Research collaboration with older people as a matter of scientific quality and ethics: a focus group study with researchers in ageing and health

BACKGROUND

Society is placing increasing demands on collaboration with actors outside the academia to be involved in the research process, and the responsibility for turning this into reality lies with the researchers. As research collaboration is a way to increase the societal relevance of research and since older people have the right to be actively involved in research that concerns them, this study is addressed to researchers who work with and for older people. The purpose of this article is to explore researchers' experiences of research collaboration with the heterogeneous group of older people, from healthy to frail.

METHODS

The focus group method was applied based on a qualitative approach that is based on a social constructivist research tradition. It differs from other qualitative methods, such as interviews, in that it encourages interaction between research participants and contributes to shedding light on a collective understanding of the world. A total of 14 researchers participated in four focus groups (three to five participants/group).

RESULTS

The results provided support for the overall theme: "Good scientific quality and ethics are balanced against the needs and abilities of older people". This means a balance between the researcher and the older people collaborating with them to receive the best possible scientific quality. This is highlighted in the core category "Positioning for research collaboration" with the subcategories "Involvement or not", "Traditional or innovative thinking" and "Selectivity or representativeness", and the core category "Research collaboration - an ethical issue of power" with the subcategories "Research collaboration a risk for freedom of research", "Research collaboration a risk of abuse of power" and "Discriminatory academic power structures create ethical issues".

CONCLUSIONS

Addressing the balancing act of collaborating with older people in research, the findings contribute with an understanding of the importance of researchers' awareness of social and academic structures to minimise the risk of epistemic injustices in research on ageing and health. We want to highlight the researchers' voice and clarify the role that researchers have in terms of the opportunities for older people to become part of the collective understanding of ageing and health and make their voices heard.

Frail older people with decreased cognition can perceive reduced self-determination in self-care and social relationships

BACKGROUND

Self-determination in old age is essential for people's experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people.

METHODS

This study was a cross-sectional secondary data analysis using baseline data with 119 frail people 75 ≥ from a larger randomized control trial. Self-determination was measured with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O). Cognition was measured using the Mini Mental State Examination (MMSE), where decreased cognition was broadly defined as a score below 25 points. Fisher's exact test was used to test differences in proportions of perceiving self-determination in relation to cognition. The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination in relation to cognitive functioning.

RESULTS

Nearly the entire study population, regardless of cognitive functioning, perceived self-determination in Financial situation. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care and in Social relationships when comparing with the participants with intact cognition.

CONCLUSION

Perceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. Organizing healthcare needs according to the older people's wants and wishes is crucial regardless of people having a cognitive decline or not when the effort is to enable the people to be as self-determined as they want. The frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should navigate the older people to get to their desired direction.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

Uncovering hidden abilities for participation in research through photo-elicitation interviews: a view on participatory research with people living in residential care facilities

BACKGROUND

Participatory research has been described to improve the relevance of research findings for the society in terms of quality of healthcare services and other public benefits. Nevertheless, there is limited guidance on how to conduct participatory research, and especially in relation to persons living in residential care facilities. To make the voices of this group heard, we therefore take a stance in the democratic approach to participatory research, and we have applied the theoretical framework Model of Human Occupation (MoHO) on participation to evaluate photo-elicitation interviews as a participatory research method with this group.

METHODS

A total of 13 persons living in two residential care facilities were involved in the study and asked to take photographs of their everyday life over one week. They were then invited to an individual interview to narrate the meaning of the photographs and to describe how they experienced the photo-elicitation method. The interviews were analysed in the six steps of theoretically driven reflexive thematic analysis.

RESULTS

The findings are described in the theme 'Uncovering hidden abilities for participation in research' that describes how photo elicitation interviews facilitated the older persons' participation in research. This is illustrated by four sub-themes: 'Bridging the ageing body', 'Altering habituation to everyday life', 'Empowering storytelling', and 'Negotiating the institutional culture'.

CONCLUSIONS

Our study findings support further application and evaluation of photo-elicitation interviews as a method for participatory research in residential care facilities. The major finding is how photo-elicitation interviews were used to reduce the impact of the institutional culture on the older persons' participation in research. The method is, however, not without limitations and we encourage researchers to study the dynamic relationship between physical, social, and cultural aspects of residential care facilities in relation to the use of photo-elicitation interviews with the persons living there.

Everyday life in a Swedish nursing home during the COVID-19 pandemic: a qualitative interview study with persons 85 to 100 years

OBJECTIVE

To understand and report on the impact of the COVID-19 pandemic on the everyday lives of frail older persons living in nursing homes by exploring their experiences of how the pandemic-related restrictions had influenced them and in what way.

DESIGN

Empirical qualitative interview study.

SETTING

A publicly run nursing home in an urban area in Sweden in June 2020. The nursing home had visitor restrictions, cancelled activities and physical distancing requirements since March 2020.

PARTICIPANTS

A total of 10 persons, 85-100 years, living in a Swedish nursing home during the COVID-19 pandemic, were recruited through nursing home management and interviewed in June 2020 using medically approved visors and physical distancing.

