| 1. |
- Baxter, Rebecca, et al.
(författare)
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COVID-19 : Opportunities for interdisciplinary research to improve care for older people in Sweden
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 49:1, s. 29-32
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Tidskriftsartikel (refereegranskat)abstract
- The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.
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| 2. |
- Dahlberg, Lena, 1970-, et al.
(författare)
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A systematic review of longitudinal risk factors for loneliness in older adults
- 2021
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Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 26:2, s. 225-249
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To effectively reduce loneliness in older adults, interventions should be based on firm evidence regarding risk factors for loneliness in that population. This systematic review aimed to identify, appraise and synthesise longitudinal studies of risk factors for loneliness in older adults.METHODS: Searches were performed in June 2018 in PsycINFO, Scopus, Sociology Collection and Web of Science. Inclusion criteria were: population of older adults (M = 60+ years at outcome); longitudinal design; study conducted in an OECD country; article published in English in a peer-review journal. Article relevance and quality assessments were made by at least two independent reviewers.RESULTS: The search found 967 unique articles, of which 34 met relevance and quality criteria. The Netherlands and the United States together contributed 19 articles; 17 analysed national samples while 7 studies provided the data for 19 articles. One of two validated scales was used to measure loneliness in 24 articles, although 10 used a single item. A total of 120 unique risk factors for loneliness were examined. Risk factors with relatively consistent associations with loneliness were: not being married/partnered and partner loss; a limited social network; a low level of social activity; poor self-perceived health; and depression/depressed mood and an increase in depression.CONCLUSION: Despite the range of factors examined in the reviewed articles, strong evidence for a longitudinal association with loneliness was found for relatively few, while there were surprising omissions from the factors investigated. Future research should explore longitudinal risk factors for emotional and social loneliness.
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| 3. |
- Dahlberg, Lena, 1970-, et al.
(författare)
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Ensamhet bland äldre personer i Norden
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Rapporten presenterar översikter av tidigare forskning och analyser av känslan av ensamhet bland äldre personer. Överlag finns det kunskap om ensamhetens konsekvenser för ohälsa, men det behövs ytterligare forskning där starkare slutsatser kan dras om sambandens riktning, och ett tydligare fokus på ensamhet i gruppen äldre personer. En systematisk översikt visar att det finns god kunskap om en del faktorer som ökar risken för ensamhet, men mer forskning behövs om andra potentiella riskfaktorer. Analyserna visar en relativt låg och stabil förekomst av ensamhet bland äldre personer i Norden, samt att ohälsa och olika indikatorer för social exkludering (t.ex. bristande sociala relationer, otillräcklig inkomst, samt otrygghet i närområdet) har samband med ensamhet. Slutligen konstateras att forskningen om nordiska interventioner för att minska ensamhet bland äldre personer är begränsad.
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| 4. |
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| 5. |
- Fagerström, Cecilia, Docent, 1973-, et al.
(författare)
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Nutrition in old age : the importance for quality of life and longevity
- 2016
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Ingår i: 23NKG2016, 23<sup>rd</sup> Nordic Congress of Gerontology. Tampere, Finland. ; , s. 167-167
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Konferensbidrag (refereegranskat)abstract
- Inadequate nutrition status results in poor health outcomes, which in turn influence quality of life and longevity. Most research concerning malnutrition in old age has focus on people living in nursing homes or hospitals, while knowledge of the condition in the older population (i.e. in both community living older persons and persons living in nursing homes) are still scarce. Aim/Methods: This presentation, based on data from the Swedish national and longitudinal study of aging and care, (SNAC-B), includes a discussion about persons (n=1402, 60+ years) who were at risk of malnutrition during a 7-year follow-up, seen from a criterionbased nutrition assessment. Findings: The risk of malnutrition significantly increased the risk of poor physical and mental health related quality of life. Moreover, at baseline, 8.6% subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. Risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, p<0.001). Conclusion: It is important to highlight older people’s functional ability both for prevention of undernutrition and promotion of quality of life and longevity.
