| 1. |
- Allebeck, Peter, 1952, et al.
(författare)
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Gothenburg study of women and alcohol: Low prevalence of abuse - trend toward increase appears to have abated : Studie i Göteborg om kvinnor och alkohol: Låg förekomst av missbruk - ökningen förefaller ha avklingat
- 2001
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Ingår i: Läkartidningen. - 0023-7205. ; 98:10, s. 1103-07
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Tidskriftsartikel (refereegranskat)abstract
- Prevalence of alcohol dependence and abuse (ADA) was determined in a cohort of women selected by stratified random sampling from the general population in Gothenburg. A questionnaire was administered to 3,130 women and 399 were interviewed. Questions were asked about social background, living conditions, family and working life. Volume and frequency of alcohol intake were recorded, and diagnoses were made according to DSM-III. We found that the one-year prevalence of ADA was 1.5 percent and the life time prevalence 3.3 percent. In a follow-up five years after base-line, the prevalence of ADA was unchanged, while indicators of high alcohol consumption and high episodic drinking showed reduced levels of problem drinking.
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| 2. |
- Andersson Hammar, Isabelle, et al.
(författare)
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Frail older people with decreased cognition can perceive reduced self-determination in self-care and social relationships.
- 2024
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Ingår i: BMC geriatrics. - 1471-2318. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Self-determination in old age is essential for people's experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people.This study was a cross-sectional secondary data analysis using baseline data with 119 frail people 75≥from a larger randomized control trial. Self-determination was measured with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O). Cognition was measured using the Mini Mental State Examination (MMSE), where decreased cognition was broadly defined as a score below 25 points. Fisher's exact test was used to test differences in proportions of perceiving self-determination in relation to cognition. The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination in relation to cognitive functioning.Nearly the entire study population, regardless of cognitive functioning, perceived self-determination in Financial situation. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care and in Social relationships when comparing with the participants with intact cognition.Perceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. Organizing healthcare needs according to the older people's wants and wishes is crucial regardless of people having a cognitive decline or not when the effort is to enable the people to be as self-determined as they want. The frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should navigate the older people to get to their desired direction.ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.
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| 3. |
- Behm, Lina, 1978, et al.
(författare)
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Positive health outcomes following health-promoting and disease-preventive interventions for independent very old persons: Long-term results of the three-armed RCT Elderly Persons in the Risk Zone
- 2014
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Ingår i: Archives of gerontology and geriatrics. - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 58:3, s. 376-383
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyze the long-term effect of the two health-promoting and disease-preventive interventions, preventive home visits and senior meetings, with respect to morbidity, symptoms, self-rated health and satisfaction with health. The study was a three-armed randomized, single-blind, and controlled trial, with follow-ups at one and two years after interventions. A total of 459 persons aged 80 years or older and still living at home were included in the study. Participants were independent in ADL and without overt cognitive impairment. An intention-to-treat analysis was performed. The result shows that both interventions delayed a progression in morbidity, i.e. an increase in CIRS-G score (OR = 0.44 for the PHV and OR = 0.61 for senior meetings at one year and OR = 0.60 for the PHV and OR = 0.52 for the senior meetings at two years) and maintained satisfaction with health (OR = 0.49 for PHV and OR = 0.57 for senior meetings at one year and OR = 0.43 for the PHV and OR = 0.28 for senior meetings after two years) for up to two years. The intervention senior meetings prevented a decline in self-rated health for up to one year (OR = 0.55). However, no significant differences were seen in postponing progression of symptoms in any of the interventions. This study shows that it is possible to postpone a decline in health outcomes measured as morbidity, self-rated health and satisfaction with health in very old persons at risk of frailty. Success factors might be the multi-dimensional and the multi-professional approach in both interventions. Trial registration: NCT0087705. © 2014 Elsevier Ireland Ltd. All rights reserved.
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| 4. |
- Berglund, Helene, 1957, et al.
(författare)
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Effects of a continuum of care intervention on frail older persons' life satisfaction: a randomized controlled study
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:7-8, s. 1079-1090
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives The aim of this study was to analyse effects of a comprehensive continuum of care (intervention group) on frail older persons’ life satisfaction, as compared to those receiving usual care (control group). The intervention included geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older persons’ own homes. Background Improvements in older persons’ subjective well-being have been shown in studies including care planning and coordination by a case manager. However, effects of more complex continuum of care interventions on frail older persons’ life satisfaction are not well explored. Design Randomised controlled study. Methods The validated LiSat-11 scale was used in face-to-face interviews to assess older persons’ life satisfaction at baseline and at three, six and 12 months after the baseline. The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three-month, three- to six-month as well as six- to 12-month follow-ups. Results Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care, between 6 and 12 month follow-ups, for satisfaction regarding functional capacity, psychological health and financial situation. Conclusions A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons’ satisfaction with functional capacity, psychological health and financial situation. Relevance to clinical practice Frail older persons represent a great proportion of the persons in need of support from the health care system. Health care professionals need to consider continuum of care interventions’ impact on life satisfaction. As life satisfaction is an essential part of older persons’ well-being, we propose that policy makers and managers promote comprehensive continuum of care solutions.
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| 5. |
- Berglund, Helene, 1957, et al.
(författare)
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Older people's views of quality of care: a randomised controlled study of continuum of care
- 2013
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 22:19-20, s. 2934-2944
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives To analyse frail older peoples views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older peoples own homes. less thanbrgreater than less thanbrgreater thanBackground Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older peoples views of quality of care. less thanbrgreater than less thanbrgreater thanDesign Randomised controlled study. less thanbrgreater than less thanbrgreater thanMethods Items based on a validated questionnaire were used in face-to-face interviews to assess older peoples views of quality of care at three, six and 12months after baseline. less thanbrgreater than less thanbrgreater thanResults Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p0005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12months (pandlt;003). less thanbrgreater than less thanbrgreater thanConclusions The study gives evidence of the advantages of a combination of components such as organising care-planning meetings in older peoples own homes, case management and interprofessional teamwork. less thanbrgreater than less thanbrgreater thanRelevance to clinical practice The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people.
