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  • 51.
    Karlsson, Staffan
    et al.
    Lund University, Sweden;Halmstad University, Sweden.
    Hallberg, Ingalill R.
    Lund University, Sweden.
    Midlöv, Patrik
    Lund University, Sweden.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Sweden;Blekinge Centre of Competence, Sweden.
    Treatment with antipsychotic medication in relation to national directives in people with dementia in a Swedish context2016In: Presented at the 26th Alzheimer Europe Conference: Excellence in dementia research and care, Copenhagen, Denmark, October 31-November 2, 2016, 2016, p. 52-52Conference paper (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in the most recent empirical studies on the treatment with antipsychotic treatment and relate it to directives and recommendations from national authorities.

    Methods: The study included; two scoping review studies and two empirical studies. The scoping studies were review of published data in electronic databases as well as Swedish recommendations and directives in the area.

    Results: The last decade, recommendations were developed regarding antipsychotic medication in Sweden, in the beginning overviewing to be more and more specific and restrictive. The scoping review showed that the treatment with antipsychotic drugs varied between 6%-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 of a decreased treatment with antipsychotics was seen over the last 15 years. The empirical studies showed that the medication with antipsychotics decreased from 23.5 % in 2001 to 12 % in 2007, for older people in general as well as for older people with dementia. In older people with dementia only, 10% were utilizing antipsychotic medication, with no difference between those in ordinary homes compared to those in nursing homes.

    Conclusions: Directives from Swedish national authorities seems to have had an impact on antipsychotic medication in people with dementia. The treatment with antipsychotic medication decreased, while other psychotropic medication increased. National directives complemented with systematic follow-ups may possibly be even more effective.

    Conclusion: Treatment with orexin suppressed phagocytosis and degradation of Aβ. Further investigation suggested that the effects of orexin may be mainly on, or mediated through actin. Further investigations concerning the effects of orexin antagonists may be able to offer new methods to arrest the progress of, or possibly treat, AD.

  • 52.
    Karlsson, Staffan
    et al.
    Lund University, Sweden;Halmstad University, Sweden.
    Hallberg, Ingalill Rahm
    Lund University, Sweden.
    Midlöv, Patrik
    Lund University, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge Centre of Competence, Sweden.
    Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia: a review of the Swedish context2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, p. 1-9, article id 251Article, review/survey (Refereed)
    Abstract [en]

    Background: 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. Results: 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.

  • 53.
    Kumlien, Christine
    et al.
    Malmö University, Sweden.
    Miller, Michael
    Lund University, Sweden.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hagell, Peter
    Kristianstad University, Sweden.
    Evaluation of self-management program outcomes: adaptation and testing of a Swedish version of the Health Education Impact Questionnaire (heiQ)2018In: Journal of Applied Measurement, ISSN 1529-7713, Vol. 19, no 3, p. 303-319Article in journal (Refereed)
    Abstract [en]

    Self-management programs require a range of indicators to evaluate their outcomes. The Health Education Impact Questionnaire (heiQ) was developed to meet this need. The heiQ contains 40 items with 4 response categories, representing eight scales. We developed a Swedish version of the heiQ that was tested by cognitive interviews (n = 15) and psychometrically (n = 177) using classical test theory (CTT) and Rasch measurement theory (RMT). The Swedish heiQ was easily understood by interviewees and met CTT criteria, with supported scaling assumptions (corrected item-total correlations, 0.37) and reliability (ordinal alpha 0.78). General support was demonstrated for the measurement properties of the eight heiQ scales by acceptable RMT fit. However, there were signs of malfunctioning response categories for four items in two scales, and of suboptimal item coverage of the measurement continua. The Swedish heiQ appears comparable to other available language versions. Further efforts may be needed to optimize response categories and measurement precision.

  • 54.
    Lagergren, Mårten
    et al.
    Stockholm Gerontology Research Center.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Sjölund, Britt-Marie
    Karolinska Institutet;Stockholm University.
    Berglund, Johan
    Blekinge Institute of Technology.
    Fratiglioni, Laura
    Stockholm Gerontology Research Center;Karolinska Institutet;Stockholm University.
    Nordell, Eva
    Lund University;Skåne University Hospital.
    von Strauss, Eva
    Karolinska Institutet;Stockholm University;Red Cross University College.
    Wimo, Anders
    Karolinska Institutet;Stockholm University.
    Elmståhl, Sölve
    Lund University;Skåne University Hospital.
    Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden2016In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 28, no 1, p. 147-158Article in journal (Refereed)
    Abstract [en]

    The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

  • 55.
    Lagergren, Mårten
    et al.
    Stockholm Gerontology Research Center.
    Sjölund, Britt-Marie
    Karolinska Institutet.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Berglund, Johan
    Blekinge Institute of Technology.
    Fratiglioni, Laura
    Stockholm Gerontology Research Center;Karolinska Institutet.
    Nordell, Eva
    Lund University;Skåne University Hospital.
    Wimo, Anders
    Karolinska Institutet.
    Elmståhl, Sölve
    Lund University;Skåne University Hospital.
    Horizontal and vertical target efficiency – a comparison between users and non-users of public long-term care in Sweden2014In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 34, no 4, p. 700-719Article in journal (Refereed)
    Abstract [en]

    The extent to which a system of services is in tune with the needs of the population can be expressed in terms of target efficiency, which includes horizontal target efficiency – the extent to which those deemed to need a service receive it – and vertical target efficiency – the corresponding extent to which those who receive a service actually need it. Vertical efficiency can be measured by looking only at those receiving services. To measure horizontal target efficiency in a population, one must have access to population surveys. Data were taken from the baseline survey of the Swedish National Study on Ageing and Care (SNAC study). The results show that more than 80 per cent of those dependent in personal activities of daily living in the studied geographic areas were users of public long-term care (LTC). Dependency in instrumental activities of daily living was identified as the most important predictor of using LTC. Vertical target efficiency was 83–95 per cent depending on age, gender and type of household, if need was defined as dependency in instrumental activities of daily living. It was considerably lower, 35–61 per cent when defined as dependency in personal daily activities. Overall, long-term target efficiency in Sweden must be regarded as high. Few persons who need public LTC services fail to receive them.