ANALYSIS

Interviews were analysed using thematic analysis, which involves familiarisation, coding and definition of themes. Transcripts were coded into data-driven categories before being organised into categories that described and explained the data.

RESULTS

The analysis resulted in the main theme 'It is like living in a bubble', that describes everyday life in the nursing home during the pandemic as a world of its own in which the older persons felt both protected and isolated. This is described in four subthemes: living 1 day at a time, without fear of the virus; feeling taken care of; having limited freedom and missing out on the little extras.

CONCLUSIONS

Contributing to the growing area of COVID-19-related research, our findings provide novel insights into how pandemic-related restrictions in nursing homes represent a risk of isolating older people from the outside world and diminishing their freedom. Put in relation to the previous research, these findings could be applied beyond the pandemic, to develop research and practice that puts focus on how to support older people to decide for themselves how to spend the rest of their lives.

'I wanted to talk about it, but I couldn't', an H70 focus group study about experiencing depression in early late life

BACKGROUND

Knowledge about experiences of depression among younger-old adults from the general population is limited. The aim was to explore experiences of depression in early late life.

METHODS

Sixteen participants in the population-based Gothenburg H70 Birth Cohort Studies (12 women and 4 men) who had reported a history of depression between ages 60-70 took part in focus group discussions (n = 4). Data were analyzed using focus group methodology.

RESULTS

The analysis resulted in the overall theme 'I wanted to talk about it, but I couldn't'. The participants expressed unmet needs of communication about depression with family, friends, and healthcare staff. Participants wanted to know more about the causes and effects of depression, available treatment options and how to avoid recurrence. Lack of knowledge was a source of frustration; trust in health care providers was diminished. Being retired meant that opportunities for communication with co-workers were no longer available, and this made it harder to break negative thought and behavioral patterns. Being depressed meant losing one's normal self, and participants were grieving this. Thoughts of death and suicide were experienced in solitude; knowing that there was an escape could generate a feeling of comfort and control.

CONCLUSIONS

Younger-old adults have expressed a need to talk about their experiences of depression. They would like to know more about available treatments, potential side effects, and how to avoid recurrence. Care providers also need to be aware there is a need for an existential dialogue about death.

Can Comprehensive Geriatric Assessment Meet Frail Older People's Needs? Results from the Randomized Controlled Study CGA-Swed

BACKGROUND

The comprehensive geriatric assessment (CGA) designed to manage frail older people requiring acute medical care, is responsible for diagnostics, assessment, treatment, and planning while addressing a person's medical, psychological, social, and functional capabilities. The aim was to investigate if CGA had an impact on frail older people's activities of daily living (ADL) status, self-rated health, and satisfaction with hospital care.

METHODS

A two-armed design with frail people aged 75 or older who required an unplanned hospital admission were randomized to either the CGA ward or to an acute medical ward. Analyses were made based on the intention-to-treat principle (ITT). The primary outcome was ADL. Data were analyzed using Chi-square and odds ratio. A subgroup analysis was performed due to non-adherence and contamination.

RESULTS

One-hundred and fifty-five people participated in the study; 78 in the intervention and 77 in the control. Participants in the intervention group had a higher odds ratio of reporting having received written information and felt that care met their needs during their hospital stay. No additional statistically significant results for the primary or secondary outcomes in the ITT analysis were achieved.

CONCLUSION

Participants felt that the care they received with the CGA ward met their needs. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings, and because a CGA during one hospital stay is probably not enough to have long-term effects.

Challenging oneself on the threshold to the world of research - frail older people's experiences of involvement in research

Background

User involvement of people outside academia in research is argued to increase relevance of research for society and to empower the involved lay persons. Frail older people can be a hard to reach group for research and thus an underrepresented group in research. There is a lack of knowledge how collaboration with frail older people should be best performed. Therefore, the aim of this study was to explore frail older people’s experiences of involvement in research.

Methods

In this study we have invited people, 75 years of age or older screened as physically frail and who have previously participated in a study as data sources, to share their experiences by intensive interviewing. Data was collected and analysed in parallel inspired by a constructivist grounded theory approach.

Results

The results demonstrate how frail older people have different incentives, how their context of ageing and the unusual position of being involved in research altogether influenced how, where and in what way they wished to be involved in research. This is described in three categories: Contributing to making a difference for oneself and others, Living a frail existence and Being on somebody else’s turf. The categories compose the core category, Challenging oneself on the threshold to the world of research, which symbolises the perceived distance between the frail older people themselves and the research world, but also the challenges the frail older people could go through when choosing to be involved in research.

Conclusions

Frail older people have a varied capacity to participate in research, but in what way and how is difficult to know before they have been involved in the process of research. Our results advocate that it is problematic to exclude frail older people a priori and that there is a potential for new perspectives and knowledge to be shaped in the encounter and in the relationship between the researcher and the frail older person. For research to be able to cater for frail older people’s needs of health services, their voices need to be heard and taken into consideration.

