| 1. |
- Karlsson, Åsa, 1972-
(författare)
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Team-based home rehabilitation after hip fracture in older adults : effects, experiences and impact of dementia
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: For an older adult a hip fracture may be a traumatic and life-changing event and has shown to be associated with reduced health-related quality of life, disability and increased mortality. Previous rehabilitation studies have often excluded older adults with cognitive impairment and those living in residential care facilities, groups with an additional risk of poor outcome. Moreover, there are few randomized controlled trials that have evaluated interdisciplinary home rehabilitation after hip fracture. These studies did not include older adults with severe cognitive impairment or dementia, those with serious medical conditions, or those living in residential care.OBJECTIVE: The aim of the thesis was to investigate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation (GIHR) for older adults with hip fracture, and specifically among those with dementia, compared to in-hospital geriatric care according to a multifactorial rehabilitation program. An additional aim was to explore how older adults experienced their rehabilitation and recovery during the year following the fracture.METHODS: The thesis evaluated a randomized controlled trial that included 205 participants with hip fracture, 70 years or older, living in ordinary housing or residential care facilities. In hospital, both the GIHR and control groups received care and rehabilitation according to a multifactorial rehabilitation program, but with the aim of early discharge for the GIHR group. The individually designed GIHR intervention focused on walking ability indoors and outdoors, independence in activities of daily living (ADL), and multifactorial fall prevention during a maximum period of 10 weeks. Participants were assessed in-hospital and at 3- and 12-month follow-up visits. Independence in walking and use of walking aids was assessed via an interview along with gait speed tests. Independence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index, and hospital length of stay (LOS) was recorded from medical charts. The effects of GIHR intervention among participants with dementia were investigated in a post hoc subgroup analysis where additional outcomes were falls, mortality and readmissions between discharge and 12 months. Individual interviews were conducted with 20 selected participants just after the 12-month follow-up. Data were analysed using qualitative content analysis.RESULTS: The postoperative hospital LOS was significantly reduced by a median of six days in the GIHR group compared to the control group, although not significantly reduced in the GIHR group for participants with dementia. Binary logistic regression analyses revealed no significant differences between the GIHR and control groups regarding independent walking ability, the ability to walk without a walking device, or independence in ADL at 3 and 12 months. Gait speed was comparable between the two groups at 3 and 12 months. At 12 months, 56% in the GIHR group and 58% in the control group had recovered their prefracture walking ability, and 41% vs. 42% in GIHR and control groups, respectively, had regained their prefracture Barthel ADL Index score. Interaction analyses showed that the GIHR group vs. the control group had comparable effects on walking ability and ADL at 3 and 12 months, and on falls and mortality between discharge and 12 months, regardless of whether the participants had dementia or not (P≥0.05 for all). The number of readmissions and hospital days after discharge was comparable between GIHR and control groups for participants with dementia. Overall, dementia was associated with significantly impaired walking ability and greater dependence in ADL at 3 and 12 months and with increased risk of falling and increased mortality between discharge and 12 months compared to participants without dementia. The interviews revealed that access to rehabilitation, provided by skilled staff, and support from others were important for participants’ well-being and recovery. Participants experienced a fundamental change in their self-image after the fracture, and faced a number of difficulties, but strove for independence and used adaptive strategies to find contentment in their lives.CONCLUSIONS: In older adults with hip fracture, early discharge followed by interdisciplinary home rehabilitation significantly reduced postoperative hospital LOS. Functional recovery during the year following the fracture was nevertheless comparable to in-hospital geriatric care according to a multifactorial rehabilitation program. The GIHR intervention seems to be appropriate also for older adults with dementia since the effects were not different in this subgroup, except for postoperative hospital LOS, which was not significantly reduced in the GIHR group for participants with dementia. Further studies with larger samples are needed to validate these results. Overall, dementia was associated with a substantial negative impact on the outcomes. According to participants’ experiences, receiving rehabilitation and support after the hip fracture seems crucial for successful recovery. Negative psychological reactions were common, suggesting that future interventions should consider both physical and psychological aspects. Different rehabilitation alternatives were appreciated by the participants. Rehabilitation should thus be customised to suit wishes and needs of older adults and may accordingly be carried out in different settings, where rehabilitation in the home can be one suitable alternative. The findings of this thesis indicate that geriatric interdisciplinary home rehabilitation after hip fracture can be an alternative and a complement to in-hospital care and rehabilitation for older adults with and without dementia.
