Ingibjörg Hjaltadóttir

Pain and its Association with Disability in Institutional Long-Term Care in Four Nordic Countries

Cross-sectional data ( n = 6,487) from four Nordic countries, Denmark, Finland, Iceland and Sweden, were utilized to determine the prevalence of daily pain and its association with disability in institutional long-term care. Every resident in each of the participating institutions was assessed with Minimum Data Set version 1.0. The sample was representative of institutional long-term care in Copenhagen and Reykjavik. In addition, the data collected from Stockholm and Helsinki provided substantial information on the residents in these capitals. The results showed that 22–24 per cent of the residents experienced daily observable pain and this was most evident in the most disabled subjects. In addition to disability and female gender, diseases or conditions independently associated with pain were terminal prognosis, osteoporosis, pneumonia, arthritis, depression, anaemia, peripheral vascular disease, cancer and cardiac heart failure. The association between pain and severe cognitive impairment was negative. The results strongly indicate that daily pain in long-term care has a complex association with disability, the latter acting together with underlying diseases as a source and/or result of pain. Thus, a vicious circle between pain and disability can be anticipated.

Tangible Interaction for Stroke Survivors: Design Recommendations

In this paper we outline the initial stages of a human centered design process aimed at the design of novel technology (tangible interactive objects) for stroke survivors. We found it useful to support standard methods, such as interviews and focus groups, with a video prototype in order to make the concept of tangible interaction, which was novel to our users, more clear. In addition we carried out a co-design workshop together with stroke survivors. Based on these activities, we present a set of preliminary design guidelines for tangible interaction for stroke survivors.

Thresholds for minimum data set quality indicators developed and applied in icelandic nursing homes.

A modified Delphi method was used to determine thresholds for Minimum Data Set quality indicators for Icelandic nursing homes. The thresholds were then applied to quality outcomes in Icelandic nursing homes for the year 2009. The thresholds indicate areas of good or poor care and can be used for planning services. Icelandic nursing homes seem to be doing best in incontinence and nutritional care. However, improvement is needed in care practices for depression, medication, and activity.

Designing Interactive Systems for Balance Rehabilitation after Stroke

This paper presents four different tangible interactive prototypes designed to support the continuation of balance rehabilitation at home. The interactive prototypes are designed to provide a more enjoyable and experience when performing balance rehabilitation exercises. Early results from preliminary tests with stroke survivors and rehabilitation professionals are promising. The aim of the designs is to allow people at different levels of rehabilitation to engage into balance training and perform the exercises according to their current skills.

Symptoms and functional status of palliative care patients in Iceland

BACKGROUND Palliative care patients experience many debilitating symptoms and functional loss, but few longitudinal studies on the subject are available. AIMS To assess the symptoms and functional status of patients admitted to specialised palliative care, to investigate whether changes occur over the admission period, and to establish whether symptoms and physical and cognitive function differ, based on the service setting. In addition, to participate in the development of the interRAI Palliative Care instrument (interRAI PC). METHODS A prospective longitudinal study (N=123) was conducted at three time points: at admission to specialised palliative care, 14 days post-admission, and at discharge or death. The interRAI PC version 8 was used for data collection. Descriptive statistics were used, together with the Friedman statistical test and Wilcoxon post-hoc test. RESULTS Patients experienced a wide spectrum of symptoms; the most frequent were fatigue, loss of appetite, pain, difficulty sleeping, insufficient nutritional intake and nausea. Some symptoms stayed relatively stable over time, but others increased, while physical and cognitive function decreased over time. The interRAI PC version 8 proved comprehensive and simple to use. CONCLUSIONS Patients experienced a significant symptom burden and functional loss from admission to discharge or death. Symptoms indicating progressive deterioration became more frequent and severe, while physical and cognitive function decreased at all levels. Overall, inpatients had more symptoms and functional decline than home-care patients. The interRAI PC version 8 proved valuable in collecting clinical information and detecting changes over time as other interRAI suite instruments.

Use of complementary therapies in nursing homes: Descriptive study

INTRODUCTION Complementary therapies may have positive effect on residents in nursing homes. The aim of this research was to investigate what kind of complementary therapies are provided in Icelandic nursing homes and who are the providers. Also whether the nursing homes need assistance to support the use of such therapies. METHOD A questionnaire was mailed to all the nursing homes in Iceland (N = 59). Total of forty-five nursing homes replied or 76% response rate. RESULTS Registered nurses and licenced practical did most of the planning and provision of complementary therapies. The most common therapies were: heat packs, physical exercise and massage. Managers would like to have more knowledge and support in providing complementary therapies. CONCLUSION The use of some complementary therapies is common in Icelandic nursing homes. More knowledge is needed to support the use of CT in Icelandic nursing homes.

Challenges in maintaining satisfactory documentation routines and evidence-based diabetes management in nursing homes

Introduction: The increasing prevalence of diabetes worldwide entails an expected rise in the number of older individuals with diabetes needing nursing home placement. Internationally, a consistent lack of adherence to clinical guidelines has been identified in the care of older people. In this study, we therefore investigated whether diabetes management in a sample of nursing homes in Norway and Iceland was in accordance with clinical guideline recommendations. Methods: We used a descriptive cross-sectional study design to assess diabetes management in 12 nursing homes: eight in Norway and four in Iceland. Results: We identified 162 residents with diabetes. The diagnosis of diabetes was available for 100% of the residents in the nursing homes in Iceland and respectively for 81 and 51% of the residents in southwestern and northern Norway. Totally, 3% of the residents with diabetes had a treatment goal for blood glucose regulation (HbA1c) documented in their medical record, 48% had agreed individualized routines for blood glucose measurements and 37% had a HbA1c value measured within the past 6 months available in their medical record. Conclusion: This study has shown a significant discrepancy between diabetes guideline recommendations and clinical diabetes practice related to documenting the diagnosis and type of diabetes, the establishment of individualized treatment goals for HbA1c and the establishment of routines for blood glucose and HbA1c measurements in nursing homes in Norway and Iceland. The results indicate a potential for improvement and a need for more nurses with advanced competence within diabetes in nursing homes.