  • 56.
    Lengstedt, Anna
    et al.
    Landstinget Blekinge.
    Fagerström, Cecilia
    Blekinge Kompetenscentrum.
    Äldres Bästa, Äldrelots i Blekinge: En brobyggare för ökad delaktighet och trygghet bland de mest sjuka äldre2015Report (Other academic)
    Abstract [sv]

    Det finns ett antal äldre som beskrivs som de mest sjuka äldre och som känner behov av att ha någon som kan ge stöd i olika sammanhang. Det finns samtidigt en del äldre som tillhör gruppen de mest sjuka äldre som inte känner detta behov. Det är heller inte ovanligt att de mest sjuka äldre är stora förbrukare av olika omsorgs- och sjukvårdinsatser och har ett behov av att insatser från olika instanser koordineras. Med denna spännvid av behov kan det vara svårt att utveckla modeller som är generellt anpassade till de olika individuella behov som de äldre upplevs ha. En samordnande och stödjande funktion som hjälper den äldre i kontakten med vård och omsorg, en person som arbetar utifrån individuella behov så att de kan uppmärksammas och att åtgärder kan genomföras skulle kunna vara ett sätt att tillmötes gå denna problematik. Med detta som grund initierades en försöksverksamhet i Blekinge. Samordnande äldrelotsar involverades med syfte att etablera en kontinuerlig kontakt med de äldre under ett år för att öka de äldres livskvalitet, delaktighet och trygghet. Detta skulle i sin tur kunna generera positiva effekter vid insatser inom social omsorg och hälso- och sjukvården.

    Syftet med denna rapport var att beskriva de mest sjuka äldre som ingick i försöksverksamheten äldrelots utifrån de äldres hälsosituation, deras behov samt delaktighet och trygghet i vård- och omsorgskontakter. Försöksverksamheten äldrelots genomfördes 2010-2013 i Blekinge. Ett hundra fyrtiotvå personer (>65 år) följdes under ett år och information samlades in genom intervjuer, arbetsplaner och enkäter. Många av personerna som valde att ha kontakt med en äldrelots bedöms vara sköra äldre, dvs. äldre som uppfyller kriteriet för frail (skör) eller prefrail eftersom många av dem upplevde begränsningar i rörlighet och förmåga till måttligt ansträngande aktiviteter. Frail och prefrail skulle därmed kunna användas ett sätt för att identifiera personer som är i behov av stöd i samband med vård- och omsorgsinsatser. Hos de äldre identifierades flera behov, behov som inte alltid uppmärksammats eller åtgärdats av befintliga verksamheter med ålagt ansvar eller uppdrag. I samband med äldrelotsens verksamhet ökade andelen personer som kände delaktighet i beslut rörande insats och trygghet med erhållen insats under de tolv månader som den äldre hade kontakt med äldrelotsen. Även de äldres livskvalitet förbättrades under året. Många äldre upplevde att det var just äldrelotsen som var viktig för att de skulle känna sig delaktiga och trygga i kontakt med vård och omsorg. Flertalet (90 %) kände sig tryggare tack vare äldrelotsen om de skulle behöva kontakta hälso- och omsorgspersonal framöver. Men de uppkomna resultaten tyder på att äldrelotsen inte primärt kan påverka den äldres upplevelse av delaktighet och trygghet i relationen till andra professioner. Äldrelotsen kunde i mötet med vård och omsorgen ses som den som överbryggar eventuella hinder som uppstår så att den äldre känner delaktighet och trygghet, dvs. en länk mellan det individuella behovet och givna insatsen. Genom äldrelotsens arbete kunde det också identifieras att information ofta saknades framförallt till dem som inte var vana vård- och omsorgstagare samt att uppföljning i flera fall uteblev.

    Äldrelotsen sedd som en överbryggare återges också i de rollerna som äldrelotsen hade. Äldrelotsen var en som informerade, stöttade och någon som lyssnade på den äldre. Äldrelotsen var också en samordnare, en som följde upp, en som frågade om behovet blev tillgodosett, en som kunde föra den äldres talan och förtydliga. Allt detta ses som viktiga faktorer för att kunna känna delaktighet och trygghet.

    Sammanfattningsvis tyder resultaten på att funktionen äldrelots är ett användbart sätt att arbeta på för att identifiera behov och påverka den äldres upplevelse av delaktighet och trygghet med erhållna insatser och därmed förbättra livskvaliteten. Resultaten visar också på att tänka och utgå utifrån processer är en viktig del i vård- och omsorgsverksamheterna för att individuella behov ska kunna tillfredsställas. Försöksverksamheten har genererat en stor kunskapsbank som innehåller information om de äldres individuellt upplevda behov. En information som mycket väl kan användas för att förbättra och utveckla insatser som vänder sig till de mest sjuka äldre.

  • 57.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology ; Lund University.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Sivberg, Bengt
    Lund University.
    Willman, Ania
    Blekinge Institute of Technology ; Malmö University.
    Concept analysis: patient autonomy in a caring context2014In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 10, p. 2208-2221Article in journal (Refereed)
    Abstract [en]

    Aim

    This paper is a report of an analysis of the concept of patient autonomy.

    Background

    Many problems regarding patient autonomy in healthcare contexts derive from the patient's dependent condition as well as the traditional authoritarian position of healthcare professionals. Existing knowledge and experience reveal a lack of consensus among nurses regarding the meaning of this ethical concept.

    Design

    Concept

    Analysis.

    Data sources

    Medline, CINAHL, The Cochrane Library and PsycINFO were searched (2005-June 2013) using the search blocks 'autonomy', 'patient' and 'nursing/caring'. A total of 41 articles were retrieved.

    Review Methods

    The Evolutionary Method of Concept Analysis by Rodgers was used to identify and construct the meaning of the concept of patient autonomy in a caring context.