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| 6. |
- Berglund, Helene, 1957, et al.
(författare)
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The impact of socioeconomic conditions, social networks, and health on frail older people's life satisfaction: a cross-sectional study
- 2016
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Ingår i: Health Psychology Research. - : Open Medical Publishing. - 2420-8124. ; 4:1, s. 26-31
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Tidskriftsartikel (refereegranskat)abstract
- It has been shown that frailty is associated with low levels of wellbeing and life satisfaction. Further exploration is needed, however, to better understand which components constitute life satisfaction for frail older people and how satisfaction is related to other life circumstances. The aim of this study was to examine relationships between frail older people's life satisfaction and their socioeconomic conditions, social networks, and health-related conditions. A cross-sectional study was conducted (n=179). A logistic regression analysis was performed, including life satisfaction as the dependent variable and 12 items as independent variables. Four of the independent variables made statistically significant contributions: financial situation (OR 3.53), social contacts (OR 2.44), risk of depression (OR 2.26), and self rated health (OR 2.79). This study demonstrates that financial situation, self-rated health conditions and social networks are important components for frail older people's life satisfaction. Health and social care professionals and policy makers should consider this knowledge in the care and service for frail older people; and actions that benefit life satisfaction such as social support should be promoted.
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| 7. |
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| 8. |
- Dahlin-Ivanoff, Synneve, 1950, et al.
(författare)
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Comprehensive geriatric assessment of frail older people: ideals and reality
- 2018
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Ingår i: Journal of Interprofessional Care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 32:6, s. 728-734
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Tidskriftsartikel (refereegranskat)abstract
- We explored different professionals’ views on and experiences of comprehensive geriatric assessment (CGA) of frail older people. Forty-six professionals working in hospitals, primary care, or municipal health and social care participated in 10 focus groups. Professional groups comprised of occupational therapists, physiotherapists, nurses, physicians, and social workers. Participants shared an ideal image of how the CGA of frail elderly people should be conducted. Experience-based competence was more often used as an assessment tool than standardized tests. The ideal image contrasted with reality, listening to the needs expressed, with the person’s problems, needs, and priorities in the foreground, as described by the categories: a need that can be met; different perspectives on needs; needs can be hidden; and needs assessment is affected by the collaboration around the person, by the context, and by the dialogue. The health and social care professionals’ first priority is to make a person-centred tailor-made comprehensive geriatric assessment and not be bound to instruments. Clear guidelines need to be developed, stating which profession assesses what, when and how in order to ensure that person-centred needs are assessed including structures and procedures for how communication and collaboration within the team as well as between the organizations are achieved in order to perform a good person-centred CGA.
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| 9. |
- Dahlin-Ivanoff, Synneve, 1950, et al.
(författare)
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Elderly persons in the risk zone: Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home
- 2010
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Ingår i: BMC geriatrics. - 1471-2318. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The very old (80+) are often described as a "frail" group that is particularly exposed to diseases and functional disability. They are at great risk of losing the ability to manage their activities of daily living independently. A health-promoting intervention programme might prevent or delay dependence in activities of daily life and the development of functional decline. Studies have shown that those who benefit most from a health-promoting and disease-preventive programme are persons with no, or discrete, activity restrictions. The three-armed study "Elderly in the risk zone" is designed to evaluate if multi-dimensional and multi-professional educational senior meetings are more effective than preventive home visits, and if it is possible to prevent or delay deterioration if an intervention is made when the persons are not so frail. In this paper the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants are presented. METHODS: The study is a randomised three-armed single-blind controlled trial with follow-ups 3 months, 1 and 2 years. The study group should comprise a representative sample of pre-frail 80-year old persons still living at home in two municipalities of Gothenburg. To allow for drop-outs, it was estimated that a total of about 450 persons would need to be included in the study. The participants should live in their ordinary housing and not be dependent on the municipal home help service or care. Further, they should be independent of help from another person in activities of daily living and be cognitively intact, having a score of 25 or higher as assessed with the Mini Mental State Examination (MMSE). DISCUSSION: We believe that the design of the study, the randomisation procedure, outcome measurements and the study protocol meetings should ensure the quality of the study. Furthermore, the multi-dimensionality of the intervention, the involvement of both the professionals and the senior citizens in the planning of the intervention should have the potential to effectively target the heterogeneous needs of the elderly.
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| 10. |
- Dahlin-Ivanoff, Synneve, 1950, et al.
(författare)
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For whom is a health-promoting intervention effective? : Predictive factors for performing activities of daily living independently
- 2016
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health-promoting interventions tailored to support older persons to remain in their homes, so-called “ageing in place” is important for supporting or improving their health. The health-promoting programme “Elderly Persons in the Risk Zone,” (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme. Methods: Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm. Results: In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up. Conclusions: Older persons living alone - as a risk of ill health - should be especially recognized and offered an opportunity to participate in health-promoting programmes such as “Elderly Persons in the Risk Zone”. Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered. Trial registration: The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009.
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| 11. |
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| 12. |
- Ebrahimi, Zahra, et al.
(författare)
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Effects of a continuum of care intervention on frail elders’ self-rated health, experiences of security/safety and symptoms: A randomised controlled trial
- 2017
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Ingår i: Nordic Journal of Nursing Research. - : SAGE Publications. - 2057-1585 .- 2057-1593. ; 37:1, s. 33-43
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to evaluate effects of the intervention on self-rated health, experiences of security/safety and symptoms. A nonblinded controlled trial was performed with participants randomised to either the intervention group or a control group, with follow-ups at 3, 6 and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of older adults, with a case manager from the municipality as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mo¨ lndal and who were discharged to their own homes in the Mo¨ lndal municipality were asked to participate. Inclusion criteria were age 80 years and older, or 65 to 79 years with at least one chronic disease and dependency in at least one activity of daily living. Analyses were conducted on the basis of the intention-to-treat principle. Outcome measures were self-rated health, experiences of security/safety and symptoms. These were analysed using Svensson’s method. Of 161 participants, 76 were allocated to the control group and 85 to the intervention group. Positive effects of the intervention were observed for frail older adult’s symptoms and self-rated health.