Positioning work related stress - GPs' reasoning about using the WSQ combined with feedback at consultation

BACKGROUND

General practitioners (GPs) regularly handle cases related to stress and work capacity, but often find this work difficult. However, using an assessment tool in a structured way can increase GPs' awareness of the risk for sick leave and need of referrals to preventive measures. Today there is no established methodical practice for this in primary health care. The aim of this study was to explore GPs' reasoning about using the Work Stress Questionnaire combined with feedback at consultation as an early intervention to reduce sick leave.

METHODS

A focus group study was performed with 23 GPs at six primary health care centres. The discussions were analysed based on a method by Krueger.

RESULTS

Three themes emerged. Positioning work-related stress describes the need to make fundamental standpoints on stress and how it should be handled, to make sense of their work concerning work-related stress. Making use of resources focuses on GPs performing to the best of their ability using assigned resources to treat patients with stress-related ill health, even if the resources were perceived as insufficient. Practising daily work focuses on the GPs' regular and preferred way of working set against the degree of intrusion and benefits. The two related themes making use of resources and practising daily work were mirrored through the third theme, positioning work-related stress, to form an understanding of how GPs should work with patients perceiving work-related stress.

CONCLUSIONS

The GPs own competence and tools, those of other professionals and the time allocated were seen as important when treating patients perceiving ill health due to work-related stress. When resources were insufficient though, the GPs questioned their responsibility for these patients. The results also indicate that the GPs viewed their ordinary consultative way of working as sufficient to identify these patients. The intervention was therefore not seen as useful for early treatment of patients at risk of sick leave due to work-related stress. However, prevention is an important part of the PHC's responsibility, and strategies concerning stress-related ill health therefore need to be more thoroughly formulated and incorporated.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02480855 . Registered 20 May 2015.

Positioning work-related stress – General practitioners’ reasoning about a brief intervention

Background

General practitioners (GP) can find it difficult to early detect and treat ill health due to work-related stress. In a randomized controlled trial, a brief early intervention using the work stress questionnaire (WSQ) combined with feedback at consultation was tested to reduce sick leave. This study explored GPs' reasoning about using the intervention.

Methods

A focus group study was performed with 23 GPs at six primary health care centers, each constituting one focus group. The discussions, lasting between 30-45 minutes, were analyses based on a method by Krueger.

Results

The GPs positioned work-related stress by making fundamental standpoints on stress and how it should be handled, in order to make sense of their work concerning work-related stress. In addition, they acted to the best of their ability with assigned resources to treat patients with ill health due to stress. Further, the GPs set their regular and preferred way of practicing daily work against the intervention's degree of intrusion and benefits. When the resources and daily work changed, the GPs formed a revised understanding of stress and how it should be handled.

Conclusions

The GPs found their ordinary way of working to be sufficient for early identification and treatment of patients with ill health due to work-related stress. However, when resources were scarce, the responsibility to handle these patients was questioned. Competence and interprofessional collaboration are therefore needed to early identify and treat ill health due to work-related stress. In addition, the GPs' responsibility in relation to other actors must be clarified.

Key messages

The primary health care’s role for patients perceiving work-related stress was not given. The GPs’ confidence in addressing ill health due to work-related stress depended on assigned resources.

Development of an instrument to assess oral hygiene ability in older adults: The oral hygiene ability instrument

OBJECTIVES

To describe the development process of an instrument to assess the ability to manage daily oral hygiene and the cause of impaired oral hygiene. The instrument is initially aimed for use by the dental team in the ageing population.

BACKGROUND

Oral hygiene is an important component of oral health. Inability to manage oral hygiene combined with other risk factors often results in poor oral health and impaired quality of life.

METHODS

A guideline for instrument development was used during the construction of the instrument. The method included three phases: I. planning: the purpose and target group of the instrument were determined, and a literature review and qualitative focus-group study were conducted; II. construction: objectives were formulated, and a pool of items was built; and III. evaluation and validation, which included two pilot studies, interviews, item analyses and revision of the instrument.

RESULTS

The planning and construction phases resulted in an instrument with 47 items comprising three parts: (a) interview, (b) clinical examination and (c) observation of activities of daily living (oral hygiene). After two pilot studies, the instrument was found to have good content validity. Analyses of qualitative and quantitative data resulted in a reduction in the number of items to 33.

CONCLUSION

OHAI can be a valuable tool as a preventive method to identify older adults at risk of impaired oral health. However, the instrument needs further evaluation before wider use.

Was it worth it? Older adults' experiences of participating in a population-based cohort study - a focus group study

BACKGROUND

At present, we know relatively little about priorities and problems with topics that older adults experience when completing different examinations in longitudinal population-based studies. To examine these topics, research must be adapted to investigate the meanings, motivations, and interpretations of the individual participants themselves. Therefore, the present study aimed to explore older adults' motives, understandings and experiences regarding participating in the Gothenburg H70 Birth Cohort Studies (the H-70 study).

METHODS

Focus group discussions were used. A total of thirty-eight persons, 19 women and 19 men participated in nine focus groups. A strategic sampling technique was used to ensure that the focus group participants represented the larger population.