    Results

    Five attributes were identified, thus creating the following descriptive definition: 'Patient autonomy is a gradual, time-changing process of (re-)constructing autonomy through the interplay of to be seen as a person, the capacity to act and the obligation to take responsibility for one’s actions’'. Patient vulnerability was shown to be the antecedent of patient autonomy and arises due to an impairment of a person's physical and/or mental state. The consequences of patient autonomy were discussed in relation to preserving control and freedom.

    Conclusion

    Patient autonomy in a caring context does not need to be the same before, during and after a care episode. A tentative model has been constructed, thus extending the understanding of this ethical concept in a caring context.

  • 58.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge Centre of Competence.
    Willman, Ania
    Blekinge Institute of Technology;Malmö University.
    Patient autonomy in a high-tech care context: A theoretical framework2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21-22, p. 4128-4140Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high-tech care context. BackgroundPutting the somewhat abstract concept of patient autonomy into practice can prove difficult as when it is highlighted in healthcare literature, the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could therefore be considered paradoxical, as in most cases, these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important. DesignTheory development. MethodsThe basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group. ResultsA theoretical frameworkthe control-partnership-transition frameworkwas delineated disclosing different parts cocreating the prerequisites for patient autonomy in high-tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients were revealed as follows: the strategy of control, the strategy of partnership, the strategy of trust and the strategy of transition. ConclusionsAn extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high-tech care environments. Relevance to clinical practiceThe control-partnership-transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of the strategies employed by patients to achieve autonomy in high-tech care contexts. The guiding principles for patient autonomy presented could be used in nursing guidelines.

  • 59.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Willman, Ania
    Malmö University.
    Sivberg, Bengt
    Lund University.
    Befriending everyday life when bringing technology into the private sphere2017In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 27, no 6, p. 843-854Article in journal (Refereed)
    Abstract [en]

    We present the findings of our phenomenological interview study concerning the meaning of being an autonomous person while dependent on advanced medical technology at home. This was elucidated in the participants' narratives as befriending everyday life when bringing technology into the private sphere. We discovered four constituents of the phenomenon: befriending the lived body, depending on good relationships, keeping the home as a private sphere, and managing time. The most important finding was the overall position of the lived body by means of the illness limiting the control over one's life. We found that the participants wanted to be involved in and have influence over their care to be able to enjoy autonomy. We therefore stress the importance of bringing the patients into the care process as chronic illness will be a part of their everyday life for a long time to come, hence challenging patient autonomy.

  • 60.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology.
    Sivberg, Bengt
    Lund University.
    Willman, Ania
    Blekinge Institute of Technology;Malmö University.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    A trajectory towards partnership in care - patient experiences of autonomy in intensive care: a qualitative study2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 5, p. 294-302Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to describe and elucidate patient experiences of autonomy in an intensive care context from a caring perspective.

    Background: Patients in intensive care units (ICUs) are critically ill and in a dependent and vulnerable position. There is thus a risk of staff taking command not only of the patients’ vital functions but also of their decision-making.

    Methods: A qualitative design was selected. Individual interviews were conducted with 11 adult patients with an intensive care episode of two days or more at six Swedish ICUs. The data were analysed using Inductive Content Analysis.

    Findings: Patient autonomy in intensive care was shown to be ’A trajectory towards partnership in care depending on state of health and mutual understanding’. It was experienced through acknowledged dependence, being recognised as a person, invited participation and becoming a co-partner in care.

    Conclusion: Patients in need of intensive care wanted to be involved in making decisions about their care as this creates a trusting and healthy care environment. Greater awareness is required about the ICU patient not only being a passive care recipient but also an active agent and where involvement in decision-making and participation in care are crucial.

  • 61.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology.
    Sivberg, Bengt
    Lund University.
    Willman, Ania
    Malmö University.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    A trajectory towards partnership in care - patients' experiences of autonomy in intensive care2015Conference paper (Refereed)
  • 62.
    Lindberg, Terese
    et al.
    Blekinge Institute of Technology.
    Andersson, Oscar
    Blekinge Institute of Technology.
    Palm, Molina
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    A systematic review and meta-analysis of dressings used for wound healing: the efficiency of honey compared to silver on burns2015In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535, Vol. 51, no 2-3, p. 121-134Article in journal (Refereed)
    Abstract [en]

    Background: Honey has the antibacterial effect of silver without the toxic effect of silver on the skin. Even so, silver is the dominant antibacterial dressing used in wound healing.

    Objectives: To evaluate the healing effects of honey dressings compared to silver dressings for acute or chronic wounds. Design: A systematic review with meta-analysis.

    Method: The search, conducted in seven databases, resulted in six randomised controlled trial studies from South Asia focusing on antibacterial properties and healing times of honey and silver.

    Result: Honey was more efficacious for wound healing than silver, as measured in the number of days needed for wounds to heal (pooled risk difference -20, 95% CI -0.29 to -0.11, p < .001). Honey turned out to have more antibacterial qualities than silver.

    Conclusion: All the included studies based on burns showed the unequivocal result that honey had an even more positive effect than silver on wound healing.

  • 63.
    Marcinowicz, Ludmila
    et al.
    Medical University of Bialystok, Poland.
    Jamiołkowski, Jacek
    Medical University of Bialystok, Poland.
    Gugnowski, Zbigniew
    Medical Center Masuria, Poland.
    Strandberg, Eva Lena
    Lund University.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Pawlikowska, Teresa
    Royal College of Surgeons in Ireland, Ireland.
    Evaluation of the trust in physician scale (TIPS) of primary health care patients in north-east Poland: a preliminary study2017In: Family Medicine and Primary Care Review, ISSN 1734-3402, E-ISSN 2449-8580, Vol. 19, no 1, p. 39-43Article in journal (Refereed)
    Abstract [en]

    Background. Trust is a complex concept, difficult to study, but very important in a patient-family physician relationship. One of the measures used to assess interpersonal trust is a scale developed by Anderson & Dedrick entitled the Trust in Physician Scale (TI PS).

    Objectives. The aim of the study was to assess the TI PS properties in relation to the age, gender, and health status of primary health care patients consulting family doctors and trainees in north-east Poland.