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| 6. |
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| 7. |
- Naseer, Mahwish, et al.
(författare)
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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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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 86
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Tidskriftsartikel (refereegranskat)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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| 8. |
- Naseer, Mahwish, et al.
(författare)
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Health related quality of life and emergency department visits in adults of age >= 66 years : a prospective cohort study
- 2018
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Ingår i: Health and Quality of Life Outcomes. - : BioMed Central. - 1477-7525. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Age increases the risk of emergency department [ED] visits. Health related quality of life (HRQoL) is often estimated as an outcome of ED visits, but it can be a risk factor of ED visits. This study aims to assess the association of HRQoL with time to first ED visit and/or frequent ED use in older adults during four-year period and if this association differs in 66-80 and 80+ age groups. Methods: Data from the Swedish National Study on Aging and Care-Blekinge of wave 2007-2009 was used in combination with electronic health records on ED visits. The analytical sample included 673 participants of age 66 years and older with information on HRQoL. Cox proportional hazard model was used to assess the association between HRQoL and time to first ED visit. Logistic regression analysis was performed to estimate the association of HRQoL with frequent ED use. Results: During the study period, 55.3% of older adults visited the ED and 28.8% had a frequent ED use. Poor physical HRQoL was independently associated with first ED visit both in total sample (p < 0.001) and in 66-80 (p < 0. 001) and 80+ (p = 0.038) age groups. Poor mental HRQoL had no significant association with first ED visit and frequent ED use. Conclusion: Findings suggest that poor physical HRQoL is associated with time to first ED visit in older adults. Therefore, physical HRQoL should be considered while planning interventions on the reduction of ED utilisation in older adults. Explanatory factors of frequent ED use may differ in age groups. Further studies are needed to identify associated factors of frequent ED visits in 80+ group.
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| 9. |
- Naseer, Mahwish, et al.
(författare)
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Individual and contextual predictors of emergency department visits among community-living older adults : a register-based prospective cohort study
- 2022
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 12:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.DESIGN: A register-based prospective cohort study.SETTING: Swedish region of Dalarna.PARTICIPANTS: Participants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period.OUTCOME MEASURES: Dependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit.RESULTS: Approximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED visit was significantly associated with older age, number of chronic diseases, receipt of home help, number of primary care visits, proportion of 80+ in the population and shorter distance to the ED; while an ED revisit was significantly associated with greater use of social care, number of hospital admissions and disposition (discharged; admitted to hospital) at initial ED visit.CONCLUSION: Contextual factors explain variance in initial ED visit, additional to that explained by individual factors alone, which indicates inequitable access to ED care. These findings suggest considering local variations in contextual factors in order to improve health-related outcomes among older adults.
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| 10. |
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| 11. |
- Naseer, Mahwish, et al.