RESULTS

The results supported the overall theme: "It was well worth the effort," which summarized how the participants felt about the population health study. The following specific themes were also identified: an intense event, for the benefit of oneself and others, confidence in health research and the researcher, key decisions about test outcomes and the survey raising questions and providing few answers.

CONCLUSIONS

Knowledge of priorities and problems with topics experienced by older adults completing different examinations when participating in longitudinal population-based studies is crucial for research to improve the health and wellbeing of older people. To date, older people's involvement in population-based cohort studies has largely been as research subjects. This study is a first step toward the participants taking a more active part by allowing them to share their experiences which can be used to improve the research procedures. This requires the participation of older adults in collaboration with the researchers, to ensure the quality of longitudinal studies of older adults. Therefore, our intention when it comes to future research will be to involve older adults-the target group-in the research procedure.

Modelling long-term cost-effectiveness of health promotion for community-dwelling older people

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

Impact of a person-centred group intervention on life satisfaction and engagement in activities among persons aging in the context of migration‡

Background: There is a growing need to support the health and wellbeing of older persons aging in the context of migration.Objectives: We evaluated whether a group-based health promotion program with person-centred approach, maintained or improved life satisfaction and engagement in activities of older immigrants in Sweden.Methods: A randomised controlled trial with post-intervention follow-ups at 6 months and 1 year was conducted with 131 older independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and a follow-up home visit) and a control group (no intervention). Outcome measures were life satisfaction and engagement in activities. Chi-square and odds ratios were calculated.Results: The odds ratios for maintenance or improvement of life satisfaction (for social contact and psychological health) were higher in the person-centred intervention group. More participants in the intervention group maintained or improved their general participation in activities compared with the control group. However, no significant between-group differences were found.Conclusion: Person-centred interventions can support older person's capability to maintain their health in daily life when aging in migration. Further research is needed with a larger sample and longer intervention period to determine the effectiveness of the intervention.

Distribution and evaluation of sense of coherence among older immigrants before and after a health promotion intervention - results from the RCT study promoting aging migrants' capability

Background

The migration process can be a threat to a person’s sense of coherence (SOC) and to their ability to experience life as comprehensible, manageable, and meaningful. Seen from a salutogenic perspective, this may have a negative impact on the experience of health.

Purpose

We describe the distribution of SOC and its components among older persons with an immigrant background now aging in Sweden. In addition, we evaluated whether a group-based health promotion program with a person-centered approach could support the SOC among older persons in this group.

Materials and methods

A randomized controlled trial with postintervention follow-ups at 6 and 12 months was conducted with 131 independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and one follow-up home visit) and a control group (no intervention but access to ordinary health care services). The outcome measure was the SOC measured by SOC-13. Chi-square and ORs were calculated.

Results

There was a significant improvement in total SOC scores for the intervention group at 6-month follow-up. Also, the ORs for the SOC components were higher in the person-centered intervention group. However, we found no significant between-group differences nor did the effect last until the 12-month follow-up.

Conclusion

Persons who have lived a long time in a host country after migration seem to have a SOC similar to native-born persons. Interventions with a person-centered approach could support the SOC by capturing individual life situations. Such interventions could support older persons by making everyday life more comprehensible and manageable and helping them to cope with challenges in daily life caused by aging.

The Gothenburg H70 Birth cohort study 2014-16: design, methods and study population

To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases. The Gothenburg H70 Birth Cohort Studies (the H70 studies) are multidisciplinary epidemiological studies examining representative birth cohorts of older populations in Gothenburg, Sweden. So far, six birth cohorts of 70-year-olds have been examined over time, and examinations have been virtually identical between studies. This paper describes the study procedures for the baseline examination of the Birth cohort 1944, conducted in 2014–16. In this study, all men and women born 1944 on specific dates, and registered as residents in Gothenburg, were eligible for participation (n = 1839). A total of 1203 (response rate 72.2%; 559 men and 644 women; mean age 70.5 years) agreed to participate in the study. The study comprised sampling of blood and cerebrospinal fluid, psychiatric, cognitive, and physical health examinations, examinations of genetics and family history, use of medications, social factors, functional ability and disability, physical fitness and activity, body composition, lung function, audiological and ophthalmological examinations, diet, brain imaging, as well as a close informant interview, and qualitative studies. As in previous examinations, data collection serves as a basis for future longitudinal follow-up examinations. The research gained from the H70 studies has clinical relevance in relation to prevention, early diagnosis, clinical course, experience of illness, understanding pathogenesis and prognosis. Results will increase our understanding of ageing and inform service development, which may lead to enhanced quality of care for older persons.

Perspectives of Older Adults on Aging Well: A Focus Group Study

BACKGROUND

With increasing number of older adults worldwide, promoting health and well-being becomes a priority for aging well. Well-being and physical and mental health are closely related, and this relation may become more vital at older ages as it may contribute to aging well. The state of well-being is a multifaceted phenomenon that refers to an individual's subjective feelings, and exploring perspectives of older adults on aging well is developing to be an important area of research. Therefore, the aim of this study was to explore perceptions on aging well among older adult Palestinians ≥60 years.