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| 13. |
- Ebrahimi, Zahra, et al.
(författare)
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Frail Elders' Experiences With and Perceptions of Health
- 2012
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 22:11, s. 1513-1523
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Tidskriftsartikel (refereegranskat)abstract
- In this study we explored frail elders' experiences with and perceptions of the phenomenon of health so as to develop a deeper understanding of living with diseases and disorders in old age. Frail elders participated in qualitative interviews that explored the meaning of the phenomenon of health for them. Eleven men and 11 women, who had diverse ratings of self-perceived health ranging from poor to excellent, were selected by means of a purposeful strategic sampling of frail elders taken from a broader sample that participated in a larger quantitative study on health. In total, 22 individual interviews were analyzed using Giorgi's descriptive phenomenology. We found that frail elders described health as being in harmony and balance in everyday life, and this occurred when participants were able to adjust to the demands of their daily lives in the context of their resources and capabilities.
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| 14. |
- Ebrahimi, Zahra, et al.
(författare)
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Health despite frailty: Exploring influences on frail older adults’ experiences of health
- 2013
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Ingår i: Geriatric Nursing. - 0197-4572 .- 1528-3984. ; 34:2013, s. 289-294
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore and identify influences on frail older adults’ experience of health. A sample of older adults, 11 men and 11 women aged 67e92, with diverse ratings of self-perceived health ranging from poor to excellent were selected through a purposeful strategic sampling of frail older adults taken from a broader sample from a quantitative study on health. In total, 22 individual qualitative interviews were analyzed using qualitative content analysis in which themes were developed from raw data through a systematic reading, categorization of selected text, theme development and interpretation. To feel assured and capable was the main theme, which consisted of five subthemes: managing the unpredictable body, reinforcing a positive outlook, remaining in familiar surroundings, managing everyday life, and having a sense of belonging and connection to the whole. The importance of supporting frail older adults in subjective resilience in their context is emphasized.
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| 15. |
- Ebrahimi, Zahra, et al.
(författare)
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Self-rated health and health-strengthening factors in community-living
- 2015
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 71:4, s. 825-836
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Aim. The aim of this study was to analyse the explanatory power of variables measuring health-strengthening factors for self-rated health among communityliving frail older people. Background. Frailty is commonly constructed as a multi-dimensional geriatric syndrome ascribed to the multi-system deterioration of the reserve capacity in older age. Frailty in older people is associated with decreased physical and psychological well-being. However, knowledge about the experiences of health in frail older people is still limited. Design. The design of the study was cross-sectional. Method. The data were collected between October 2008 and November 2010 through face-to-face structured interviews with older people aged 65–96 years (N = 161). Binary logistic regression was used to analyse whether a set of explanatory relevant variables is associated with self-rated health. Results. The results from the final model showed that satisfaction with one’s ability to take care of oneself, having 10 or fewer symptoms and not feeling lonely had the best explanatory power for community-living frail older peoples’ experiences of good health. Conclusion. The results indicate that a multi-disciplinary approach is desirable, where the focus should not only be on medical problems but also on providing supportive services to older people to maintain their independence and experiences of health despite frailty.
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| 16. |
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| 17. |
- Eklund, Kajsa, 1952, et al.
(författare)
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Long term outcome of frailty and ADL following "Continuum of care for frail elderly persons"
- 2012
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Ingår i: The Gerontologist. 2012 GSA Annual Scientific Meeting Abstracts. - 0016-9013 .- 1758-5341. ; 52:S1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The current trend in Western societies facing a growing proportion of older people is to support frail older persons to remain in their homes as long as possible, so-called ageing in place. Older persons comprise a group whose reserve of strength is decreasing, and whose activity and participation levels will deteriorate with increasing frailty, often leading to dependence in daily activities. Frail older persons need integrated care from different caregivers at different care levels with multi-professional competences. An intervention study for frail community-dwelling older people was designed, creating a continuum of care from the hospital through and back to their own homes. Objectives were to evaluate its effects on activities of daily living (ADL) and frailty up to one year. The study design was a RCT with participants randomized to either the intervention or a control group with follow-ups at three-, six- and 12 months. The study group includes 161 older people who sought care at the emergency department at Mölndal hospital, Sweden, and discharged to their own homes. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in ADL. Frailty was measured as a sum of eight core frailty indicators and ADL with the ADL staircase. The analyses were made on the basis of the intention-to-treat principle. At both three- and twelve-month follow-up the intervention group had a higher OR in improved number of ADL managed independently. There were no significant differences between the groups regarding frailty.
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| 18. |
- Eklund, Kajsa, 1952, et al.
(författare)
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One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; "Continuum of care for frail older people"
- 2013
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: The intervention; "Continuum of Care for Frail Older People", was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person's own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL). Methods: The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Molndal and who were discharged to their own homes in the municipality of Molndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR). Results: A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three-and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 - 4.68) and (2.04, 95% CI; 1.03 - 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 - 0.98) compared to the control group. Conclusions: The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.
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| 19. |
- Eklund, Kajsa, 1952, et al.
(författare)
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Outcomes of Coordinated and Integrated Interventions Targeting Frail Elderly – a systematic review of randomized controlled trials
- 2009
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Ingår i: Health and Social Care in the Community. ; 17:5, s. 447-58
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Forskningsöversikt (refereegranskat)abstract
- The aim was to review randomised controlled trials on integrated and coordinated interventions targeting frail elderly living in the community; their outcome measurements and their effects on the client, the caregiver and the health care utilization. The literature search was made in PubMed, AgeLine, Cinahl and AMED with following inclusion criteria: original article; integrated intervention including case management or equivalent coordinated organization; frail elderly living in the community; randomized controlled trials; in the English language, and published in refereed journals between 1997 and July 2007. The final review included nine articles, each describing one original integrated intervention study. Of these studies, one was from Italy, three from the US and five from Canada. Seven studies reported at least one outcome measurement significantly in favour of the intervention, one reported no difference and one in favour of the control. Five of the studies reported at least one outcome on client level in favour of the intervention. Only two studies reported caregiver outcomes, both in favour of the intervention on caregiver satisfaction, but no effect on caregiver burden. Outcomes focusing health care utilization were reported significantly in favour of the intervention in five of the studies. Five of the studies used outcome measurements with unclear psychometric properties and four with disease specific measurements. This review indicates that an integrated and coordinated care is beneficial for the frail elderly population. There is still a need for further studies performed in different health care systems. There is also a lack of knowledge of how integrated and coordinated care affects the caregiver. This review pinpoints the importance of using valid outcome measurements and to describe the intervention both to content and implementation.
