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  • 1.
    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 capacity2008Ingår i: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 29, nr 1, s. 48-57Artikel i tidskrift (Refereegranskat)
    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.

  • 2. Borglin, Gunilla
    et al.
    Fagerström, Cecilia
    Blekinge University of Technology.
    Nursing students understanding of critical thinking and academic writing2010Ingår i: Scholarship of Teaching and Learning 2010, Karlskrona, 2010Konferensbidrag (Refereegranskat)
  • 3.
    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 study2012Ingår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 12, nr 6, s. 356-360Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Bratt, Anna S.
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för psykologi (PSY).
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Blekinge County Council.
    Self-compassion in old age: confirmatory factor analysis of the 6-factor model and the internal consistency of the Self-compassion scale-short form2019Ingår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    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 Countries2007Ingår i: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 62, nr 6, s. 371-379Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    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 healthcare2017Ingår i: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 35, nr 7, s. 358-363Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Healthy ageing: positive health among older people with focus on sleep habits and falls2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr suppl 1, s. 10-10Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Fagerström, Cecilia
    Lund University.
    Life Satisfaction and Feeling Hindered by Health Problems at 60 Years and Above2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Idag finns det flera studier där livstillfredsställelse bland äldre har undersökts. Studierna är dels genomförda i varierande kontext och dels innehåller de varierande faktorer som hälsa, funktionell förmåga, självkänsla, sociala kontakter och finansiell situation. Därmed är det inte självklart att det finns gemensamma eller specifika faktorer, vilka är förknippade med livstillfredsställelse bland äldre i olika europeiska länder. Flertalet personer med hälsoproblem och nedsatt funktionsförmåga bor i ordinärt boende. En orsak till att de inte känner tillfredsställelse med livet kan vara att de har en funktionsnedsättning eller att de känner sig hindrade till följd av sina hälsoproblem. Självskattad hälsa, funktionell förmåga, självkänsla, sociala kontakter och finansiell situation har alla visat sig vara faktorer betydelsefulla för livstillfredsställelse, men det är osäkert om dessa också är av betydelse för om personer känner sig hindrade i sitt dagliga liv till följd av hälsoproblem. Bättre kunskap om hur detta hänger samman skulle vara värdefullt, för att förstå på vilket sätt nedsatt hälsa och funktionsförmåga begränsar de dagliga aktiviteterna, och hur denna begränsning kan utgöra ett hinder för att känna livstillfredsställelse. Det övergripande syftet med den här avhandlingen var att undersöka gemensamma eller specifika faktorer för livstillfredsställelse i de sex europeiska länderna: Sverige, Storbritannien, Neder-länderna, Luxemburg, Österrike och Italien bland personer, 60 år eller äldre. Syftet var dessutom att undersöka om faktorer av betydelse för livstillfredsställelse också är av betydelse för om personer känner sig hindrade i sitt dagliga liv till följd av sina hälsoproblem, samt om faktorerna är av olika betydelse beroende av hur nedsatt funktionsförmågan är.

    Avhandlingen bygger på två datainsamlingar. Den datainsamlingen, som delstudie ett, två och tre bygger på, omfattar personer i åldern 60?89 år, som bor i ordinärt boende och ingår i en europeisk tvärsnittsstudie: European Study of Adult Well-being (ESAW). Tvärsnittsstudien genomfördes i Sverige, Storbritannien, Nederländerna, Luxemburg, Österrike och Italien under 2001 till 2002. I studien användes ett frågeformulär med strukturerade frågor från Older Americans Resources and Service schedule (OARS), Multi-dimensional Functional Assessment Questionnaire (OMFAQ). Formuläret omfattade frågor om självrapporterad funktionsförmåga (ADL-skala), hälsoproblem, sociala kontakter och ekonomisk situation. Metoderna är tidigare testade avseende validitet och reliabilitet på personer, som är 60 år eller äldre i USA. I studien användes också Rosenbergs instrument Self-esteem för att undersöka självkänsla och Neugartens instrument Life Satisfaction Index Z (LSIZ) för att bedöma livstillfredsställelse. Båda instrumenten är testade avseende validitet och reliabilitet. Det unika med denna studie är att ett gemensamt frågeformulär användes och att sex europeiska länder ingick. Detta gjorde det möjligt att undersöka vad som var betydelsefullt för äldres livstillfredsställelse i de olika europeiska länderna och därmed kunskap om gemensamma och specifika faktorer i dessa länder.

    Den andra datainsamlingen, som delstudie fyra bygger på, omfattar personer i åldern 60?96 år, som bor i ordinärt boende och ingår i en nationell longitudinell multi-centerstudie: The Swedish National study on Aging and Care (SNAC). Studien genomfördes på fyra forskningscentra i Sverige, varav centrat i Karlskrona, Blekinge är ett (The Swedish National study on Aging and Care ? Blekinge, SNAC?B). Personer, som deltog vid undersökningen 2001 i Karlskrona utgjorde urval för delstudie fyra. Vid undersökningen ingick tio åldersgrupper. Personer i de fyra yngsta åldersgrupperna (60 66, 72 och 78 år) var slumpmässigt utvalda medan samliga personer inkluderades i de sex äldsta åldersgrupperna (81, 84, 87, 90, 93 och 96 år). Datainsamlingen utfördes genom en intervju och en medicinsk undersökning samt ett kompletterande frågeformulär. I SNAC användes etablerade instrument och frågor, som omfattade självrapporterad funktionsförmåga (ADL-skala), hälsoproblem, sociala kontakter, finansiell situation, känsla av sammanhang (KASAM) och livstill-fredsställelse (LSIZ).