METHODS

A qualitative research design in the context of focus group discussions was used; seven focus groups were conducted including fifty-six participants (aged 63-81 years). Data were analyzed using a qualitative interpretative thematic approach described by Braun and Clarke.

RESULTS

Three major themes were identified, "sense of well-being," "having good physical health," and "preserving good mental health." The participants perceived that aging well is influenced by positive feelings such as being joyous, staying independent, having a life purpose, self-possessed contentment, and financially secured, in addition to be socially engaged and enjoying good physical and mental health.

CONCLUSION

This study contributes to get a better insight concerning older adults' perspectives on aging well. Enhancing physically active lifestyle, participation in social and leisure activities, healthy eating habits, having a purpose in life, and being intellectually engaged are all contributing factors to aging well. Vital factors are to be considered in developing strategic health and rehabilitative plans for promoting aging well among older adults.

Promoting aging migrants' capabilities: A randomized controlled trial concerning activities of daily living and self-rated health

The aim was to evaluate the 6-month and 1-year effects of a person-centered group-based health-promoting intervention on independence in daily activities and self-rated health. The study was an RCT with follow-ups at 6 months and 1 year. A total of 131 independent living people (70+) who have migrated to Sweden from Finland or Western Balkan region were included. Participants were independent in activities of daily living and cognitively intact. They were randomized to an intervention group receiving four weekly group-meetings and a follow-up home visit, or a control group (no intervention). An overall chi-squared test was performed and the odds ratio calculated. A high proportion of the participants maintained independence in activities of daily living and improved or maintained self-rated health. However, no significant differences were found between the groups. The result indicates that the intervention was offered too early in the aging process to be able to detect effects. Methodological challenges were met during both the recruitment and implementation phases. In response to lessons learned, a multicenter design is recommended for future research in order to strengthen the findings. Furthermore, this study has contributed with experiences on both opportunities and challenges in terms of research with and about older people aging in the context of migration, as is discussed.

Risk for depression affects older people's possibilities to exercise self-determination in using time, social relationships and living life as one wants: A cross-sectional study with frail older people

Exercising self-determination in daily life is highly valued by older people. However, being in the hands of other people may challenge the older people’s possibilities to exercise self-determination in their daily life. Among frail older people living in Sweden, risk for depression is highly predominant. There is a knowledge gap regarding if, and how having a risk of depression affects older people’s self-determination. The objective was, therefore, to explore if, and in that case how, frail older people’s self-determination is affected by the risk of depression. In this cross-sectional, secondary data analysis, with 161 communitydwelling frail older people, simple logistic regression models were performed to explore the association between self-determination, the risk of depression and demographic variables. The findings showed that risk for depression and reduced self-determination were significantly associated in the dimensions: use of time (P=0.020), social relationship (P=0.003), help and support others (P=0.033), and the overall self-determination item (P=0.000). Risk for depression significantly affected self-determination in use of time (OR=3.04, P=0.014), social relationship (OR=2.53, P=0.011), and overall self-determination (OR=6.17, P=0.000). This point out an increased need of strengthening healthcare professionals’ perspectives, and attitudes towards a self-determined, friendly, and person-centred dialogue.

Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study

Background

Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.

Methods

The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.

Result

Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment − 0.80 [95% CI 1.06, − 0.57], occupational therapy assistive devices − 0.73 [95% CI 1.00, − 0.47], discharge planning −0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, −0.02]. Controlling for documented risk assessments, the intervention had for falls − 0.94 [95% CI 1.08, − 0.08], nutrition − 0.87 [95% CI 1.06, − 0.67], decubitus ulcers − 0.94 [95% CI 1.08, − 0.80], and ADL status − 0.80 [95% CI 1.04, − 0.57].

Conclusion

The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.

Trial registration

Clinical Trials ID: NCT02773914. Registered 16 May 2016.

Supporting decision-making by a health promotion programme: experiences of persons ageing in the context of migration

This study is part of the Promoting Aging Migrants’ Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants’ everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70–83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.

For whom is a health-promoting intervention effective? Predictive factors for performing activities of daily living independently

BACKGROUND

Health-promoting interventions tailored to support older persons to remain in their homes, so-called "ageing in place" is important for supporting or improving their health. The health-promoting programme "Elderly Persons in the Risk Zone," (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme.

METHODS

Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm.

RESULTS

In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up.

CONCLUSIONS

Older persons living alone - as a risk of ill health - should be especially recognized and offered an opportunity to participate in health-promoting programmes such as "Elderly Persons in the Risk Zone". Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered.

TRIAL REGISTRATION

The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009.