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| 20. |
- Eklund, Kajsa, 1952, et al.
(författare)
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Screening for frailty among older emergency department visitors: validation of the new FRESH-screening instrument: validating a short screening for frailty
- 2016
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Ingår i: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 16:27
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Tidskriftsartikel (refereegranskat)abstract
- Background The identification of frail older persons in different health care settings is widely seen as an important step in improving the healthcare system. Screening at an emergency department (ED) should be handled in just a few minutes without the use of tests or measurements. The FRESH-screening was developed for this purpose. This study’s aim was to evaluate the FRESH-screening and its construct validity; also assessed were the sensitivity, specificity, and predictive values for frailty screening. Methods The study had a cross-sectional design. A total of 161 elderly people who sought care at the emergency department at Mölndal Hospital were included. Inclusion criteria were ages ≥80 years or ages 65–79 with at least one chronic disease and dependence in at least one daily living activity. Sensitivity, specificity, and predictive values were calculated to describe the accuracy of the FRESH-screening in identifying those with frailty, as assessed by eight frailty indicators. Sensitivity and specificity were both set at a minimum of 80%, and a percentage sum ≥150 of the sensitivity and positive prediction was considered a measure of excellent value. Result Both sensitivity and specificity were high (81% and 80%, respectively) when comparing the four questions of the FRESH-screening against the eight frailty indicators. The percentage sum of sensitivity and positive prediction was 173 (81% + 92%), thus exceeding the 150 cutoff.
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| 21. |
- Falk Erhag, Hanna, et al.
(författare)
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The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature
- 2023
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Ingår i: Clinical Interventions in Aging. - 1178-1998. ; 18, s. 249-261
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Tidskriftsartikel (refereegranskat)abstract
- Background: Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill.Purpose: To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings. Design: Systematic review with narrative synthesis.Methods: Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Results: Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review.Conclusion: A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
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| 22. |
- Fornazar, Robin, et al.
(författare)
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Alcohol Consumption among the Oldest Old and >How It Changes during Two Years
- 2013
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Ingår i: ISRN Geriatrics. - : Hindawi Limited. - 2314-4750. ; 2013
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Tidskriftsartikel (refereegranskat)abstract
- This longitudinal study aimed to examine the pattern of alcohol consumption (using the AUDIT-C) among the oldest old (80+) and how it changed two years later. Five hundred seventy-six persons from the Gothenburg metropolitan area were interviewed between 2008 and 2011. Men represented a higher proportion of at-risk consumers (21.8%) than women (14.5%), but there was no sex difference in binge drinking (13.8% versus 12%). Men decreased their weekly consumption and also the proportion of binge drinking, and women decreased only in binge drinking. Further studies of the causality between alcohol consumption and health are suggested.
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| 23. |
- Gudnadottir, Gudny Stella, 1979, et al.
(författare)
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Multimorbidity and Readmissions in Older People with Acute Coronary Syndromes.
- 2022
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Ingår i: Cardiology. - : S. Karger AG. - 1421-9751 .- 0008-6312. ; 147:2, s. 121-132
-
Tidskriftsartikel (refereegranskat)abstract
- This study aimed to examine the multimorbidity as well as the 30-day and 1-year readmission rates in a large, unselected cohort of elderly patients with acute coronary syndrome (ACS).All patients ≥70 years hospitalized due to ACS during January 1, 2006, to December 31, 2013, and registered in the SWEDEHEART registry were included. In-hospital multimorbidity and disease burden were determined. Outcomes included 30-day and 1-year all-cause mortality, any readmission, and readmissions due to ACS, heart failure, ischaemic stroke or transient ischaemic attack (TIA), and bleeding events. Out of 80,176 patients, 25.6% had ST-elevation myocardial infarction (STEMI) and 74.4% non-ST-segment elevation ACS (NSTE-ACS). The mean age was 79.8 (±6.4 standard deviation) and 43.4% were women. Multimorbidity, or two chronic diseases, was present in 67.7%, thereof in 53.0% of STEMI patients and 72.7% of NSTE-ACS patients. In-hospital mortality was 7.0%. Of the 74,577 patients who survived to discharge, 24.6% were readmitted within 30 days and 59.5% were readmitted during the following year. Multimorbid patients had a higher risk of readmissions than those without multimorbidity. Multimorbid STEMI patients were admitted the following year in 56.2% of cases compared to 44.5% of STEMI patients without multimorbidity, adjusted odds ratio (OR) 1.35 (95% confidence interval: 1.26-1.45). Multimorbid patients with NSTE-ACS were readmitted in 63.4% of cases the following year compared with 49.1% of those without multimorbidity, adjusted OR 1.42 (1.35-1.50). More than half of the readmissions were due to cardiovascular causes (ACS, stroke, TIA, or heart failure) or bleeding events.Older people with ACS have a high multimorbidity burden and a high readmission rate both within 30 days and 1 year. Half of the readmissions were due to a cardiovascular event or a bleeding event. The presence of multimorbidity increases the risk of readmissions for patients with ACS. As hospital admissions are costly for the health care system and can include risks, especially for older patients, there may be opportunities in better risk stratifying this group at discharge for subsequent decrease in readmission rates.
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| 24. |
- Gustafsson, Susanne, et al.
(författare)
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A person-centred approach to health promotion for persons 70+ who have migrated to Sweden : Promoting aging migrants' capabilities implementation and RCT study protocol
- 2015
-
Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 15
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There are inequities in health status associated with ethnicity, which may limit older foreign-born persons' ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study 'Promoting Aging Migrants' Capabilities' was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula. Methods/Design: This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings ('senior meetings') and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated. Discussion: The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context. Trial registration: The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853.