    Delstudie 1: Livstillfredsställelse och relaterade faktorer bland personer som är 60 år eller äldre i sex europeiska länder

    Syftet med denna studie var att undersöka livstillfredsställelse i relation till hälsoproblem, funktionsförmåga, självkänsla, sociala kontakter och finansiell situation bland personer som var mellan 60 och 89 år i sex europeiska länder. Urvalet bestod av 7699 personer som deltog i ESAW projektet och som hade fyllt i instrumentet LSIZ. Stickprovet bestod till 45,0 % av män och medelåldern var 71 år. Det svenska stickprovet hade den högsta andelen personer 80 år eller äldre med 22,6 %, jämfört med de övriga länderna som varierade mellan 12,2 % och 14,8 %. I stickprovet hade flertalet god funktionsförmåga, men i de olika länderna varierade andelen mellan 61,3 % och 72,9 %. Generellt ansåg personerna att de träffade anhöriga och vänner så ofta de önskade (77,2 %), men frekvensen i kontakter skilde sig åt i de olika länderna. Det svenska stickprovet hade den lägsta andelen personer (35,9 %), som hade dagliga kontakter, jämfört med de övriga länderna, som varierade mellan 64,4 % och 76,3 %. Medianen för livstillfredsställelse var 18 och flertalet av personerna i stickproven från de olika europeiska länderna var tillfredsställda med livet. Dock visade det sig att personer i det italienska stickprovet hade en lägre livstillfredsställelse med median 15 (q1?q3 = 11?19), jämfört med personer i de övriga länderna som varierade mellan median 18 och 19 (q1?q3 = 14?22). Fyra faktorer: att inte vara tillfredställd med sociala kontakter, att ha dålig finansiell situation, att känna sig hindrad i det dagliga livet till följd av hälsoproblem och att ha låg självkänsla var associerade med låg livs-tillfredsställelse i samtliga länder. Nedsatt funktionsförmåga var förknippad med låg livstillfredsställelse i fyra av länderna. Resultaten visade att även om olikheter i sociala kontakter, finansiell situation, hälsoproblem och funktionsförmåga förekom mellan de sex europeiska länderna fanns det fyra gemensamma faktorer, som var av betydelse för livstillfredsställelse. Fynden tyder på att flera faktorer, som är av betydelse för livstillfredsställelse är enhetliga i olika europeiska länder. Fynden visade också att både individuella och omgivningsfaktorer är viktiga för att personer ska känna livstillfredsställelse. Samtliga kan anses vara av betydelse att uppmärksamma i vården och omsorgen om äldre.

    Delstudie 2: Livstillfredsställelse i sex europeiska länder relaterat till hälsa, självkänsla, sociala kontakter och finansiell situation bland personer i åldern 65?89 år med nedsatt funktionsförmåga.

    Syftet med denna studie var att undersöka livstillfredsställelse bland personer (65?89 år) med nedsatt funktionsförmåga i relation till hälsa, självkänsla, sociala kontakter och finansiell situation i de sex europeiska länderna. Urvalet i denna studie bestod av 2195 personer som hade fyllt i LSIZ fullständigt och som hade minst en funktions-nedsättning enligt ADL-skalan. Totalt var det 40,2 % av personerna i 65?89 års ålder som hade funktionsnedsättning i en variabel eller fler, men andelen varierade i de deltagande länderna. Stickprovet bestod till 38,7 % av män och medelåldern i stick-provet var 76 år. Bland personerna med nedsatt funktionsförmåga var medelvärde för livstillfredsställelse 15,1 (SD 5,7). Även i denna delstudie var medelvärdet för livs-tillfredsställelse lägre i det italienska stickprovet med medelvärde 12,2 (SD 5,3) jämfört med de övriga länderna, som varierade mellan medelvärde 15,4 och 16,3 (SD 5,2?6,0). Det visade sig vara flera faktorer som var förknippade med livstill-fredsställelse, men det var bara tre faktorer: allmän hälsa, ensamhetskänsla och själv-känsla, som var förknippade med livstillfredsställelse i samtliga sex länder. Goda sociala kontakter, finansiell situation, deltagande i fysiska aktiviteter, ålder och kön var förknippade med hög livstillfredsställelse i fyra stickprov eller färre. Resultaten visade att bland personer med nedsatt funktionsförmåga var tre faktorer gemensamma för livstillfredsställelse i de olika europeiska länderna medan flera faktorer var landsspecifika. Detta tyder på att generellt finns det flera faktorer som är av betydelse för livstillfredsställelse, men för dem som har en nedsatt funktionsförmåga innebär livstillfredsställelse olika saker i olika europeiska länder. Resultaten tyder också på att i samband med nedsatt funktionsförmåga, är det individers personlighet och upplevda hälsa som är av betydelse för livstillfredsställelse snarare än resurser som finns i omgivningen.

