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- Karlsson, Staffan, 1959-
(author)
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Older people`s public health care and social services : Functional ability, health complaints, agreement in needs assessment and care satisfaction
- 2008
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Doctoral thesis (other academic/artistic)abstract
- The overall aim was to describe and compare functional ability and health complaints of older people receiving municipal care in relation to housing and informal care, and factors associated with medical health care, municipal care and informal care. Further, the aim was to investigate agreement in needs assessments between personnel and older people and to investigate care satisfaction and health-related quality of life among older people receiving municipal care and services. Study I and II included 1958 persons aged 65 years and above, who were assessed for functional ability, health complaints, and level of informal and municipal care and service. Study II in addition included data from a register including medical health care. In study III (n=152), standardised needs assessments were performed by the staff. Later, the older person’s view was collected in a personal interview concerning functional ability, health complaints, public and informal care. In addition (Study IV, n=166), SF-12 was used for measuring health-related quality of life and for measuring care satisfaction. Cohabitation was a predictor of a combination of municipal and informal care at home (OR: 5.935), while assistance with Instrumental Activities of Daily Living (IADL) provided by municipal home care and services predicted municipal care only (OR: 0.344). Care in special accommodation was predicted by advanced age (OR: 1.051), dependency in IADL (OR: 19.883), Personal Activities of Daily Living (PADL) (OR: 02.695), and impaired cognitive ability (OR: 3.849) with receiving municipal care only as a reference. Living alone (OR: 0.106), dependency in IADL (OR: 11.348) and PADL (OR: 2.506), impaired cognitive ability (OR: 3.448), impaired vision or blindness (OR: 1.812) and the absence of slowly healing wounds (OR: 0.407) were predictors of special accommodation with a combination of informal and municipal care at home as a reference. 35% of those with public care at home were admitted to hospital and 76% had contact with outpatient care by physician compared to 26% and 87% respectively of those in special accommodation. Living in special accommodation was associated with more contacts with primary health care (B=0.643) and fewer contacts with specialist care (B=-0.722). Informal care was associated with more contacts with primary health care (B=0.413), specialist care (B=0.787), admissions to (B=0.265) and days in hospital (B=1.573). Agreement for dependency in IADL and PADL varied between good (κ=0.78) and moderate (κ=0.43). Poor agreement was found for dizziness (κw=0.17) and fair agreement for impaired hearing, urinary incontinence, pain, anxiety and depressed mood (κw between 0.21 and 0.37). Older persons reported more health complaints than were found in the personnel’s assessments, although significantly lower estimation was found only for incontinence and vision. Agreement for provided public care at home was poor, while for informal care it varied between very good and moderate. Low care satisfaction was associated with dependency in IADL (B=-1.338 and B=-1.630), impaired mobility (B=-12.579), blindness (B=-26.143), faeces incontinence (B=-11.898 and B=-17.529) and anxiety (B=-6.105 and B=-27.197), while high care satisfaction was associated with dependency in PADL (B=2.109) and receiving informal care with IADL from spouse (B=8.738). In special accommodation, low care satisfaction had to do with continuity, timing, the staff’s personal characteristics and with their ability to give service. At home, the older people were the least satisfied with the staff’s ability to do housework and to give medical care, with the staff’s amount of time and with their own influence over their care.
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- Engelheart, Stina, 1976-
(author)
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Nutritional status in a functional perspective : A study in a cohort of older people in home health care
- 2021
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Doctoral thesis (other academic/artistic)abstract
- High age is a risk factor for most acute and chronic diseases, injuries and function disabilities, and hence, an important risk factor for nutritional problems. A great deal of elderly health care in Sweden are performed in the patient’s home environment and home health care has been transformed to more advanced medical care the last decades.The aim of this thesis was to comprehensively describe the nutritional status and its change over time in a population of older people receiving home health care. The aim includes to propose a framework for investigating and analysing the nutritional status in older people.Nutritional status was studied at enrolment in home health care and regularly followed up for three years. Patients that were 65 years or older and needed home health care for at least three months between 2012 and 2017 were asked to join the study, resulting in 69 participants (64%women).Data collection and analysis of the nutritional status was based on the proposed model for assessing the nutritional status in a comprehensive functional perspective (paper 1). The model comprises four domains that affect the nutritional status and functional outcome in a bidirectional way. In paper 2 we concluded that malnutrition, sarcopenia, frailty and dehydration are highly prevalent in the population and the most important indicators were loss of appetite and dehydration. This was confirmed in paper 3, were nutritional status was analysed with a statistical approach. A total of 103 indicators of nutritional status were reduced to 19 that were suggested to be primary investigated. Also, the paper empirically confirmed the relationship within as well as between the domains suggested in paper 1. Finally, we studied meal pattern, being a part of one of the domains (paper 4). We found indications that presence of at least one large meal (high energy intake) per day had more impact on the total daily energy and protein intake than more eating occasions during the day.