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| 25. |
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| 26. |
- Gustafsson, Susanne, 1963, et al.
(författare)
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Health-Promoting Interventions for Persons 80 Years and Over are Successful in the Short Term – Results from the Randomized and Three-Armed Study Elderly Persons in the Risk Zone
- 2012
-
Ingår i: Journal of the American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 60:3, s. 447-454
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The study Elderly Persons in the Risk Zone was designed to evaluate if it is possible to delay deterioration if a health-promoting intervention is made when the older adults (80+) are at risk of becoming frail, and if a multi-professional group intervention is more effective in delaying deterioration than a single preventive home visit. This paper examined the outcome with regard to frailty, self-rated health, and Activities of Daily Living (ADL) at the three-month follow-up. DESIGN: A randomized, three-armed, single-blind, and controlled trial performed between November 2007 and May 2011. SETTING: Two municipalities of Gothenburg, Sweden. PARTICIPANTS: A total of 459 older adults were included. They were 80 years or older, living in their ordinary housing, and not dependent on the municipal home help service. INTERVENTION: A preventive home visit or four weekly multi-professional senior group meetings with one follow-up home visit. MEASUREMENTS: The change in frailty, self-rated health, and ADL between baseline and the three-month follow-up. RESULTS: Both interventions delayed deterioration of self-rated health (OR=1.99, 95% CI=1.12 to 3.54). As regards postponing dependence in ADL, senior meetings were found to be the most beneficial intervention (OR=1.95, 95% CI=1.14 to 3.33). No effect on frailty could be demonstrated. CONCLUSION: Health-promoting interventions, made when older adults are at risk of becoming frail, can delay deterioration of self-rated health and ADL in the short term. Also, a multi-professional group intervention such as the senior meetings described seems to have a greater impact on delaying deterioration in ADL than a single preventive home visit. Further research is needed to examine the outcome in the long term, and in different contexts.
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| 27. |
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| 28. |
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| 29. |
- Gustafsson, Susanne, et al.
(författare)
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Long-term outcome for ADL following the health-promoting RCT-Elderly persons in the risk zone
- 2013
-
Ingår i: The Gerontologist. - : Oxford University Press. - 0016-9013 .- 1758-5341. ; 53:4, s. 654-663
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To examine independence in activities of daily living (ADL) at the 1- and 2-year followups of the health-promoting study Elderly Persons in the Risk Zone. Design and Method: A randomized, three-armed, single-blind, and controlled study. A representative sample of 459 independent and community-dwelling older adults, 80 years and older, were included. A preventive home visit was compared with four weekly multiprofessional senior group meetings including a follow-up home visit. Results: Analysis showed a significant difference in favor of the senior meetings in postponing dependence in ADL at the 1-year follow-up (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.19-3.10) and also in reducing dependence in three (OR = 0.52, 95% CI = 0.31-0.86) and four or more ADL (OR = 0.40, 95% CI = 0.22-0.72) at the 2-year follow-up. A preventive home visit reduced dependence in two (OR = 0.40, 95% CI = 0.24-0.68) and three or more ADL (OR = 0.37, 95% CI = 0.17-0.80) after 1 year. Implications: A long-term evaluation of Elderly Persons in the Risk Zone showed that both senior meetings and a preventive home visit reduced the extent of dependence in ADL after 1 year. The senior meetings were superior to a preventive home visit since additional significant effects were seen after 2 years. To further enhance the long-term effects of the senior meetings and support the process of self-change in health behavior, it is suggested that booster sessions might be a good way of reinforcing the intervention.
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| 30. |
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| 31. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75
- 2023
-
Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 27:10, s. 2052-2060
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectivesNon-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode.MethodLongitudinal population-based study in adults aged >= 75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode.ResultsThere were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care.ConclusionThe use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.
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| 32. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Psychoactive medication use and risk of suicide in long-term care facility residents
- 2022
-
Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 37:3
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate psychoactive medication use and risk of suicide in long-term care facility (LTCF) residents aged 75 and above. A second aim was to investigate the role of psychiatric and medical conditions in the occurrence of suicide in LTCF residents. Methods: A Swedish national register-based cohort study of LTFC residents aged ≥75years between 1 January 2008 and 31 December 2015, and followed until 31 December 2016 (N=288,305). Fine and Gray regression models were used to analyse associations with suicide. Results: The study identified 110 suicides (15.8 per 100,000 person-years). Half of these occurred during the first year of residence. Overall, 54% of those who died by suicide were on hypnotics and 45% were on antidepressants. Adjusted sub-hazard ratio (aSHR) for suicide was decreased in those who were on antidepressants (aSHR 0.64, 95% confidence interval 0.42–0.97), even after the exclusion of residents who had healthcare contacts for dementia or were on anti-dementia drugs. The aSHR for suicide was more than two-fold higher in those who were on hypnotics (2.20, 1.46–3.31). Suicide risk was particularly elevated in those with an episode of self-harm prior to LTCF admittance (15.78, 10.01–24.87). Specialized care for depression was associated with increased risk, while medical morbidity was not. Conclusions: A lower risk of suicide in LTCF residents was found in users of antidepressants, while elevated risk was observed in those on hypnotics. Our findings suggest that more can be done to prevent suicide in this setting. © 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley& Sons Ltd.
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| 33. |
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| 34. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Erfarenheter av självbestämmande hos personer som nyligen utvecklat ett beroende i dagliga aktiviteter
- 2013
-
Ingår i: AT-Forum (Arbetsterapeuternas nationella konferens). Stockholm, 24-25 april 2013 (Muntlig presentation).
