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  • 1.
    Backåberg, Sofia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Calgary, Canada.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Halling, Anders
    Lund University, Sweden.
    Lincke, Alisa
    Linnaeus University, Faculty of Technology, Department of computer science and media technology (CM).
    Löwe, Welf
    Linnaeus University, Faculty of Technology, Department of computer science and media technology (CM).
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet, Sweden.
    Evaluation of the Skeleton Avatar Technique for Assessment of Mobility and Balance Among Older Adults2020In: Frontiers of Computer Science, ISSN 2095-2228, E-ISSN 2095-2236, Vol. 2, article id 601271Article in journal (Refereed)
    Abstract [en]

    Background: Mobility and balance is essential for older adults’ well-being an independence and the ability tomaintain physically active. Early identification of functionalimpairmentmay enable early risk-of-fall assessments and preventivemeasures.  There is a need to find new solutions to assess functional ability in easy, efficient, and accurateways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques.

    Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality.

    Methods: Fifty-four older adults (+65 years) were recruited through pensioners’ associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included.

    Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST.

    Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.

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    Skeleton Avatar Technique in Assessment of Mobility and Balance
  • 2.
    Borg, Christel
    et al.
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Lund University.
    Balducci, Cristian
    INRCA, Italy.
    Burholt, Vanessa
    University of Wales, UK.
    Ferring, Dieter
    University of Luxembourg, Luxembourg.
    Weber, Germain
    University of Vienna, Austria.
    Wenger, Clare G.
    University of Wales, UK.
    Holst, Göran
    Blekinge Institute of Research and Development.
    Hallberg, Ingalill R.
    Lund University ; Vårdal Institute.
    Life satisfaction in 6 European countries: The relationship to health, self-esteem, and social and financial resources among people (aged 65-89) with reduced functional capacity2008In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 29, no 1, p. 48-57Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate how overall health, participation in physical activities, self-esteem and social and financial resources are related to life satisfaction among people (65+) with reduced Activities of Daily Living (ADL) capacity in six European countries. A subsample of the European Study of Adults’ Well-Being (ESAW), consisting of 2195 people with reduced ADL capacity from Sweden, the UK, the Netherlands, Luxembourg, Austria, and Italy, was included. The Older Americans’ Resources Schedule (OARS), the Life Satisfaction Index Z, and the Self-esteem scale were used. In all national samples, overall health, self-esteem and feeling worried, rather than ADL capacity, were significantly associated with life satisfaction. The findings indicate the importance of not only taking the reduction in functional capacity into account, but also the individual’s perception of health and self-esteem, when outlining health care and nursing aimed at improving life satisfaction. The study thus suggests that personal, rather than environmental, factors are important for life satisfaction among people with reduced ADL capacity living in Europe.

  • 3. Borglin, Gunilla
    et al.
    Fagerström, Cecilia
    Blekinge University of Technology.
    Nursing students understanding of critical thinking and academic writing2010In: Scholarship of Teaching and Learning 2010, Karlskrona, 2010Conference paper (Refereed)
  • 4.
    Borglin, Gunilla
    et al.
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Nursing students understanding of critical thinking and appraisal and academic writing: a descriptive qualitative study2012In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 12, no 6, p. 356-360Article in journal (Refereed)
    Abstract [en]

    In Sweden, regulations from the National Agency for Higher Education advocate an education that equips students with independence as well as critical, problem-based thinking, i.e. academic literacy skills. However, some research findings indicate that students may leave higher education without mastering these skills effectively. As part of quality-assuring a nursing programme at a university college in south-east Sweden we explored the nursing student's view of crucial academic literacy skills, such as critical thinking and appraisal and academic writing, by conducting a descriptive, qualitative study. Informants were recruited through an advertisement posted on the university's e-learning tool. Eight focused interviews were conducted during autumn 2010. The transcribed interviews were analysed – inspired by content analysis – and two categories became apparent: constantly questioning and formality before substance. The latter revealed a gap between the student's perception of academic writing and that of the educators, thus implying that nursing students might not be equipped with the tools they need to develop within academia. We suggest that students could benefit in their academic endeavours from theoretical educational models that integrate several academic skills simultaneously and which could be incorporated into the development of syllabuses and curriculums.

  • 5.
    Bratt, Anna S.
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Perceptions of General Attitudes towards Older Adults in Society: Is There a Link between Perceived Life Satisfaction, Self-Compassion, and Health-Related Quality of Life?2023In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, no 4, article id 3011Article in journal (Refereed)
    Abstract [en]

    Negative attitudes towards aging are common in society. However, few studies haveinvestigated how older adults perceive this phenomenon. This study investigated (a) how olderadults in Sweden perceive general attitudes towards the older population and whether negativeperceptions are associated with low life satisfaction, self-compassion, and health-related qualityof life (HRQL), and (b) whether perceived attitudes predict life satisfaction when controlling forHRQL, self-compassion, and age. The sample comprised 698 randomly selected participants, aged66–102 years, from the Blekinge part of the Swedish National Study on Ageing and Care. The resultsshowed that 25.7% of the participants held negative attitudes towards older adults and reportedlower life satisfaction and HRQL. Self-compassion was related to higher life satisfaction, perceivedpositive attitudes, and better mental HRQL. Overall, perceived attitudes, HRQL, self-compassion,and age predicted 44% of the participants’ life satisfaction. Understanding the factors that influenceolder adults’ life satisfaction is crucial, as health-related losses might reduce the opportunity fora successful life. Our study makes an important contribution to the field, showing that perceivedattitudes explained 1.2% of the variance of life satisfaction, whereas mental and physical HRQLaccounted for 18% of life satisfaction.

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  • 6.
    Bratt, Anna S.
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Blekinge County Council, Sweden.
    Self-compassion in old age: confirmatory factor analysis of the 6-factor model and the internal consistency of the Self-compassion scale-short form2020In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 24, no 4, p. 642-648Article in journal (Refereed)
    Abstract [en]

    Objectives: Self-compassion is a psychological construct associated with self-acceptance and coping with the aging process. The Self-Compassion Scale (SCS), in both long and short forms, is the most widely used measure of self-compassion. Studies on the psychometric properties of the short form (SCS-SF) are scarce. The aim of this study was to translate into Swedish and test the psychometric properties of the SCS-SF. Another aim was to investigate whether self-compassion differs by age and gender in older adults.

    Method: We tested the Swedish SCS-SF in a sample of 594 randomly selected older adults, aged 66 to 102 years, for internal consistency, construct validity, and factor structure.

    Results: The results showed the SCS-SF had acceptable internal consistency in the total sample (Cronbach’s alpha = 0.68) and somewhat higher (Cronbach’s alpha = 0.76) in the youngest old (age 66 years). The six-factor structure found in the original study was not observed in confirmatory factor analyses in our older sample. Exploratory factor analyses showed that a two-factor solution, formed by the positive and negative components had the best fit; however, only the negative component had good internal consistency.

    Conclusion: Overall, the SCS-SF seemed to have insufficient reliability in this sample of older adults and further studies are needed to see whether new instruments are needed for this population. Self-compassion was generally higher in men than women, but did not differ by age in this sample of older adults.

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  • 7.
    Bratt, Anna S.
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Johansson, Maude
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala University, Sweden;Mälardalen University, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kronoberg, Sweden.
    Rusner, Marie
    Region Västra Götaland, Sweden;University of Gothenburg, Sweden.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden;Region Stockholm, Sweden.
    An internet-based compassion course for healthcare professionals: Rationale and protocol for a randomised controlled trial2022In: Internet Interventions, ISSN 2214-7829, Vol. 28, article id 100463Article in journal (Refereed)
    Abstract [en]

    Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research hasshown that compassion interventions for healthcare professionals can decrease work-related stress through theintroduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations.Internet-based stress management interventions have hitherto shown promising results in reducing stress.However, further research is needed to examine the effectiveness of internet-based compassion interventions forhealthcare professionals.Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effectsof an internet-based compassion course for healthcare professionals on work-related stress and stress ofconscience.Method: Healthcare professionals will be offered an internet-based stress management course of five modulesacross a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled inone of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n =120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stressmanagement course (n = 36). We hypothesise that the internet-based compassion course would reduce theparticipants’ stress of conscience to a greater degree compared to the other two groups. The secondary hypothesisis that the compassion course would increase the participants’ professional quality of life (i.e., higher jobsatisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion courseis expected to reduce the participants’ work-related stress and sick leave rates to the same degree (non-inferiority)as the cognitive behavioural stress management course and to a higher degree when compared to thewaitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondaryoutcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related StressCopenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will beperformed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimatingequation for repeated measurements to examine whether changes over time differ between the groups andwhether the improvements persist over time.Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and addto the existing knowledge of internet-based interventions for stress management in healthcare professionals.

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  • 8.
    Burholt, Vanessa
    et al.
    Swansea University, UK.
    Windle, Gill
    University of Wales, UK.
    Ferring, Dieter
    University of Luxembourg, Luxembourg.
    Balducci, Cristian
    University of Trento, Italy.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Thissen, Frans
    University of Amsterdam, The Netherlands.
    Weber, Germain
    University of Vienna, Austria.
    Wenger, Clare G.
    University of Wales, UK.
    Reliability and Validity of the Older Americans Resources and Services (OARS) Social Resources Scale in six European Countries2007In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 62, no 6, p. 371-379Article in journal (Refereed)
    Abstract [en]

    Objectives. The purpose of this article is to examine data quality, reliability, and construct validity of the Older Americans Resources and Services social resources scale in six European countries (The Netherlands, Luxembourg, Italy, Austria, the United Kingdom, and Sweden).

