BackgroundContinuity of care is viewed as a hallmark of high-quality care in the primary care context. Measures to evaluate the quality of provider performance are scarce, and it is unclear how the assessments correlate with patients' experiences of care as coherent and interconnected over time, consistent with their preferences and care needs.AimTo develop and evaluate a patient-reported experience measure of continuity of care in primary care for patients with complex care needs.MethodThe study was conducted in two stages: (1) development of the instrument based on theory and empirical studies and reviewed for content validity (16 patients with complex care needs and 8 experts) and (2) psychometric evaluation regarding factor structure, test-retest reliability, internal consistency reliability, and convergent validity. In all, 324 patients participated in the psychometric evaluation.ResultsThe Patient Experienced Continuity of care Questionnaire (PECQ) contains 20 items clustered in four dimensions of continuity of care measuring Information (four items), Relation (six items), Management (five items), and Knowledge (five items). Overall, the hypothesized factor structure was indicated. The PECQ also showed satisfactory convergent validity, internal consistency, and stability.Conclusion/ImplicationsThe PECQ is a multidimensional patient experience instrument that can provide information on various dimensions useful for driving quality improvement strategies in the primary care context for patients with complex care needs.Patient or Public ContributionPatients have participated in the content validation of the items.

People aged 65 years or older with complex care needs are at risk of fragmented care. This may jeopardise patient safety. Complex care needs are defined as care needs that require the performance of time-consuming processes such as reviewing medical history, providing counselling, and prescribing medications. A scoping review was conducted with the aim of mapping the literature regarding continuity of care from the perspective of older people with complex care needs. Search results from seven databases (PubMed, Cinahl, PsycInfo, ASSIA, Web of Science, Google Scholar, Scopus, DOAJ), grey literature (BASE), and a hand-search search of key journals were used. A deductive analysis based on aspects of continuity of care was performed. The search resulted in 5704 records. After a title and abstract screening, 93 records remained. In total, 18 articles met the inclusion criteria and were included in the scoping review. Older people's sense of continuity of care increases when fewer healthcare workers are involved in their care but help from skilled professionals is more important than meeting the same person. It is vital for older people's feeling of continuity of care that discharge planning involves them, their families, and care providers in an organised way. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Aim: The aim of the study was to describe continuity from the perspective of working as an agency nurse (AN).

Design: Qualitative design was applied using individual semi-structured interviews. 

Method: Individual interviews with fifteen registered nurses working at agency companies were conducted in 2020. The interviews were analyzed with thematic analysis. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework.

Results: Thematic analysis yielded one theme – standing strong and taking command – and four categories: being competent and experienced, being prepared and at ease, ensuring an unbroken chain of care, and belonging on my own terms. The categories illustrated the engagement, professionalism, and natural leadership showed by the ANs to uphold quality and continuity.

Rätt till fast läkarkontakt kan absolut vara bra, speciellt för diagnostik, bedömning och medicinsk behandling. Men det räcker inte, skriver forskare och lärare vid Linnéuniversitetet.

Knowledge about psychological distress in older cardiac arrest (CA) survivors is sparse, and the lack of comparisons with general populations make it difficult to draw any strong conclusions about prevalence and potential changes caused by CA. Our aim was to compare psychological distress between older CA survivors and a general population. This study included survivors 65–80 years old and an age‐ and sex‐matched general population. Data on survivors was collected from the Swedish Register of Cardiopulmonary Resuscitation. The Hospital Anxiety and Depression Scale was used to measure psychological distress. Data were analyzed with non‐ parametric statistics. The final sample included 1,027 CA survivors and 1018 persons from the general population. In both groups, the mean age was 72 years (SD = 4) and 28% were women. The prevalence of anxiety was 9.9% for survivors and 9.5% for the general population, while the corresponding prevalence for depression was 11.3% and 11.5% respectively. Using the cut‐off scores, no significant differences between the groups were detected. However, CA survivors reported significantly lower symptom levels using the subscale scores (ΔMdn = 1, p < 0.001). In conclusion, the CA survivors did not report higher symptom levels of anxiety and depression than the general population. However, since psychological distress is related to poor quality‐of‐life and recovery, screening for psychological distress remains important.

Background

Depression in older people often goes undetected but has severe consequences on physical health, functioning and quality of life. As the aging population is growing, mental ill-health already is and will continue to be an important public health problem. There is a need for adequate strategies to meet this challenge.

Aims

(1) To investigate the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex in a random Swedish sample in the age group 65-80 years, and to investigate to what extent those scoring ≥ 8 in the depression dimension of the Hospital Anxiety and Depression Scale (HAD) had visited health care professionals and/ or used antidepressive medication.