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| 2. |
- Sundén, Jenny, Professor, 1973-
(författare)
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Networked Intimacies : Pandemic Dis/Connections Between Anxiety, Joy, and Laughter
- 2021
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Ingår i: Disentangling. - Oxford : Oxford University Press. - 9780197571873 - 9780197571880 ; , s. 273-294
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- This chapter zooms in on transformations of intimacy and relational spaces in a time of a viral, global crisis. Set against the backdrop of “social distancing” practices, the chapter opens with a discussion of digital intimacy, focusing on the layering of anxiety and anticipation within networked connectivity. Secondly, it moves on to discuss how such anticipatory anxiety may become punctuated by pleasure and joy. Considering the dynamics between physical disconnection and digital intensity within pandemic hookup practices, it explores in particular instances of quarantine humor in queer hookup cultures. This humor stems from impossibly contradictory spaces of self-isolation, desire, and longing, in relation to which the swiftness of the swipe is transformed into a disconnect in the shape of a delay. The chapter ends with an example of Swedish, queer quarantine humor and a discussion of partial disconnections, or selective connectivity in difficult times in the interest of self-care.
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| 3. |
- Kempen, Thomas G. H., 1988-
(författare)
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Medication reviews by clinical pharmacists in older hospitalised patients : Implementation, performance and effects
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Inappropriate use of medications is a leading cause of avoidable harm in health care. Medication reviews by clinical pharmacists improve medication use, but evidence on hard clinical outcomes in older hospitalised patients is scarce and implementation in practice is challenging. The aim of this thesis was to study the implementation, performance and effects of medication reviews by clinical pharmacists in older hospitalised patients.Methods A case study explored the factors involved in the implementation and sustainability of medication reviews by clinical pharmacists in Region Uppsala, Sweden. A pragmatic multicentre cluster-randomised crossover trial (MedBridge) was conducted to study the effects of hospital-based comprehensive medication reviews (CMRs) including post-discharge follow-ups on older patients’ healthcare utilisation, compared with only hospital-based reviews and usual care. The primary outcome measure was the incidence of unplanned hospital visits within 12 months. A process evaluation was conducted alongside the trial, for which different methods were applied: semi-structured interviews with patients and healthcare professionals, intervention fidelity assessment and process outcomes assessment. A practical tool to identify medication-related hospital admissions, one of the trial’s secondary outcomes, was developed and validated.Results Multiple factors involved in the implementation and sustainability of medication reviews by clinical pharmacists were identified. Examples of facilitating factors were a national focus on quality of care for the elderly and clinical pharmacy education. In total, 2637 participants (median age 81 years) were included in the MedBridge trial. The primary outcome measure did not differ between the treatment groups. Analysis of the interviews with patients and healthcare professionals resulted in seven and six themes, respectively, that were related to the performance of the trial’s interventions. A recurrent theme was the unclear role and responsibilities of the ward-based pharmacist. The intervention fidelity was high during hospital admission and lower surrounding discharge. In 77% of the intervention patients, at least one medication discrepancy or drug-related problem was solved. The developed tool, AT-HARM10, was deemed valid for use by pharmacy students to identify medication-related admissions in older patients.Conclusions This thesis suggests that, despite a high percentage of patients with medication discrepancies or drug-related problems being solved, hospital-based CMRs with and without post-discharge follow-ups, as conducted in the MedBridge trial, do not decrease the incidence of unplanned hospital visits in older patients. Future research and clinical initiatives may benefit from addressing the factors related to the implementation and performance of medication reviews that were identified in this thesis.
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| 4. |
- Lindvall, Daniel, et al.