    Methods. A questionnaire was administered through face-to-face interviews in five countries, and postal interview in the sixth, to representative populations of adults aged 50 to 90 living independently (N = 12,478). This article examines missing values and distribution of items in the social resources scale, and consistency of skew and kurtosis across countries. We performed item–total correlations and ran confirmatory factor analyses to test a three-factor model obtained in previous U.S. and Spanish analyses. Cronbach's alpha determined the reliability of the factors.

    Results. We observed a relatively large proportion of missing data for one item (have someone who would help you). All items correlated with a score equal to or greater than 0.20. Although the confirmatory factor analyses generally supported the acceptability of the three-factor structure in the European data, the reliability of two dimensions (dependability and affective) was unacceptably low.

    Discussion. Differences across countries make it unlikely that researchers can develop a single social resources scale that would have item equivalence in multiple countries.

  • 9.
    Christiansen, Line
    et al.
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Nilsson, Lina
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Nurses' use and perception of an information and communication technology system for improving coordination during hospital discharges: a survey in Swedish primary healthcare2017In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 35, no 7, p. 358-363Article in journal (Refereed)
    Abstract [en]

    To facilitate communications between care levels and improve coordination during hospital discharges, there is great potential in using information and communication technology systems, because they can significantly help to deter unnecessary readmissions. However, there is still a lack of knowledge about how often nurses use information and communication technology and the indicators related to its use. The aims of this study were to describe the indicators related to nurses' use of an information and communication technology system for collaboration between care levels and to estimate whether the level of use can be related to nurses' perceptions of the information and communication technology system's contribution to improve coordination during hospital discharges. A quantitative survey of 37 nurses from 11 primary healthcare centers was performed in a county in southern Sweden. The data were analyzed using descriptive and comparative analyses. The results showed that perceptions concerning the information and communication technology system's usability and time consumption differed between nurses who used the system and those who did not. Simultaneously, the nurses were rather unaware of the ability of the information and communication technology system to improve coordination during patient discharges.

  • 10.
    Djukanovic, Ingrid
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Tuvesson, Hanna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Taking command of continuity: An interview study with agency nurses2023In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 4, p. 2477-2484Article in journal (Refereed)
    Abstract [en]

    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.

     

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  • 11.
    Ekstedt, Mirjam
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Karolinska Institutet, Sweden.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Backåberg, Sofia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Calgary, Canada.
    Ljungholm, Linda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    ‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 5, article id e057261Article in journal (Refereed)
    Abstract [en]

    Objective Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients’ functioning and health. The aim of this study is to explore assistant nurses’ adaptive responses to everyday work to ensure safe care in the home care context.

    Design A qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.

    Setting Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.Participants Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.

    Results Home care workers’ adaptive responses to provide safe home care were driven by an ambition to ‘make it work in the best interests of the person’ by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people’s independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.

    Conclusions Safety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.

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  • 12.
    Elmståhl, Solve
    et al.
    Lund University, Sweden.
    Berglund, Johan Sanmartin
    Blekinge Institute of Technology, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Blekinge Institute of Technology, Sweden.
    Ekström, Henrik
    Lund University, Sweden.
    The Life Satisfaction Index-A (LSI-A): Normative Data for a General Swedish Population Aged 60 to 93 Years2020In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 15, p. 2031-2039Article in journal (Refereed)
    Abstract [en]

    Purpose of Study: To gain Swedish norm value for the Life Satisfaction Index-A (LSI-A) in a population 60-93+ years old stratified for sex and age and to relate these norm values with respect to number of chronic diseases and functional impairment. Materials and Methods: The study population included a random sample of 2656 men (45.7%) and 3159 (54.3%) women from the longitudinal national studies' "Good Aging in Skane" (GAS) and SNAC-B, both part of the Swedish National Study on Aging and Care (SNAC). Data on Neugartens Life Satisfaction Index-A (LSI-A), medical history, activities of daily life (ADL) and socio-demographics were collected through structured interviews and questionnaires. Results: Men scored significantly higher than women; 28.5, sd=6.9, and 27.3, sd=6.6, respectively, out of maximum 40 points. For both genders the scores decreased with age, mean score 6.0 points, lower for men and 7.1 points lower for women between 60 and 93+ years. The highest score was noted for healthy individuals where both men and women scored 29.5 points, sd=6.2. Increased number of chronic diseases and dependency in ADLs were associated with lower LS. Conclusion: Nom values here presented may facilitate assessments and evaluation of life satisfaction in the general elder population and as reference values to clinical trials. Female sex, rising age, morbidity and impaired functional ability were all associated with impaired LS.

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  • 13.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Healthy ageing: positive health among older people with focus on sleep habits and falls2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no suppl 1, p. 10-10Article in journal (Refereed)
    Abstract [en]

    Introduction: Satisfactory sleep has many positive benefits for older adults1,2; it may produce daytime wakefulness and reduce the risk of falls3. Sleep complaints and falls are both common with advancing age and negative determinants for health4. However, their relationship with good health or improving health has not been clearly established. The aim of this presentation is to discuss sleep and fall predictors of positive self-rated health among people (n=656, > 78 years), who participated in the longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC), in 2001 and 20045. Positive odds ratio is used in the logistic regression analyses instead of commonly used Odds ratio.

    Method: Research synthesis from a longitudinal, multi-centre cohort study, 2001 and 2004.

    Results: Findings indicate that younger age, no fear of falling, no problem with balance, or no difficulties sleeping because of mood were associated with positive health, in the model that was adjusted for age, gender and co-morbidity.

    Conclusion: It is important to target older adults who are at risk of losing their balance and have low mood to prevent future health problems with advancing age. Also, the use of positive odds ratios appears to be useful when identifying positive health among older people.

  • 14.
    Fagerström, Cecilia
    Lund University.
    Life Satisfaction and Feeling Hindered by Health Problems at 60 Years and Above2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to investigate how older people’s capacity to perform activities of daily living (ADL), health, social and financial resources, and self-esteem can be related to their life satisfaction. The aim was also to investigate how people feel hindered by health problems in relation to their ADL capacity, health problems, social and financial resources, self-esteem, sense of coherence, and life satisfaction. The thesis focused on people 60–96 years of age in six European countries, living at home. The data were collected in two cross-sectional studies, using standardised self-reported questionnaires and a medical examination. The first study (papers I, II and III) included people in six European countries (Sweden, the UK, the Netherlands, Luxembourg, Austria, and Italy) who participated in the European Study of Adult Well-being (ESAW) in 2001 to 2002. Paper I included people (n = 7699) aged 60−89 in all six countries, Paper II included people with reduced ADL capacity (n = 2195), and Paper III included people living in Sweden (n = 1297) with at least one health problem. In the ESAW, questions from the Older Americans Resources and Services schedule, (OARS), the Life Satisfaction Index Z (LSIZ) and Rosenberg’s Self-Esteem Scale were used. The other study (Paper IV) included people (n = 958) aged 60−96 years of age who participated in a baseline survey in one of the four centres (Blekinge) of the longitudinal multi-centre cohort study named The Swedish National study on Aging and Care (SNAC) in 2001. Established questions and instruments were used to collect the data, and quantitative descriptive statistics, comparative statistics and multiple regressions were used when analysing the data.

    In all ESAW country samples, factors such as feeling hindered by health problems, low social and financial resources, and low self-esteem played a crucial role in creating conditions for low life satisfaction. It is also possible to identify both common and country-specific factors influential for life satisfaction in the six European countries. The analysis furthermore revealed that personal as well as environmental factors were important, though personal factors were more important for life satisfaction than environmental factors among people with impaired ADL capacity. Among those with impaired ADL capacity in the six national samples, people afflicted by poor overall health and people who were feeling worried and had low self-esteem suffered an increased risk of low life satisfaction in all countries. At the same time, social and financial resources had an impact on life satisfaction in four countries.

    Results suggest that self-esteem and perceived health are of universal importance for life satisfaction irrespective of ADL capacity, and these phenomena are thus essential to target in health care interventions. Furthermore, feeling hindered by health problems in daily living, rather than the impairment in ADL capacity, appears to increase the risk for low life satisfaction. In addition to this, people felt hindered by their problems although they had excellent ADL capacity. Several factors contributed to people feeling hindered, and the importance of these factors differed according to the level of the ADL capacity of the individual. The results suggest that people seemingly re-evaluate the importance of their resources when health declines, making certain activities in daily life more important than others.

