1.
Iwarsson, Susanne
(författare)
Functional Capacity And Physical Environmenal Demand. Exploration of Factors Influencing Everyday Activity and Health in the Elderly Population
1997
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The general aim of this thesis was to explore relationships between functional capacity, environmental factors, everyday activity, and health in the elderly population. Initially, the Enabler, an instrument for assessment of the physical home environment's accessibility, was translated to Swedish and revised, and tested for reliability and validity. Further, a systematic random sample of individuals aged 75-84, in ordinary housing in a Swedish rural district, was drawn. Multi-dimensional data were collected on home-visits (N=133). The main finding was that independence/ dependence in activities of daily living (ADL) correlated highly significantly with housing accessibility. The results also supported Lawton's docility hypothesis, i.e. that individuals with low functional capacity are more vulnerable to environmental demand. Finally, data from 25-years longitudinal investigations of a rural population were utilized for an analysis of the covariation between everyday activity and survival. Significant differences in survival between "more active" and "less active" females supported the occupational therapy (OT) core hypothesis: "Activity is health promoting." In this thesis, multi-dimensional methodology was developed and applied in empirical research. However, throughout the studies methodological problems were encountered and managed, for example concerning gender differences and differences between rural and urban areas. In conclusion, with the results presented a potential public health problem has been defined: housing accessibility problems covary with the prevalence of ADL disability in the elderly population. Health promotive and preventive efforts ought to be initiated, since reduced everyday activity is health-threatening. The results have practical implications for rehabilitation, especially for OT, and for public planning of housing for senior citizens, as well as theoretical implications for further understanding of the complex of disablement.
2.
Sidenvall, Birgitta
(författare)
The meal in geriatric care : Habits, values and culture
1995
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of the present thesis was to study the meal situation in geriatric care, focusing on cultural, social, psychological and nutritional qualities of the meals for the patients as well as caring strategies and actions performed at meals by the nursing staff. The studies were carried out in a rehabilitation and long-term care clinic providing geriatric care. The data were gathered during two periods. In the first period 18 consecutive elderly patients and their personal enrolled nurses participated (paper I and II). In the second study the informants were 45 patients as well as registered nurses, enrolled nurses and nurse's assistauts working in the clinic (paper III, IV and V). The main approach was ethnographic, using interviews, observations and documents. Furthermore, the nutritional status was assessed by weight index and biochemistry as well as by records of dietary intake. The meal situation was found to be a meeting place between individual patients and the collective hospital culture. In the ward the patients strove to reach their own standards of acceptable table manners and retain their independence and dignity. Their conflicts at table were related to three themes. The first, "Mind your manners", demonstrated problems in managing food and objects, keeping clean, and conduct at table. Thesecond, "Appetite for food", was connected to tradition and taste, healthy food and the need not to waste food. The third, "Be content and do not complain", illustrated the elderly patients' socialized manners in talking about meals and food. The evaluation of the elderly patients' meal patterns showed a strong reduction in daily eating frequency during the time before hospitalization, which might lead to nutritional deficiency. The nursing assessment strategies were defective as patients at risk of malnutrition were missed and patients' experiences of their own and others' limited eating competence were rarely taken into consideration enough. One reason for this was shown to be the organization of the meal and the fixed form of the working phases. Ritualized practices gave the main form to the hospital meal and the serving procedures. Based on checks of patients' ability and caregivers' working conditions, the praxis was to make eating possible and facilitate the procedures. Three norms guided the caregivers; "To provide a homelike situation with fellowship for training purposes", "To ensure each patient gets what they need/want by means of a fair method of serving"and "To keep things in order and to be responsible". The thesis points out the problem that arises when institutionalized habits and values gave the meals such a fixed form that alterations in serving procedures were difficult to make. As the elderly patients strove to keep their dignity and adapt to the demands communicated, these were factors which minimized the possibilities of adjusting the eating procedures to the individual needs of the patient.
3.
Elmståhl, Sölve, et al.
