-life dependency may occur. We examined associations between job strain and the risk of entering late-life dependency. Individually linked nationwide Swedish registers were used to identify people 70+ alive in January 2014, and who did not experience the outcome (late-life dependency) during two months prior to the start of the follow-up. Late-life dependency was operationalized as use of long-term care. Information about job strain was obtained via a job exposure matrice and matched with job titles. Cox regression models with age as time-scale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios (HR) for entering late-life dependency during the 24 months of follow-up (n=993,595). Having an initial high starting point of job strain followed by an increasing trajectory throughout working life implied a 23% higher risk of entering late-life dependency at a younger age, compared with the reference group (low starting point with a decreasing trajectory). High initial starting point followed by a stable trajectory implied a 12% higher risk of entering late-life dependency at a younger age. High initial starting point followed by a decreasing trajectory implied a 10% risk reduction, and a low starting point with a stable trajectory implied a 22% risk reduction, of entering late-life dependency at a younger age. Reducing stressful jobs across working life may contribute to postponing late-life dependency.
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| 14. |
- Liljas, Ann E. M., et al.
(author)
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Impact of Integrated Care on Patient-Related Outcomes Among Older People - A Systematic Review
- 2019
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In: International Journal of Integrated Care. - : Ubiquity Press, Ltd.. - 1568-4156 .- 1568-4156. ; 19:3
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Research review (peer-reviewed)abstract
- Introduction: The growing number of older adults with multiple needs increases the pressure to reform existing healthcare systems. Integrated care may be part of such reforms. The aim of this systematic review was to identify important patient-related outcomes of integrated care provided to older adults. Methods: A systematic search of 5 databases to identify studies comprising older adults assessing hospital admission, length of hospital stay, hospital readmission, patient satisfaction and mortality in integrated care settings. Retrieved literature was analysed employing a narrative synthesis. Results: Twelve studies were included (2 randomised controlled trials, 7 quasi-experimental design, 2 comparison studies, 1 survey evaluation). Five studies investigated patient satisfaction, 9 hospital admission, 7 length of stay, 3 readmission and 5 mortality. Findings show that integrated care tends to have a positive impact on hospital admission rates, some positive impact on length of stay and possibly also on readmission and patient satisfaction but not on mortality. Conclusions: Integrated care may reduce hospital admission rates and lengths of hospital stay. However due to lack of robust findings, the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown. Further research is needed to establish the effect of integrated care on these patient-related outcomes.
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| 15. |
- Liljas, Ann E. M., et al.
(author)
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Risk factors for infection in older adults who receive home healthcare and/or home help : A protocol for systematic review and meta-analysis
- 2022
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In: Medicine. - 0025-7974 .- 1536-5964. ; 101:45
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Research review (peer-reviewed)abstract
- Background: The shift towards home-based care has resulted in increased provision of home healthcare and home help to older adults. Infections acquired in older adults while receiving home care have increased too, resulting in unplanned yet avoidable hospitalizations. In recent years, several studies have reported an array of factors associated with risk of infection; however, no previous systematic review has compiled such evidence, which is important to better protect older adults. Therefore, we have outlined the work of a systematic review that aims to identify risk factors for infection in older adults receiving home healthcare and/or home help.Methods: Searches for relevant studies will be conducted in five databases [MEDLINE, EMBASE (Excerpta Medica Database), Web of Science Core Collection, Cinahl (Cumulative Index to Nursing & Allied Health Literature) and Sociological Abstracts]. All types of studies will be included. Exposures considered refer to medical, individual, social/behavioral and environmental risk factors for infection (outcome). Two researchers will independently go through the records generated. Eligible studies will be assessed for risk of biases using the Cochrane risk of bias assessment tool and an overall interpretation of the biases will be provided. If the data allow, a meta-analysis will be conducted. It is possible that both quantitative and qualitative studies will be identified and eligible. Therefore, for the analysis, the Joanna Briggs Institute Reviewers’ Manual for mixed methods systematic reviews will be used as it allows for two or more single method reviews (e.g., one quantitative and one qualitative) to be conducted separately and then combined in a joint overarching synthesis.Results: The findings of the planned systematic review are of interest to healthcare professionals, caregivers, older adults and their families, and policy- and decisions makers in the health and social care sectors as the review will provide evidence-based data on multiple factors that influence the risk of infection among older adults receiving care in their homes.Conclusion: The results could guide future policy on effective infection control in the home care sector.
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| 16. |
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| 17. |
- Naseer, Mahwish, et al.
(author)
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Factors associated with emergency department revisits among older adults in two Swedish regions : A prospective cohort study
- 2020
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In: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 86
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Journal article (peer-reviewed)abstract
- ObjectivesTo assess the association between baseline characteristics at an index ED visit and ED revisit within 30 days among adults aged ≥ 65 years in two Swedish regions.MethodsThis was a register-based prospective cohort study. The sample included (N=16 688; N=101 017) older adults who have had an index ED visit in 2014 at hospital based EDs in the regions of Dalarna and Stockholm, Sweden. Several registers were linked to obtain information on sociodemographic factors, living conditions, social care, polypharmacy and health care use. Multivariate logistic regression was used to analyse the data.ResultsSeventeen percent of the study sample in Dalarna and 20.1% in Stockholm revisited ED within 30 days after an index ED visit. In both regions, male gender, being in the last year of life, excessive polypharmacy (≥ 10 drugs), ≥11 primary care visits and ED care utilization were positively associated with ED revisits. In Stockholm, but not in Dalarna, low level of education, polypharmacy, and institutional care was also associated with ED revisits. In contrast, home help was associated with ED revisits in Dalarna but not in Stockholm.ConclusionThese findings call for further in-depth examinations of variations within single countries. ED revisits among older adults are driven by need of care but also by the social and care situation.
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| 18. |
- Nilsen, Charlotta, et al.
(author)
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History of working conditions and the risk of old-age dependency : a nationwide Swedish register-based study
- 2023
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In: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905.
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Journal article (peer-reviewed)abstract
- Aims: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions' association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care. Methods: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up (n = 931,819). Results: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19-1.27; physical demands: HR 1.36, 95% CI 1.31-1.40, and hazardous work: HR 1.35, 95% CI 1.30-1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency. Conclusions: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.
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