  • 15.
    Fagerström, Cecilia
    et al.
    Lund University ; Blekinge Institute of Technology.
    Borg, Christel
    Blekinge Institute of Technology.
    Balducci, Cristian
    INRCA, Italy.
    Burholt, Vanessa
    University of Wales, UK.
    Wenger, Clare G.
    University of Wales, UK.
    Ferring, Dieter
    University of Luxembourg, Luxembourg.
    Weber, Germain
    University of Vienna, Austria.
    Holst, Göran
    Blekinge Institute of Research & Development.
    Hallberg, Ingalill R.
    The Vårdal Institute.
    Life satisfaction and associated factors among people aged 60 years and above in six European countries2007In: Applied Research in Quality of Life, ISSN 1871-2584, E-ISSN 1871-2576, Vol. 2, no 1, p. 33-50Article in journal (Refereed)
    Abstract [en]

    Life satisfaction is a concept frequently used to measure wellbeing of older people. However, there is still a lack of cross-national comparative research investigating factors associated with life satisfaction. There may be unique and common factors associated with life satisfaction across European countries. This study aimed to investigate life satisfaction among people aged 60–89 years in six European countries in relation to health problems, ADL capacity, self-esteem, social and financial resources. A cross-sectional study was performed, including 7699 people aged 60–89 years, in Sweden, the UK, the Netherlands, Luxemburg, Austria and Italy, participating in the European Study of Adult Wellbeing, using questions from the Older Americans Resources and Services schedule, Multidimensional Functional Assessment Questionnaire, Life Satisfaction Index Z and Rosenberg’s Self-Esteem Scale. Logistic regression analysis was performed to determine factors associated with life satisfaction in the six national samples. In cases where people were less satisfied with their life it was fairly satisfactory and unsatisfactory social contacts (Odds Ratio (OR) 1.5–13.8), poor financial resources (OR 1.7–15.1), feeling greatly hindered by health problems (OR 2.2–5.4) and self-esteem (OR 2.1–5.1) rather than the ability to perform activities of daily living and the extent of social contacts that gave the greatest risk of low life satisfaction in all the six European countries. There were both common and country-specific factors important for life satisfaction in the six European countries. However, the importance of satisfactory social contacts, financial resources, self-esteem and feeling hindered by health problems seems universal in the six included countries and thus important to target in preventive interventions.

  • 16.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Borglin, Gunilla
    Blekinge Institute of Technology.
    Mobility, functional ability and health-related quality of life among people 60 years or older2010In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 22, no 5-6, p. 387-394Article in journal (Refereed)
    Abstract [en]

    Background and aims: Knowledge about Health-Related Quality of Life (HRQoL) in advanced age is sparse. This study investigated to what extent mobility factors explained older people’s HRQoL when age, gender and functional ability (ADL) were controlled for. 

    Methods: Subjects were 1128 people aged 60–96 participating in a Swedish longitudinal multi-center cohort study. Besides descriptive and correlation statistics, a three-tier multiple logistic regression analysis was performed, which included the ADL scale, mobility tests and items, with physical and mental HRQoL as outcome variables. 

    Results: In the models containing the control variables, functional ability was found to be associated with both physical and mental HRQoL. In the models including both functional ability and mobility factors, the importance of functional ability remained for mental but not for physical HRQoL. The mobility factors were found to have a stronger negative influence on HRQoL, i.e., physical and mental, than functional ability in itself. 

    Conclusions: For optimal identification of various types of disabilities and their impact on older people’s HRQoL, the ADL scale should be used together with more targetspecific tests of disabilities. However, in certain situations, it appears that one mobility factor alone — the ability to walk — has the capacity to pick up changes in both physical and mental HRQoL. Thus, it is important that healthcare professionals should focus activities toward maintaining older people’s mobility as a means of enhancing their HRQoL.

  • 17.
    Fagerström, Cecilia
    et al.
    Blekinge University of Technology.
    Borglin, Gunilla
    Blekinge University of Technology.
    Mobility, functional ability and quality-of-life among people of 60 years or older2009In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 13, no suppl 1, p. S442-S442, article id PB7 327Article in journal (Refereed)
    Abstract [en]

    It is well known that reduced ability to perform activities of daily living (ADL) and declining mobility are both related to advanced age. This relation is also valid for low quality-of-life. It is not, however, the advanced age per se that causes the low quality-of-life. Rather, it seems that it is the declining mobility that unable people to manage their daily lives satisfactory - a circumstance that is often overlooked, since the most frequently used measuring method, the ADL-scale, is mainly focusing on people's functional ability and not their mobility. Hence, the assumption and aim for this study has been to investigate to which extent mobility factors, in comparison to the control factors age, gender and ability to perform ADL, may explain low (physical) quality-of-life (SF-12, PCS-12). The study includes people (n=1402) aged 60-96, who participated in a baseline survey in one (Blekinge) of four included centres of the longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC), in 2001, a study with a 61% response rate. Collected data indicated that mobility factors such as reduced ability either to walk a distance of 200 metres or less without stopping, or walking in stairs, or rising from a chair or opening a bottle played a crucial part when developing conditions of low (physical) quality-of-life (PCS-12), while control factors such as gender, age and ability to perform ADL, did not. The results suggest that multiple factors of reduced mobility, rather than impairment in ability to perform ADL, appear to increase the risk for low (physical) quality-of-life, and that targeting these phenomena in health care interventions, are essential.

  • 18.
    Fagerström, Cecilia
    et al.
    Blekinge University of Technology.
    Burholt, Vanessa
    Wenger, Clare G.
    Meer, M. van der
    Ferring, Dieter
    Glück, J.
    Sources of Social Support in Six European Countries2004In: ISA RC11 Conference, 2004Conference paper (Refereed)
  • 19.
    Fagerström, Cecilia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Elmståhl, Sölve
    Lund University.
    Sandin Wranker, Lena
    Lund University.
    A gender perspective on factors affecting quality of life when being a caregiver in old age: findings from the Swedish National Study on Aging and Care (SNAC) study2017Conference paper (Refereed)
  • 20.
    Fagerström, Cecilia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Blekinge, Sweden.
    Elmståhl, Sölve
    Lund University, Sweden.
    Wranker, Lena Sandin
    Lund University, Sweden.
    Analyzing the situation of older family caregivers with a focus on health-related quality of life and pain: a cross-sectional cohort study2020In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 18, no 1, p. 1-10, article id 79Article in journal (Refereed)
    Abstract [en]

    Background For a significant proportion of the older population, increasing age is associated with health problems and worsening health. Older family caregivers are largely responsible for care of next-of-kin living at home, which impacts their own physical and mental health both positively and negatively. However, evidence is insufficient regarding the health situation of older caregivers. The aim of this study was to investigate health-related quality of life (HRQoL) and pain, and their associations, among caregivers aged >= 60 years. Methods The participants (n = 3444) were recruited from the Swedish National Study on Aging and Care-Blekinge and Good Aging in Skane during 2001-2004. Participants aged >= 60 years were selected randomly and underwent cognitive tests, with demographic information obtained through questionnaires. The response rate was 60%. A predefined research protocol was used. HRQoL was measured with the Short-Form Health Survey, dimension mental health. Logistic regression models were used to investigate the associations between HRQoL and pain as well as control factors. Results Family caregiving was reported by 395 (11.5%) of the participants, and 56.7% of the caregivers reported pain. Family caregivers reported lower pain intensity on the Visual Analogue Scale and were younger, on median, than non-caregivers. Irrespective of caregiver status, pain was associated with mental HRQoL. Concerns about personal health and financial status had the strongest associations with mental HRQOL in both groups, but the levels were higher among caregivers. Conclusion Pain was one factor associated with low HRQoL regardless of family caregiver status and remained important when controlling for factors related to advanced age. This finding remained among family caregivers, though they reported lower pain intensity. Factors other than pain were shown to be important to mental HRQoL and should also be taken into consideration when discussing actions for family caregivers to maintain and improve health and HRQoL.

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  • 21.
    Fagerström, Cecilia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge kompetenscentrum.
    Eriksen, Sara
    Blekinge Tekniska högskola.
    Nilsson, Lina
    Linnaeus University, Faculty of Technology, Department of Informatics.
    The Implementation of a Decision Support Tool in Home Healthcare: Nurses’ Experiences of Professional Adaptation when Healthcare is in Transformation2017Conference paper (Refereed)
  • 22.
    Fagerström, Cecilia
    et al.
    Blekinge Tekniska Högskola.
    Hellström, Amanda
    Blekinge Tekniska Högskola.
    Sleep complaints and their association with comorbidity and health-related quality of life in anolder population in Sweden2011In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 15, no 2, p. 204-213Article in journal (Refereed)
    Abstract [en]

    Objective: The relationship between sleep complaints, comorbidity and health-related quality of life (HRQoL) in advanced age has not been clearly established. The aim of this study is therefore to investigate the presence of sleep complaints and discuss their association with morbidity and the HRQoL among the people aged 60 years and above.

    Methods: Data regarding demography, sleep, comorbidity and HRQoL were collected through questionnaires and interviews among 1128 people in Sweden. The Johns Hopkins adjusted clinical groups (ACG®) Case-Mix System 6.0 and the Short-Form Health Survey-12 were used to assess morbidity and HRQoL, respectively.

    Results: There was a divergence in the number of sleep complaints between those with no morbidity and those who had a high degree of comorbidity. Most of the sleep complaints related to low HRQoL were found among those with a high degree of comorbidity.

    Conclusions: People with a high degree of comorbidity appear to be a group with a high risk of having both sleep complaints and a low HRQoL. Thus, this study suggests that even if sleep complaints appear to be difficult to identify and treat successfully, it is important to pay particular attention to those people who suffer from a high degree of comorbidity if their HRQoL is to be maintained.