(författare)
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Upphettning - Demokratin i klimatkrisens tid
- 2020
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Vi står inför en existentiell utmaning med förändrade villkor för allt liv på jorden. Samtidigt genomgår den moderna demokratin sin värsta kris sedan andra världskriget. Är hotet mot demokratin och den globala upphettningen två kriser som går ihop till en ödesdiger storm? Eller finns det vägar mot minskade utsläpp och en stabil demokratisk framtid? Upphettning är en djupdykning i klimatförnekelse som politisk rörelse. Utifrån aktuell forskning diskuterar boken de utmaningar som den globala uppvärmningen ställer på vårt demokratiska styrelseskick utifrån frågeställningar som: Kan vi med demokratins hjälp hantera klimatfrågan? Varför motsätter sig den auktoritära nationaliströrelsen så aktivt klimatvetenskap? “Den här boken är angelägen för att den i detalj avslöjar sambanden mellan förnekelsen av klimathotet och undergrävandet av demokratin och det öppna samhället.” Sverker Sörlin, professor i miljöhistoria vid KTH ”Med imponerande kunskapsbredd ger boken en insiktsfull, engagerande och hoppingivande förståelse för hur demokratisk drivna samhällstransformationer kan övervinna fossilekonomins djupt rotade strukturer.” Björn-Ola Linnér, professor vid Tema Miljöförändring med inriktning internationell klimatpolitik ”Upphettning är en heltäckande och lärd exposé av klimatkrisen historia i världen och i Sverige, globalt och lokalt. Rekommenderad läsning för alla i klimatkrisens tidevarv.” Gustaf Arrhenius,VD, Institutet för framtidsstudier, professor i praktisk filosofi ”Detta är en efterfrågad och mycket viktig bok för alla som vill förstå en av samtidens viktigaste debatter: den av människan skapade globala klimatkrisen och hur det kommer sig att vissa grupper i samhället förnekar att krisen överhuvudtaget existerar.” Ann-Kristin Bergquist, docent i ekonomisk historia vid Umeå universitet
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| 5. |
- Fine, Kimberly L., et al.
(författare)
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Association Between Early Prescribed Opioid Initiation and Risk of Suicidal Behavior
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Prescription opioid use has been linked to increased risk of suicidal behavior in adults. However, little research exists examining the role of prescription opioid use on risk of suicidal behavior in children and adolescents. This population is at high risk for suicidal behavior, as suicide is the second leading cause of death for people ages 10 to 34. Using healthcare data from Swedish population registers, we aimed to characterize the extent to which exposure to opioids at a young age leads to an increased risk of new onset suicidal behavior, for those with no history of suicidal behavior. Compared to demographically matched non-recipients, young people who initiated prescription opioids had just under three times the rate of subsequent suicidal behavior (HR = 2.64, 95% CI, 2.47-2.81). Compared to their unexposed siblings, young people who initiated prescription opioids had roughly two times the rate of subsequent suicidal behavior (HR = 1.83, 95% CI, 1.67-2.01). Finally, compared to young people initiating prescription NSAIDs, young people who initiated prescription opioids had only 19% relatively greater rates of suicidal behavior (HR, 1.19, 95% CI, 1.11-1.27). These results suggest the association between prescription opioids and suicidal behavior may be driven by the underlying pain indication.
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| 6. |
- Najar, Jenna
(författare)
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Risk factors for dementia. Lifestyle, hormones, neurochemistry, and genetics
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The aim of this thesis was to expand the understanding about the effects of lifestyle factors, indicators of endogenous estrogens, and genetic factors on the risk of dementia and cerebrospinal fluid (CSF) markers for Alzheimer’s disease (AD). Method: We used population-based samples from the Gothenburg H70 Birth Cohort Studies (H70-studies), the Prospective Population Study of Women (PPSW), and the Mayo Clinic Study of Aging (MCSA 70+ study). Information on exposures (marital status [married vs not married], cognitive and physical activity [active vs inactive], indicators of endogenous estrogen [age at menarche and menopause, reproductive period, number of pregnancies, and months of breastfeeding], and genetic factors [polygenic risk scores for AD (AD-PRSs), and APOE genotype]) was obtained through interviews and examinations performed by experienced health personnel. Dementia was diagnosed according to established criteria based on information from the examinations. CSF levels of Aβ42, Aβ40, P-tau, and T-tau were measured with immunochemical methods. Results: In Project I (the H70-studies, n=913; the MCSA 70+ study, n=3,471), we found that married men had a reduced risk of dementia compared to unmarried men, while no association was observed in women. In Project II (PPSW and the H70-studies, n=784), we found that midlife cognitive and physical activity were independently associated with reduced risk of late-life dementia disorders. In Project III (PPSW and the H70-studies, n=1,364), we found that longer reproductive period and later age at menopause were associated with increased risk of dementia and AD. In Project IV (PPSW and the H70-studies, n=75), we found that longer reproductive period was associated with CSF biomarkers for AD (lower levels of Aβ42, lower ratio of Aβ42/Aβ40, and higher levels of P-tau). In Project V (the H70-studies, n=2,052), we found that AD-PRSs (including 39 and 57 genetic variants) and APOE genotype were associated with risk of dementia up to very old ages. Conclusion: The results from this thesis add knowledge about risk factors for dementia, and add further knowledge on the protective effects of cognitive and physical activity on different dementia disorders.