(författare)
Treatment of dysphagia improves nutritional conditions in stroke patients
1999
Ingår i: Dysphagia. - 1432-0460. ; 14:2, s. 61-66
Tidskriftsartikel (refereegranskat) abstract
Dysphagia is a common symptom in stroke patients, and malnutrition is prevalent among these patients. Thus far, nutritional effects of dysphagic treatment have not been evaluated. The aim of the present report was to study the effects of swallowing techniques on nutritional and anthropometric variables. A survey with follow-up was performed at the Departments of Geriatric Medicine and Neurology, Malmo University Hospital, Sweden. Thirty-eight stroke patients, 53-89 years of age, with subjective complaints of dysphagia and oral/pharyngeal dysfunction according to videofluoroscopic barium swallowing examination (VSBE), were given swallowing treatment. The treatment included oral motor exercise, different swallowing techniques, positioning, and diet modification. Plasma protein levels, body composition, VSBE, and a viso-analogical scale for subjective complaints were repeated before and after treatment. At baseline, 94% of cases had signs of penetration and 50-72% had plasma protein levels below recommended levels. Treatment reduced the degree of oral dysfunction, (dissociation) and pharyngeal dysfunction (penetration and constrictor paresis). Sixty percent of cases showed an improved overall VSBE score, and improved levels of albumin and total iron-binding capacity were restricted to this group. In cases with unchanged or decreased VSBE score, body weight was reduced and a negative correlation to total iron-binding capacity was noted (r = -0.60, p < 0.05). Changes of subjective complaints did not correlate with swallowing function or nutritional improvements. Swallowing treatment improves swallowing function, and improved swallowing function is associated with improvements in nutritional parameters. Subjective complaints is not sufficient to evaluate the clinical course, and nutritional parameters should be monitored in patients with oral or pharyngeal dysfunction.
4.
Häggblom Kronlöf, Greta, 1961, et al.
(författare)
Elderly women´s way of relating to assistive devices.
1999
Ingår i: Gerontechnology, Third International Conference. Book of abstract. 10-13 October, 1999. Technische Universität, Munchen,Germany. (Oral presentation).
Konferensbidrag (övrigt vetenskapligt/konstnärligt)
5.
Häggblom Kronlöf, Greta, 1961, et al.
(författare)
Elderly women's way of relating to assistive devices.
1999
Ingår i: Technology and Disability. - 1055-4181 .- 1878-643X. ; 10:3, s. 161-169
Tidskriftsartikel (refereegranskat) abstract
The objective of this study was to describe how elderly users of assistive devices perceive and relate to their assistive devices in occupational performance. Study design.The research approach used was phenomenography, which endeavours to describe different ways of peoples experience. Result.User attitude is described as: the assistive devices are well incorporated; the elderly are forced to accept; the necessity of using the device gives the feeling of inadequacy. Accommodation to the use of assistive devices in daily activities are described as: modification and resignation. The Support of assistive device is perceived in three different ways; external safety, internal security and respect. Conclusion. Elderly women's experience of what it is like to rely on an artificial device is important when planing for support. The main feature that appears is an endeavour to gain control of, or a feeling of being able to take control of, one's occupational performance
6.
Jensen, Elmo, et al.
(författare)
Insomnia in an 80-year-old population: relationship to medical, psychological and social factors
1998
Ingår i: Journal of Sleep Research. - : Wiley. - 1365-2869 .- 0962-1105. ; 7:3, s. 183-189
Tidskriftsartikel (refereegranskat) abstract
In this study, insomnia in 80-year-olds was related to medical, psychological and social factors. The data were based on examinations every year in people aged between 80 and 89 years. Of 333 people living in the city of Lund and born in 1908, 67% participated. Increased severity of insomnia was significantly associated with use of diuretics, other cardiovascular drugs, hypnotics and laxatives, and with nervousness, difficulty relaxing, anorexia, nausea, constipation, backache, feeling cold, sweating, loss of weight, dizziness, depression, general fatigue, exhaustion, angina pectoris, cardiac insufficiency, worsened objective and subjective health, presence of negative T-waves on ECG, anxiety, total life satisfaction, neuroticism, disbelief in a just world, feeling lonely and lower survival rates. Thus insomnia has widespread associations with different aspects of life in 80-year-olds.