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| 5. |
- Lindborg, Ann-Louise, 1979-
(author)
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Usability Requirements for User-Controlled Robotic Eating Aids
- 2021
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Licentiate thesis (other academic/artistic)abstract
- The meal is fundamental in terms of nutrition but also from a social perspective. To be able to eat independently is described as important for the meal experience. The development of a robotic eating aid called Bestic and the evolvement of a list of usability criteria for such an aid are described in this thesis. The work has been ongoing for 16 years. Bestic has been developed through user centred design, an iterative process with reoccurring evaluations and development. The design principle “it is not supposed just to work, but to be worth using” has guided the work. The feedback provided by the users throughout this process has had a great impact on the strategic choices of which features to prioritize during further development and what to keep as it is and has contributed to the list of usability requirements for robotic eating aids. The context in which the robotic eating aid is used is of importance for the usability requirements. To further understand the environment that the robotic eating aid is used in, studies about the meal situation for older people in both Scandinavian/Swedish and Japanese contexts were conducted. The secondary users (care professionals or next of kin) were also taken into consideration when deriving the usability requirements and while performing the evaluations of the robotic eating aid.The most important research outcome from this work is a list of usability requirements for robotic eating aids. The requirements are divided into functional requirements and social requirements. The functional requirements for robotic eating aids include:· how well they work to eat with· how they are controlled· safety aspects· portability· possibility to adapt to different users. The social requirements for robotic eating aids include:· how to fit into the meal situation· not to disturb the conversation· the needs from secondary users.
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- Söderström, Lisa, 1982-
(author)
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Nutritional status among older people : Risk factors and consequences of malnutrition
- 2013
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Licentiate thesis (other academic/artistic)abstract
- Despite the high frequency and serious consequences of protein–energy malnutrition, prevention and treatment of malnutrition do not currently receive appropriate attention. Increased awareness of the importance of nutritional screening among older people is needed. The overall aim of this thesis was to extend our current knowledge about malnutrition and the consequences of a poor nutritional status in relation to preterm death, and to identify possible risk factors for developing malnutrition among older people. The aim of Paper I was to estimate the prevalence of malnutrition and to examine the associations between mealtime habits, meal provision, and malnutrition among older people admitted to a Swedish hospital. The aim of Paper II was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in older people.The baseline survey was a cross-sectional study of 1771 patients aged ³65 years who were admitted to hospital. Nutritional status was assessed using the MNA instrument, and possible risk factors associated with malnutrition were recorded during the hospital stay (Paper I). Overall survival was followed up after 35–50 months in a cohort study of 1767 participants (Paper II).Of the 1771 participants, 35.5% were well-nourished, 55.1% were at risk of malnutrition, and 9.4% were malnourished at baseline. An overnight fast >11 hours was associated with risk of malnutrition (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.14–1.87) and being malnourished (OR 1.67; 95% CI 1.04–2.69). Fewer than four eating episodes a day was associated with both risk of malnutrition (OR 1.88, 95% CI 1.52–2.32) and being malnourished (OR 3.10; 95% CI 2.14–4.49). Not cooking independently was also associated with both risk of malnutrition (OR 1.9; 95% CI 1.30–2.93) and being malnourished (OR 5.04; 95% CI 2.95–8.61). At the 50-month follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants. After adjusting for confounders, the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18–2.07) in the group at risk of malnutrition and 3.71 (2.28–6.04) in the malnourished group. Nutritional status defined according to the three categories in the full MNA independently predicted preterm death in people aged 65 years and older.This thesis provides additional knowledge of the current nutritional situation among older people admitted to hospital. The high prevalence and serious consequences of malnutrition demonstrated in this thesis underline the importance of screening and taking actions to counteract malnutrition among older people. The data showing that the length of overnight fasting and number of eating episodes per day are possible risk factors for malnutrition are consistent with the current nutritional recommendations. This knowledge may stimulate care providers to decrease the length of overnight fasting and increase the number of eating episodes per day among older people at risk of malnutrition.
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