Petra von Heideken Wågert

The importance of a daily rhythm in a supportive environment--promoting ability in activities in everyday life among older women living alone with chronic pain.

Abstract Purpose: The aim of this study was to explore how older women living alone with chronic musculoskeletal pain, describe their ability in performing activities in everyday life and what could promote their ability in activities in everyday life as well as their perceived meaning of a changed ability to perform activities in everyday life. Method: Qualitative interviews were conducted with 12 women, and an inductive content analysis was used. Results: The results showed the importance of a daily rhythm of activities. Activities included in the daily rhythm were socializing with family and friends, physical activities, doing own activities as well as activities supported by relatives and the community. The activities described by the women also promoted their ability in activities in everyday life. Other findings were the women’s perceived meaning of being independent and maintaining that independency, along with the meaning of accepting and adapting to a changed life situation. Conclusion: This paper concludes that it is important to be sensitive of individual needs regarding the daily rhythm of activities when health-care professionals intervene in the activities in everyday life of older women living alone, promote the women’s independency, and enable them to participate in the community. Implications for Rehabilitation A daily rhythm of activities is important for older women who live alone with chronic musculoskeletal pain. The importance of health-care professionals being sensitive to individual needs to promote ability in activities in everyday life and to encourage the everyday activities into a daily rhythm. Facilitate the women’s desire and will of independency, despite their needs of help from their environment to manage their everyday life.

Can Caregiver Singing Improve Person Transfer Situations in Dementia Care

Everyday person transfer situations involving persons with dementia and their caregivers can be reciprocally problematic. Group interviews with professional caregivers were conducted, focusing on the caregivers’ experiences of singing during person transfer situations with residents with dementia, and a qualitative content analysis was performed. The caregivers expressed that com- pared to everyday transfer situations without singing, there were obvious differences during singing. When the caregiver sang, communication was mutually enhanced between the caregivers and the residents. Caregivers reported that residents seemed to show their true personalities, were able to move more fluidly and easily, seemed to better understand what was going on, and reacted with a spirited cheerfulness. The caregivers experienced themselves as more competent in and motivated to provide care in addition to positive emotions and moods. Caregiver singing during transfer situations may be one of several suitable non-pharmacological interventions that can be utilized when caregivers need to assist persons with dementia in transfer.

Fall-related self-efficacy in instrumental activities of daily living is associated with falls in older community-living people

ABSTRACT Introduction: The aim of this study was to identify fall risk factors in community-living people 75 years or older. Methods: From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75–101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls. Results: The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93–21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers. Conclusion: Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.

Chronic pain among older women living alone. A study focusing on disability and morale

Abstract Purpose: To investigate (i) how older women who are living alone perceive chronic musculoskeletal pain, activities of daily living (ADL), physical activity, affective distress, pain-related beliefs, pain management, and rate pain-related disability and morale, and (ii) the relationships between demographic variables, ADL, physical activity, affective distress, pain-related beliefs, and pain management with pain-related disability and morale. Method: The study had a cross-sectional and correlational design. Sixty women, living alone with chronic pain and community support aged ≥ 65 years were included. Results: The women were on average 81 years old and had lived with pain for about 21.5 years. They reported low scores of affective distress, catastrophizing thoughts and self-efficacy, high scores of fear of movement, low degrees of pain-related disability and low levels of morale. The multiple regression analysis showed that only catastrophizing thoughts significantly explained the variation in pain-related disability, and both affective distress and catastrophizing thoughts significantly explained the variation in morale. Conclusion: These older women living alone with chronic pain reported similar prevalence of chronic pain and pain-related disability but lower morale when comparing the results with similar studies about older people in the same age group or older people who are in need of help to manage their daily life. The only variable that was independently associated with both pain-related disability and morale was catastrophizing. Further research should focus on identifying catastrophizing thoughts, on developing a rehabilitation programme based on a biopsychosocial perspective with the goal to decrease catastrophizing, pain-related disability and increase morale for this target group.

Reciprocal struggling in person transfer tasks – Caregivers’ experiences in dementia care

Purpose: This study describes caregivers’ experiences of person transfer situations involving people with dementia. Method: Qualitative focus group interviews were conducted with a total of 10 caregivers; two groups with five persons each, including two men and eight women. The resulting data were extracted and condensed into meaning units and codes using content analysis. Findings: One main theme was formulated that represents the caregivers’ experiences of person transfer situations involving people with dementia: “Reciprocal struggle in person transfer tasks”. Five categories were formulated: “Becoming familiar and making contact”, “Risking ones own body to protect the resident from injury”, “Focused yet aware of the surroundings”, “Identifying needs to facilitate the person transfer” and “Struggling to be understood”. Conclusion: Person transfer situations involving people with dementia are subject to sudden changes. The ongoing challenge is to ensure a dynamic approach that can be adapted to the needs of the person with dementia at any given time. There is a need for more studies within the field about care and rehabilitation among people with dementia. We suggest that assessment of person transfer situations involving people with dementia and their caregivers is an important issue for further investigation and physiotherapeutic interventions.