(författare)
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Psychometric properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA) in a study of Swedish people aged ≥ 60 years
- 2017
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Ingår i: JARCP - The Journal of Aging Research & Clinical Practice. - : Serdi Publisher. - 2273-421X. ; 6, s. 32-39
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to investigate the risk of malnutrition and to evaluate the psychometric properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA), SOMRA cut-offs and Swedish-Guidelines on Malnutrition Risk Assessment (SGMRA) for Swedish people aged ≥ 60 years.Setting: This study included both older people living at home and those in special housing.Participants: 1222 of the 1402 subjects aged ≥ 60 years who had participated in the baseline survey (2001–2003) as part of the ongoing National Study on Aging and Care-Blekinge (SNAC-B) were included because they had provided complete information on Mini-Nutritional Assessment (MNA).Measurements: The risk of malnutrition was estimated by the SOMRA, MNA, and SGMRA. To measure concurrent validity, the Receiver Operating Characteristics (ROC) curve, Cohen’s kappa (κ) and Spearman’s rank correlation coefficient rho (rs) were used. Youden’s index (J) was computed to assess the optimal cut-off on SOMRA. Cronbach’s alpha (α) was used to test reliability.Results: The risks of malnutrition measured by SOMRA, MNA and SGMRA were 6.5%, 8.6% and 20.9%, respectively. The risk was higher among older people living in special housing compared to those at home (p < 0.05). Different optimal cut-offs on SOMRA were observed for residents living at home (≥ 1) and those in special housing (≥ 3). Compared to SGMRA, the SOMRA and SOMRA cut-off ≥ 3 gave higher values for J (0.68, 0.81, and 0.84, respectively), κ (0.59, 0.77, and 0.84, respectively) and rs (0.64, 0.78, and 0.84, respectively) for the older people in special housing. The reliability for SOMRA was α = 0.71.Conclusion: The risk of malnutrition was higher among older people in special housing than among those living at home. For the people in special housing, the SOMRA and SOMRA cut-off ≥ 3 showed higher concurrent validity with MNA compared to the SGMRA, but not for older people living at home. SOMRA includes six items, takes less time to implement and is composed of both subjective and anthropometric measurements; therefore, it is suitable for use in special housing and/or clinical settings to identify the risk of malnutrition or the need for nutritional support.
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| 12. |
- Naseer, Mahwish, et al.
(författare)
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The role of social connections and support in the use of emergency care among older adults
- 2023
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier Ireland Ltd. - 0167-4943 .- 1872-6976. ; 111
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Limited and inconsistent findings have been reported on the link between social connections and support and emergency department (ED) visits in older populations. Moreover, the adequacy of informal care for older adults has rarely been considered. This study explored the associations of social connections, social support, and informal care with ED visits in younger-old (<78 years) and oldest-old (≥78 years) adults. Methods: This is a prospective cohort study based on community-living adults ≥60 years old participating in the Swedish National Study on Aging and Care in Kungsholmen (N=3066 at wave 1, 2001-2004; N=1885 at wave 3, 2007-2010; N=1208 at wave 5, 2013-2016). Standardised indexes were developed to measure social connections, social support, and informal care. The outcome variable was hospital-based ED visits within 4 years of the SNAC-K interview. Associations between exposure variables and ED visits were assessed through negative binomial regressions using generalised estimating equations. Results: Medium (IRR 0.77; 95% CI 0.59–0.99) and high (IRR 0.77; 95% CI 0.56–0.99) levels of social support were negatively associated with ED visits compared to low levels of social support, but only in oldest-old adults. No statistically significant associations were observed between social connections and ED visits. Higher ED visit rates were seen in oldest-old adults with unmet informal care needs, even if the differences did not reach statistical significance. Conclusions: ED visits were associated with social support levels among adults aged ≥78 years. Public health interventions to mitigate situations of poor social support may improve health outcomes and reduce avoidable ED visits in oldest-old adults. © 2023
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| 13. |
- Naseer, Mahwish
(författare)
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Why do older adults seek emergency care? The impact of contextual factors, care, health, and social relations