    Material and methods. A cross-sectional study using the TI PS was conducted in primary health care units in north-east Poland. 120 patients (60 who came to see family doctors, and 60 who came to see trainees) were asked to participate in the survey.

    Results. The Trust in Physician Scale has good reliability in primary care patients in north-east Poland (Cronbach’s alpha coefficient was 0.90). Patients displayed statistically significant greater trust in family doctors than in trainees. A negative correlation was found between age and the trust scale (r = -0.30; p = 0.005); the younger the respondent, the higher trust in the physician, and conversely, a positive correlation between self-assessment of health and the trust scale (r = 0.3; p = 0.003).

    Conclusions. The Polish translation of the TI PS instrument performed well in terms of acceptability in the family medicine environment. It can be used to differentiate between the level of trust in family doctors and in trainees. A relation between age, sex, education level and self-assessment of health needs to be confirmed using a larger sample.

  • 64.
    Naseer, M.
    et al.
    Malmö University.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Prevalence and association of undernutrition with quality of life among Swedish people aged 60 years and above: results of the SNAC-B study2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 10, p. 970-979Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aimed to assess the prevalence of undernutrition among elderly and to investigate the association of risk of undernutrition with health-related quality of life and life satisfaction controlling for age, gender, marital status, economic status, housing arrangement, education level, functional ability, and diseases.

    Design: A cross-sectional study design was used for this study. The baseline data (2001-€“2003) of "€œThe Swedish National Study of Aging and Care-Blekinge (SNAC-B)"€ was used.

    Setting: This population-based study focused on both home-living and special-housing residents.

    Participants: The participants (n=1402) were randomly selected and included both males and females 60-€“96 years of age residing in a municipality of south-east Sweden.

    Measurements: The risk of undernutrition was estimated by the occurrence of at least one anthropometric measure (body mass index, mid-arm circumference, and calf circumference) below cut-off, in addition to the presence of at least one subjective measure (declined food intake, weight loss, and eating difficulty). The dependent variables, health-related quality of life and life satisfaction, were measured by the validated short form health survey (SF-12) and Liang’s life satisfactions index A (LSIA), respectively.

    Results: According to the criterion, 8.5% of the participants were at risk of undernutrition, and subjects at nutritional risk were significantly older, female, unmarried/widowed/divorced, residing in special housing, and functionally impaired. The risk of undernutrition was significantly associated with poor health-related quality of life, both in the physical (OR 2.31, 95% CI 1.18-€“4.52) and mental (OR 2.34, 95% CI 1.22-€“4.47) dimensions. However, no significant association was observed between nutritional status and life satisfaction (OR 1.30, 95% CI 0.70-€“2.40).

    Conclusion: The risk of undernutrition significantly increases the risk of poor physical and mental health-related quality of life but has negligible impact on life satisfaction. This study also highlights the importance of functional ability both for the prevention of undernutrition and promotion of quality of life. However, more studies are needed to validate the tool used here for undernutrition risk assessment before it can be used in clinical or population settings.

  • 65.
    Naseer, M.
    et al.
    Blekinge Institute of Technology.
    Forssell, H.
    Blekinge Centre of Competence.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study2016In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, no 3, p. 399-404Article in journal (Refereed)
    Abstract [en]

    Background/Objectives:

    This study aimed to assess the association between risk of malnutrition and 7-year mortality, controlling for functional ability, socio-demographics, lifestyle behavior and diseases, and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality.

    Subjects/Methods:

    A longitudinal study on home-living and special-housing residents aged 60 years was conducted. Of 2312 randomly invited participants, 1402 responded and 1203 provided information on both nutritional status and functional ability. The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure (BMI, MAC and CC) below cut-off in addition to the presence of at least one subjective measure (decreased food intake, weight loss and eating difficulty).

    Results:

    At baseline, 8.6% of subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. The risk of malnutrition was independently associated with 7-year mortality (hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.28–2.65). Additional independent predictors were dementia (HR 2.76, 95% CI 1.85–4.10), activity of daily living (ADL) dependence (HR 2.08, 95% CI 1.62–2.67), heart disease (HR 1.44, 95% CI 1.16–1.78), diabetes (HR 1.41, 95% CI 1.03–1.93) and older age (HR 1.09, 95% CI 1.07–1.10). Moreover, the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, P<0.001).

    Conclusions:

    The risk of malnutrition significantly increases the risk of mortality in older people. Moreover, risk of malnutrition and ADL dependence together explain a significantly poorer survival rate; however, the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality.

  • 66.
    Naseer, Mahwish
    et al.
    Dalarna University;Karolinska Institutet;Stockholm University.
    Dahlberg, Lena
    Dalarna University;Karolinska Institutet;Stockholm University.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge County Council.
    Health related quality of life and emergency department visits in adults of age >= 66 years: a prospective cohort study2018In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 16, article id 14Article in journal (Refereed)
    Abstract [en]

    Background: Age increases the risk of emergency department [ED] visits. Health related quality of life (HRQoL) is often estimated as an outcome of ED visits, but it can be a risk factor of ED visits. This study aims to assess the association of HRQoL with time to first ED visit and/or frequent ED use in older adults during four-year period and if this association differs in 66-80 and 80+ age groups. Methods: Data from the Swedish National Study on Aging and Care-Blekinge of wave 2007-2009 was used in combination with electronic health records on ED visits. The analytical sample included 673 participants of age 66 years and older with information on HRQoL. Cox proportional hazard model was used to assess the association between HRQoL and time to first ED visit. Logistic regression analysis was performed to estimate the association of HRQoL with frequent ED use. Results: During the study period, 55.3% of older adults visited the ED and 28.8% had a frequent ED use. Poor physical HRQoL was independently associated with first ED visit both in total sample (p < 0.001) and in 66-80 (p < 0. 001) and 80+ (p = 0.038) age groups. Poor mental HRQoL had no significant association with first ED visit and frequent ED use. Conclusion: Findings suggest that poor physical HRQoL is associated with time to first ED visit in older adults. Therefore, physical HRQoL should be considered while planning interventions on the reduction of ED utilisation in older adults. Explanatory factors of frequent ED use may differ in age groups. Further studies are needed to identify associated factors of frequent ED visits in 80+ group.