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Övergången från att vara oberoende till att utveckla sårbarhet och beroende av annan person i dagliga aktiviteter kan vara fylld med utmaningar. I takt med att en person utvecklar ett beroende, kan möjligheten till självbestämmande i dagliga aktiviteter försämras vilket kan upplevas stressande för den äldre personen. Äldre som är beroende uttrycker ett behov att kunna fortsätta vara delaktiga i beslutsfattande som rör dagliga aktiviteter. För att äldre ska kunna bibehålla god hälsa och välbefinnande är det viktigt att de involveras och tillåts att ta beslut som rör deras dagliga aktiviteter. Hälso- och sjukvårdspersonal är medvetna om vikten av äldres rätt till självbestämmande, dock påvisar studier att professionella efterfrågar mera kunskap om äldres erfarenheter för att kunna stödja de äldre till ökat självbestämmande. Syfte: Att undersöka erfarenheter av självbestämmande vid övergången från oberoende till beroende av annan person i daglig aktivitet hos personer 80 år och äldre. Tillvägagångssätt och analys: En explorativ design baserad på Grounded Theory beskriven av Charmaz används i studien. Semistrukturerade intevjuer kommer att genomföras på ca 15 personer i åldern 80 år och äldre som börjat uppleva svårigheter i dagliga aktiviteter eller som utvecklat ett beroende i minst en Instrumentell Daglig Aktivitet (I-ADL) och/eller minst en Personlig Daglig Aktivitet (P-ADL) enligt ADL-trappan. Insamlad data kommer att analyseras med Grounded Theory. Både intervjuer och analys av data har påbörjats. Resultat/förväntat resultat: Studien förväntas ge en förståelse för hur personer vilka är 80 år och äldre erfar sitt självbestämmande vid övergången från oberoende till beroende av annan person i daglig aktivitet. Slutsatser: Förväntat resultat kommer att leda till ökad kunskap om hur personal inom hälso- och sjukvården kan stödja äldre personer som är i övergången till att utveckla ett beroende i dagliga aktiviteter till ökat självbestämmande.
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| 35. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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From Intervention Trial to Full-scale Implementation Research: Positive Tendencies for Frailty and Self-rated Health in Frail Older People.
- 2018
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Ingår i: International Journal of Geriatrics and Gerontology. - 2577-0748. ; 2018:2
-
Tidskriftsartikel (refereegranskat)abstract
- A continuum of care for frail older people was created to link the chain between the hospital, and discharge to the person’s home. Despite earlier positive findings, it remains unclear if the benefits are sustainable in a real-life context. The present longitudinal study aimed at evaluate the effects of the implementation of a full-scale process program for frail older people in a real-life context regarding levels of frailty, self-rated health and activities of daily living up to one year later. The sample consisted of a total of 143 frail people aged 75 years and older, divided in the two groups: 77 participants from the full-scale process program and 66 historical controls. The findings showed that at the six months follow-up, the participants partaking in the full-scale process program had a significantly higher odds of displaying decreased frailty (p=0.015), and at twelve months, this sample had a significant lower likelihood of reporting decreased self-rated health (p=0.023). Thus, the findings showed positive results on frailty level and self-rated health when implementing the intervention in real life, indicating that a person-centred, multi-professional team with a case manager is beneficial for frail older people.
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| 36. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Governing or being governed: Older persons' experiences of self-determination
- 2014
-
Ingår i: Age Well - 22nd Nordic Congress of Gerontology, 25-28 maj, Göteborg, Sverige.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: In Sweden it is a legal right for older persons to exercise self-determination. Exercising self-determination is also important for older persons’ health and well-being. Health professionals are in general aware of the importance, but research shows that older persons’ self-determination is not fully respected within the health care sector. Research on self-determination from the perspective of older persons who are in the beginning to develop dependence in daily activities is limited. In order to deepen the knowledge of older persons own experiences in this process, further studies are needed. Aim: The aim of this study was to explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older. Method: Qualitative interviews with 11 persons aged 84-95 years who were in the beginning to experience difficulties in daily activities were performed in accordance with the constructivist grounded theory method. Results: The core category, shifting between governing oneself or being governed by others, illustrates the complexity and the shifting of the experiences during the development of dependence. The categories struggling against the aging body, guarding one’s own independence and transferring the performance highlights different ways of governing in one’s life, whereas exercising self-determination is in the hands of others is a result of the increasing dependence. Conclusions: For community-dwelling older persons, the social context and the ageing body may influence the possibilities to exercise self-determination in daily life. Professionals and health care providers should enable and encourage older persons to exercise self-determination related their own healthcare.
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| 37. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Impact on Participation and Autonomy – test of validity and reliability for older persons
- 2014
-
Ingår i: Health Psychology Research. - : Open Medical Publishing. - 2420-8124. ; 2:3, s. 68-73
-
Tidskriftsartikel (refereegranskat)abstract
- In research and health care it is important to measure older person’s self-determination in order to improve their possibilities to decide for themselves in daily life. The questionnaire Impact on Participation and Autonomy (IPA) assesses self-determination, but is not constructed for older persons. The aim of this study was to examine the validity and reliability of the IPA-S questionnaire for persons aged 70 years and older. The study was performed in two steps; first a validity test of the Swedish version of the questionnaire, IPA-S, followed by a reliability test-retest of an adjusted version. The validity was tested with focus groups and individual interviews on persons aged 77-88 years, and the reliability on persons aged 70-99 years. The validity test result showed that IPA-S is valid for older persons but it was too extensive and the phrasing of the items needed adjustments. The reliability test-retest on the adjusted questionnaire, IPA-for Older persons (IPA-O), showed that 15 of 22 items had high agreement. IPA-O can be used to measure older persons’ right to self-determination in their care and rehabilitation.