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| 7. |
- Malmgren, Linnea
(författare)
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Kidney Function During Ageing and its Association with Bone Mass, Fracture and Mortality
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Osteoporosis and osteoporosis related fractures are a major health care challenge both in Sweden and globally. The cost and suffering from osteoporosis are expected to increase since the population of elderly is increasing. Bone health can be affected by altered mineral homeostasis, which in its turn can be affected by reduced kidney function. However, the course of age-related decline in kidney function and its association to osteoporosis andfracture in the very elderly need further investigation since longitudinal data are scarce. Therefore, this thesis has two main aims; 1) to investigate kidney function during ageing and 2) its association to bone health in a cohort ofelderly women.Data was collected through the Malmö Osteoporosis Prospective Risk Assessment (OPRA) cohort, a prospective cohort of 1044 community dwelling women, all aged 75 and followed for ten years with reinvestigations at age 80and 85. Data on BMD, fracture and blood biochemistry was available at all three time points.Estimated kidney function greatly depends on which marker and study equation is used. The discrepancies are to such an extent that could affect whether a person is diagnosed with chronic kidney disease (CKD) or not, of particular importance in the elderly. Only women with the worst kidney function, corresponding to CKD stage 3b-5, had continuously increased mortality risk. This indicates that an age-dependent CKD definition would be of valuein elderly women.Kidney function in elderly women was associated with markers of mineral homeostasis, bone loss and BMD, but the effect size was relatively small compared to other risk factors. Also, fracture risk was increased only in womenwith mild-moderate reduction of kidney function (CKD stage 3a) and not in women with the worst kidney function (CKD stage 3b-5). Low BMD was associated with increased fracture risk independent of kidney function. Havingboth reduced kidney function and osteoporosis could present an additional risk increase.In conclusion, estimated kidney function in elderly women greatly depends on method of estimation and the results advocate for an age-adapted CKD definition. Maintaining adequate kidney function is important formaintaining bone health, although in old age it is probable that the effect size of any single specific risk factor is smaller compared with younger individuals.
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| 8. |
- Brännström, Jon, 1977-
(författare)
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Adverse effects of psychotropic drugs in old age
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: With increasing age, the body and mind transform. Many of our organs gradually lose capacity, making them more sensitive to the effects of several drugs. In parallel, many of us accumulate an increasing burden of disease and other conditions warranting the use of medications. Hence, the use of most classes of drugs increases with age, especially so in elderly women.At the same time, medical science is lagging behind due to the fact that the oldest people in society often are excluded from pharmacological studies, where young males are the most coveted subjects.In the absence of strong evidence, much of the knowledge about the clinical and adverse effects of several drugs in the elderly is derived from observational studies, prone to bias and confounding. The use of psychotropic drugs in elderly people is particularly controversial, and even more so in people suffering from major neurocognitive disorders (NCD). Psychotropics have been associated with several adverse effects as well as limited clinical effect. Still, they are frequently prescribed to elderly patients.Aims: This thesis aims to explore the associations between several types of psychotropic drugs and two of the most severe adversities attributed to their use, increased mortality and the risk of hip fracture. It aims to explore mortality in data from well-controlled studies. It also aims to employ novel statistical methods to investigate the associations between drug exposure and hip fracture, in an attempt to gain information on possible causality from observational data.Methods: This thesis uses quantitative, comparative and epidemiological methods, prospective as well as retrospective. Two of the four papers are based on data collections conducted by the Department of Community Medicine and Rehabilitation, Umeå University, and include 992 and 1,037 individuals, respectively. The other two papers are based on Swedish nationwide registers and include 408,144 and 255,274 subjects, respectively. In all four papers multivariable regression models were used to investigate the associations between the exposures and outcomes, adjusted for possible confounding variables.Results: In a population-based sample of very old people, and in old people with major NCD, ongoing use of psychotropic drugs was not independently associated with increased mortality. Analyses did show, however, a significant impact of sex on the mortality risk, with tendencies for antidepressant