Sini Eloranta

Personal resources supporting living at home as described by older home care clients.

This study describes the personal resources of older (> or = 75 years) home care clients in Finland and their perceptions of factors that enhance and constrain their ability to live independently at home. The data were collected by unstructured interviews with 21 older home care clients. Inductive content analysis were used to analyse the data. The resources of older people consisted of a sense of control over ones life and a determination to remain active. Factors enhancing older peoples resources were their involvement in leisure activities and social networks, factors undermining their resources were conditions on living imposed by outsiders, declining health and loneliness. The results show that home care professionals do not yet have sufficient skills and abilities to identify and support older peoples existing resources. As well as having access to necessary resources, it is also crucial that older people know how to use them.

Breast cancer patients receiving postoperative radiotherapy: Distress, depressive symptoms and unmet needs of psychosocial support

BACKGROUND AND PURPOSE The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and distress, and unmet needs for psychosocial support were assessed among breast cancer patients receiving postoperative radiotherapy. MATERIAL AND METHODS Out of 389 consecutive patients, 276 responded and comprised the final study group. Depressive symptoms were assessed with the Beck Depression Inventory. Distress was measured with the Distress Thermometer. Hospital records of the patients were examined for additional information. RESULTS Nearly one third of patients (32.1%) displayed depressive symptoms, and more than a quarter of patients (28.4%) experienced distress. Younger age (p=0.001) and negative hormone receptor status (p=0.008) were independent factors associated with distress. One quarter of the patients expressed an unmet need for psychosocial support, which was independently associated with depressive symptoms and/or distress (p=0.001) and younger age (p=0.006). CONCLUSIONS During radiotherapy for breast cancer, the staff should have awareness of the higher risk of depression and distress in their patients and should consider screening tools to recognise distress and depressive symptoms. Special attention should be paid to younger patients.

Multiprofessional collaboration promoting home care clients' personal resources: perspectives of older clients

Home care can be decisive in supporting older people in the home environment. However, one professional in home care cannot take the whole responsibility for promotion alone; on the contrary multiprofessional collaboration is needed. The aim of the study is to describe the experiences of multiprofessional collaboration in promoting personal resources among older home care clients (75+ years) in Finland. The data were collected by unstructured interviews with 21 older home care clients. Their mean age was 83.5 years, ranging from 75 to 91, with 17 female and four male participants. Inductive content analysis was used to analyze the data. The interviewees described the work of professionals from four perspectives: expertise, communication, decision-making and responsibility. Multiprofessional collaboration promoted the personal resources of interviewees with physical, psychological and social support. This study showed that the professionals worked as being expert-oriented: in the multiprofessional collaboration, each expert took care of his/her own part of the clients situation. This included the risk,, that the clients overall situations remained uncharted. However, the clients overall situation is a very important aspect when professionals suppport older people living in their own homes as long as possible. This study revealed the need for developing collaboration skills between social and health care professionals so that the staffs serve the needs of aged clients better together.

Positive life orientation in old age: a 15-year follow-up.

BACKGROUND Positive life orientation (PLO) is considered an important dimension of successful aging. AIM To investigate how self-reported PLO changed among home-dwelling people from age 70 to 80 and 85 years. STUDY DESIGN A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. SUBJECTS AND METHODS The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (N=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. PLO was assessed with the following items: life satisfaction, feeling needed, having plans for the future, having zest for life, feeling depressed, and suffering from loneliness. We created a PLO score from the answers to these questions, where 1 represented the best PLO and 0 the poorest. RESULTS At baseline, the participants showed rather high levels of positive life orientation (PLO total score 0.83). PLO declined markedly after the 70-year-old participants reached the age of 80 and 85 years (p<.001). However, depressive feelings remained quite stable. The decrease was similar among men and women except for the items suffering from loneliness and feeling needed. At age 70 and 80 years women suffered more from loneliness than men, while men experienced feeling needed more than women. CONCLUSIONS Positive life orientation declines during old age, especially from age 70 to 80 years. Thereafter the decline is less steep except for changes in future plans and feeling needed.

Empowering knowledge and its connection to health-related quality of life: A cross-cultural study: A concise and informative title: Empowering knowledge and its connection to health-related quality of life.

AIMS Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty. METHOD This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported health-related quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden. RESULTS The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre- and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative health-related quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece. CONCLUSIONS Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

A collaborative approach to home care delivery for older clients: perspectives of home care providers.

A collaborative approach to home care (HC) delivery for older clients has taken centre stage (Nies, 2006). In Finland, public home help and home health care services have been combined to form the home care unit, whose goal is to provide a collaborative approach to care delivery through cooperation and sharing of responsibilities. In this model, the general practitioner (GP), home care nurses (HCN) and home help workers (HHW) care for shared clients. GPs and HCNs provide health care, such as monitoring of clients’ health status, and HHWs assist with personal care tasks such as dressing, washing and meal preparation. As the needs of older clients are multiple, collaboration is needed as one professional group cannot take sole responsibility (Nies, 2006). This paper reports on a study undertaken to examine home care unit care providers’ perspectives of the collaborative approach to HC delivery for older clients.