7.
McCamish-Svensson, C, et al.
(författare)
Informal and formal support from a multi-disciplinary perspective: a Swedish follow-up between 80 and 82 years of age
1999
Ingår i: Health & Social Care in the Community. - 0966-0410. ; 7:3, s. 163-163
Tidskriftsartikel (refereegranskat) abstract
This longitudinal study used a multi-disciplinary approach and examined the relationship between psychosocial and health characteristics and the pattern of informal and formal support for non-institutionalized very old people. The data were derived from a single cohort of 80-year-old people living in Lund, Sweden who were followed over a 3-year period. In order to account for potential sample bias, an analysis at 80 years measured the differences between the participants who were measured at both test periods, the drop-outs who discontinued from the study prior to 82 years, and the deceased who died prior to 82 years (n = 212). Results revealed that the groups differed significantly according to reported number of children and health measures: the participants were most likely to have children and exhibited the best health. Bivariate analyses examined social, psychological and health variables for survivors (n = 93) at both 80 and 82 years in relationship to independent, informal, and formal support type. Loneliness was significantly and consistently associated with support type at both 80 and 82 years: both frequency and strength of loneliness were most often reported in the formal support group. Depression was significantly related to support type at age 80 only. Looking at change in the psychosocial and health measures and change in support over the 3-year period, no significant relationships were found. Our study concludes that for the very old, in addition to requiring increased support over a 3-year period, loneliness is a significant characteristic that may accompany the receipt of support. Professionals who plan and implement social support programmes for elderly persons should also consider emotional and psychological needs.
8.
McCamish-Svensson, C, et al.
(författare)
Social relationships and health as predictors of life satisfaction in advanced old age: results from a Swedish longitudinal study
1999
Ingår i: International Journal of Aging and Human Development. - 0091-4150. ; 48:4, s. 301-324
Tidskriftsartikel (refereegranskat) abstract
This longitudinal study examines the relationship between family and friend social support, health, and life satisfaction for a single cohort of eighty-year-old persons living in Lund, Sweden. Results indicate that participants who remained in the study are healthier and score higher on life satisfaction when compared with those who either drop-out or die prior to age eighty-three. Even though well-integrated with family and friends, the number of friends decreases significantly from eighty to eighty-three years; those who reported no close friends nearly doubled from eighty to eighty-three years. However, for those with close friends, contact with friends increases with age. In contrast to previous research, a correlational analysis indicates that neither child nor friend support is related to life satisfaction at either eighty or eighty-three years. However, health measures and satisfaction with sibling contact are related to total life satisfaction at age eighty-three only. These findings indicate the multidimensionality of both social support and life satisfaction for the old-old.
9.
10.
Agrell, Berit
(författare)
Stroke in geriatric patients - Aspects of depression, cognition and motor activity
1998
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Six depression rating scales, GDS, Zung, CES-D, CPRS-D and Cornell, were compared in 40 patients. The validity was good for all scales except for the Cornell scale. A comprehensive investigation was done in 116 elderly stroke patients. There was no difference in prevalence and severity of post-stroke depression in relation to side of lesion. A test for receptive aphasia, the Token test, showed that 75% of patients with left hemisphere lesion and aphasia, 36% of patients with right hemisphere lesion and 5% of controls had abnormal test initially. The relationships and sensitivity of different visuo-spatial neglect tests were examined. Sensitivity was around 50% for the best tests. Neglect patients showed a greater cognitive dysfunction initially and a slower recovery. The validity of a cognitive test, the MMSE, was examined. Five neuropsychological tests were used as a subgroup of patients.MMSE scores were significant lower for the patients than for the controls. The sensitivity of the MMSE was 56%, the specificity 80% and the false negative ratio 39% against the neuropsychological tests. Motor activity after stroke was assessed by parts of the Fugl-Meyer test in different infarction subgroups and initial severity groups. The initial severity groups were better predictors for outcome. Multiple regression showed three variables to be predictors: initial motor activity, Barthel Index and right hemisphere lesion.
