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  • Eklund, Patrik (författare)
  • Information and process in health
  • 2021
  • Ingår i: Integrated care and fall prevention in active and healthy aging. - Hershey, PA : IGI Global. - 9781799844129 - 9781799844112 - 9781799881322 ; , s. 263-279
  • Bokkapitel (refereegranskat)abstract
    • Cooperation and partnership in healthy ageing enhances and enriches the underlying information and process models within integrated care. On information, functioning oriented data as part of health and social data describes medical conditions and functioning capacity of the older person. Similarly, the notion of a good practice, as embracing a conglomerate of guidelines, is also well understood but less so in terms of process substance. Process structure granularity is often quite coarse and less formal, comparable to process descriptions annotated with clinical guidelines. This chapter describes an algebraic framework for representation of functioning data typically found in contexts of integrated care processes in healthy ageing.
  • Finkel, Deborah, et al. (författare)
  • Does the length of institutionalization matter? Longitudinal follow-up of persons with severe mental illness 65 year and older : shorter-stay versus longer-stay
  • 2021
  • Ingår i: International Journal of Geriatric Psychiatry. - : John Wiley & Sons. - 0885-6230 .- 1099-1166. ; 36:8, s. 1223-1230
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: As part of the process of de-institutionalization in the Swedish mental healthcare system, a reform was implemented in 1995, moving the responsibility for services and social support for people with severe mental illness (SMI) from the regional level to the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. The aim of this study is to investigate functional levels, living conditions, need of support in daily life, and how these aspects changed over time for older people with SMI.METHODS: In this study we used data from surveys collected in 1996, 2001, 2006, and 2011 and data from national registers. A group of older adults with severe persistent mental illness (SMI-O:P) was identified and divided into those who experienced shorter stays (less than 3 years) in a mental hospital (N = 118) and longer stays (N = 117).RESULTS: After correcting for longitudinal changes with age, the longer-stay group was more likely than the shorter-stay group to experience functional difficulties and as a result, were more likely to have experienced "re-institutionalization" to another care setting, as opposed to living independently.CONCLUSIONS: The length of mental illness hospitalization has significant effects on the living conditions of older people with SMI and their ability to participate in social life. This article is protected by copyright. All rights reserved.
  • Gaber, Sophie N., et al. (författare)
  • Social Citizenship Through Out-of-Home Participation Among Older Adults With and Without Dementia
  • 2022
  • Ingår i: Journal of Applied Gerontology. - : SAGE PUBLICATIONS INC. - 0733-4648 .- 1552-4523.
  • Tidskriftsartikel (refereegranskat)abstract
    • There is limited empirical knowledge about how older adults living with dementia enact their social citizenship through out-of-home participation. This study aimed: (a) to investigate out-of-home participation among older adults with and without dementia in four countries and (b) to compare aspects of stability or change in out-of-home participation. Using a cross-sectional design, older adults with mild-to-moderate dementia and without dementia, aged 55 years and over, were interviewed using the Participation in ACTivities and Places OUTside the Home questionnaire in Canada (n = 58), Sweden (n = 69), Switzerland (n = 70), and the United Kingdom (n = 128). Data were analyzed using descriptive statistics and a two-way analysis of variance. After adjustment for age, diagnosis of dementia and country of residence had significant effects on total out-of-home participation (p < .01). The results contribute to policies and development of programs to facilitate social citizenship by targeting specific activities and places.
  • Garcia-Ptacek, Sara, et al. (författare)
  • Differences in diagnostic process, treatment and social Support for Alzheimer's dementia between primary and specialist care : resultss from the Swedish Dementia Registry
  • 2017
  • Ingår i: Age and Ageing. - : Oxford University Press. - 0002-0729 .- 1468-2834. ; 46:2, s. 314-319
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: the increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC). Design: cross-sectional study. Subjects: a total of, 9,625 patients diagnosed with AD registered 2011-14 in SveDem, the Swedish Dementia Registry. Methods: descriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication. Results: a total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P < 0.001), had lower MMSE (median 21 vs. 22; P < 0.001) and more likely to receive home care (31% vs. 20%; P < 0.001) or day care (5% vs. 3%; P < 0.001). Fewer diagnostic tests were performed in PC and diagnostic time was shorter. Basic testing was less likely to be complete in PC. The greatest differences were found for neuroimaging (82% in PC vs. 98% in SC) and clock tests (84% vs. 93%). These differences remained statistically significant after adjusting for MMSE and demographic characteristics. PC patients received less antipsychotic medication and more anxiolytics and hypnotics, but there were no significant differences in use of cholinesterase inhibitors between PC and SC. Conclusion: primary and specialist AD patients differ in background characteristics, and this can influence diagnostic work-up and treatment. PC excels in restriction of antipsychotic use. Use of head CT and clock test in PC are areas for improvement in Sweden.