Effects of a continuum of care intervention on frail elders’ self-rated health, experiences of security/safety and symptoms: A randomised controlled trial

We aimed to evaluate effects of the intervention on self-rated health, experiences of security/safety and symptoms. A non-blinded controlled trial was performed with participants randomised to either the intervention group or a control group, with follow-ups at 3, 6 and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of older adults, with a case manager from the municipality as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the Mölndal municipality were asked to participate. Inclusion criteria were age 80 years and older, or 65 to 79 years with at least one chronic disease and dependency in at least one activity of daily living. Analyses were conducted on the basis of the intention-to-treat principle. Outcome measures were self-rated health, experiences of security/safety and symptoms. These were analysed using Svensson’s method. Of 161 participants, 76 were allocated to the control group and 85 to the intervention group. Positive effects of the intervention were observed for frail older adult’s symptoms and self-rated health.

The Impact of Socioeconomic Conditions, Social Networks, and Health on Frail Older People's Life Satisfaction: A Cross-Sectional Study

It has been shown that frailty is associated with low levels of well-being and life satisfaction. Further exploration is needed, however, to better understand which components constitute life satisfaction for frail older people and how satisfaction is related to other life circumstances. The aim of this study was to examine relationships between frail older people’s life satisfaction and their socioeconomic conditions, social networks, and health-related conditions. A cross-sectional study was conducted (n=179). A logistic regression analysis was performed, including life satisfaction as the dependent variable and 12 items as independent variables. Four of the independent variables made statistically significant contributions: financial situation (OR 3.53), social contacts (OR 2.44), risk of depression (OR 2.26), and self-rated health (OR 2.79). This study demonstrates that financial situation, self-rated health conditions and social networks are important components for frail older people’s life satisfaction. Health and social care professionals and policy makers should consider this knowledge in the care and service for frail older people; and actions that benefit life satisfaction – such as social support – should be promoted.

Feeling like a stranger: negotiations with culture as experienced by Chilean occupational therapists

BACKGROUND

Although occupational therapy has begun to focus on the subject of culture, few studies have examined how occupational therapists outside the English-speaking countries reflect on it.

AIM

To explore how Chilean occupational therapists reflect on their personal and professional experiences in regard to the complexity of culture, and its different understandings and expressions.

METHODS

This qualitative study uses content analysis to establish common trends in participants' experiences. A validation phase and data triangulation were implemented to ensure trustworthiness.

RESULTS

Culture is experienced as a continuous negotiation in personal and professional terms. One central theme, 'negotiating through the dynamism of culture', and three categories, 'dealing with power', 'understanding local and global identities', and 'crossing the boundaries into the client's land', emerged. These experiences are complex, chaotic, and highly context-dependent.

DISCUSSION

During therapeutic encounters, practitioners and clients may experience cultural barriers even if their differences are not obvious in cultural terms. As a result of this finding, we recommend the inclusion of culture and cultural issues in professional training. The impact of a multicultural research team is discussed. Future research should explore how the construct of culture is introduced in occupational therapy professional training in Chile.

Development of a Cultural Awareness Scale for Occupational Therapy Students in Latin America: A Qualitative Delphi Study

Cultural awareness is a key issue in healthcare worldwide. Valid and reliable assessments are needed to assess cultural awareness for occupational therapy students. The purpose of this study was to develop a scale to assess cultural awareness for Latin American occupational therapy students. A Delphi design was implemented considering four rounds with experts from four countries. A 30-item scale in Spanish was developed to assess three categories of items: personal, therapeutic strategies and persons' cultures. The experts highlighted local features for professional practice as a key aspect of the scale. Local differences in practice were considered with the profession's traditions and prevailing knowledge across the scale. A participatory strategy and an international group of experts enriched the cultural relevance. A subsequent study of statistical reliability is required (the scale is not presented in an extended version here). Further research should consider the application of the scale and strategies to improve cultural awareness across the curricula. Copyright © 2016 John Wiley & Sons, Ltd.

Self-determination among community-dwelling older persons: explanatory factors

BACKGROUND

Although it is acknowledged that exercising self-determination in daily activities affects older people's health and well-being, few studies have focused on the explanatory factors for self-determination in daily life.

OBJECTIVE

To investigate explanatory factors for self-determination in the context of community-dwelling older persons.

METHOD

This cross-sectional study combined two sets of data that included community-dwelling persons 80 years and older (n = 456). A bivariate logistic regression was performed to analyse the association of self-determination and a set of explanatory factors.

RESULTS

The final bivariate logistic regression model revealed five explanatory factors that were significantly associated with perceiving reduced self-determination: high education (OR = 2.83), frailty (OR = 2.70), poor self-rated health (OR = 2.54), dissatisfaction with physical health (OR = 6.50), and receiving help from public homecare service (OR = 2.46).

CONCLUSION

Several explanatory factors related to the ageing body and environmental aspects were associated with reduced self-determination. To help older people maintain self-determination, healthcare professionals should consider using a person-centred and capability approach to care.

Understanding the "black box" of a health-promotion program: Keys to enable health among older persons aging in the context of migration

Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researcher-community partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.

Health Promotion Can Postpone Frailty: Results from the RCT Elderly Persons in the Risk Zone

OBJECTIVE

Very old persons (80+) are often described as "frail", implying that they are particularly vulnerable to adverse health outcomes. Elderly Persons in the Risk Zone was designed to determine whether a preventive home visit or multiprofessional senior group meetings could postpone deterioration in frailty if the intervention is carried out when the person is not so frail.