    Delstudie 3: Funktionsförmåga och att känna sig hindrad till följd av hälsoproblem bland personer som är 60 år eller äldre

    I den första delstudien visade det sig att känna sig hindrad i dagligt liv var en faktor av betydelse för låg livstillfredsställelse i samtliga ESAW-länderna. I denna studie kombinerades den övergripande frågan om personer kände sig hindrade i dagligt liv med funktionsförmågan enligt ADL-skala för att undersöka hur hälsoproblem påverkade dagligt liv. Syftet med studien var att undersöka huruvida personer i åldern 60?89 år kände sig hindrade i det dagliga livet till följd av hälsoproblem i relation till funktionsförmåga, hälsoproblem, livstillfredsställelse, sociala kontakter och finansiell situation. Hälsoproblem definierades i delstudien som sjukdom, nedsatt hörsel eller nedsatt syn. Urvalet bestod av 1297 personer från Sverige, som deltog i ESAW-studien. I studien exkluderades personer, som inte angav något hälsoproblem, samt enkäter som innehöll för stort bortfall och i vilka frågan om hälsa hindrade personer i det dagliga livet inte var ifylld. De undersökta bestod till 54,1 % av män och medelåldern i urvalet var 73 år. Som mest rapporterades 11 hälsoproblem. Resultatet visade att det var 52,1 %, som kände sig hindrade i det dagliga livet trots att de inte hade någon funktionsnedsättning enligt ADL-skala medan det var 29,2 %, som inte kände sig hindrade eller kände sig lite hindrade trots att de hade en svår funktionsnedsättning. Olika faktorer var förknippade med att personerna kände sig mycket hindrade vid olika grad av funktionsnedsättning. I de fall då personerna inte hade någon funktionsnedsättning var det antalet hälsoproblem, inte tillgång till hjälp vid behov och låg livstillfredsställelse som var av betydelse för att de kände sig mycket hindrade i dagligt liv, medan i de fall då de hade en lätt funktionsnedsättning var det antalet hälsoproblem, låg självkänsla och livstillfredsställelse som var av betydelse. Resultatet kan tolkas som att vetskap om eller förvissning om att hjälp finns att tillgå när behov uppstår, är viktiga komponenter för att personer inte ska känna sig hindrade till följd av hälsoproblem. Detta är särskilt betydelsefullt på ett tidigt stadium av olika sjukdomar då problemen inte alltid är synbara för andra. Veterligen har inga tidigare studier berört huruvida hälsoproblem påverkar personers dagliga liv, med hjälp av frågekombinationen som förekom i denna studie. En utveckling av idén med fler förklarande faktorer samt att undersöka den i ett annat stickprov ansågs därför vara motiverat.

    Delstudie 4. Faktorer som är förknippade med att personer (60-96 år) känner sig hindrade i det dagliga livet till följd av hälsoproblem.

    Syftet med denna delstudie var att, i ett nytt stickprov, undersöka huruvida personer kände sig hindrade i det dagliga livet till följd av hälsoproblem i relation till funktions-förmåga, hälsoproblem, sociala kontakter, finansiell situation, känsla av sammanhang och livstillfredsställelse. Definitionen på hälsoproblem var samma, som användes i delstudie III. Urvalet bestod av 958 personer i åldern 60?96 år, som ingick i SNAC?B. Även i denna studie var inklusionskriterierna att personer skulle ha rapporterat minst ett hälsoproblem samt ha svarat på frågan om hälsoproblem hindrade dem i det dagliga livet. Likartade frågor, som dem i delstudie tre användes i denna studie. Funktionella tester lades till för att få en mer heltäckande bild av faktorer som kunde vara av betydelse för om personerna kände sig hindrade i det dagliga livet. Stickprovet bestod till 46,5 % av män och medelåldern i stickprovet var 76 år. Tre fjärdedelar av personerna i stickprovet hade god funktionsförmåga. Resultatet visade att hälften av personerna rapporterade att de hade fem hälsoproblem eller fler. I denna studie kände sig 43,4 % hindrade trots god funktionsförmåga och 10,2 % kände sig enbart lite hindrade trots svår funktionsnedsättning. Oförmåga att resa sig från en stol var av betydelse för att personer kände sig mycket hindrade i dagligt liv, oavsett funktionsförmåga. Dessutom, i likhet med delstudie tre, förknippades huruvida personer kände sig mycket hindrade i det dagliga livet med olika faktorer beroende på om personerna hade god respektive nedsatt funktionsförmåga. Även om inte några kausala slutsatser kan dras i studien kan resultatet tolkas som att faktorer av betydelse för huruvida personer känner sig hindrade vid god funktionsförmåga får mindre värde när funktionsförmågan försämras. Trötthet, som var ett sådant exempel, var av betydelse för om personer kände sig hindrade vid god funktionsförmåga. Vid nedsatt funktionsförmåga var det inte längre trötthet som var av betydelse utan det var att personer undvek utomhusvistelse av rädsla för att falla som gjorde att de kände sig mycket hindrade. Detta tyder på att i samband med en försämrad förmåga går det åt mer kraft och tid att utföra olika aktiviteter. Aktiviteter kan också vara förknippade med olika risker. Detta kan leda till att vikten av aktiviteter värderas, omvärderas eller att de rent av väljs bort. Fynden från delstudie III och IV, att ungefär hälften av dem som inte hade någon funktionsnedsättning kände sig hindrade i det dagiga livet kan vara ett tidigt tecken till att de senare utvecklar en funktionsnedsättning. För att säkerställa detta fynd krävs det dock longitudinella studier.