  • Ghani, Zartashia, 1980-, et al. (författare)
  • The Cost-Effectiveness of Mobile Health (mHealth) Interventions for Older Adults : Systematic Review
  • 2020
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:15
  • Forskningsöversikt (refereegranskat)abstract
    • The objective of this study was to critically assess and review empirical evidence on the cost-effectiveness of Mobile Health (mHealth) interventions for older adults. We systematically searched databases such as Pubmed, Scopus, and Cumulative Index to Nursing and Allied Literature (CINAHL) for peer-reviewed economic evaluations published in English from 2007 to 2018. We extracted data on methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and assessed if this evidence supported the reported findings in terms of cost-effectiveness. The consolidated health economic evaluation reporting standards (CHEERS) checklist was used to assess the reporting quality of the included studies. Eleven studies were identified and categorized into two groups: complex smartphone communication and simple text-based communication. Substantial heterogeneity among the studies in terms of methodological approaches and types of intervention was observed. The cost-effectiveness of complex smartphone communication interventions cannot be judged due to lack of information. Limited evidence of cost-effectiveness was found for interventions related to simple text-based communications. Comprehensive economic evaluation studies are warranted to assess the cost-effectiveness of mHealth interventions designed for older adults.
  • Gori, Cristiano, et al. (författare)
  • How different countries allocate long-term care resources to older users : changes over time
  • 2016
  • Ingår i: Long-term care reforms in OECD countries. - Bristol : Policy Press. - 978 144731 071 6 ; , s. 77-116
  • Bokkapitel (refereegranskat)abstract
    • A key policy debate in long-term care (LTC) policies across OECD countriestoday can be summarised by the following question: what measures and strategiescan be adopted to optimise resources? New policies are required for balancingfinances and access to care, with different options on the table and waiting forgovernments’ decisions.This chapter looks at changes over time in public resource allocation amongLTC users in the same OECD countries considered in the previous chapter (exceptfor Australia). As in Chapter Four, this chapter focuses exclusively on publiccare inputs, defined as those inputs that are (at least partially) publicly funded,and looks at users aged 65 and over. Chapter Four led the way to reconsideringhow public resources are allocated in different LTC systems through an in-depthanalysis of current spending. To complement that analysis, this chapter adopts along-term perspective, investigating the changes that have occurred over the last20–25 years in three crucial dimensions of resource allocation: the mix of LTCservices for older people, their intensity, and their coverage.The countries considered are representative of the OECD environment withrespect to both the overall welfare models and the models of LTC policies.Concerning the former, as Campbell et al have noted in Chapter Four, ‘wehave Sweden in social-democratic Northern Europe, Italy in familial SouthernEurope, Germany in corporatist mid-continent, Australia, the US and Englandas quite different versions of the Anglo-Saxon “residual” model, and Japan as therelatively new entry that shares aspects of all the other models.’ From the pointof view of LTC policies, the sample of countries selected represents the differentmodels in the OECD context:• Universal coverage within a single programme: this model guarantees people access toformal services without taking into account users’ income or assets as eligibilitycriteria. It is also organised as a single system, separated or integrated with theoverall health system (Germany, Japan and Sweden).• Mixed systems: in this case, LTC is provided through a mix of different universalprogrammes and benefits operating alongside, or a mix of universal and meanstestedLTC entitlements (England and Italy).• Means-tested systems: under this type of scheme, LTC coverage is providedthrough safety-net programmes. In countries using this system, income and/or asset tests are used to define thresholds for eligibility to publicly fundedcare. Only those falling below a set threshold are entitled to publicly fundedservices or benefits (the US) (Colombo et al, 2011).This chapter is organised as follows. First, it addresses the issue of resourceallocation, providing a definition of the topic and the methodology used. Themain policies implemented in each of the six countries are then examined. Finally,a comparative discussion on the trends emerging across our sample is presented,followed by a final paragraph looking ahead.
  • Grundberg, Åke, et al. (författare)
  • Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity.