  • 67.
    Naseer, Mahwish
    et al.
    Blekinge Centre of Competence.
    Fagerström, Cecilia
    Blekinge Centre of Competence;Blekinge Institute of Technology.
    Psychometric properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA) in a study of Swedish people aged ≥ 60 years2017In: JARCP - The Journal of Aging Research & Clinical Practice, ISSN 2273-421X, Vol. 6, p. 32-39Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to investigate the risk of malnutrition and to evaluate the psychometric properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA), SOMRA cut-offs and Swedish-Guidelines on Malnutrition Risk Assessment (SGMRA) for Swedish people aged ≥ 60 years.

    Setting: This study included both older people living at home and those in special housing.

    Participants: 1222 of the 1402 subjects aged ≥ 60 years who had participated in the baseline survey (2001–2003) as part of the ongoing National Study on Aging and Care-Blekinge (SNAC-B) were included because they had provided complete information on Mini-Nutritional Assessment (MNA).

    Measurements: The risk of malnutrition was estimated by the SOMRA, MNA, and SGMRA. To measure concurrent validity, the Receiver Operating Characteristics (ROC) curve, Cohen’s kappa (κ) and Spearman’s rank correlation coefficient rho (rs) were used. Youden’s index (J) was computed to assess the optimal cut-off on SOMRA. Cronbach’s alpha (α) was used to test reliability.

    Results: The risks of malnutrition measured by SOMRA, MNA and SGMRA were 6.5%, 8.6% and 20.9%, respectively. The risk was higher among older people living in special housing compared to those at home (p < 0.05). Different optimal cut-offs on SOMRA were observed for residents living at home (≥ 1) and those in special housing (≥ 3). Compared to SGMRA, the SOMRA and SOMRA cut-off ≥ 3 gave higher values for J (0.68, 0.81, and 0.84, respectively), κ (0.59, 0.77, and 0.84, respectively) and rs (0.64, 0.78, and 0.84, respectively) for the older people in special housing. The reliability for SOMRA was α = 0.71.

    Conclusion: The risk of malnutrition was higher among older people in special housing than among those living at home. For the people in special housing, the SOMRA and SOMRA cut-off ≥ 3 showed higher concurrent validity with MNA compared to the SGMRA, but not for older people living at home. SOMRA includes six items, takes less time to implement and is composed of both subjective and anthropometric measurements; therefore, it is suitable for use in special housing and/or clinical settings to identify the risk of malnutrition or the need for nutritional support.

  • 68.
    Nedfors, Karin
    et al.
    Blekinge Centre of Competence;Blekinge Institute of Technology.
    Borg, Christel
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Centre of Competence;Blekinge Institute of Technology.
    Communication with physicians in hospital rounds: an interview with nurses2016In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 3, p. 122-127Article in journal (Refereed)
    Abstract [en]

    A hospital round is a long tradition in which nurses and physicians communicate to develop an integrated plan of care together with the patient. There is insufficient knowledge of care professionals’ experiences of communication during hospital rounds, particularly in surgical units, where the physician is frequently absent during daily care. Hence, the aim of this study was to describe nurses’ experiences of communication with physicians during hospital rounds in a surgical unit. Nine qualitative unstructured interviews with nurses were conducted and analysed using Burnard’s description of content analysis. ‘An encounter involving opportunities for and challenges to teamwork’ was found to be the predominant theme. The hospital round in a surgical unit is a short encounter that can be challenged by missing patient care goals, difficulties in transmitting messages and frustration over unshared information. Further studies are needed to overcome existing knowledge gaps about communication during hospital rounds.

  • 69.
    Nedfors, Karin
    et al.
    Blekinge kompetenscentrum.
    Fagerström, Cecilia
    Blekinge Kompetenscentrum.
    Användning av Icke Farmakologiska Metoder (IFM) bland äldre personer: en begreppsdefinition2015Report (Other academic)
  • 70.
    Nilsson, Lina
    et al.
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge County Council.
    Decision-makers and mediators in a home healthcare digitisation process: nurses' experiences of implementation and use of a decision support system2018In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535, Vol. 54, no 4-5, p. 511-521Article in journal (Refereed)
    Abstract [en]

    Background: This study focuses on a decision support system (DSS) for home healthcare and the implementation of it.Aim: To describe home healthcare nurses' experiences of the implementation and use of a new DSS, with a focus on how it influences decision making in everyday work practice.Design: A qualitative research design.Methods: Data was collected through three focus group interviews with six home healthcare nurses.The data analysis was drawn from Burnard's method for content analysis.Results: The DSS was experienced as bringing support to decisions, but sometimes incompatible with home healthcare nurses' work practice. Professional understanding and the DSS were sometimes experienced as parallel support systems not assisting work across healthcare organisations.Conclusion: When a DSS is used to transform work of healthcare organisations several aspects should be highlighted. If the organisation does not consider these aspects, nurses may adopt a role as mediator in the implementation process.

  • 71.
    Rennemark, Mikael
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences.
    Holst, Göran
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Halling, Anders
    Lund University.
    Factors related to frequent usage of the primary healthcare services in old age: findings from the Swedish National study on Aging and Care2009In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 17, no 3, p. 304-311Article in journal (Refereed)
    Abstract [en]

    People aged 60 or more are the most frequent users of healthcare services.

    In this age range, however, both frequent and infrequent users can be found.

    Frequent users have high rates of illnesses. Previous research has found that

    the frequency may be influenced also by psychological and social factors.