    Sammanfattningsvis visade studierna att faktorer som var förknippade med att personer kände sig hindrade i det dagliga livet till följd av hälsoproblem varierade beroende på om personerna hade god respektive nedsatt funktionsförmåga. De visade också att personer kände sig hindrade av sina hälsoproblem trots att de hade god funktionsförmåga. Intressant var att i samtliga deltagande länder visade det sig att känna sig hindrad i det dagliga livet tillsammans med dåliga sociala och finansiella resurser och låg självkänsla var faktorer av betydelse för låg livstillfredsställelse, medan nedsatt funktionsförmåga var det inte. I det urvalet som enbart innehöll personer med nedsatt funktionsförmåga var det tre faktorer: upplevd hälsa, ensamhets-känsla och självkänsla, som var av betydelse för livstillfredsställelse i samtliga länder. Övriga faktorer var av betydelse i fyra länder eller färre. Detta tyder på att det finns både gemensamma och landspecifika faktorer som är förknippade med livstillfredsställelse i de europeiska länderna som inkluderades i studien. Det tyder också på att upplevd hälsa och självkänsla är faktorer av betydelse för livstillfredsställelse, oavsett funktionsförmåga. Resultaten är betydande i det avseendet att i arbetet med äldre personer kan man inte enbart koncentrera sig på funktionsförmåga utan även andra faktorer såsom upplevd hälsa, självkänsla, sociala och finansiella resurser för att bibehålla eller höja livstillfredsställelsen hos äldre. En medvetenhet om att olika faktorer är av betydelse vid olika grad av funktionsnedsättning kan också vara viktigt för att kontinuerligt anpassa insatser efter omfattningen av funktionsförmågan.

  • 9.
    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 countries2007Ingår i: Applied Research in Quality of Life, ISSN 1871-2584, E-ISSN 1871-2576, Vol. 2, nr 1, s. 33-50Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    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 older2010Ingår i: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 22, nr 5-6, s. 387-394Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    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 older2009Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 13, nr suppl 1, s. S442-S442, artikel-id PB7 327Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    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 Countries2004Ingår i: ISA RC11 Conference, 2004Konferensbidrag (Refereegranskat)
  • 13.
    Fagerström, Cecilia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    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) study2017Konferensbidrag (Refereegranskat)
  • 14.
    Fagerström, Cecilia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Blekinge kompetenscentrum.
    Eriksen, Sara
    Blekinge Tekniska högskola.
    Nilsson, Lina
    Linnéuniversitetet, Fakulteten för teknik (FTK), Institutionen för informatik (IK).
    The Implementation of a Decision Support Tool in Home Healthcare: Nurses’ Experiences of Professional Adaptation when Healthcare is in Transformation2017Konferensbidrag (Refereegranskat)
  • 15.
    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 Sweden2011Ingår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 15, nr 2, s. 204-213Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    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 above2010Ingår i: 20th Nordic Congress of Gerontology: 30 May – 2 June 2010 - Reykjavík, Iceland, 2010Konferensbidrag (Refereegranskat)
    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.

  • 17.
    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 above2006Ingår i: GERIATRICS 2006 International Congress Of Elderly Health: 2nd to 6th April 2006, ISTANBUL, Harbiyet, Turkey, 2006Konferensbidrag (Refereegranskat)
    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.

  • 18.
    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 above2007Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 44, nr 2, s. 181-201Artikel i tidskrift (Refereegranskat)
    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.

  • 19.
    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 capacity2005Ingår i: 18th Congress of the International Association of Gerontology: Rio de Janeiro, Brazil, June 26-30, 2005, 2005Konferensbidrag (Refereegranskat)
    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.

  • 20.
    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.2012Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 55, nr 2, s. 349-356Artikel i tidskrift (Refereegranskat)
    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.

     

  • 21.
    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 oflife and longevity2016Ingår i: 23NKG2016, 23rd Nordic Congress of Gerontology. Tampere, Finland: Abstracts, 2016, s. 167-167Konferensbidrag (Refereegranskat)
    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.

  • 22.
    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 study2011Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, nr 7, s. 863-871Artikel i tidskrift (Refereegranskat)
    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.

