Göran Holst

A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC)

Background and aims: A large, national, long-term, longitudinal, multi-purpose study has been launched in Sweden — the Swedish National study on Aging and Care (SNAC). The study involves four research centers collecting data in four different areas of Sweden. Methods: The study consists of two parts: the population part and the care and services part. In the population part, a large, representative panel of elders in different age cohorts is followed over time to record and describe the aging process from different aspects. In the care and services part, a systematic, longitudinal, individually-based collection of data is performed concerning provision of care and services together with functional ability, specific health care problems, and living conditions of the recipients living in the area. Results: The data collection in the population part of the SNAC is not yet completed. In the present article, some preliminary results are reported from the care and services part. These pertain to comparisons between the participating areas with respect to the prevalence of disability among those receiving care and social services in their ordinary homes and those receiving care in special accommodation. A comparison is also presented with regard to the amount of home help provided to subjects with a given disability. Conclusions: This project has several advantages. It is expected to generate a rich data base relevant for future research on aging and care and to have a direct impact on the future Swedish system of care and services for the elderly.

Exploring the meaning of everyday life, for those suffering from dementia

Living with dementia means struggling to preserve a sense of self, to retain (and reevaluate) ones values in a new situation, and to search for a new way of life. This study explored the meaning of everyday life as expressed by 11 people suffering from dementia. Data were collected through interviews with people in the early stage of a diagnosed dementia disease. The findings indicate that many people with dementia feel shame, sorrow, and sadness when their life with the disease begins but also indicate prospects of a more manageable life. Since the reaction and adjustment to dementia differs from person to person, professional caregivers need to use a casespecific approach in the provision of care.

Cooperation during Morning Care between Nurses and Severely Demented Institutionalized Patients

Nurse-patient cooperation during morning care in two wards for the care of severely demented patients (107 observations) were analyzed by using a hermeneutic-phenomenological approach. Nurse-patient cooperation was found to be characterized by their acting in mutuality or unilaterality and in or out of pace with each other. When acting in pace and mutuality, the nurse and patient turned to each other as persons as well as to the task. This theme related to confirming nurse actions and actions that provided opportunities for the patient to participate. When acting out of pace and unilaterality, cooperation was mainly task oriented and related to acts of resistance, the use of force, loss of attention or turning to others, or the patient wanted to escape. The findings were interpreted within the contexts of power, empowerment and powerlessness and may serve as indicators of low- or high-quality nurse-patient cooperation during morning care provided for demented patients.

Determinants of feeling hindered by health problems in daily living at 60 years and above

Although the ability to perform activities of daily living (ADL) is frequently used to identify the impact on daily living caused by health problems such as diseases, impaired eyesight or hearing, it is still not well known what makes people feel hindered in daily living with more or less inability to perform ADL. The aim of this study was to investigate feeling hindered by health problems in daily living among people (n = 958, 60-96 years) in relation to ADL capacity, health problems as well as social and financial resources, sense of coherence and life satisfaction. The data are taken from a baseline survey in one of the four included centres (Blekinge) of the longitudinal multicentre cohort study, The Swedish National Study on Aging and Care. The result showed that people felt hindered by their health problems despite no impairment in ADL capacity. Feeling greatly hindered by health problems was associated with factors linked to mobility but also to fatigue, no help when needed, and avoiding being outdoors due to fear of falling. Factors associated with feeling greatly hindered differed depending on whether people were impaired in ADL capacity or not. In people with excellent ADL capacity feeling hindered was associated with picking up things from the floor and rising from a chair and fatigue, whereas avoiding being outdoors, no help when needed and rising from a chair were found to be associated with feeling hindered by health problems among people with impaired ADL capacity. Combining peoples ADL capacity with questions about feeling hindered may provide knowledge of determinant factors of feeling hindered in relation to ADL capacity, impaired or not, to identify people in need of rehabilitation or other interventions.