  • 23.
    Fagerström, Cecilia
    et al.
    Blekinge University of Tehcnology.
    Hellström, Amanda
    Sleep complaints and their relationship with Comorbidity and Health Related Quality of Life among people aged 60 years and above2010In: 20th Nordic Congress of Gerontology: 30 May – 2 June 2010 - Reykjavík, Iceland, 2010Conference paper (Refereed)
    Abstract [en]

    Background: The relationship between comorbidity, sleep complaints and Health Related Quality of Life (HRQoL) is not yet clearly confirmed. Few published studies exist investigating the relationship between sleep complaints, the degree of comorbidity and HRQoL among those 60 years and older. This study therefore aims to investigate the frequency of sleep complaints and to discuss their relationship with comorbidity as well as HRQoL in a population aged 60+.

    Method: This study contained of 1128 people aged 60-96 who participated at baseline (2001) in one out of four centres of the Swedish longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC).

    Result: Our findings indicate that some of the investigated sleep complaints such as having difficulties sleeping because of pain or itch and being dependent on drugs to fall asleep are related to comorbidity whilst others such as waking up early in the morning, feeling tired daytime and waking up during the night might rather be related to conditions associated with the aging process. The women in this study showed to have a higher risk of suffering from sleep complaints and from comorbidity than the men. Their mental and physical HRQoL scores were additionally lower than the men’s and they were also more frequent users of sleeping drugs in comparison with the men. The findings also showed that the higher degree of comorbidity the more sleep complaints were also reported.

    Discussion: Consequently, older women with a high degree of comorbidity appear to be a vulnerable group and worth paying attention to. They may not only have several diseases at the same time they may also have several sleep complaints which are linked to conditions related to the actual diseases. Circumstances, which all, mean an increased risk of developing a low HRQoL.

  • 24.
    Fagerström, Cecilia
    et al.
    Blekinge University of Technology.
    Holst, Göran
    Blekinge University of Technology.
    Hallberg, Ingalill R.
    Blekinge University of Technology.
    ADL capacity and feeling hindered by health problems at 60 years and above2006In: GERIATRICS 2006 International Congress Of Elderly Health: 2nd to 6th April 2006, ISTANBUL, Harbiyet, Turkey, 2006Conference paper (Refereed)
    Abstract [en]

    A common consequence of health problems such as diseases is a reduced ability to manage activities in daily living (ADL). Despite ADL capacity is frequently used to identify the impact of health problems on daily living it is still not well known what make people feel hindered in daily life with more or less inability to perform ADL. Such knowledge about feeling hindered by health problems can be useful when planning for interventions in an early stage already when people, regarding to ADL-rating scales have modest impaired ability to perform ADL or even not captured by ADL-scales. The aim of this study was to investigate feeling hindered by health problems among people (n=958) age 60-96 years living in ordinary home in relation to ADL capacity, health problems as well as social and financial resources, sense of coherence and life satisfaction. The data is taken from a questionnaire and a medical examination which were carried out in a baseline survey in one of the four including centres (Blekinge) of the longitudinal multi-centre cohort study The Swedish National study on Ageing and Care (SNAC) (Lagergren et al., 2004). Data indicated that people feel hindered by their health problems before they became impaired in ADL capacity. Feeling greatly hindered by health problems was mainly associated with factors linked to the person’s musculoskeletal system but also to fatigue as well as avoiding being outdoors afraid to fall and had a varying association with feeling hindered in various levels of ADL capacity. The broader question about feeling hindered by health problems used in this study might be an early marker of the impact of functional limitations in daily activities. Combining people’s ADL capacity with the question of feeling hindered may also be a more sensitive way to identify those in need of rehabilitation or other interventions, especially at early stages of health decline compared to investigate ADL capacity solely.

  • 25.
    Fagerström, Cecilia
    et al.
    Lund University ; Blekinge Institute of Technology.
    Holst, Göran
    Blekinge Institute of Technology.
    Hallberg, Ingalill R
    Lund University ; The Vårdal Institute.
    Feeling hindered by health problems and functional capacity at 60 years and above2007In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 44, no 2, p. 181-201Article in journal (Refereed)
    Abstract [en]

    It is common to use activities of daily living (ADL) rating scales to identify the impact of health problems such as diseases, impaired eyesight or hearing on daily life. However, for various reasons people with health problems might feel hindered in daily life before limitations in ability to perform ADL have occurred. In addition, there is sparse knowledge of what makes people feel hindered by health problems in relation to their ADL capacity. The aim was to investigate feeling hindered by health problems among 1297 people aged 60–89 living at home in relation to ADL capacity, health problems, life satisfaction, self-esteem, and social and financial resources, using a self-reported questionnaire, including questions from OARS (Older Americans’ Resources and Services schedule), Rosenberg’s self-esteem and Life Satisfaction Index Z. People feeling greatly hindered by health problems rarely had anyone who could help when they needed support, had lower life satisfaction and self-esteem than those not feeling hindered. Feeling hindered by health problems appeared to take on a different meaning depending on ADL capacity, knowledge that seems essential to include when accomplishing health promotion and rehabilitation interventions, especially at the early stages of reduced ADL capacity.

  • 26.
    Fagerström, Cecilia
    et al.
    Blekinge University of Technology.
    Holst, Göran
    Blekinge University of Technology.
    Hallberg, Ingalill R.
    Blekinge University of Technology.
    People’s (60+) perception of feeling hindered by health problems in relation to ADL capacity2005In: 18th Congress of the International Association of Gerontology: Rio de Janeiro, Brazil, June 26-30, 2005, 2005Conference paper (Refereed)
    Abstract [en]

    Health problems as impaired mobility, eyesight or hearing problems in old age are often associated with reduced ADL (activities of daily living) capacity and as a result people may give up activities that contribute to well-being. However, the knowledge is sparse about the relation between feeling hindered by health problems in relation to ADL capacity, decreased or not. Such knowledge may be useful when outlining interventions to people already when people have no or modest impaired ability to perform ADL. Such information can not be captured through ADL-scales but by an overarching question about feeling hindered in daily living by health problems. Purpose: This study presents data on people’s (n=1524) 60-89 years feeling hindered by health problems in relation to their ability to perform ADL, health problems, social and financial resources, self-esteem and life satisfaction. Method: OARS (Older Americans Resources and Services schedule), Rosenberg’s self-esteem and Life Satisfaction Index Z. Results: People who felt greatly hindered by health problems had rarely someone who could help them when needing support, had lower life satisfaction and self-esteem compared to those not. Different factors were associated with feeling greatly hindered by health problems at different levels of ADL ability. Conclusions: Data from this study suggest that feeling hindered in daily living takes on a different meaning depending on functional capacity and thus preventive and visiting work should start early and be outlined differently depending on their ADL capacity. Also such an overarching question may be useful in detecting those in need of interventions.

  • 27.
    Fagerström, Cecilia
    et al.
    Blekinge Tekniska Högskola.
    Lindwall, Magnus
    Göteborgs Universitet.
    Berg, Anne-Ingeborg
    Göteborgs Universitet.
    Rennemark, Mikael
    Blekinge Tekniska Högskola.
    Factorial validity and invariance of the Life Satisfaction Index in older people across groups and time: Addressing the heterogeneity of age, functional ability, and depression.2012In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 55, no 2, p. 349-356Article in journal (Refereed)
    Abstract [en]

    In the last decades, extensive research efforts have been directed at exploring life satisfaction in old age, and the Life Satisfaction Index A scale (LSIA), developed by Neugarten et al. in the 1960s, is one of the most commonly used instruments. However, studies have focused on predicting and comparing changes in people’s life satisfaction without testing if the LSIA instrument is equally valid for different subgroups of people. The present study investigated the underlying dimensions of the LSIA in a Swedish population (n=1402) of people 60−96 years of age. The study also examined factorial invariance across age, gender, functional ability and depression during a six-year period. The results showed that while a five-factor solution of the LSIA did not exhibit an acceptable fit to the data, a three-factor solution did show a close fit. The two three-factor models that demonstrated the best fit showed invariance across gender and across time, but noninvariance across groups with different levels of reduced functional ability, depressive symptoms and age. These findings suggest that the psychometric properties of life satisfaction instruments like the LSIA need to be taken into consideration before drawing conclusions about life satisfaction when comparing older people of different ages and with different depression and function levels.

     

  • 28.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Naseer, Mahwish
    Blekinge Centre of Competence.
    Nutrition in old age: the importance for quality of life and longevity2016In: 23NKG2016, 23rd Nordic Congress of Gerontology. Tampere, Finland: Abstracts, 2016, p. 167-167Conference paper (Refereed)
    Abstract [en]

    Inadequate nutrition status results in poor health outcomes, which in turn influence quality of life and longevity. Most research concerning malnutrition in old age has focus on people living in nursing homes or hospitals, while knowledge of the condition in the older population (i.e. in both community living older persons and persons living in nursing homes) are still scarce. Aim/Methods: This presentation, based on data from the Swedish national and longitudinal study of aging and care, (SNAC-B), includes a discussion about persons (n=1402, 60+ years) who were at risk of malnutrition during a 7-year follow-up, seen from a criterionbased nutrition assessment. Findings: The risk of malnutrition significantly increased the risk of poor physical and mental health related quality of life. Moreover, at baseline, 8.6% subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. Risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, p<0.001). Conclusion: It is important to highlight older people’s functional ability both for prevention of undernutrition and promotion of quality of life and longevity.