  • 23.
    Fagerström, Cecilia
    et al.
    Blekinge University of Technology ; Lund University.
    Persson, Helen
    Feeling hindered by health problems at age of 60 and above2008Ingår i: International Nursing Research Conference : Facing the Challenge of Health Care Systems in Transition: 30th June to 3rd July 2008, Jerusalem, Israel, Jerusalem, 2008Konferensbidrag (Refereegranskat)
    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.

  • 24.
    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 context2017Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, nr 3, s. 434-448Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 25.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Willman, Ania
    Blekinge Institute of Technology.
    Home Care in Denmark2013Ingår i: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2013, 1, s. 60-66Kapitel i bok, del av antologi (Refereegranskat)
  • 26.
    Fagerström, Cecilia
    et al.
    Blekinge Insitute of Technology.
    Willman, Ania
    Blekinge Insitute of Technology.
    Home care in Norway2013Ingår i: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2013, 1, s. 207-213Kapitel i bok, del av antologi (Refereegranskat)
  • 27.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology.
    Willman, Ania
    Blekinge Institute of Technology.
    Home care in Sweden2013Ingår i: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2013, s. 272-279Kapitel i bok, del av antologi (Refereegranskat)
  • 28.
    Fagerström, Cecilia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). 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 conditions2017Ingår i: Journal of Aging Research, ISSN 2090-2204, E-ISSN 2090-2212, artikel-id 2720942Artikel i tidskrift (Refereegranskat)
    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.

  • 29.
    Garcia, Danilo
    et al.
    Blekinge Centre of Competence, Sweden;University of Gothenburg, Sweden;Network for Empowerment and Well-Being, Sweden.
    Cloninger, Kevin
    Blekinge Centre of Competence, Sweden;Network for Empowerment and Well-Being, Sweden;Anthropedia Foundation, USA.
    Molander-Söderhölm, Kristian
    Blekinge Centre of Competence, Sweden;Network for Empowerment and Well-Being, Sweden.
    Carleheden-Ottosson, Lil
    Blekinge Centre of Competence, Sweden.
    Jönsson, Inger
    Blekinge Centre of Competence, Sweden.
    Wåhlin, Annika
    Blekinge Centre of Competence, Sweden.
    Rapp Riccciardi, Max
    Blekinge Centre of Competence, Sweden;University of Gothenburg, Sweden;Network for Empowerment and Well-Being, Sweden.
    Zielinski, Andrzej
    Blekinge Centre of Competence, Sweden.
    Haddad, Farad
    Blekinge Centre of Competence, Sweden.
    Lindskär, Erik
    Blekinge Centre of Competence, Sweden;Network for Empowerment and Well-Being, Sweden.
    Al Nima, Ali
    Blekinge Centre of Competence, Sweden;Network for Empowerment and Well-Being, Sweden.
    Fagerström, Cecilia
    Blekinge Centre of Competence, Sweden.
    Person-centered care2019Ingår i: Encyclopedia of personality and individual differences / [ed] Virgil Zeigler-Hill & Todd K. Shackelford, Springer, 2019, s. 1-7Kapitel i bok, del av antologi (Refereegranskat)
  • 30.
    Garcia, Danilo
    et al.
    Region Blekinge, Sweden;University of Gothenburg, Sweden;Network Empowerment & Well Being, Gothenburg, Sweden.
    Jedel, Izabella
    University of Gothenburg, Sweden;Network Empowerment & Well Being, Gothenburg, Sweden.
    Rapp-Ricciardi, Max
    University of Gothenburg, Sweden;Network Empowerment & Well Being, Gothenburg, Sweden.
    Lindskar, Erik
    Region Blekinge, Sweden;Network Empowerment & Well Being, Sweden.
    Molander-Soderholm, Kristian
    Region Blekinge, Sweden.
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Region Blekinge, Sweden.
    Sikström, Sverker
    Network Empowerment & Well Being, Gothenburg, Sweden;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 profile2019Ingår i: Heliyon, E-ISSN 2405-8440, Vol. 5, nr 3, s. 1-17, artikel-id e01389Artikel i tidskrift (Refereegranskat)
    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.

  • 31.
    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 focus2012Ingår i: 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, s. 55-70Kapitel i bok, del av antologi (Refereegranskat)
    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.

  • 32.
    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 review2011Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, s. 1-14, artikel-id 207Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 33.
    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 Europe2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr suppl 1, s. 14-14Artikel i tidskrift (Refereegranskat)
    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.

  • 34.
    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 with2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr suppl 1, s. 49-49Artikel i tidskrift (Refereegranskat)
    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.

  • 35.
    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 Europe2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr suppl 1, s. 48-48Artikel i tidskrift (Refereegranskat)
    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.

  • 36.
    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 process2012Ingår i: 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, s. 71-104Kapitel i bok, del av antologi (Refereegranskat)
    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.

  • 37.
    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 Europe2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr suppl 1, s. 48-48Artikel i tidskrift (Refereegranskat)
    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.

  • 38.
    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 Europe2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr suppl 1, s. 48-49Artikel i tidskrift (Refereegranskat)
    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.

  • 39.
    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 elderly2015Ingår i: The 6th International Conference on Probabilistic Models for Measurement in Education: Psychology, Social Science and Health, 12 - 14 January 2015, University of Cape Town, 2015Konferensbidrag (Refereegranskat)
    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. 