Development of a new assessment scale for measuring interaction during staff-assisted transfer of residents in dementia special care units

BackgroundMobility problems and cognitive deficits related to transferring or moving persons suffering from dementia are associated with dependency. Physical assistance provided by staff is an important component of residents’ maintenance of mobility in dementia care facilities. Unfortunately, hands-on assistance during transfers is also a source of confusion in persons with dementia, as well as a source of strain in the caregiver. The bidirectional effect of actions in a dementia care dyad involved in transfer is complicated to evaluate. This study aimed to develop an assessment scale for measuring actions related to transferring persons with dementia by dementia care dyads.MethodsThis study was performed in four phases and guided by the framework of the biopsychosocial model and the approach presented by Social Cognitive Theory. These frameworks provided a starting point for understanding reciprocal effects in dyadic interaction. The four phases were 1) a literature review identifying existing assessment scales; 2) analyses of video-recorded transfer of persons with dementia for further generation of items, 3) computing the item content validity index of the 93 proposed items by 15 experts; and 4) expert opinion on the response scale and feasibility testing of the new assessment scale by video observation of the transfer situations.ResultsThe development process resulted in a 17-item scale with a seven-point response scale. The scale consists of two sections. One section is related to transfer-related actions (e.g., capability of communication, motor skills performance, and cognitive functioning) of the person with dementia. The other section addresses the caregivers’ facilitative actions (e.g., preparedness of transfer aids, interactional skills, and means of communication and interaction). The literature review and video recordings provided ideas for the item pool. Expert opinion decreased the number of items by relevance ratings and qualitative feedback. No further development of items was performed after feasibility testing of the scale.ConclusionsTo enable assessment of transfer-related actions in dementia care dyads, our new scale shows potential for bridging the gap in this area. Results from this study could provide health care professionals working in dementia care facilities with a useful tool for assessing transfer-related actions.

Home Help Service Staffs’ Descriptions of Their Role in Promoting Everyday Activities Among Older People in Sweden Who Are Dependent on Formal Care

The study aimed to explore how home help service staff described their role in improving the abilities of older people, in particular, older women with chronic pain who are dependent on formal care, to perform everyday activities. Three focus group interviews were conducted, and a qualitative inductive thematic content analysis was used. The analysis resulted in one theme: struggling to improve the care recipients’ opportunities for independence but being inhibited by complex environmental factors. By encouraging the care recipients to perform everyday activities, the staff perceived themselves to both maintain and improve their care recipients’ independence and quality of life. An important goal for society and health care professionals is to improve older people’s abilities to “age in place” and to enable them to age independently while maintaining their quality of life. A key resource is home help service staff, and this resource should be utilized in the best possible way.

Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review

ABSTRACT In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum’s behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university’s initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

Everyday life in older men living alone – a complex view needing a biopsychosocial perspective

Abstract Purpose: To explore how older men living alone, describe their everyday activities and their abilities as well as how they could be helped in everyday life. Materials and methods: Qualitative semi-structured interviews were analysed with inductive content analysis. Eight men aged 65+ years were included. They were all living alone, albeit with home help services. They were able to walk and had sufficient cognitive ability. Results: The analysis resulted in one theme “A driving force of managing activities and overcome hindering factors requires a broad spectrum of prerequisites for participating in everyday life” with the following four categories: Importance of everyday activities; individual prerequisites enabling everyday activities; body and mind inhibit, and react to the decreased, abilities; and importance of the environment. Conclusions: The results generate a complex view of older men’s everyday life. It is important for older men’s independence that health care and rehabilitation staff adopt a comprehensive view and work from a biopsychosocial (BPS) perspective. Implications for rehabilitation To be an older man living alone might mean a decreased health and good health is a strong predictor for increased abilities in everyday activities. The living situation of older men living alone is not well studied and needs to be explored to a greater extend, especially from their own perspective. An interaction of biological, psychological, and social factors was expressed as important for older men’s everyday life, in accordance with the biopsychosocial (BPS) model. The expressed importance of participation as well as performing both physical and social activities reflects the need of individualised goals in rehabilitation according to the behavioural medicine approach. It is of outmost importance that health care and rehabilitation staff in contact with this group has a comprehensive view and works from a biopsychosocial (BPS) perspective, for maintenance of the older men’s independence in everyday life.

Inter- and Intra-Rater Reliability of a Newly Developed Assessment Scale: The Dyadic Interaction in Dementia Transfer Assessment Scale (DIDTAS)

ABSTRACT Aim: To study the inter- and intra-rater reliability of a newly developed assessment scale, the Dyadic Interaction in Dementia Transfer Assessment Scale (DIDTAS). Methods: Two physiotherapists completed the observational form of the DIDTAS while watching 20 video-films of sit-to-stand-transfers or bedside transfers (i.e., caregiver-assisted transfers), videotaped in a dementia special care unit. Two-way analyses of variance (ANOVAs) were used for calculating ICC values of each item. Results: The results supported the overall reliability of the DIDTAS items with variations in inter- and intra-rater reliability, with ICC values from 0.35 to 0.92. Conclusion: On the basis of the transfer-related actions of dementia care dyads, the DIDTAS was shown to be sufficiently reliable. This in turn can provide healthcare professionals seeing and treating individuals suffering from dementia with a new method for assessing actions related to person transfer situations in dementia care facilities.