  • 29.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Palmqvist, Roger
    Blekinge Institute of Technology.
    Carlsson, Johanna
    Blekinge Institute of Technology.
    Hellström, Ylva
    Blekinge Institute of Technology.
    Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: a population-based cohort study2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 7, p. 863-871Article in journal (Refereed)
    Abstract [en]

    Background: Malnutrition is a common problem among older people and associated with reduced functional and cognitive ability. Furthermore, malnutrition among people living in special housing, i.e. in nursing homes or sheltered accommodation, appears to be more common than among those living in regular housing, i.e. in their own homes. However, it is still unclear if the relationship between malnutrition and impaired cognitive ability is connected to living arrangement, i.e. if the relationship is stronger among those who live alone compared to those who cohabit in regular housing.

    Objectives: The purpose with the present study was to describe the relationship between nutritional status and cognitive ability among people 60 years of age and above in Sweden, with a focus on housing and living arrangement.

    Design: Population-based cohort study.

    Setting and participants: The study focused on people living in regular or in special housing and comprised 1402 randomly selected individuals (60-96 years of age) who lived in one municipality in south-eastern Sweden and participated in SNAC-B (the Swedish study on Aging and Care - Blekinge), 2001-2003.

    Methods: Data regarding demography, nutrition and functional and cognitive ability were collected through questionnaires, medical examinations and structured interviews.

    Results: The relationship was the strongest between cognitive ability and nutritional status among those living in special housing. Regardless of housing and living arrangement, older people with a moderate or severe cognitive impairment risked (OR 2.59-16.00) being malnourished, irrespective of functional ability.

    Conclusion: This study highlights that those with a moderate and severe cognitive impairment suffer a risk of developing malnutrition, irrespective of living and housing arrangement. The findings suggest that nurses in the social service and health care system need to consider changes in weight and nutritional intake as well as the individual needs of older people with cognitive impairment to avoid malnutrition.

  • 30.
    Fagerström, Cecilia
    et al.
    Blekinge University of Technology ; Lund University.
    Persson, Helen
    Feeling hindered by health problems at age of 60 and above2008In: International Nursing Research Conference : Facing the Challenge of Health Care Systems in Transition: 30th June to 3rd July 2008, Jerusalem, Israel, Jerusalem, 2008Conference paper (Refereed)
    Abstract [en]

    Reduced capacity to perform activities in daily living (ADL capacity) is not the only thing significant for people and their life satisfaction, the importance people attach to being able to perform a specific activity is also crucial. Personal interests may have an impact on the importance of an activity. The ADL scale provides information about functional impairment, but it provides no understanding of the time or effort it takes to perform a certain activity or if a specific individual has to give up valuable activities. More knowledge is therefore needed about what makes people to feel hindered by their health problems in daily living. The aim of this study was to investigate how people (n=958) aged 60–96 years feel hindered in daily living in relation to their ADL capacity, health problems, social and financial resources, sense of coherence, and life satisfaction. The data is taken from a questionnaire and a medical examination which were carried out in a baseline survey in one of the four including centres (Blekinge) of the longitudinal multi-centre cohort study The Swedish National study on Ageing and Care (SNAC). Response rate was 61%. Data indicated that in people with preserved ADL capacity, feeling hindered in daily living meant, above all, fatigue. At the same time, for people with impaired ADL capacity, feeling insecure about available help and about going outdoors were factors that contributed to people feeling hindered by health problems. Accordingly, when nurses, as well as other health professionals, plan to carry out interventions for preventive and rehabilitative purposes, as well as when making follow ups as ADL capacity declines, they should be aware of the fact that different factors are associated with the feeling of being hindered in daily life in people with or without impaired ADL capacity.

  • 31.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Tuvesson, Hanna
    Blekinge Institute of Technology.
    Axelsson, Lisa
    Blekinge Institute of Technology.
    Nilsson, Lina
    Blekinge Institute of Technology.
    The role of ICT in nursing practice: An integrative literature review of the Swedish context2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 3, p. 434-448Article, review/survey (Refereed)
    Abstract [en]

    Background: The Swedish healthcare system employs information and communication technologies (ICT) in nursing practice to meet quality-, security- and efficiency-related demands. Although ICT is integrated with nursing practices, nurses do not always feel that they are convenient to use it. We need to improve our knowledge of the role of ICT in healthcare environments and so we decided to complement existing experience of how ICT influences nursing practice. Aim: This study aimed to review and synthesise the available literature on the role of ICT in nursing practice in Swedish healthcare settings. Method: To consolidate previous studies based on diverse methodologies, an integrative literature review was carried out. Three databases were used to search for literature, 20 articles met the inclusion criteria. Results: The literature review indicates that ICT integration into nursing practice is a complex process that impacts nurses’ communication and relationships in patient care, working conditions, and professional identities and development. Nurses are found to express ambiguous views on ICT as a usable service in their everyday practice since it impacts both positively and negatively. Discussion and conclusion: Although ICT cannot replace physical presence, it can be considered a complementary service that gives rise to improved patient care. However, nonverbal communication cues may be missed when ICT is used as mediating tool and ICT can be limiting because it is not always designed to meet nurse and patient needs. The meaning of an encounter appears to change when ICT is used in nursing practice, not only for patient relationships but also for interpersonal communication.

  • 32.
    Fagerström, Cecilia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Welmer, Anna-Karin
    Karolinska Institutet, Sweden.
    Elmståhl, Sölve
    Lund University, Sweden.
    Tuvesson, Hanna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Life weariness, suicidal thoughts and mortality: a sixteen-year longitudinal study among men and women older than 60 years2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, article id 1359Article in journal (Refereed)
    Abstract [en]

    BackgroundSuicide in old age is a significant contributor to mortality. However, the extent to which life weariness and suicidal thoughts impact on mortality in a long-term perspective is unknown. The aim of this study was to investigate the effect of life weariness and suicidal thoughts on long-term survival (16 years) in an older Swedish population, controlling for demographic and social network factors and depression. A further aim was to investigate differences in sex and age interactions in relation to mortality among individuals with and without life weariness and suicidal thoughts.

    MethodsA longitudinal cohort study on a national, representative sample of individuals aged 60+ years was conducted within the Swedish National Study of Aging and Care study. The sample included 7213 individuals, who provided information about life weariness and suicidal thoughts through an item derived from the Montgomery-Åsberg Depression Rating Scale. Data were analysed with multivariate Cox proportional hazards models, adjusted for potential confounders.

    ResultsAt baseline, 12.5% of the participants (14.6% of females and 9.5% of males) reported life weariness and suicidal thoughts. During the 16-year follow-up, a mean survival time was 11.5 years (standard deviation (SD) 5.6), and 3804 individuals died (59.5% females and 40.5% males). Individuals with life weariness and suicidal thoughts had half the survival rate compared with those without such thoughts (24.5% vs. 50.6%), with a mean survival time of 8.4 years (SD 5.7) versus 12.0 years (SD 5.4). The multi-adjusted hazard ratio of mortality for those reporting life weariness and suicidal thoughts was 1.44 (95% confidence interval, 1.30–1.59), with the population attributable risk at 11.1%. In the models, being male or female 80+ years showed the highest multi-adjusted hazard ratio of long-term mortality (ref. female 60–69 years).

    ConclusionsThe findings suggested that life weariness and suicidal thoughts were risk factors for long-term mortality, when controlled for sex and age interactions that were found to strongly predict long-term mortality. These findings have practical implications in prevention of mortality, emphasising the importance of screening, identifying, and intercepting older men and women with signs of life weariness and suicidal thoughts.

  • 33.
    Fagerström, Cecilia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Wickström, Hanna
    Lund University, Sweden;Blekinge Wound Healing Centre, Sweden.
    Tuvesson, Hanna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Linnaeus University, Linnaeus Knowledge Environments, Digital Transformations.
    Still engaged – healthcare staff’s engagement when introducing a new eHealth solution for wound management: a qualitative study2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 103Article in journal (Refereed)
    Abstract [en]

    Background

    eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management.

    Methods

    A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis.

    Results

    Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others.

    Conclusions

    The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.

  • 34.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Willman, Ania
    Blekinge Institute of Technology.
    Home Care in Denmark2013In: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2013, 1, p. 60-66Chapter in book (Refereed)
  • 35.
    Fagerström, Cecilia
    et al.
    Blekinge Insitute of Technology.
    Willman, Ania
    Blekinge Insitute of Technology.
    Home care in Norway2013In: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2013, 1, p. 207-213Chapter in book (Refereed)
  • 36.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Willman, Ania
    Blekinge Institute of Technology.
    Home care in Sweden2013In: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2013, p. 272-279Chapter in book (Refereed)
  • 37.
    Fagerström, Cecilia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge Centre of Competence.
    Wranker, Lena Sandin
    Lund University.
    Kabir, Zarina Nahar
    Karolinska Institutet.
    Sternäng, Ola
    Jönköping University;Södertörn University.
    Everyday health among older people: a comparison between two countries with variant life conditions2017In: Journal of Aging Research, ISSN 2090-2204, E-ISSN 2090-2212, article id 2720942Article in journal (Refereed)
    Abstract [en]

    This study described health factors of importance for everyday health, such as pain, tiredness, and sleeping problems, in a cross-national context. Data for persons 60+ years were obtained from the Poverty and Health in Aging study, Bangladesh, and the Swedish National Study on Aging and Care-Blekinge. The strongest associations with everyday health in Sweden were found for pain and tiredness, while in Bangladesh they were financial status, tiredness, and sleeping problems. As similarities were found regarding the associations of tiredness on everyday health, tiredness may be a universal predictor of everyday health in older adults irrespective of country context.