    The aim of this study was to investigate to what degree such factors add to

    the explanation of differences in number of visits to a physician. A crosssectional

    study was conducted with a random sample consisting of 1017

    individuals, aged 60 to 78 years, from the Blekinge part of the Swedish

    National Study on Aging and Care database. The data were collected during

    2001 to 2003. Hierarchical logistic regression analyses were used with

    frequent (three visits or more during a year) and infrequent use as a

    dichotomous dependent variable. The final statistical analyses included

    643 individuals (63% of the sample). Independent variables were sense of

    coherence (SOC), internal locus of control, education level and social

    anchorage. Control variables were age, gender, functional ability and

    comorbidity. The results showed that comorbidity was most strongly related

    to frequent use [adjusted odds ratio (OR) = 8.17, 95% confidence interval (CI)

    5.54–12.04]. In addition, SOC and internal locus of control had small, but

    significant effects on the odds of being a frequent user (adjusted OR = 1.03,

    95% CI 1.00–1.06 and adjusted OR = 1.14, 95% CI 1.02–1.27, respectively).

    The lower the SOC and the internal locus of control were, the higher were the

    odds of frequent use. Education level and social anchorage were unrelated

    to frequency of use. The results indicate that frequent healthcare services

    users are more ill than infrequent users. Psychological factors influence the

    use only marginally, and social factors as well as age and gender are not by

    themselves reason for frequent healthcare services use.

  • 72. Rennemark, Mikael
    et al.
    Holst, Göran
    Fagerström, Cecilia
    Blekinge University of Technology ; Lund University.
    Halling, Anders
    What makes old people utilise the health care services?2007In: VI European Congress Advances in Gerontology, St Petersburg, 2007Conference paper (Refereed)
  • 73.
    Sandberg, Magnus
    et al.
    Lund University.
    Kristensson, Jimmie
    Lund University.
    Midlöv, Patrik
    Lund University.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Jakobsson, Ulf
    Lund University.
    Prevalence and predictors of healthcare utilization among older people (60+): focusing on ADL dependency and risk of depression2012In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 54, no 3, p. 349-363Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate healthcare utilization patterns over a six-year period among older people (60+), classified as dependent/independent in Activities of Daily Living (ADL) and/or at/not at risk of depression and to identify healthcare utilization predictors. A sample (n = 1402) comprising ten age cohorts aged between 60 and 96 years was drawn from the Swedish National study on Aging and Care (SNAC). Baseline data were collected between 2001 and 2003. Number and length of hospital stays were collected for six years after baseline year. Group differences and mean changes over time were investigated. Healthcare utilization predictors were explored using multiple linear regression analysis. The results revealed that 21–24% had at least one hospital stay in the six years after baseline, 29–37% among ADL dependent subjects and 24–33% among those at risk of depression. There was a significant increase of hospital stays in all groups over time. ADL-dependent subjects and those at risk of depression had significant more hospital stays, except for those at/not at risk of depression in years 2, 4 and 5. The healthcare utilization predictors 5–6 years after baseline were mainly age, previous healthcare utilization and various symptoms and, in 1–2 and 3–4 years after baseline, age, various diagnostic groups and various physical variables. Thus healthcare utilization patterns seem to be similar for the different groups, but it is difficult to find universal predictors. This suggests that different variables should be considered, including both ADL and psychosocial variables, when trying to identify future healthcare users

  • 74.
    Selan, Suzana
    et al.
    Lund University;Blekinge Institute of Technology.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Impact of nutritional status and sleep quality on hospital utilisation in the oldest old with heart failure2016In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 20, no 2, p. 170-177Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe three-year trends in nutritional status and sleep quality and their impact on hospital utilisation in the oldest old (80 +) with heart failure (HF). Design: Single-centred longitudinal observational study. Setting: South-eastern Sweden. Participants: 90 elderly (80+) with objectively verified HF. Measurements: Baseline data from the Mini Nutritional Assessment (MNA) and on sleep quality were collected through structured interviews following the HF diagnosis (n= 90) and at a three-year follow-up (n= 41). Data on hospital utilisation during the three years following the HF diagnosis were also collected. Results: Nineteen percent of the participants were found to have impaired nutritional status, a condition that increased hospital utilisation by four bed days per year. A majority (85%) had impaired sleep quality, but no impact on hospital utilisation was found. Nutritional status and sleep quality were stable over the three-year period. Conclusion: In the oldest old with HF, impaired nutritional status and impaired sleep quality are already common at HF diagnosis. Impaired nutritional status increases hospital utilisation significantly. Therefore, it is of supreme importance to systematically evaluate nutritional status and sleep quality in the oldest old when they are diagnosed with HF, as well as to take action if impairments are present.

  • 75.
    Selan, Suzana
    et al.
    Blekinge Institute of Technology;Lund University.
    Siennicki-Lantz, Arkadiusz
    Malmö University Hospital.
    Berglund, Johan
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Self-awareness of heart failure in the oldest old-an observational study of participants, ≥ 80 years old, with an objectively verified heart failure2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, p. 1-8, article id 23Article in journal (Refereed)
    Abstract [en]

    Background

    One of the primary reasons for hospitalisation among elderly individuals with heart failure (HF) is poor self-care. Self-awareness of having HF may be a key-element in successful self-care. The prevalence of self-awareness of HF, and how it is affected by age-and HF-related factors, remains poorly understood. The aims of the present study were to determine the prevalence of self-awareness of HF in participants, ≥ 80 years of age, and to investigate the association between this self-awareness and age-related and HF-related factors.

    Methods

    A single-centre observational study was conducted in which non-hospitalised participants (80+) with objectively verified HF were identified (n = 90). The statement of having HF or not having HF was used to divide the participants into two groups for comparisons: aware or unaware of one’s own HF. Logistic regression models were completed to determine the impact of age-and HF-related factors on self-awareness.

    Results

    Twenty-six percent (23/90) were aware of their own HF diagnosis. No significant differences were found between the participants who were aware of their own HF diagnosis and the participants who were not. Neither age-nor HF-related factors had influence on the prevalence of self-awareness.

    Conclusions

    Prevalence of self-awareness of own HF in the oldest old is insufficient, and this self-awareness may be influenced by external factors. One such factor is likely the manner in which the HF diagnosis is relayed to the patient by health care professionals.