Depressive symptoms among older people: a 15-year follow-up

Background and aims: Depressive symptoms are common symptoms impairing the quality of life of older people. This population-based birth year cohort study investigated the prevalence of depressive symptoms and factors associated with them among home-dwelling older people. Study Design: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. Methods: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (n=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. All examinations included an identical study protocol; the participants’ self-reported health status/habits and depressive symptoms were investigated via a questionnaire. Afterwards, thorough clinical examinations including the Zung depression scale were conducted by a nurse and physician/geriatrician. Results: The mean of the Zung depression scale total score was 34 (SD 7.7) at the age of 70 and a significant increase was found in both re-examinations. At the age of 80 the mean of the Zung score was 35.8 (SD 7.5) while it was 37.6 (SD 8.9) at the age of 85 years. A similar increasing trend was found in the proportion of persons classified into the high Zung score group (≧45 points) indicating more depressive symptoms over the 15 year follow-up. Univariate and multivariate analyses showed that mostly functional and social factors were associated with subjectively reported depressive symptoms, while few associations were evidenced between depressive symptoms and medical conditions or poor health. Conclusions: Our findings revealed an increase in prevalence of depressive symptoms throughout the course of the investigation. Our findings suggest that even in the absence of a diagnosis of major depression, depressive symptoms assume importance in the evaluation of the health status and need for health care services among older people.

Predictors of institutionalization among home-dwelling older Finnish people: a 22-year follow-up study

Background Identification of predictive factors on institutionalization provides the basis for the development and application of preadmission assessment. There is a lack of evidence for predictors of institutionalization for older people. Aims To examine the effect of predictive factors on institutionalization in home-dwelling 70-year-old people. Methods The data were collected in 1991 by the clinical examinations, a postal questionnaire and an interview from the residents of Turku, Finland, born in 1920 (n = 1032). Institutionalization was defined as entry into a nursing home or sheltered housing at any time during a 22-year follow-up. Results A rate of institutionalization was 22.0 %. In multivariable Cox regression analysis, impaired cognitive function (MMSE 18–26) (hazard ratio 1.37, confidence interval 1.17–1.62), low BMI (\25 kg/m) (1.60, 1.29–2.00), having several falls during the previous year (1.87, 1.21–2.87), and not having anyone who helps when needed (1.21, 1.01–1.46) remained significant predictors of institutionalization. In addition, high BMI (C30 kg/m) (compared with BMI 25–29.9 kg/m) (1.28, 1.02–1.61) significantly predicted institutionalization in multivariable analyses. Conclusions We conclude that impaired cognitive function, frequent falling, low and high BMI and lack of help when needed predicted institutionalization during the 22-year follow-up. In order to reduce or postpone institutionalization, interventions should target risk factors, such as physical limitations and falling. Also community-based services according to the needs and functional ability of the home-dwelling older people should be developed.

Prediction of the Future Need for Institutional Care in Finnish Older People: A Comparison of Two Birth Cohorts

Background: More recent birth cohorts of older people have better physical and cognitive status than earlier cohorts. As such, this could be expected to diminish the need for institutional care. The prediction of the future need for institutional care provides essential information for the planning and delivery of future care and social services as well as the resources needed. Objective: To predict the future need for institutional care among older Finnish people born in 1940. Methods: Representative samples of home-dwelling 70-year-olds from Turku, Finland were examined with similar methods in 1991 (those born in 1920) (n = 1,032) and in 2011 (those born in 1940) (n = 956). Predictors of institutionalization rates from the earlier 1920 cohort, together with data of sociodemographic factors, health, psychosocial and physical status, the need for help, and health behavior, were used to predict the future institutionalization rate among the 1940 cohort in this study using Cox regression models. Results: Health as well as psychosocial and physical status were significantly better in the 1940 cohort compared to the earlier cohort. In the 1940 cohort, the predicted rates of institutionalization were 1.8, 10.4, and 26.0% at the ages of 80 (year 2020), 85 (year 2025), and 90 years (year 2030), respectively. At every age (80, 85, and 90 years), the predicted rates of institutionalization by Mini-Mental State Examination (MMSE) were about two-fold among those with MMSE scores 18-26 (3.0-38.8%) compared to those with scores 27-30 (1.6-23.7%) and those with a body mass index (BMI) <25 (2.5-34.3%) compared to those with a BMI of 25-29.9 (1.4-20.9%), and about three-fold among participants with several falls (5.3-57.0%) compared to participants with no falls (1.5-23.1%). Conclusions: The 1940 cohort performed better in health as well as psychosocial and physical status than the 1920 cohort. Nevertheless, the predicted rates of future need for institutional care were high, especially at the ages of 85 and 90 years, among those with a lowered cognitive or physical status.

A scoping review of Finnish doctoral dissertations in older people nursing science

Scientific research is important in guiding the development of evidence-based, cost-effective and comprehensive healthcare. The purpose of this scoping review was to analyse the current stage of research in the field of older people nursing science based on doctoral dissertations completed in Finnish universities. Altogether 418 doctoral dissertations in nursing science were published (1990–2015), and 44 of these (11%) represented older people nursing. The majority of the dissertations focused on patient and family or nursing activities. Usual topics were care procedures and clinical nursing (36%); self-care ability, independence (23%) and existence, being and feeling as an individual person (18%). Only one randomised controlled trial was conducted. The main informants were older people (78%) who were typically interviewed or surveyed. Research in older people nursing science in Finland is focusing on traditional clinical nursing settings. More innovative research is necessary from the perspective of health promotion and technological solutions.