  • 40.
    Hellström, Amanda
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Condelius, Anna
    Lund University.
    Willman, Ania
    Blekinge Institute of Technology;Malmö University.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    The rhythm of the unit is the pace of life: a study of everyday activities and sleep in Swedish residential care2015Ingår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 5, nr 8, s. 697-706Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Social and physical activities can improve sleep in older people. However, living in a residential care facility has been associated with a limited potential for activities and increased inactivity, reflected in poor sleep among residents. In turn, poor sleep can impair physical and mental functions. This paper explores sleep habits and everyday activities at three residential care facilities and investigates the link between sleep habits and everyday activities from the perspective of the residents. Data were collected through observations of daily life and interviews with residents.

    The results showed that fixed times during the day reduced daytime sleep and motivated them to go to the day room, thus enabling social interaction. More impaired residents spent more time in the day room napping or being less active. The residents stated that going outdoors was a desired activity, thought to improve sleep. However, the activity did not occur to the extent the residents wished for. Maintaining mobility and influence over daily activities together with regularity seemed to improve sleep. Awareness among staff of the need for stimulating and enriching activities, as well as access to bright light is requisite. Specific consideration should be given to residents who have difficulties communicating their wishes and/or impaired mobility.

  • 41.
    Hellström, Amanda
    et al.
    Blekinge Institute of Technology ; Lund University.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Willman, Ania
    Blekinge Institute of Technology.
    Promoting sleep by nursing interventions in health care settings: A systematic review2011Ingår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 8, nr 3, s. 128-142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Sleep disturbances are a common problem among individuals in hospitals and institutions. Although several studies have explored this phenomenon, there is still a lack of knowledge about the effectiveness of sleep-promoting nursing interventions. This systematic review aims to describe and evaluate the effectiveness of sleep-promoting nursing interventions in health care settings. Design: A systematic review was performed. Method: In June 2009, a literature search was carried out in the following databases: Academic Search Elite, CINAHL, the Cochrane Library and MedLine/PubMed. Fifty-two references were identified and after critical appraisal nine studies were selected. A compilation of the results and the outcomes of the interventions were carried out. Further, the evidence strength of the interventions was assessed. Findings: Evidence for the nursing interventions sleep hygiene, music, natural sound and vision, stimulation of acupoints, relaxation, massage and aromatherapy, is found to be low or very low. Still large effects of interventions where found when using massage, acupuncture and music, natural sounds or music videos. The use of sleep hygiene and relaxation on the other hand showed only small effects. Conclusion: The paucity of studies implies that the confidence in the effects shown, and the lack of high evidence strength for many nursing interventions, most certain will change if further studies are carried out. The uncertainty about the effects calls for more research before implementing the interventions into clinical practice.

  • 42.
    Hellström, Amanda
    et al.
    Lund University.
    Hagell, Peter
    Blekinge University of Technology.
    Fagerström, Cecilia
    Lund University.
    Willman, Ania
    Lund University.
    How to measure and classify insomnia in elderly persons2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr suppl 1, s. 147-148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Since sleep is found to be a fundamental part in experiencing quality of life and health it is of importance that nurses and other health care personnel strive to improve sleep and prevent sleep disturbances. Insomnia, which is the most common form of sleep disturbances, has also been found to be related with cardiac disorders. Elderly people are especially vulnerable for poor sleep; prevention of sleep disturbances should be of regard when caring for older persons. The Minimal Insomnia Symptom Scale (MISS) is a three item screening instrument previously found to be psychometrically sound and capable of identifying insomnia in the general population (20-64 years). However, its measurement properties have not been studied in an elderly population. Our aim was to test the measurement properties of the MISS among people aged 65+ in Sweden.

    Methods and materials: Data from a cross-sectional survey of 548 elderly individuals were analyzed in terms of assumptions of summation of items, reliability and optimal cut-off score by means of ROC-curve analysis and compared with self-reported insomnia criteria. The items of MISS describes the major features of insomnia, i.e. difficulties initiating sleep, waking at night and not feeling refreshed by sleep. A total score ranging between 0 and 12 is calculated, where higher scores indicate more severe insomnia.

    Results: Reliability was found to be 0.81. ROC analysis where MISS was compared with self-reported insomnia criteria (i. e. day-time sleepiness, not feeling refreshed by sleep, experiencing sleep difficulties). Optimal cut-off score was identified as more or equal to 7, and sensitivity 93%, specificity 84%.

    Conclusions: Data support the measurement properties of MISS as an insomnia screening instrument among elderly persons and its brevity as well as the easy scoring system makes it appealing in clinical practice.

  • 43.
    Hellström, Amanda
    et al.
    Blekinge Institute of Technology, Sweden ; Lund University, Sweden.
    Hagell, Peter
    Lund University, Sweden.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Sweden.
    Willman, Ania
    Blekinge Institute of Technology, Sweden.
    Measurement properties of the Minimal Insomnia Symptom Scale (MISS) in an elderly population in Sweden2010Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 10, artikel-id 84Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Insomnia is common among elderly people and associated with poor health. The Minimal Insomnia Symptom Scale (MISS) is a three item screening instrument that has been found to be psychometrically sound and capable of identifying insomnia in the general population (20-64 years). However, its measurement properties have not been studied in an elderly population. Our aim was to test the measurement properties of the MISS among people aged 65 + in Sweden, by replicating the original study in an elderly sample.