  • 76.
    Tuvesson, Hanna
    et al.
    Blekinge Institute of Technology.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sjöberg, L.
    Karolinska Institutet;Stockholm University.
    Sjölund, Britt-Marie
    University of Gävle;Karolinska Institutet;Stockholm University.
    Nordell, E.
    Skåne University Hospital.
    Fagerström, Cecilia
    Blekinge County Hospital.
    Life weariness and suicidal thoughts in late life: a national study in Sweden2018In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, no 10, p. 1365-1371Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aimed at investigating the point prevalence of life weariness and suicidal thoughts and their relationship with socio-demographic characteristics in a population of older adults in Sweden. Method: Data from 7913 individuals aged 60 years and older were drawn from the Swedish National Study on Aging and Care, a collaborative study in Sweden. Life weariness and suicidal thoughts were measured by one item derived from the Montgomery–Åsberg Depression Rating Scale. A multinomial regression model was used to investigate the relationships of socio-demographic characteristics with life weariness and suicidal thoughts. Results: Living in urban and semi-urban areas, being of advanced age, being divorced and having lower educational levels were related to life weariness. Living in a residential care facility, being widowed or unmarried, being born in a non-Nordic European country and experiencing financial difficulties were related to both life weariness and suicidal thoughts. Sex was found to be unrelated to either life weariness or suicidal thoughts. Conclusion: This study found that several socio-demographic variables were associated with life weariness and suicidal thoughts among older adults. Specific attention to older individuals with these characteristics may be warranted as they might be more vulnerable to life weariness and suicidal thoughts.

  • 77.
    Tuvesson, Hanna
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge Institute of Technology, Sweden.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sjöberg, Linnea
    Karolinska Institutet, Sweden.
    Sjölund, Britt-Marie
    Karolinska Institutet, Sweden.
    Nordell, Eva
    Skåne University Hospital, Sweden.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Sweden.
    Life weariness and suicidal thoughts in older adults: a multi-center study in Sweden2016In: Presented at the 23rd Nordic Congress of Gerontology (23 NKG), Tampere, Finland, June 20-22, 2016, 2016Conference paper (Other academic)
    Abstract [en]

    Aims: Suicidality in late life is a public health concern worldwide and suicidal thoughts may be an important risk factor for suicide in old age. The overall aim of the present study was to investigate the possible importance of demographic characteristics, especially sex and age, for suicidal thoughts in a Swedish population-based cohort of older adults aged 60+ years.

    Methods: In this multicenter study, data from 7913 individuals aged 60+ years from the Swedish National Study on Aging and Care (SNAC) were used. One item of the Montgomery-Åsberg Depression Rating Scale was used to measure life weariness and suicidal thoughts. Logistic regression models were used to determine the relationship between socio-demographic characteristics and suicidal thoughts.

    Findings: Multivariate analysis showed that suicidal thoughts independently increased with age. Sex was, however, found to be unrelated to suicidal thoughts after controlling for other socio-demographic factors. Living in an urban or midsize geographical area, being widowed/unmarried/divorced, born in an European country other than the Nordic countries, in a residential care facility and having financial difficulties was related to suicidal thoughts.

    Conclusions: Taking these socio-demographic characteristics into consideration may aid in the design of prevention programs for late life suicidality.

  • 78. Wennstig, Mats
    et al.
    Fagerström, Cecilia
    Blekinge Centre of Competence.
    Levnadsberättelser i Blekinges särskilda boende för äldre2017Report (Other academic)
    Abstract [sv]

    BakgrundDemenssjukdom och liknande tillstånd innebär att en person efterhand får allt svårare att delge information om sig själv och sitt liv. En dokumenterad levnadsberättelse kan för dessa personer utgöra ett av de viktiga redskapen för att få en personcentrerad vård och omsorg. Eftersom det i Blekinge fanns en osäkerhet kring levnadsberättelsens användning i särskilt boende beslutades att genomföra en kartläggning i länet. Syftet med undersökningen var att kartlägga förekomsten av levnadsberättelser i särskilt boende, graden av ifyllnad och vissa kvalitetsmått i befintliga levnadsberättelser. Syftet var även att beskriva undersköterskors uppfattning kring användandet av levnadsberättelsen i deras dagliga arbete.

    MetodUndersökningen bestod av två delar; en personalenkät till 701 undersköterskor samt en granskning av 77 enheter med totalt 873 brukare. Resultatet presenteras i form av beskrivande statistik och kommentarer. I analysen har även samband undersökts.

    ResultatResultatet visade att 38 % av brukarna i särskilt boende har en dokumenterad levnadsberättelse. I de fall det finns en tydlig rutin för levnadsberättelsen används den i högre grad som ett arbetsredskap i vård och omsorg. En klar majoritet (94 %) av undersköterskorna i undersökningen anser att levnadsberättelsen skulle kunna användas mer i vardagen. Rutiner på boendet kring ifyllandet av levnadsberättelsen, användning av levnadsberättelsen i arbetsgruppen och användning av levnadsberättelsen som underlag för genomförandeplanen visar sig ha samband med hur den enskilda undersköterskan fyller i och använder sig av levnadsberättelsen i vården och omsorgen kring den äldre som bor på boendet

    SlutsatsEnbart en tredjedel av brukarna i denna undersökning har en dokumenterad levnadsberättelse, samtidigt som nästan all personal anser att den skulle kunna användas mer i samband med brukarens vård och omsorg. Den relativt låga implementeringen av levnadsberättelsen tillskrivs bristen av rutiner på arbetsplatsen. Eftersom levnadsberättelsen kan ha stor betydelse för den enskilde personens vård och omsorg i vardagen, anser vi att det är angeläget att den implementeras i högre grad i Blekinges särskilda boenden. I vidare studier skulle det vara värdefullt att undersöka levnadsberättelsens effekter på den enskildes hälsa, men framförallt, undersöka orsaker till det låga användandet presenterad i denna rapport och testa olika arbetssätt ämnade att öka levnadsberättelsens användande i särskilda boende samt säkerställa inflyttningsprocessen.