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  • 38.
    Frisendahl, Nathalie
    et al.
    Karolinska Institutet, Sweden;Stockholm University, Sweden.
    Ek, Stina
    Karolinska Institutet, Sweden;Stockholm University, Sweden.
    Rosendahl, Erik
    Umeå University, Sweden.
    Boström, Anne-Marie
    Karolinska Institutet, Sweden;Karolinska University Hospitl, Sweden;Stockholms Sjukhem, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Blekinge, Sweden.
    Elmståhl, Sölve
    Lund University, Sweden.
    Welmer, Anna-Karin
    Karolinska Institutet, Sweden;Stockholm University, Sweden;Karolinska University Hospital, Sweden;Stockholm Gerontology Research Center, Sweden.
    Predictive Performance of the FIF Screening Tool in 2 Cohorts of Community-Living Older Adults2020In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 21, no 12, p. 1900-1905Article in journal (Refereed)
    Abstract [en]

    Objectives: The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in communityliving older adults who may benefit from primary preventive interventions. The aim of this study was to evaluate the predictive performance of the FIF tool in 2 cohorts of older adults. Design: Longitudinal cohort study. Setting and Participants: The Swedish National Study on Aging and Care in Skane (SNAC-S) and Blekinge (SNAC-B), Sweden. Community-living people aged >= 60 years (n = 2766). Methods: Nurses and physicians collected data in the 2 cohorts through interviews and testing. Data on injurious falls were collected from register data and were defined as receipt of care after a fall. The FIF tool, consisting of 3 questions and 1 balance test, was examined in relation to injurious falls for up to 5 years of follow-up using Cox proportional hazards models. The predictive performance of the FIF tool was further explored using Harrell C statistic and Youden cut-off for sensitivity and specificity. Results: The hazard ratios (HRs) of an injurious fall in the high-risk group for women and men were 3.80 (95% confidence interval [CI] 2.53, 5.73) and 5.10 (95% CI 2.57, 10.12) in SNAC-S and 4.45 (95% CI 1.86, 10.61) and 32.58 (95% CI 4.30, 247.05) in SNAC-B compared with those in the low risk group. The sensitivity and specificity of the Youden cut-off point (3 or higher for high-risk) were 0.64 and 0.69 for women and 0.68 and 0.69 for men in SNAC-S, and 0.64 and 0.74 for women and 0.94 and 0.68 for men in SNAC-B. The predictive values (Harrell C statistic) for the scores for women and men were 0.73 and 0.74 in SNAC-S and 0.72 and 0.89 in SNAC-B. Conclusions and Implications: Our results suggest that the FIF tool is a valid tool to use for prediction of first-time injurious falls in community-living older adults. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

  • 39.
    Fu, Yu
    et al.
    Blekinge Institute of Technology, Sweden.
    Hu, Yan
    Blekinge Institute of Technology, Sweden.
    Sundstedt, Veronica
    Blekinge Institute of Technology, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    A Survey of Possibilities and Challenges with AR/VR/MR and Gamification Usage in Healthcare2021In: Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies - HEALTHINF / [ed] Pesquita, C;Fred, A;Gamboa, H, SciTePress, 2021, Vol. 5, p. 733-740Conference paper (Refereed)
    Abstract [en]

    Software and applications of augmented reality (AR), virtual reality (VR), and mixed reality (MR) technology combined with game/gamification techniques in healthcare have increasingly been studied in academia. However, there is a need to explore the usage, challenges and opportunities of AR/VR/MR game/gamification software/applications in the healthcare system. To explore this, we present an online survey conducted in the healthcare-relevant system (including hospital-based system, homecare-based system, institute and university, and industry). Based on the answers, we found examples of digital games and AR/VR/MR applications used in healthcare, as well as some general information (name and feature, purpose, target user, and use occasion), usage situation, and user experience. This presented survey is beneficial for both researchers and developers in computer science and medical science. It can familiarise them with existing products and their current use, advantages and potential issues of AR/VR/MR and game applications in healthcare. In future work, the survey would be extended to obtain other user experiences and feedback of AR/VR/MR techniques and game/gamification technology applied to healthcare, as well as to study how to overcome the challenges, and develop the opportunities further.

  • 40.
    Garcia, Danilo
    et al.
    Region Blekinge, Sweden;University of Gothenburg, Sweden;Network for Empowerment and Well-Being, Sweden.
    Cloninger, Kevin M.
    Region Blekinge, Sweden;Network for Empowerment and Well-Being, Sweden;Anthropedia Foundation, USA.
    Molander-Söderholm, Kristian
    Region Blekinge, Sweden;Network for Empowerment and Well-Being, Sweden.
    Carleheden Ottosson, Lil
    Region Blekinge, Sweden.
    Jönsson, Inger
    Region Blekinge, Sweden.
    Rapp Riccciardi, Max
    Region Blekinge, Sweden;University of Gothenburg, Sweden;Network for Empowerment and Well-Being, Sweden.
    Zielinski, Andzrej
    Region Blekinge, Sweden.
    Haddad Nik, Farad
    Region Blekinge, Sweden.
    Lindskär, Erik
    Region Blekinge, Sweden;Network for Empowerment and Well-Being, Sweden.
    Al Nima, Ali
    Region Blekinge, Sweden;Network for Empowerment and Well-Being, Sweden.
    Fagerström, Cecilia
    Region Blekinge, Sweden.
    Person-centered care2018In: Encyclopedia of personality and individual differences / [ed] Virgil Zeigler-Hill & Todd K. Shackelford, Cham, Switzerland: Springer, 2018Chapter in book (Other academic)
  • 41.
    Garcia, Danilo
    et al.
    Region Blekinge, Sweden;University of Gothenburg, Sweden.
    Jedel, Izabella
    University of Gothenburg, Sweden.
    Rapp-Ricciardi, Max
    University of Gothenburg, Sweden.
    Lindskar, Erik
    Region Blekinge, Sweden.
    Molander-Soderholm, Kristian
    Region Blekinge, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Blekinge, Sweden.
    Sikström, Sverker
    Lund University, Sweden.
    Creative utterances about person-centered care among future health care professionals are related to reward dependence rather than to a creative personality profile2019In: Heliyon, E-ISSN 2405-8440, Vol. 5, no 3, p. 1-17, article id e01389Article in journal (Refereed)
    Abstract [en]

    Background: Creativity can be defined as the creation of something that is novel, useful, and valuable for society (i.e., high-level creativity) and/or everyday life. In this context, people have implicit theories of creativity as being either nonmalleable (i.e., a fixed creative mindset) or malleable (i.e., a growth creative mindset). Our aim was twofold: (1) to test an improved creative mindset priming paradigm (i.e., adding high-level/everyday creativity perspectives and using an organizational important task) by assessing if participants used different ways to answer to the prime and (2) to analyse the relationship between personality and creative utterances regarding an important topic in participants ' future professions. Method: Students (N = 73) from different health care professions were randomly assigned to the non-malleable or malleable creative mindset priming paradigm (i.e., fixed vs. growth) and then asked to write about (a) their own creativity, (b) person-centered care in their professions (i.e., unusual use test), and to (c) self-rate their personality (Temperament and Character Inventory). We used natural language processing methods (i.e., Latent Semantic Algorithm) to analyse participants ' responses in the different conditions and also responses in relation to selfreported personality. Results: The fixed versus growth condition was predicted (r = .55, p < 0.0001), following Bonferroni correction for multiple comparisons by participants' descriptions about creativity. Although the condition was not predicted (r = .07, p < 0.2755) by participants ' utterances about person-centered care, a t-test suggested that participants used words that were semantically different depending on the condition they were randomly assigned to (t(2371) = 5.82, p = .0000). For instance, participants in the growth condition used verbs more frequently, while those in the fixed condition used the personal pronoun I more often. Finally, only the temperament trait of reward dependence (r = .32, p < 0.01) predicted the person-centered care utterances. Conclusion: We argue that the paradigm successfully primed participants to write about creativity and person-centered care using narratives with different semantic content. However, individuals ' ambition to be socially accepted, rather than creative personality traits, elicited the utterances about person-centered care. The creative mindset priming paradigm presented here along language processing methods might be useful for measuring creative potential at work. We suggest that if health care personnel ' s notions of the activities related to care are generated from their drive to be socially accepted and not from a truly creative profile, the activities might be self-serving and not person-centered.