    Methods

    Data from a cross-sectional survey of 548 elderly individuals were analysed in terms of assumptions of summation of items, floor/ceiling effects, reliability and optimal cut-off score by means of ROC-curve analysis and compared with self-reported insomnia criteria.

    Results

    Corrected item-total correlations ranged between 0.64-0.70, floor/ceiling effects were 6.6/0.6% and reliability was 0.81. ROC analysis identified the optimal cut-off score as ≥7 (sensitivity, 0.93; specificity, 0.84; positive/negative predictive values, 0.256/0.995). Using this cut-off score, the prevalence of insomnia in the study sample was 21.7% and most frequent among women and the oldest old.

    Conclusions

    Data support the measurement properties of the MISS as a possible insomnia screening instrument for elderly persons. This study make evident that the MISS is useful for identifying elderly people with insomnia-like sleep problems. Further studies are needed to assess its usefulness in identifying clinically defined insomnia.

  • 44. Hellström, Amanda
    et al.
    Hagell, Peter
    Fagerström, Cecilia
    Blekinge University of Tehcnology.
    Willman, Ania
    Usefulness of the Minimal Insomnia Symptom Scale (MISS) in elderly persons2010Ingår i: 20th Nordic Congress of Gerontology: 30 May – 2 June 2010 - Reykjavík, Iceland, Reykjavik: Nordisk Gerontologisk Forening , 2010Konferensbidrag (Refereegranskat)
    Abstract [en]

    Sleep is found to be a fundamental part in experiencing health. Sleep is needed for memory consolidation, metabolic balance, immune functioning and alertness at day time and experiencing quality of life. Insomnia has also been found to be associated with cardiac disorders. Elderly people are especially vulnerable for poor sleep, why prevention of sleep disturbances should be of regard when caring for older persons. MISS is a 3 item questionnaire, with a total-score of 0-12 that could be used to find insomnia in elderly persons. Aim: To test of the measurement properties of the Minimal Insomnia Symptom Scale in an elderly sample ≥65 years in Sweden. Study sample Persons participating in the Swedish National Study on Ageing and Care – Blekinge were invited. ● 548 participated (response-rate 61.4%) ● Mean age 77.8 (SD 8.63) years ● Female 57.5% Results Reliability was found to be 0.81. ROC analysis where MISS was compared with self-reported insomnia criteria (i.e. day-time sleepiness, not feeling refreshed by sleep, experiencing sleep difficulties) identified optimal cut-off score as ≥7, and sensitivity 93%, specificity 84%. Area under curve = 0.93. Conclusion Data support the measurement properties of MISS as an insomnia screening instrument among elderly persons and its brevity makes it appealing. Through insomnia-screening, older persons at risk of health problems can be found and offered treatment and thereby health and quality of life can be restored.

  • 45.
    Hellström, Amanda
    et al.
    Blekinge Institute of Technology;Lund University.
    Hellström, Patrik
    Blekinge Institute of Technology.
    Willman, Ania
    Blekinge Institute of Technology;Malmö University.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Association between Sleep Disturbances and Leisure Activities in the Elderly: A Comparison between Men and Women2014Ingår i: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, artikel-id 595208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It has been suggested that physical or social activity is associated with fewer sleep disturbances among elderly people. Women report more sleep disturbances than men, which could indicate a variation in activity patterns between the genders. The aim of this study was to investigate associations between sleep disturbances and leisure activities in men and women (n = 945) aged ≥60 years in a Swedish population. Sleep disturbances were measured using eight dichotomous questions and seventeen variables, covering a wide range of leisure activities. Few leisure activities were found to be associated with sleep disturbances and their importance decreased when the models were adjusted for confounders and gender interactions. After clustering the leisure activities and investigating individual activities, socio-intellectual activities were shown to be significant for sleep. However, following adjustment for confounders and gender interactions, home maintenance was the only activity significant for sleep. Being a female increased the effect of home maintenance. Besides those leisure activities, poor/fair self-rated health (OR 7.50, CI: 4.27-11.81) and being female (OR 4.86, CI: 2.75-8.61) were found to have the highest association with poor sleep. Leisure activities pursued by elderly people should focus on activities of a socio-intellectual nature, especially among women, to promote sleep.

  • 46.
    Hellström, Amanda
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Nilsson, Camilla
    County Council Värmland.
    Nilsson, Annina
    County Council Blekinge.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Leg ulcers in older people: a national study addressing variation in diagnosis, pain and sleep disturbance2016Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, artikel-id 25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. Methods: The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9 % were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. Results: We found the prevalence of pain intensity >= 5 on the NRS to be 34.8 % in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p < 0.001) and were found in 34.8 % of the total sample. Although more women than men reported pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venousarterial ulcers increased the risk of sleep disturbances, as did higher pain scores. Conclusions: The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met. National guidelines in managing leg ulcers, which also consider consequences such as sleep disturbances, pain and discomfort, are needed.