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| 38. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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People dependent of support in daily activities perceives reduced self-determination – a cross-sectional study with community-dwelling older people
- 2015
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Ingår i: Quality in Ageing and Older Adults. - 1471-7794. ; 16:4, s. 208-221
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to explore the relationship of self-determination with degree of dependence in daily activities among community-dwelling persons aged 80 years and older. Design/methodology/approach – This cross-sectional study focused on community-dwelling people 80 years or older with varied degree of dependence in daily activities. Self-determination in daily life was assessed with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O), and degree of dependence in daily activities was assessed with the activities of daily living (ADL) staircase. Data were analysed using Fisher’s exact test, and the relative risk with a 95 per cent confidence interval was used to explore the risk of perceiving reduced self-determination in daily life. Findings – Compared to the independent persons, the perceived self-determination was significantly lower among persons dependent in instrumental activities of daily living (I-ADL), and persons dependent in personal activities of daily living (P-ADL). Reduced self-determination was most pronounced in persons requiring help with P-ADL. Practical implications – Following key features could be applied to strengthen the community-dwelling older people’s self-determination; incorporating a dialogue where self-determined questions are raised; adopting a person-centred approach between the persons involved; acknowledging older people’s capabilities – what they are able to do and to be, and what they value. Originality/value – This study highlights the need of integrating a self-determined dialogue into healthcare where the older person and the professional focus on self-determined questions.
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| 39. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Self-determination among community-dwelling older persons: explanatory factors
- 2016
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 23:3, s. 198-206
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Tidskriftsartikel (refereegranskat)abstract
- Background Although it is acknowledged that exercising self-determination in daily activities affects older people’s health and well-being, few studies have focused on the explanatory factors for self-determination in daily life. Objective To investigate explanatory factors for self-determination in the context of community-dwelling older persons. Method: This cross-sectional study combined two sets of data that included community-dwelling persons 80 years and older (n=456). A bivariate logistic regression was performed to analyse the association of self-determination and a set of explanatory factors. Results The final bivariate logistic regression model revealed five explanatory factors that were significantly associated with perceiving reduced self-determination: high education (OR=2.83), frailty (OR=2.70), poor self-rated health (OR=2.54), dissatisfaction with physical health (OR=6.50), and receiving help from public homecare service (OR=2.46). Conclusion Several explanatory factors related to the ageing body and environmental aspects were associated with reduced self-determination. To help older people maintain self-determination, healthcare professionals should consider using a person-centred and capability approach to care.
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| 40. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Shifting between self-governing and being governed: a qualitative study of older persons’ self-determination
- 2014
-
Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Older persons’ right to exercise self-determination in daily life is supported by several laws. Research shows that older persons’ self-determination is not fully respected within the healthcare sector. In order to enable and enhance older persons’ self-determination, extensive knowledge of older persons’ self-determination is needed. Aim: To explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older. Methods: Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons aged 84–95 years who were beginning to develop dependence in daily activities. Results: The data analysis revealed the core category, “Self-determination - shifting between self-governing and being governed”. The core category comprised three categories: “Struggling against the aging body”, “Decision-making is relational”, and “Guarding one’s own independence”. Self-determination in daily activities was related to a shifting, which was two-fold, and varied between self-governing and being governed by the aging body, or by others. Conclusions: The findings imply a need to adopt a person-centered approach where the older persons’ own preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.
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| 41. |
- Ottenvall Hammar, Isabelle, 1984, et al.
(författare)
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Validitet och reliabilitet av frågeformuläret Inverkan på Delaktighet och Autonomi för äldre personer
- 2013
-
Ingår i: Posterpresentation AT-Forum Stockholmsmässan 24-25/4-2013.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Frågeformuläret Inverkan på Delaktighet och Autonomi (IPA) har konstruerats för att mäta en persons upplevda delaktighet och självbestämmande/beslutande autonomi. Eftersom validiteten och reliabiliteten av IPA är testade på personer under 75 års ålder, behövs ytterligare studier riktade mot äldre. Syfte: Att undersöka validiteten och reliabiliteten av frågeformuläret IPA för personer i åldern 70 år och äldre. Metod: Studien utfördes i två steg som figuren visar; först ett validitetstest av den svenska versionen av IPA och därefter ett test-retest reliabilitetstest av det reviderade frågeformuläret. I test-retesten användes Svenssons program, ett statistiskt program som är lämpligt vid analys av ordinaldata. Resultat: Deltagarna ansåg att frågorna var viktiga men omfattande. När de besvarade frågorna framkom att de fokuserade på enbart utförandet av aktiviteterna. Revideringen resulterade i 22 frågor om upplevd delaktighet och självbestämmande. Test-retesten visade att den procentuella överensstämmelsen varierade, 15 frågor hade hög reliabilitet (70 % eller över). Slutsatser: IPA-Ä är valit och reliabelt för den äldre populationen. IPA-Ä kan användas som ett utvärderingsinstrument för att säkerställa äldre personers rätt till självbestämmande och delaktighet. IPA-Ä rekommenderas som ett utvärderingsinstrument vid geriatrisk rehabilitering.
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| 42. |
- Rydén, Lina, 1982, et al.
(författare)
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Agreement between self-reports, proxy-reports and the National Patient Register regarding diagnoses of cardiovascular disorders and diabetes mellitus in a population-based sample of 80-year-olds
- 2019
-
Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 48:4, s. 513-518
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: cognitive impairment is common among older adults, necessitating the use of collateral sources in epidemiological studies involving this age group. The objective of this study was to evaluate agreement between self- and proxyreports of cardiovascular disorders and diabetes mellitus in a population-based sample of 80-year-olds. Further, both self and proxy-reports were compared with hospital register data. Methods: data were obtained from the Gothenburg H70 Birth Cohort Studies in Sweden. The study had a cross-sectional design and information was collected through semi-structured interviews in 2009–2012 from participants born in 1930 (N = 419) and their proxy informants. The National Patient Register provided diagnoses registered during hospital stays. Agreement was measured with Kappa values (K). Results: agreement between self- and proxy-reports was substantial for diabetes mellitus (K = 0.79), atrial fibrillation (K = 0.61), myocardial infarction (K = 0.75), angina pectoris (K = 0.73) and hypertension (K = 0.62), and fair for intermittent claudication (K = 0.38) and heart failure (K = 0.40). Compared to the National Patient Register, a large proportion of those with a hospital discharge diagnosis were also self- and proxy-reported. Conclusions: proxy informants can be an important source of information, at least for well-defined conditions such as myocardial infarction, angina pectoris and diabetes mellitus.
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| 43. |
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| 44. |
- Westgård, Theresa, 1969, et al.