  • 79.
    Westergren, Albert
    et al.
    Högskolan i Kristianstad.
    Broman, Jan-Erik
    Uppsala Universitet.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge Tekniska Högskola.
    Fagerström, Cecilia
    Blekinge Tekniska Högskola ; Blekinge Kompetenscentrum.
    Willman, Ania
    Blekinge Tekniska Högskola ; Malmö Högskola.
    Hagell, Peter
    Högskolan i Kristianstad.
    Measurement properties of the Minimal Insomnia Symptom Scale (MISS) as an insomnia screening tool among adults and the elderly2015In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 16, no 3, p. 379-384Article in journal (Refereed)
    Abstract [en]

    Background: The psychometric properties of the 3-item Minimal Insomnia Symptom Scale (MISS) have been evaluated using classical test theory. Different cut-offs for identifying insomnia have been suggested in two age groups (≥6 and ≥7 among adult and elderly people, respectively). The aim of this study was to test the measurement properties of the MISS using the Rasch measurement model, with special emphasis on differential item functioning by gender and age.

    Methods: Cross-sectional MISS data from adult (age 20-64 years; n=1075) and elderly (age 65+; n=548) populations were analysed by the Rasch measurement model.

    Results: Data generally met Rasch model requirements and the scale could separate between two distinct groups of people, but there was differential item functioning by age. The difference between the adult and elderly samples was lower for the originally recommended ≥6 points cut-off (0.09 logits) than for the ≥7 points cut-off (0.23 logits), but greater at the lower and higher ends of the scale.

    Conclusions: This study provides support for the measurement properties of the MISS. However, caution should be exercised in comparing raw MISS scores between age groups, but applying a ≥6 cut-off appears to allow for valid comparisons between adults and elderly

  • 80.
    Wickström, Hanna L.
    et al.
    Lund University;Blekinge Wound Healing Centre.
    Oien, Rut Frank
    Blekinge Wound Healing Centre;Blekinge Centre of Competence.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge Centre of Competence.
    Anderberg, Peter
    Blekinge Institute of Technology.
    Jakobsson, Ulf
    Lund Uniersity.
    Midlov, Patrik J.
    Lund University.
    Comparing video consultation with inperson assessment for Swedish patients with hard-to-heal ulcers: registry-based studies of healing time and of waiting time2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 2, article id e017623Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate differences in ulcer healing time and waiting time between video consultation and inperson assessment for patients with hard-to-heal ulcers. Setting Patients treated at Blekinge Wound Healing Centre, a primary care centre covering the whole of Blekinge county (150 000 inhabitants), were compared with patients registered and treated according to the Registry of Ulcer Treatment, a Swedish national web-based quality registry. Participants In the study for analysing ulcer healing time, the study group consisted of 100 patients diagnosed through video consultation between October 2014 and September 2016. The control group for analysing healing time consisted of 1888 patients diagnosed through inperson assessment during the same period. In the study for analysing waiting time, the same study group (n=100) was compared with 100 patients diagnosed through inperson assessment. Primary and secondary outcome measures Differences in ulcer healing time were analysed using the log-rank test. Differences in waiting time were analysed using the Mann-Whitney U test. Results Median healing time was 59 days (95% CI 40 to 78) in the study group and 82 days (95% CI 75 to 89) in the control group (P<0.001). Median waiting time was 25 days (range: 1-83 days) in the study group and 32 days (range: 3-294 days) for patients diagnosed through inperson assessment (P=0.017). There were no significant differences between the study group and the control group regarding age, gender or ulcer size. Conclusions Healing time and waiting time were significantly shorter for patients diagnosed through video consultation compared with those diagnosed through inperson assessment.

  • 81.
    Wimo, Anders
    et al.
    Karolinska Institutet;Uppsala University;County Council of Gävleborg;HC Bergsjö.
    Elmstål, S.
    Lund University.
    Fratiglioni, L.
    Karolinska Institutet;Stockholm Gerontology Research Center.
    Sjölund, B.-M.
    Karolinska Institutet.
    Sköldunger, A.
    Karolinska Institutet.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Berglund, Johan
    Blekinge Institute of Technology.
    Lagergren, M.
    Stockholm Gerontology Research Center.
    Formal and informal care of community-living older people: a population-based study from the Swedish National study on Aging and Care2017In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Objectives: Study formal and informal care of community-living older people in the Swedish National study of Aging and Care (SNAC).

    Design: Cross-sectional, population based cohort.

    Setting: Three areas in Sweden: Municipality of Nordanstig, Stockholm and Skåne County.

    Participants: 3,338 persons ≥72 years.

    Measurements: Patterns and amounts of informal and formal care by cognition and area of residence.

    Results: 73% received no care; 14% formal care; and 17% informal care (7% received both). In the whole study population, including those who used no care, individuals in small municipalities received 9.6 hours of informal care/month; in mid-size municipalities, 6.6; and in urban areas, 5.6. Users of informal care received 33.1 hours of informal care/month in small municipalities, 54.6 in mid-size municipalities and 36.1 in urban areas. Individuals with cognitive impairment received 14.1 hours of informal care/month, 2.7 times more than people with no/slight impairment. In the whole study population, individuals in small municipalities received an average of 3.2 hours of formal care/month; in mid-size municipalities 1.4; and in urban areas, 2.6. Corresponding figures for formal care users were 29.4 hours in small municipalities, 13.6 in mid-size municipalities and 16.7 in urban areas. Formal care users received 7.1 hours, and informal care users, 5.9 hours for each hour/month received by people in the study population as a whole.

    Conclusions: More informal than formal care was provided. Informal care is more frequent in small municipalities than urban areas and for those with than without cognitive impairment. The relationship between data on the whole population and the data on users or care indicates that population-based data are needed to avoid overestimates of care.

  • 82.
    Åkesson, Nina
    et al.
    Blekinge Centre of Competence.
    Frank Öien, Rut
    Blekinge Centre of Competence.
    Forsell, Henrik
    Blekinge Centre of Competence.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy2014In: British Journal of Community Nursing, ISSN 1462-4753, E-ISSN 2052-2215, Vol. 19, no Sup9, p. 6-13Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.

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