drug use to be protective in men, but not in women, and for benzodiazepines to increase the mortality risk in men, but not in women. In two cohorts of old people, based on several nationwide registers, investigating the associations between psychotropic drug use and hip fracture revealed that users of antidepressants, as well as users of antipsychotics, had significantly increased risks of hip fracture, independent of a wide range of covariates. However, when studying how the risk changed over time, the strongest associations were found before the initiation of treatment with the respective drug, and no dose-response relationships were found.Discussion: The finding that psychotropic drug use was not independently associated with an elevated mortality risk was not in line with previous research, most of which have been based on data from large registers, and shown an increased risk of mortality. One reason for this difference is that the cohorts studied in this thesis were thoroughly investigated and characterised, making it possible to perform extensive adjusting for confounding variables. Hence, we expect a lesser amount of residual confounding, than in most other studies. Another explanation is that we studied ongoing drug use at baseline, rather than associations following initiation of treatment. This might have introduced a selection bias in our studies, where the individuals most sensitive to adverse effects would have discontinued treatment or passed away. The finding of a significant impact of sex on the risk of mortality adds to the unexplored field of sex differences in drug responses in old age, and warrants further investigation.In our register studies of psychotropic drug use and the risk of hip fracture, novel methods were applied. We have tried to overcome the hurdles of several types of confounding through the investigation of associations before and after the initiation of antidepressants, and antipsychotics, respectively. Our finding that the associations between psychotropic drug use and hip fracture were not only present, but indeed strongest, before the initiation of treatment indicates a strong presence of residual confounding and confounding by indication, and points toward the absence of a causal relationship between psychotropic drug use and hip fracture.Conclusion: The evidence supporting causal relationships between psychotropic drug use and serious adverse events in old age is insufficient. Our results point towards bias and confounding having strong influences on the observed associations between psychotropic drug use and mortality, and hip fracture, respectively.
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| 9. |
- Burman, Maria, 1983-
(författare)
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Malnutrition and obesity among older adults, assessed by Mini Nutritional Assessment and the body mass index, respectively : prevalence and associations with mortality and urinary tract infection
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- INTRODUCTION: Malnutrition and obesity are health concerns among older (aged ≥ 65 years) adults, but the combination of them have not been studied thoroughly nor have they been thoroughly investigated in very old (aged ≥ 85 years) adults. The aims of this thesis were to investigate the prevalence, trends in prevalence and associations with mortality of malnutrition and obesity, assessed by Mini Nutritional Assessment (MNA) and the body mass index (BMI), respectively, and to examine the combined effects of these conditions on mortality. Malnutrition as a risk factor for urinary tract infection (UTI) was also investigated. MATERIAL AND METHODS: The studies reported on in papers I and II were conducted with data from the Umeå85+/Gerontological Regional Database study, a population-based study of cohorts of very old adults. Data from all four Swedish cohorts (2000–2002, 2005–2007, 2010–2012 and 2015–2017), and from the 2000–2002 and 2005–2007 Swedish cohorts and a 2005–2006 Finnish cohort, respectively, were used. In the paper I study, trends in the prevalence of malnutrition (by MNA score) and obesity (by BMI) were investigated across cohorts. In the paper II study, the associations of MNA scores and BMI with 5-year mortality were investigated. The study reported on in paper III was conducted with data from the Senior Alert national quality registry; associations of Mini Nutritional Assessment–Short Form (MNA-SF) scores, BMI and 2-year mortality in older adults living in residential care facilities in Sweden were investigated. The study reported on in paper IV was conducted with data from the Frail Older People–Activity and Nutrition and Umeå Dementia and Exercise studies; risk factors for UTI among older adults in residential care facilities were investigated. RESULTS: In the paper I study, mean BMI increased between 2000–2002 and 2015–2017 and the prevalence of obesity were 13.4% and 18.3%, respectively; the prevalences of underweight were 7.6% and 3.0%, respectively. Mean MNA scores increased between 2000–2002 and 2010–2012 and were slightly lower in 2015–2017. The prevalence of malnutrition according to MNA scores in the four cohorts were 12.2%, 6.4%, 5.1% and 8.7%, respectively, and the prevalence of at risk thereof were 31.8%–37.2%. In the paper II study, 13.3% of participants were malnourished, and 