  • 42.
    Garms-Homolová, Vjenka
    et al.
    Alice Salomon University of Applied Sciences, Germany.
    Naiditch, Michel
    Institute for Research and Information in Health Economics (IRDES), France.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Lamoura, Giovanni
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Melchiorre, Maria Gabriella
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Gulàcsi, László
    Corvinus University, Hungary.
    Hutchinson, Allen
    University of Sheffield, UK.
    Clients in focus2012In: Home care across Europe: current structure and future challenges / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., European Observatory on Health Systems and Policies , 2012, 1, p. 55-70Chapter in book (Refereed)
    Abstract [en]

    For every person over the age of 65 in today’s European Union, there are four people of working age but, by 2050, there will only be two. Demand for long-term care, of which home care forms a significant part, will inevitably increase in the decades to come. Despite the importance of the issue, however, up-to-date and comparative information on home care in Europe is lacking. This book attempts to fill some of that gap by examining current European policy on home care services and strategies. Home care across Europe probes a wide range of topics including the links between social services and health-care systems, the prevailing funding mechanisms, how service providers are paid, the impact of governmental regulation, and the complex roles played by informal caregivers. Drawing on a set of Europe-wide case studies (available in a second, online volume), the study provides comparable descriptive information on many aspects of the organization, financing and provision of home care across the continent. It is a text that will help frame the coming debate about how best to serve elderly citizens as European populations age.

  • 43.
    Genet, Nadine
    et al.
    NIVEL-Netherlands Institute for Health Services Research, The Netherlands.
    Boerma, Wienke G. W.
    NIVEL-Netherlands Institute for Health Services Research, The Netherlands.
    Kringos, Dionne S.
    NIVEL-Netherlands Institute for Health Services Research, The Netherlands.
    Bouman, Ans
    Maastricht University, The Netherlands.
    Francke, Anneke L.
    NIVEL-Netherlands Institute for Health Services Research, The Netherlands ; EMGO Institute for Health and Care Research (EMGO+) of VU University Medical Center, The Netherlands .
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Melchiorre, Maria Gabriella
    INRCA - National Institute of Health and Science on Aging, Italy.
    Greco, Cosetta
    INRCA - National Institute of Health and Science on Aging, Italy.
    Devillé, Walter
    NIVEL-Netherlands Institute for Health Services Research, The Netherlands ; University of Amsterdam, The Netherlands.
    Home care in Europe: a systematic literature review2011In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 11, p. 1-14, article id 207Article, review/survey (Refereed)
    Abstract [en]

    Background: Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need, by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods: A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care ‘policy & regulation’, 'financing', ‘organisation & service delivery’, and ‘clients & informal carers’. Results: Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions: It can be concluded that home care systems appeared to differ not just between but also within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially papers comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires gathering of information using a uniform framework and methodology.

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  • 44.
    Genet, Nadine
    et al.
    NIVEL, Netherlands.
    Ersek, Katalin
    Corvinus University of Budapest, Hungary.
    Boerma, Wienke
    NIVEL, Netherlands.
    Hutchinson, Allen
    Sheffield University, UK.
    Garms-Homolova, Vjenka
    Alice Salomon University of Applied Sciences, Germany.
    Naiditch, Michel
    Institut de Recherche et Documentation en Economie de la Sante (IRDES), France.
    Lamura, Giovanni
    INRCA Istituto Nazionale Riposo e Cura Anziani, Italy.
    Chablicz, Slawomir
    Medical University of Bialystok, Poland.
    Gulacsi, Laszlo
    Corvinus University of Budapest, Hungary.
    Fagerström, Cecilia
    Blekinge University of Technology.
    Bolibar, Bonaventura
    IDIAP, Spain.
    Integrating home care services in Europe2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no suppl 1, p. 14-14Article in journal (Refereed)
    Abstract [en]

    Introduction: A key feature of home care is its divided nature. Conditions for coordination are poor. A variety of professionals provides a coherent mix of services. The social care system is in general local, less professionalised and usually moor poorly financed than the health care system. These differences are related to or result in different interests, culture and style and are a ground for communication problems. The existence of this divide will be explored it will be considered what remedies are available and are applied.

    Methods and Materials: This presentation is drawn upon the results of the EC-financed EURHOMAP project and a discussion between country experts invited to the conference. The study has collected a wealth of data on various types of home care (including nursing care, personal care, domestic aid and respite care). In 31 countries information was gathered on a large set of indicators in the areas of policy & regulation, financing, organisation & delivery and clients & informal carers.

    Results: Home care services may stem from different sectors, systems and organisations. Several countries have identified and addressed problems related to this situation. However, the degree of splitting varies among countries. It can exist at one or more of the following levels: governance and regulation; entry to the home care system; delivery of services. Furthermore the extent to which the division occurs may differ as well. Integration at governance level creates more favourable conditions for integration at access and delivery level. From a clients’ perspective poor integration may manifest itself both at the point of entry (absence of a clear-cut easy access point), and in the delivery of services (which are not tailored to what is needed or lack flexibility).

    Conclusion: There are many possible remedies against problems of poor integration; depending on the level and the situation where the problem occurs.

  • 45.
    Genet, Nadine
    et al.
    NIVEL, Netherlands.
    Garms-Homolova, Vjenka
    Alice Salomon University of Applied Sciences, Germany.
    Boerma, Wienke
    NIVEL, Netherlands.
    Ersek, Katalin
    Corvinus University of Budapest, Hungary.
    Hutchinson, Allen
    Sheffield University, UK.
    Naiditch, Michel
    Institut de Recherche et Documentation en Economie de la Sante (IRDES), France.
    Lamura, Giovanni
    INRCA Istituto Nazionale Riposo e Cura Anziani, Italy.
    Chablicz, Slawomir
    Medical University of Bialystok, Poland.
    Gulacsi, Laszlo
    Corvinus University of Budapest, Hungary.
    Fagerström, Cecilia
    Blekings University of Technology.
    Bolibar, Bonaventura
    IDIAP, Spain.
    Current trends and challenges and how they are dealt with2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no suppl 1, p. 49-49Article in journal (Refereed)
    Abstract [en]

    Introduction: Besides the ageing of populations there are many more factors that have an influence on home care demand or supply; such as increased mobility; changing character of family structures; intergeneration solidarity; labour participation of women and the labour market for home care. This presentation will sketch the current trends, problems and how they can be tackled. The year 2025 is still far away but we will try to look ahead without losing the sense of reality.

    Methods & Materials: This presentation is drawn upon the EC- financed EURHOMAP project, which included an inventory of contextual factors, problems related to policy, financing and delivery of home care and future challenges in each country. The study has col- lected a wealth of data in each of 31 countries on a large set of indicators.

    Results: Trends influencing home care will be presented. We will notice that different trends may apply to groups of countries. The possible affects of more or less general problems will be explored, such as scarcity of financial and human resources. Besides less general, but still burning problems in some countries, will be examined; for instance the lack of integration and coordination between types of home care services; inequalities resulting from decentralisation of authority; limited access to home care services for middle income groups; and absent or poor control of the quality of services. Examples will be presented of how countries respond to the earlier mentioned challenges.

    Conclusion: Some problems, such as those related to financial and human resources apply to most countries and are expected to be persistent. Private models of provision may also be considered to be of growing importance. However, cross-country differences in trends and problems will continue to exist, especially between countries with a long tradition of home care and those where it was recently developed.

  • 46.
    Genet, Nadine
    et al.
    NIVEL, Netherlands.
    Gulacsi, Laszlo
    Corvinus University of Budapest, Hungary.
    Boerma, Wienke
    NIVEL, Netherlands.
    Hutchinson, Allen
    Sheffield University, UK.
    Garms-Homolova, Vjenka
    Alice Salomon University of Applied Sciences, Germany.
    Naiditch, Michel
    Institut de Recherche et Documentation en Economie de la Sante (IRDES), France.
    Lamura, Giovanni
    INRCA Istituto Nazionale Riposo e Cura Anziani, Italy.
    Chablicz, Slawomir
    Medical University of Bialystok, Poland.
    Ersek, Katalin
    Corvinus University of Budapest, Hungary.
    Fagerström, Cecilia
    Blekinge University of Technology.
    Bolibar, Bonaventura
    IDIAP, Spain.
    Financing home care in Europe2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no suppl 1, p. 48-48Article in journal (Refereed)
    Abstract [en]

    Despite the assumption that care delivered at home is more cost-effective than care provided in institutions, such as nursing homes, the pressure on expenditures for home care will remain. Financial incentives are widely used to get better value for money. Incentives can be applied to authorities responsible for home care, or to agencies that provide services or to clients who receive care. Details of the financing system of home care services very much determine the possibilities for financial incentives. At present, there is a need for comparative information on financing mechanisms for home care. This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been developed in this project to map the home care systems in Europe, including details of financing. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation. Prevailing models of financing for home care will be presented as well as information of the extent to which home care across Europe is pressured by financial restraints. Especially in Eastern European countries, where home care is not well developed yet, funding is a major problem. Co-payments are applicable in most countries to reduce expenditures and to prevent over-utilisation of services. Usually, financing mechanisms for social community based services differ from the mechanisms in place for home health care services. Consequently, modes of reimbursement for providers of different sorts of home care services and the financial implications for clients differ. Co-payments are more prevalent with social services than with health care. Another financial allocation mechanism is means testing, which is frequently used with publicly financed home care services. There is a large diversity in the type of financing mechanism, both between and within countries in Europe. Budgetary restraints are one of the main problems with regard to home care in almost all countries. Usually, access to home care services is restricted in some way by financial restrictions.