(författare)
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Can comprehensive geriatric assessment meet frail older people’s needs? Results from the randomized controlled study CGA-swed
- 2020
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Ingår i: Geriatrics (Switzerland). - : MDPI AG. - 2308-3417. ; 5:4
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 by the authors. Licensee MDPI, Basel, Switzerland. Background: The comprehensive geriatric assessment (CGA) designed to manage frail older people requiring acute medical care, is responsible for diagnostics, assessment, treatment, and planning while addressing a person’s medical, psychological, social, and functional capabilities. The aim was to investigate if CGA had an impact on frail older people’s activities of daily living (ADL) status, self-rated health, and satisfaction with hospital care. Methods: A two-armed design with frail people aged 75 or older who required an unplanned hospital admission were randomized to either the CGA ward or to an acute medical ward. Analyses were made based on the intention-to-treat principle (ITT). The primary outcome was ADL. Data were analyzed using Chi-square and odds ratio. A subgroup analysis was performed due to non-adherence and contamination. Results: One-hundred and fifty-five people participated in the study; 78 in the intervention and 77 in the control. Participants in the intervention group had a higher odds ratio of reporting having received written information and felt that care met their needs during their hospital stay. No additional statistically significant results for the primary or secondary outcomes in the ITT analysis were achieved. Conclusion: Participants felt that the care they received with the CGA ward met their needs. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings, and because a CGA during one hospital stay is probably not enough to have long-term effects.
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| 45. |
- Westgård, Theresa, 1969, et al.
(författare)
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Comprehensive geriatric assessment is associated with increased antidepressant treatment in frail older people with unplanned hospital admissions-results from the randomised controlled study CGA-Swed
- 2022
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Ingår i: Bmc Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment. Aims: The aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA). Methods: This secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above. Instruments included Montgomery Asberg Depression Rating Scale (MADRS), the ICE Capability measure for older people (ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score >= 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention. Results: The prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50-12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15-4.71, p = 0.019) compared to patients in the control group who received regular medical care. Conclusion: Symptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people.
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| 46. |
- Westgård, Theresa, 1969, et al.
(författare)
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Feeling respected as a person: a qualitative analysis of frail older people's experiences on an acute geriatric ward practicing a Comprehensive Geriatric Assessment
- 2019
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Ingår i: Geriatrics. - : MDPI AG. - 0016-867X .- 2308-3417. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Comprehensive geriatric assessment (CGA) practices multidimensional, interdisciplinary, and diagnostic processes as a means to identify care needs, plan care, and improve outcomes of frail older people. Conventional content analysis was used to analyze frail older people’s experiences of receiving CGA. Through a secondary analysis, interviews and transcripts were revisited in an attempt to discover the meaning behind the participants’ implied, ambiguous, and verbalized thoughts that were not illuminated in the primary study. Feeling “respected as a person” is the phenomenon participants described on a CGA acute geriatric ward, achieved by having a reciprocal relationship with the ward staff, enabling their participation in decisions when engaged in communication and understanding. However, when a person was too ill to participate, then care was person-supportive care. CGA, when delivered by staff practicing person-centered care, can keep the frail older person in focus despite them being a patient. If a person-centered care approach does not work because the person is too ill, then person-supportive care is delivered. However, when staff and/or organizational practices do not implement a person-centered care approach, this can hinder patients feeling “respected as a person”.
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| 47. |
- Westgård, Theresa, 1969, et al.
(författare)
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Voices of Ill Frail Older People: Personal Resources and Experiences of Health Care Services : Special Issue Article “Healthy Aging and Elder Care”
- 2021
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Ingår i: Gerontology and Geriatric Research. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: For many older people, ageing may become associated with frailty. Frequently reduced physical functioning and health are common in frailty; however, this is only one part of the big picture that may affect a frail older person’s wellbeing. To understand a frail older person’s unique capability, the study aimed to identifying their personal resources’ to comprehend how they experienced receiving health care services. Method: Ten participants aged 75 or older, screened as frail were interviewed one month after discharge from the hospital ward practicing the Comprehensive Geriatric Assessment. Result: Frail older people have personal resources established earlier in life and these remained intact and useful when receiving health care services. These personal resources were service: being service minded, having confidence in organizing and conversing and negotiating; and inherent abilities: being resilient and being hopeful and optimistic. Conclusion: Even though people have, personal resources it does not meant that they could use them, since it was dependent upon a collaboration between a person ’s social networks, physical environments and person resources. Identifying personal resources could give frail older people the boost they need to experience that they are still competent and capable when needing and receiving health care services. This would require that the health care staff and the health care organization support frail older people by practicing integrated care that is person-centered.
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| 48. |
- Wiktorsson, Stefan, 1955, et al.
(författare)
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Assessing the role of physical illness in young old and older old suicide attempters
- 2016
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 31:7, s. 771-774
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Tidskriftsartikel (refereegranskat)abstract
- © 2015 John Wiley & Sons, Ltd. Objectives: Attributions for attempting suicide were explored in older adults with and without serious physical illness. Methods: An open-ended question was used to explore attributions for attempting suicide in 101 hospitalized persons aged 70+. Serious physical illness was defined as a score of 3 or 4 on any of the 13 non-psychiatric organ categories in the Cumulative Illness Rating Scale for Geriatrics. Results: Roughly one-third of hospitalized persons with (22/62) and without (12/39) serious physical illness attributed the suicide attempt to somatic distress. Among 70- to 79-year-olds, seriously physically ill patients were more likely than healthier patients to attribute their attempt to psychological pain (84% vs. 48%, p=0.013). There were no significant differences in attributions in persons with and without serious health problems in the 80+ group. Conclusions: The processes by which physical illness confers risk for attempted suicide in older adulthood may be age dependent. Interventions are needed to mitigate psychological pain in physically ill older patients, especially those in their seventies. Research is needed to understand how the psychological processes that influence the desire for suicide change across older adulthood.
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| 49. |
- Wilhelmson, Katarina, 1958
(författare)
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Att åldras
- 2009
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Ingår i: Livslots för seniorer. - : Vårdalinstitutet. ; , s. 9-26
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 50. |
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