Factors related to frequent usage of the primary healthcare services in old age: findings from The Swedish National Study on Aging and Care

People aged 60 or more are the most frequent users of healthcare services. In this age range, however, both frequent and infrequent users can be found. Frequent users have high rates of illnesses. Previous research has found that the frequency may be influenced also by psychological and social factors. The aim of this study was to investigate to what degree such factors add to the explanation of differences in number of visits to a physician. A cross-sectional study was conducted with a random sample consisting of 1017 individuals, aged 60 to 78 years, from the Blekinge part of the Swedish National Study on Aging and Care database. The data were collected during 2001 to 2003. Hierarchical logistic regression analyses were used with frequent (three visits or more during a year) and infrequent use as a dichotomous dependent variable. The final statistical analyses included 643 individuals (63% of the sample). Independent variables were sense of coherence (SOC), internal locus of control, education level and social anchorage. Control variables were age, gender, functional ability and comorbidity. The results showed that comorbidity was most strongly related to frequent use [adjusted odds ratio (OR) = 8.17, 95% confidence interval (CI) 5.54–12.04]. In addition, SOC and internal locus of control had small, but significant effects on the odds of being a frequent user (adjusted OR = 1.03, 95% CI 1.00–1.06 and adjusted OR = 1.14, 95% CI 1.02–1.27, respectively). The lower the SOC and the internal locus of control were, the higher were the odds of frequent use. Education level and social anchorage were unrelated to frequency of use. The results indicate that frequent healthcare services users are more ill than infrequent users. Psychological factors influence the use only marginally, and social factors as well as age and gender are not by themselves reason for frequent healthcare services use.

Case managers for older persons with multi-morbidity and their everyday work – a focused ethnography

BackgroundModern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences.MethodsThe study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis.ResultsAn overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy.ConclusionsFindings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.

Loneliness among Older People: Results from the Swedish Study on Aging and Care -Blekinge

Objectives: To investigate the prevalence and predictors of loneliness in older people (aged 78+) over a six- year period. Method: The sample (n=828) was drawn from the Swedish National Study on Aging and Care and the respondents were followed up at three and six years. Data were collected by means of structural interviews with supplementary questionnaires. Results: Half of the respondents reported that they felt lonely sometimes or more often. Women, widows/-ers living alone were more prone to report loneliness. Both independent associated factors and predictors were identified showing that loneliness is associated with and predicted by both physical and psychosocial outcomes. Discussion: Loneliness is common among older people and seems to be a steady state affected mainly by psychological and psychosocial factors such as personality, satisfaction with life, risk of depression, lack of friends and loss of spouse. Psychosocial interventions targeting emotional loneliness and social isolation are suggested.

The work of case managers as experienced by older persons (75+) with multi-morbidity – a focused ethnography

BackgroundComplex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers.MethodsThe study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013.ResultsThe data revealed four themes illustrating the older persons’ experiences of case managers:1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present.ConclusionsThis study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

European Academy of Nursing Science and the Swedish Society of Nursing Summer Conference 2017: The Future Direction of European Nursing and Nursing Research

Osteoporosis is highly prevalent worldwide and is associated with increased risk of low trauma fracture (LTF) [1], increased morbidity and mortality [2]. Major advances in diagnosis, management and BMC Nursing 2017, 16(Suppl 1):32 Page 3 of 11 prevention of secondary fractures have occurred [3] but implications for acute nursing care are less well documented. This project investigated practitioners’ experiences of caring for people with osteoporosis, knowledge of the disease, explored implications for moving and handling, reported patients’ care experiences, and developed education for frontline staff.We welcome all high quality abstracts related to the following three conference themes: Methodological innovations moving beyond the established; Researching nursing interventions moving beyond the “uniqueness” of nursing; Humanitus – returning to the essential principles of clinical nursing care. Online submission opens 16th of August, 2016 on www.swenurse.se Submission deadline is 18th of November, 2016 Call for Abstracts – The 2017 European Conference in Nursing and Nursing Research Fo to : W er n er N ys tr an d

European Academy of Nursing Science and the Swedish Society of Nursing Summer Conference 2017: The Future Direction of European Nursing and Nursing Research: Malmö, Sweden. 04-05 July 2017

Osteoporosis is highly prevalent worldwide and is associated with increased risk of low trauma fracture (LTF) [1], increased morbidity and mortality [2]. Major advances in diagnosis, management and BMC Nursing 2017, 16(Suppl 1):32 Page 3 of 11 prevention of secondary fractures have occurred [3] but implications for acute nursing care are less well documented. This project investigated practitioners’ experiences of caring for people with osteoporosis, knowledge of the disease, explored implications for moving and handling, reported patients’ care experiences, and developed education for frontline staff.We welcome all high quality abstracts related to the following three conference themes: Methodological innovations moving beyond the established; Researching nursing interventions moving beyond the “uniqueness” of nursing; Humanitus – returning to the essential principles of clinical nursing care. Online submission opens 16th of August, 2016 on www.swenurse.se Submission deadline is 18th of November, 2016 Call for Abstracts – The 2017 European Conference in Nursing and Nursing Research Fo to : W er n er N ys tr an d