DESIGN AND SAMPLE

The study was a RCT with follow-ups at 1 and 2 years. A total of 459 persons (80+), still living at home, were included. Participants were independent in activities of daily life and cognitively intact.

MEASURES

Frailty was measured in two complementary ways, with the sum of eight frailty indicators and with the Mob-T Scale measuring tiredness in daily activities.

RESULTS

Both interventions showed favorable effects in postponing the progression of frailty measured as tiredness in daily activities for up to 1 year. However, neither of the two interventions was effective in postponing frailty measured with the sum of frailty indicators.

CONCLUSIONS

The results in this study show the potential of health promotion to older persons. The multiprofessional approach, including a broad spectrum of information and knowledge, might have been an important factor contributing to a more positive view of aging.

A person-centred approach to health promotion for persons 70+ who have migrated to Sweden: promoting aging migrants' capabilities implementation and RCT study protocol

Background

There are inequities in health status associated with ethnicity, which may limit older foreign-born persons’ ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study ‘Promoting Aging Migrants’ Capabilities’ was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula.

Methods/Design

This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings (‘senior meetings’) and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated.

Discussion

The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context.

Trial registration

The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853.

Shifting between self-governing and being governed: a qualitative study of older persons' self-determination

Background

Older persons’ right to exercise self-determination in daily life is supported by several laws. Research shows that older persons’ self-determination is not fully respected within the healthcare sector. In order to enable and enhance older persons’ self-determination, extensive knowledge of older persons’ self-determination is needed. The aim of this study was to explore experiences of self-determination when developing dependence in daily activities among community-dwelling persons 80 years and older.

Methods

Qualitative interviews were performed in accordance with a grounded theory method, with 11 persons aged 84–95 years who were beginning to develop dependence in daily activities.

Results

The data analysis revealed the core category, “Self-determination - shifting between self-governing and being governed”. The core category comprised three categories: “Struggling against the aging body”, “Decision-making is relational”, and “Guarding one’s own independence”. Self-determination in daily activities was related to a shifting, which was two-fold, and varied between self-governing and being governed by the aging body, or by others.

Conclusions

The findings imply a need to adopt a person-centered approach where the older persons’ own preferences and needs are in focus, in order to enhance their possibilities to exercise self-determination.

Healthy ageing and home: the perspectives of very old people in five European countries

This paper reports on in-depth research, using a grounded theory approach, to examine the ways in which very old people perceive healthy ageing in the context of living alone at home within urban settings in five European countries. This qualitative study was part of a cross-national project entitled ENABLE-AGE which examined the relationship between home and healthy ageing. Interviews explored the notion of healthy ageing, the meaning and importance of home, conceptualisations of independence and autonomy and links between healthy ageing and home. Data analysis identified five ways in which older people constructed healthy ageing: home and keeping active; managing lifestyles, health and illness; balancing social life; and balancing material and financial circumstances. Older people reflected on their everyday lives at home in terms of being engaged in purposeful, meaningful action and evaluated healthy ageing in relation to the symbolic and practical affordances of the home, contextualised within constructions of their national context. The research suggests that older people perceive healthy ageing as an active achievement, created through individual, personal effort and supported through social ties despite the health, financial and social decline associated with growing older. The physicality and spatiality of home provided the context for establishing and evaluating the notion of healthy ageing, whilst the experienced relationship between home, life history and identity created a meaningful space within which healthy ageing was negotiated.

Life Satisfaction and Frailty Among Older Adults

Functional and physical impairment are factors believed to lead to declined life satisfaction among older adults. This study aimed to examine life satisfaction among older adults and the influence of frailty. Baseline data from two studies addressing frail older adults aged 80+ in Gothenburg, Sweden, (n=577) were used. Frailty was measured through eight indicators. Life satisfaction was measured with Fugl-Meyer’s instrument LiSat-11. Perceived life satisfaction was rather high within the studied population, with 66% being satisfied with life as a whole. Most life satisfaction items were significantly associated with frailty status, with non-frail participants being satisfied to a higher extent for all items with the exception of financial situation, sexual life and partnership relation. The factors significantly explaining life satisfaction were psychological health, partner relationship, leisure and ADL. This study shows that older adults’ satisfaction with life as a whole is almost as high as in younger age groups. Respondents with higher degree of frailty reported significantly lower degrees of life satisfaction, indicating a possibility to maintain life satisfaction by preventing or delaying the development of frailty.

Life satisfaction and frailty among older adults

Functional and physical impairment are factors believed to lead to declined life satisfaction among older adults. This study aimed to examine life satisfaction among older adults and the influence of frailty. Baseline data from two studies addressing frail older adults aged 80+ in Gothenburg, Sweden, (n=577) were used. Frailty was measured through eight indicators. Life satisfaction was measured with Fugl-Meyer’s instrument LiSat-11. Perceived life satisfaction was rather high within the studied population, with 66% being satisfied with life as a whole. Most life satisfaction items were significantly associated with frailty status, with non-frail participants being satisfied to a higher extent for all items with the exception of financial situation, sexual life and partnership relation. The factors significantly explaining life satisfaction were psychological health, partner relationship, leisure and ADL. This study shows that older adults’ satisfaction with life as a whole is almost as high as in younger age groups. Respondents with higher degree of frailty reported significantly lower degrees of life satisfaction, indicating a possibility to maintain life satisfaction by preventing or delaying the development of frailty.