  • 2014
  • Ingår i: Journal of Multidisciplinary Healthcare. - : DOVE Medical Press Ltd.. - 1178-2390 .- 1178-2390. ; 7, s. 189-199
  • Tidskriftsartikel (refereegranskat)abstract
    • Mental health promotion needs to be studied more deeply within the context of primary care, because persons with multiple chronic conditions are at risk of developing poor mental health. In order to make progress in the understanding of mental health promotion, the aim of this study was to describe the experiences of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity - what these seniors believe is important for achieving a dialogue that may promote their mental health. Seven interviews with six women and one man, aged 83-96 years, were analyzed using qualitative content analysis. The results were summarized into nine subcategories and three categories. The underlying meaning of the text was formulated into an overarching theme that embraced every category, "perceived and well-managed as a unique individual". These seniors with multimorbidity missed someone to talk to about their mental health, and needed partners that were accessible for health dialogues that could promote mental health. The participants missed friends and relatives to talk to and they (crucially) lacked health care or social service providers for health-promoting dialogues that may promote mental health. An optimal level of care can be achieved through involvement, continuity, and by providing a health-promoting dialogue based on seniors' needs and wishes, with the remembrance that general health promotion also may promote mental health. Implications for clinical practice and further research are discussed.
  • Jegermalm, Magnus, 1962-, et al. (författare)
  • Filling the gaps? The role of voluntary organizations in supporting older people with severe mental illnesses
  • 2020
  • Ingår i: Nordic Social Work Research. - : Taylor & Francis. - 2156-857X .- 2156-8588. ; 10:3, s. 219-229
  • Tidskriftsartikel (refereegranskat)abstract
    • Older people ageing with severe mental illness (SMI) usually fall in between mental health care and old age care services. The role of informal care in filling this gap is recognized. The role of other welfare providers, such as voluntary organizations, is unclear. The aim of this article is to analyze and discuss local voluntary organizations' ability to recognize and respond to the needs of older people with SMI in the community.11 local organizations focusing on mental illness, social care or old age were identified in a mid-sized Swedish city. Seven voluntary organizations participated in the study.Our analysis revealed three overarching themes: 'Age as a non-issue?', 'Public and voluntary sector (non)links' and 'organizational vulnerabilities'. Our results show that older people with SMI are to some extent also invisible in the voluntary sector. We were also able to discern differences in the 'we-for-us' organizations that provide support for their own members with SMI, and 'we-for-them' organizations that provide help to a broader group.Overall, older people with SMI remain a relatively invisible as a group for the voluntary organizations. We discuss these findings in relation to the specificity of the group and welfare contexts of voluntary work in communities.
  • Lagerin, Annica, et al. (författare)
  • Extent and quality of drug use in community-dwelling people aged >= 75 years : A Swedish nationwide register-based study
  • 2020
  • Ingår i: Scandinavian Journal of Public Health. - 1403-4948 .- 1651-1905. ; 48:3, s. 308-315
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged >= 75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged >= 75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages.
  • Lamura, Giovanni, et al. (författare)
  • Current LTC challenges in Italy
  • 2013
  • Ingår i: The Journal of Nutrition, Health & Aging. - 1279-7707 .- 1760-4788. ; 17:Supplement 1, June/july, s. S227-S227
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The rapid ageing of the Italian population is reflected by a growing demand for LTC services. As families are facing increasing difficulties in providing everyday elder care, the pressure on formal services is growing. At the same time, the current financial crisis is making the public response less and less able to provide the needed resources. As a consequence, the current approach of indirect public support to the private employment of migrant care workers (MCWs) through cash-for-care schemes is likely to continue.Method: The presentation is based on a detailed analysis of empirical findings and policy documents, outlining the crucial features characterising the Italian LTC system and describing also some of the main differences existing between different regional care approaches.Results: After adecade of increasing availability of publicly funded LTC services for older people, in some sectors, such as integrated home care, the audience of recipients has started receiving a lower number of hours of care. The mainly monetary focus of the Italian care regime has a clear incentivizing effect to employ foreign migrant care workers, often on an undeclared basis, to provide everyday elder care in Italian homes. Another crucial characteristic is the strong heterogeneity of Italian regions, according to which today different clusters of regions can beidentified, with strong inequalities in LTC provision.Conclusion : Thelack of a coherent national LTC policy has been recently accompaniedby an increasing focus on cash-for-care payments, which in the future will require a stronger attention to care quality issues.
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