(2) To evaluate the effect of group discussions, in which structured reminiscence and a Problem Based Method (PBM) were used, on depressive symptoms, Quality of Life (QoL) and Self-Rated Health (SRH) among older people.

(3) To describe the individual´s experiences of the year before and the time after retirement.

(4) To evaluate the factorial structure of the HAD in a general older population 65-80 years and to examine the possible presence of differential item functioning (DIF) related to sex.

Result

More men than women reported depressive symptoms, few were offered psychological treatment and a quarter used antidepressant medication. Depressive symptoms were associated with loneliness and this association decreased with increasing age.  

Participation in group discussions resulted in a decrease in depressive symptoms and an increase in QoL and SRH. Both expectations and fears were experienced the year before and the time after retirement.

The psychometric evaluation of the HAD showed a two-factorial structure and invariance regarding sex.

Conclusion

The result highlights the importance of detecting depressive symptoms and loneliness in older people and offer adequate treatment. Transition into retirement should receive more attention both from a health care and organizational perspective. Group discussions with structured reminiscence and PBM as a nursing intervention, seem to be a promising method to prevent depressive symptoms in older people, but further research is needed. The HAD can be recommended to assess anxiety and depression among a general population 65-80 years old.  

Background: The HADS (Hospital Anxiety and Depression Scale) aims to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression). The HADS is widely used but has shown ambiguous results both regarding the factor structure and sex differences in the prevalence of depressive symptoms. There is also a lack of psychometric evaluations of the HADS in non-clinical samples of older people. The aim of the study was to evaluate the factor structure of the HADS in a general population 65-80 years old and to exam possible presence of differential item functioning (DIF) with respect to sex. Methods: This study was based on data from a Swedish sample, randomized from the total population in the age group 65-80 years (n = 6659). Confirmatory factor analyses (CFA) were performed to examine the factor structure. Ordinal regression analyses were conducted to detect DIF for sex. Reliability was examined by both ordinal as well as traditional Cronbach's alpha. Results: The CFA showed a two-factor model with cross-loadings for two items (7 and 8) had excellent model fit. Internal consistency was good in both subscales, measured with ordinal and traditional alpha. Floor effects were presented for all items. No indication for meaningful DIF regarding sex was found for any of the subscales. Conclusions: HADS Anxiety and HADS Depression are unidimensional measures with acceptable internal consistency and are invariant with regard to sex. Despite pronounced ceiling effects and cross-loadings for item 7 and 8, the hypothesized two-factor model of HADS can be recommended to assess psychological distress among a general population 65-80 years old.

Retirement is one of the most important transitions in a person's life, which also might affect health and well-being. Adjustment to a life as retiree does not follow a uniform pattern, which emphasizes the importance of an individual perspective. This article uses transition theory as a theoretical perspective. In-depth interviews were conducted with 13 individuals newly retired, focusing on experiences from the last year of work and the time after retirement. Content analysis was used to analyze data. Two themes emerged: ‘become aware of’ and ‘become adapted to’. Nine subthemes describe the individual experiences reflecting positive expectations and outcomes but also feelings of grief and disconnectedness and fears about loss of social network and identity. Transition into retirement should receive more attention from a nursing perspective since experiences such as, for example, grief, disconnectedness and loss of identity if unaddressed could lead to an unhealthy transition.

Aims and objectives: To evaluate the effect of group discussions, in which structured reminiscence and a problem-based method were used, on depressive symptoms, quality of life and self-rated health among older people. Background: Depressive symptoms in older people have a considerable impact on self-rated health and quality of life, with a high rate of co-morbidity and mortality. As the ageing population is growing, late-life depression is becoming an important public health problem and there is a need to find preventive interventions to avert unnecessary suffering. Design: The study was quasi-experimental, with a one-group pretest-post-test design and follow-up after one year. Methods: Initially, a questionnaire was sent to the total population of 55-80-year-old retirees in a community in the northeast of Sweden, (n=679). The questionnaire concerned demographics and covered areas such as health, depression and quality of life. The intervention consisted of group discussions where structured reminiscence and a problem-based method were used. The participants (n=18) met 10 times under the guidance of a group-leader, a registered nurse educated in the method. Each session had different themes with a focus on positive memories but also on the present situation and the future. Parametric, nonparametric tests and content analysis were used.Results: Participants evaluated the intervention positively, showed a decrease in depressive symptoms, an increase in self-rated health and experienced an increased autonomy. No long- lasting effect was seen. Conclusion: Group discussions where structured reminiscence and a problem-based method are used might be an option to prevent depressive symptoms in older people. Relevance to clinical practice: This method might provide an opportunity for older people with depressive symptoms to improve their quality of life, however, to maintain the positive outcome the intervention should probably be continuous.