One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people"

Background

The intervention; “Continuum of Care for Frail Older People”, was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person’s own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL).

Methods

The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR).

Results

A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 – 4.68) and (2.04, 95% CI; 1.03 – 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 – 0.98) compared to the control group.

Conclusions

The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.

Trial registration

ClinicalTrials.gov: NCT01260493

Comparison of visual acuity charts identifying visual impairment among older people outside the eye clinic

PURPOSE

Evaluate the construct validity and describe sensitivity, specificity and predictive value of two short charts of visual acuity (VA) and examine whether these can identify and detect signs of visual impairment among older people.

METHOD

The study included 43 persons, >65 years, with age related eye disease, living in their own homes. An ophthalmologist assessed the individuals' VA at an eye clinic with the 5 m KM chart. A research assistant assessed individuals' VA by the 1 m KM chart and the Visual Acuity Screening Test in their home environment.

RESULTS

All persons with a VA level of <0.5 were correctly identified by both instruments. The instruments have good positive and negative predictive values for the 1 m KM chart (73% and 100%) and for the Visual Acuity Screening Test (69% and 100%). The construct validity between the instruments was good, but the assessment at the eye clinic assessed the participants as having higher VA level.

CONCLUSIONS

Both instruments have good construct validity, considering they were carried out in poorer lighting conditions and a good predictive value for screening out VA levels <0.5. The 1 m KM chart showed the best agreement with the 5 m KM chart.

Health-promoting interventions for persons aged 80 and older are successful in the short term--results from the randomized and three-armed Elderly Persons in the Risk Zone study

OBJECTIVES

To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self-rated health, and activities of daily living (ADLs) at 3-month follow-up.

DESIGN

Randomized, three-armed, single-blind, controlled trial performed between November 2007 and May 2011.

SETTING

Two urban districts of Gothenburg, Sweden.

PARTICIPANTS

Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service.

INTERVENTION

A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit.

MEASUREMENTS

Change in frailty, self-rated health, and ADLs between baseline and 3-month follow-up.

RESULTS

Both interventions delayed deterioration of self-rated health (odds ratio (OR) = 1.99, 95% confidence interval (CI) = 1.12-3.54). Senior meetings were the most beneficial intervention for postponing dependence in ADLs (OR = 1.95, 95% CI = 1.14-3.33). No effect on frailty could be demonstrated.

CONCLUSION

Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term. A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit. Further research is needed to examine the outcome in the long term and in different contexts.

Concurrent Validity of the Executive Function Performance Test in People with Mild Stroke

Introduction:

Studies have shown that executive dysfunction is common in adults after stroke. Occupational therapists working in acute care assess the performance of activities of daily living; most instruments focus on personal care. However, the assessment of instrumental activities of daily living has been shown to discriminate executive dysfunction more effectively. An instrument for assessing executive dysfunction in more complex activities that is easy to handle in acute care is consequently required for clinical use. The Executive Function Performance Test (EFPT) was recently introduced into Sweden. The purpose of this study was to evaluate the concurrent validity of the EFPT in acute care for patients with mild stroke.

Method:

Twenty-three patients from an acute stroke unit were assessed with both the EFPT and the Assessment of Motor and Process Skills (AMPS).

Results:

The correlation between the EFPT and the AMPS assessments was highly significant (p = 0.003) and the concurrent validity was rho = 0.61.

Conclusion:

Since there is a risk that adult patients with mild stroke are discharged without rehabilitation, and there is a lack of a relevant instrument for occupational therapists that discriminates executive dysfunction in acute stroke care, the EFPT may be a suitable instrument to use with these patients.

Effects of walking speed and results of timed get-up-and-go tests on quality of life and social participation in elderly individuals with a history of osteoporosis-related fractures

OBJECTIVE

To investigate the relationships between physical performance, quality of life (QoL), and social participation among elderly men and women with a history of osteoporosis-related fractures.

METHOD

The study was a population-based cross-sectional study including 155 participants aged 60 to 93 years from the Swedish longitudinal investigation, "Good Aging in Skåne." The participants had suffered fracture of the vertebrae, hip, pelvis, or ankle. Physical performance was expressed as walking speed (WS) and timed get-up-and-go (TUG). QoL was measured as using the Health Related Quality of Life (HRQoL) and Life Satisfaction (LS) scales. Social participation was defined as taking part in social, cultural, and leisure activities.

RESULTS

Lower WS and/or TUG were associated with lower HRQoL, lower LS, and a reduction in social participation, after adjustment for confounding factors.

DISCUSSION

Measurements of WS and TUG could be used to determine QoL and social participation in elderly people having sustained fractures.