  • 47.
    Holst, Göran
    et al.
    Blekinge Institute of Technology, Sweden.
    Willman, Ania
    Blekinge Institute of Technology, Sweden.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Borg, Christel
    Blekinge Institute of Technology, Sweden.
    Hellström, Ylva
    Blekinge Institute of Technology, Sweden.
    Borglin, Gunilla
    Blekinge Institute of Technology, Sweden.
    Quality of care: prevention of pressure ulcers - nursing students as facilitators of evidence based practice2010Ingår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 30, nr 1, s. 40-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This development project was aimed at engaging nursing students in a project targeting the prevention and reduction of pressure ulcers on an education based hospital ward. An intervention was implemented based on systematic assessment, skin observation, together with training and educational sessions, i.e. on how to make risk assessments and how to prevent and treat a pressure ulcer, were carried out. The project demonstrated the importance of offering nursing students an environment for clinical practice which supports them in participating and developing patient care starting from Evidence-Based Practice. During the project no patients developed pressure ulcers while on the ward. The opportunityto act as facilitators of evidence-based methods was found to enhance student ability to draw conclusions and make connections between quality of care and end result.

  • 48.
    Holst, Göran
    et al.
    Blekinge Institute of Technology.
    Willman, Ania
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Borg, Christel
    Blekinge Institute of Technology.
    Hellström, Ylva
    Blekinge Institute of Technology.
    Borglin, Gunilla
    Blekinge Institute of Technology.
    Quality of care: prevention of pressure ulcers - nursing students as facilitators of evidence based practice2010Ingår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 30, nr 1, s. 40-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This development project was aimed at engaging nursing students in a project targeting the prevention and reduction of pressure ulcers on an education based hospital ward. An intervention was implemented based on systematic assessment, skin observation, together with training and educational sessions, i.e. on how to make risk assessments and how to prevent and treat a pressure ulcer, were carried out. The project demonstrated the importance of offering nursing students an environment for clinical practice which supports them in participating and developing patient care starting from Evidence-Based Practice. During the project no patients developed pressure ulcers while on the ward. The opportunityto act as facilitators of evidence-based methods was found to enhance student ability to draw conclusions and make connections between quality of care and end result.

  • 49.
    Karlsson, Staffan
    et al.
    Lund University;Halmstad University.
    Hallberg, Ingalill R.
    Lund University.
    Midlöv, Patrik
    Lund University.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Antipsychotic medication in relation to national directives in people with dementia in Sweden2017Ingår i: Program Abstracts from the 21st International Association of Gerontology and Geriatrics (IAGG) World Congress, Washington, DC: The Gerontological Society of America , 2017, s. 348-349Konferensbidrag (Refereegranskat)
    Abstract [en]

    The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care as reported in the most recent empirical studies on the topic, and to relate these trends to directives and recommendations from national authorities.

    The study included two scoping review studies and two empirical studies. The scoping studies reviewed published data in electronic databases as well as Swedish recommendations and directives in the field.

    During the past decade, recommendations have been developed regarding antipsychotic medication in Sweden. These recommendations were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and those with moderate cognitive impairment and living in nursing homes for people with dementia. A trend towards a decrease in antipsychotic use has been seen over the last 15 years. The empirical studies showed that the medication with antipsychotics decreased from 23.4% in 2001 to 11.5% in 2007, for older people in general as well as for older people with dementia. Among older people with dementia, 10% were utilizing antipsychotic medication, with no difference between those cared for at home and those in nursing homes.

    Directives from Swedish national authorities seem to have had an impact on antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while other psychotropic medication has increased. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.

  • 50.
    Karlsson, Staffan
    et al.
    Halmstad University.
    Hallberg, Ingalill R.
    Lund University.
    Midlöv, Patrik
    Lund University.
    Fagerström, Cecilia
    Blekinge Centre of Competence.
    The trends in treatment with antipsychotic medication in relation to national directives in people with dementia: Review in a Swedish context2017Ingår i: Capacity, Creativity and Ageing in Clinical Practice: Faculty of Psychiatry of Old Age Conference 2017, 2017, s. 36-36Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Antipsychotic medication has been commonly used in dementia treatment despite various side effects, which differ for different drug generations. As there is no clear evidence for treatment with antipsychotic medication among older people with dementia, may a review of empirical studies and national directives be beneficial.

    Objectives: The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in nursing homes as reported in the most recent empirical studies on the topic, and to relate these trends to directives from the national authorities.

    Methods: The study included two scoping review studies based on searches of electronic databases as well as the Swedish directives in the field.

    Findings: During the past decade, directives have been developed for antipsychotic medication in Sweden. These directives were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and in those with moderate cognitive impairment and living in nursing homes for people with dementia. A decreasing trend in antipsychotic use has been seen over the last 15 years.

    Conclusions: Directives from the authorities in Sweden may have had an impact on treatment with antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while treatment with combinations of psychotropic medications is common. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.

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