  • 47.
    Genet, Nadine
    et al.
    Netherlands Institute for Health Services Research (NIVEL), The Netherlands.
    Hutchinson, Allen
    University of Sheffield, UK.
    Naititch, Michel
    Institute for Research and Information in Health Economics (IRDES), France.
    Garms-Homolová, Vjenka
    Alice Salomon University of Applied Sciences, Germany.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Melchiorre, Maria Gabriella
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Kroneman, Madelon
    Netherlands Institute for Health Services Research (NIVEL), The Netherlands.
    Greco, Cosetta
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Management of the care process2012In: Home care across Europe: current structure and future challenges / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelene; Hutchinson, Allen; Saltman, Richard B., European Observatory on Health Systems and Policies , 2012, 1, p. 71-104Chapter in book (Refereed)
    Abstract [en]

    For every person over the age of 65 in today’s European Union, there are four people of working age but, by 2050, there will only be two. Demand for long-term care, of which home care forms a significant part, will inevitably increase in the decades to come. Despite the importance of the issue, however, up-to-date and comparative information on home care in Europe is lacking. This book attempts to fill some of that gap by examining current European policy on home care services and strategies. Home care across Europe probes a wide range of topics including the links between social services and health-care systems, the prevailing funding mechanisms, how service providers are paid, the impact of governmental regulation, and the complex roles played by informal caregivers. Drawing on a set of Europe-wide case studies (available in a second, online volume), the study provides comparable descriptive information on many aspects of the organization, financing and provision of home care across the continent. It is a text that will help frame the coming debate about how best to serve elderly citizens as European populations age.

  • 48.
    Genet, Nadine
    et al.
    NIVEL, Netherlands.
    Lamura, Giovanni
    INRCA Istituto Nazionale Riposo e Cura Anziani, Italy.
    Boerma, Wienke
    NIVEL, Netherlands.
    Hutchinson, Allen
    Sheffield University, UK.
    Garms-Homolova, Vjenka
    Alice Salomon University of Applied Sciences, Germany.
    Naiditch, Michel
    Institut de Recherche et Documentation en Economie de laSante (IRDES), Paris, France.
    Chablicz, Slawomir
    Medical University of Bialystok, Poland.
    Ersek, Katalin
    Corvinus University of Budapest, Hungary.
    Gulacsi, Laszlo
    Corvinus University of Budapest, Hungary.
    Fagerström, Cecilia
    Blekings University of Technology.
    Bolibar, Bonaventura
    IDIAP, Spain.
    Human resources in home care in Europe2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no suppl 1, p. 48-48Article in journal (Refereed)
    Abstract [en]

    Introduction: The increasing old-age dependency ratio implies future reduction of human resources available to provide services. Little information is available about the level of qualification, contractual aspects, payment and working conditions of home care workers and the existence of staff shortages and recruitment problems in different countries.

    Methods & Materials: This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been devel- oped in this project to map the home care systems in Europe, includ- ing details of human resources. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation.

    Results: In many countries numbers of those working in private organisations are not available. Furthermore financial incentives and working conditions will be compared, as well as the task division between home care workers and to what extent educational require- ments are explicitly formalised. Mechanisms of quality control of human resources differ strongly (e.g. recertification of nurses; rules for the education of home care nurses). An interesting phenomenon, related to pressures to increase efficiency, is the transfer of tasks or substitution which is taking place between home care workers of dif- ferent qualification levels. In contrast to the provision of technical nursing, the provision of personal care and domestic aid is less strictly related to specific qualifications.

    Conclusion: Shortages in human resources are a common problem in many countries, but expectedly most in countries just having developed home care. There is a strong variation in mechanisms of quality control of home care professionals; in the level of education required; and in the strength of the position of home care workers.

  • 49.
    Genet, Nadine
    et al.
    NIVEL, Netherlands.
    Naiditch, Michel
    Institut de Recherche et Documentation en Economie de laSante (IRDES), France.
    Boerma, Wienke
    NIVEL, Netherlands.
    Hutchinson, Allen
    Sheffield University, UK.
    Garms-Homolova, Vjenka
    Alice Salomon University of Applied Sciences, Germany.
    Lamura, Giovanni
    INRCA Istituto Nazionale Riposo e Cura Anziani, Italy.
    Chablicz, Slawomir
    Medical University of Bialystok, Poland.
    Ersek, Katalin
    Corvinus University of Budapest, Hungary.
    Gulacsi, Laszlo
    Corvinus University of Budapest, Hungary.
    Fagerström, Cecilia
    Blekinge University of Technology.
    Bolibar, Bonaventura
    IDIAP, Spain.
    Recipients of home care and the role of informal care in Europe2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no suppl 1, p. 48-49Article in journal (Refereed)
    Abstract [en]

    In many cases home care is no viable option without the efforts of clients and informal carers. So, an understanding of home care systems would not be complete without taking into account the role of clients and informal carers. As resources and criteria of eligibility are very different across countries, clients differ in their dependency, frailty and availability of informal care. In some countries recipients of home care more behave like critical consumers knowing their rights than those in other countries. Henceforth, systems may differ in the way clients are informed, can choose and, if necessary, can submit complaints. Another difference concerns the acknowledgement and role of informal carers, which is reflected, for instance, in the possibility for informal carers to be supported (e.g. with respite care). Here again, it turns out that very little comparative information is available at this point. On the basis of results of a literature review and from consultations with experts across Europe, the EC-financed EURHOMAP project has developed an extensive set of indicators to map home care systems, including the position and situation of clients and informal carers. EURHOMAP partners collected the data in 2009 and early 2010, in collaboration with experts in 31 European countries. Results were described in uniformly structured country reports and fed back to national experts for validation. An additional source of information was the answers on questions related to four ‘vignettes’ (hypothetical case descriptions of home living people in need of care). These questions were answered by a panel of key informants in each country. In most countries the largest share among recipients of home care consists of people above the age of 65 years. The number of recipients of home care varied enormously. In some countries home is almost limited to the elderly, while in other countries a wider range of services is provided to a wider vaiety of client and patient groups, including those in need of palliative (end-of-life) care and those in need of post-hospital care. Great differences were found in empowering recipients of home care (such as: offering choice of provider, type of provider; personal budget as an option; and availability of benchmark information to enable recipients to compare providers). The 31 countries will be compared on the availability of payment of informal carers; whether the tasks of informal carers have been laid down in a care protocol; whether the availability of informal care is taken into account in the needs assessment. Countries strongly differ in the number of home care recipients, their position in the system and the role of informal carers in the allocation and provision of formal care.

  • 50.
    Hagell, Peter
    et al.
    Kristianstad University.
    Broman, Jan-Erik
    Uppsala University.
    Hellström, Amanda
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Willman, Ania
    Malmö University.
    Westergren, Albert
    Kristianstad University.
    Measurement properties of the Minimal Insomnia Symptom Scale (MISS) as an insomnia screening tool among adults and the elderly2015In: The 6th International Conference on Probabilistic Models for Measurement in Education: Psychology, Social Science and Health, 12 - 14 January 2015, University of Cape Town, 2015Conference paper (Refereed)
    Abstract [en]

    Background: The Minimal Insomnia Symptom Scale (MISS) has been suggested as a brief 3-item screening tool for detecting insomnia. Each item has an ordered 5-category (0-4) response scale and the instrument yields a total score between 0-12 (higher scores = more insomnia). Available MISS evaluations have been based on classical test theory (CTT) approaches. Different cut-offs for identifying insomnia have been suggested for adults (aged 20-64) and elderly (aged 65+). For adults, a cut-off of ≥6 has been suggested, while a cut-off of ≥7 has been suggested for the elderly, as determined from applications of the Youden index.

    Aim: To test the measurement properties of the MISS using the Rasch measurement model, with special emphasis on Differential Item Functioning (DIF) by age, and to explore implications for the two suggested cut-off scores.

    Design: Cross-sectional MISS data from adult (n=1075) and elderly (n=548) populations were analysed by the unrestricted polytomous Rasch measurement model using the RUMM2030 software program. To avoid an inflated type I error rate, sample size was algebraically adjusted to 500 in the calculation of P-values while leaving all other aspects of data (e.g., locations, fit residuals) unaltered.

    Results: Mean person location was -1.095 (SD, 1.28), i.e. items tend to represent more severe levels of insomnia than that experienced by the sample. However, for the purpose of screening this may be considered acceptable. There were no statistically significant deviations from model expectations, with a non-significant overall item-trait interaction (χ2 = 26.94, P=0.173). Reliability (PSI) was 0.59 suggesting that the MISS can separate approximately two statistically distinct groups of people (1.92 strata). The highest Information Function (IF) was found at -0.2 logits. There were no disordered response category thresholds. There was uniform DIF by age for all three items, which disappeared following adjustment (split by age group) for the most pronounced DIF, suggesting that DIF was artificial for two items. Examination of raw scores-to-location estimates between the two age groups revealed differences at the lower and higher ends of the scale. The raw score cut-off of ≥6 was associated with a smaller logit difference between age groups than the ≥7 cut-off (0.09 vs. 0.23). That is, at a raw score of 6 the two age groups were comparable regarding their logit location estimates. This raw score (representing a logit value of -0.03 for the pooled sample) was also the one closest to the location of the highest IF (i.e., -0.2 logits).

    Summary and implications: This study provides general support for the measurement properties of the MISS. However, caution should be exercised in comparing MISS scores between age groups, but applying a ≥6 raw score cut-off appears to allow for valid comparisons between adults and elderly regarding the presence of insomnia. Nevertheless, additional studies are needed to determine the clinically optimal cut-score for identification of insomnia. 

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