40.3% at risk thereof according to MNA scores, and malnutrition was more common among women than men. Twenty-five percent of the population had BMIs ≥28.0 kg/m2. Of those with malnutrition according to MNA scores, 17.4% had BMIs ≥ 24.7 kg/m2; of those with good nutritional status according to MNA scores, 13.8% had BMIs < 22.2 kg/m2. Compared to malnutrition according to MNA, lesser mortality was found in individuals with good nutritional status. Compared to individuals with BMI <22.2 kg/m2, lesser mortality was found in those with BMI ≥28.0 kg/m2. In the paper III study, 14.6% of the population was malnourished, and 45.0% at risk of malnutrition according to MNA-SF scores and 16.0% were obese. Compared to individuals with good nutritional status, greater mortality was found in those with malnutrition according to MNA-SF. Mortality was greater among underweight than among normal-weight participants and lesser among participants with obesity, including severe obesity. Higher BMIs were also associated with reduced mortality in subgroups defined by MNA-SF scores. In the paper IV study, malnutrition according to MNA scores was not a risk factor for UTI in the whole sample or in women. In men, the MNA score was associated with UTI in univariate analysis. CONCLUSIONS: The results of this thesis highlight the importance of nutritional screening in older adults in residential care facilities and in very old adults, since malnutrition risk was common and associated with greater mortality among these populations. Malnutrition according to MNA was not a clear risk factor for UTI in older adults living in residential care facilities. Time trends indicated an increasing prevalence of obesity whereas no change in nutritional status according to MNA was observed among very old adults, although these trends need further investigation. The results also confirmed that higher BMIs were beneficial for survival in these populations, and in the residential care population this seems to apply also for BMIs reflecting severe obesity. Finally, in the residential care population, regardless of nutritional status according to MNA-SF, higher BMIs were associated with better survival.
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| 10. |
- Westgård, Theresa
(författare)
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Comprehending the Comprehensive Geriatric Assessment. Feasibility, outcomes and experiences of frail older people
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT Despite existing knowledge on how to approach frail people in health care, the care they receive is commonly not designed to meet their complex needs and support them in maintaining their activities of daily living. One way to support frail older people when needing health care could be to enable them to share their life-stories and communicate their wants and wishes. Learning about a person’s social history can be a key element in comprehending older people in their care needs. The overall aim of this thesis was to evaluate the Comprehensive Geriatric Assessment (CGA) for frail older people aged 75 or older and to explore their experiences of care following a CGA. Methods: A pilot study with 30 frail older people (>75 years) was performed to determine the feasibility of the CGA, the process and procedures, instruments and proof of principle. Participants were included to the CGA intervention group or the control group that received regular medical care. After the pilot was determined to be feasible, the full RCT was carried out with an additional 125 participants. The 155 participants were followed up at one and six months. During the RCT 10 participants from the CGA ward partook in additional qualitative interviews, which explored through narratives 1) what personal resources they had and how they experienced health care services using three dimensional-analysis, and 2) how they experienced receiving a CGA, using a conventional content analysis. Results: Identifying and screening frail older people who might benefit from a CGA was successful, and those receiving the intervention were met by staff practicing increased attention to safety, ADLs, assistive devices, and discharge planning (Study I). The participants to a high extent agreed that the CGA care met their needs (Study II). The CGA participants experienced having a voice when receiving health care services by using their personal resources (Study III), and they felt respected as a person who could communicate, understand and participate in their care (Study IV). Conclusion: CGA provides care that is better adapted to frail older people’s needs, as they themselves felt that the care met their needs; however, no statistically significant effects for frail older people receiving care based on CGA were achieved. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings leading to a risk of low statistical power. In addition, a CGA during a single hospital stay is probably not enough to have long-term effects, since frail older people are in need of integrated care provided by multidisciplinary teams. To best benefit frail older people when receiving health care, an organized continuum of care is needed. In order to secure the care is based on what people need, a person-centered approach is fundamental.
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