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Emergency department (ED) visits are becoming more prevalent globally. EDs provide care for acute health conditions, but some of these visits are driven by needs unmet by primary health care and social care for older adults, indicating ineffective social care and healthcare systems. The ED is often an inappropriate setting for older adults because of the lack of interdisciplinary teams with clinical competence in the care of an increasingly ageing population and because of poor continuity of care which entails the risk of adverse health outcomes. The Andersen model of health services use proposes contextual and individual factors to understand health care utilisation better. However, there are knowledge gaps in research on ED care in relation to contextual factors, home help receipt, and aspects related to inadequate informal care. Moreover, selection bias often limits previous research on ED care. Aim: The overall aim was to study factors associated with ED care use in older adults. Design: Prospective cohort study Study sample: All adults ≥65 years with ED visits in 2014 living in two Swedish regions (Dalarna, N=16 688 and Stockholm, N=101 017) participated in study I. The study population in study II was all community-living older-old adults (≥80 years) who were registered residents of Dalarna on 31 December 2014, excluding those who moved into residential care facilities during 2015 (N=16 543). In study III, the participants were adults ≥60 years who participated in the Swedish National Study on Aging and Care-Kungsholmen (SNAC-K). The data were pooled from three waves (W) of SNAC: W1= 2001-2003, W3=2007-2009, and W5=2013-2015. Persons living in residential care facilities were excluded from study III providing an analytical sample of N=3 066 at W1, N=1 885 at W3, and N=1 208 at W5. In study IV, adults ≥66 years who participated in the SNAC-Blekinge study (W3: 2007-2009) and who provided information on the exposure variable were included (N=673). Data sources: The four studies of this thesis were based on national and regional registers and survey data. The registers were the Longitudinal Integration Database for Health Insurance and Labour Market, the Social Services Register, the Swedish Prescribed Drug Register, the National Patient Register, and the health care databases of Region Blekinge, Dalarna, and Stockholm. Municipal-level data were accessed from Kolada, a publicly accessible, comprehensive national database. Survey data were based on the Swedish National study on Aging and Care in Blekinge and Kungsholmen. Dependent variables: The dependent variables were ED visits, at least one ED revisit within 30 days of an initial ED visit, and frequent ED use. Independent variables: The independent variables included contextual factors (the proportion of adults aged ≥80 years in the total population, annual social care expenditures per person aged ≥80 years, home help quality, median days in residential care, and distance to the ED), individual-level predisposing factors (age, gender, and education), individual-level enabling resources (living arrangements, social connections, social support, and informal care), individual-level need factors (subjective and objective health status), and health care and social care use (primary health care visits, specialist care visits, hospital admissions, ED visits in the previous year, disposition at initial ED visit (admission to inpatient care/discharged home), residential care receipt, and home help receipt). Data analyses: Logistic regression models were used to analyse the associations between independent variables and dichotomous dependent variables (ED visits, ED revisits, frequent ED use). Cox regression models were computed to determine the association between independent variables and time to the first ED visit. Associations between independent variables and the number of ED visits were assessed using generalised estimating equations with negative binomial regressions. In studies III and IV, all analyses were stratified by age group (Study III: younger-old, <78 years, older-old, ≥78 years; Study IV: younger-old, ≤80 years, older-old >80 years). Results: Analysis of contextual factors showed that the proportion of adults aged ≥80 years in the total population and shorter distance to the ED were associated with ED visits in older-old adults (Study II). There were mixed findings on age, gender, and education level for individual-level predisposing factors. Regarding individual-level enabling resources, higher levels of social support were negatively associated with ED visits but only in older-old adults (Study III). In relation to the need for care factors, poor health status was associated with ED visits (Studies II-IV), ED revisits (Study I), and frequent ED use (Study IV). Concerning the utilisation of care, primary health care visits in the previous 12 months were associated with ED visits (Study II) and ED revisits (Study I). Hospital admissions and ED visits 12 months before the initial ED visit were associated with ED revisits (Studies I & II). Older-old adults admitted to inpatient care at the initial ED visits were 29% less likely to revisit an ED within 30 days of the initial ED visit than those discharged home (Study II). Older-old adults receiving home help for instrumental services and personal care were 148% more likely to visit an ED compared to those not receiving home help. This group with intensive home help also had a 30% higher likelihood of an ED revisit within 30 days of the initial ED visit (Study II). Conclusions: Contextual factors contribute to understanding ED care use in older adults. Our findings on poor health status suggest that the need for care determines ED care use in older adults. However, factors other than health status also explain the use of ED care. For example, social support indicates inequalities and suggests investing in public health resources to address these risk factors. Discharge to home from the ED and risk of an ED revisit could indicate that health care and post-discharge care are not meeting the needs of older patients. Findings on the home help receipt and ED care use illustrate the vulnerability of this group and highlight the importance of future research on self-reported unmet needs of home help and the effect of unmet needs on the use of ED care.
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