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Becoming a guest in your own home: Home care in Sweden from the perspective of older people with multimorbidities.

https://arctichealth.org/en/permalink/ahliterature297921
Source
Int J Older People Nurs. 2018 Sep; 13(3):e12194
Publication Type
Journal Article
Date
Sep-2018
Author
Aleksandra Jarling
Ingela Rydström
Marie Ernsth-Bravell
Maria Nyström
Ann-Charlotte Dalheim-Englund
Author Affiliation
Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Boras, Sweden.
Source
Int J Older People Nurs. 2018 Sep; 13(3):e12194
Date
Sep-2018
Language
English
Publication Type
Journal Article
Keywords
Adaptation, Psychological
Aged
Aged, 80 and over
Aging - psychology
Chronic Disease - nursing - psychology
Culture
Dependency (Psychology)
Female
Home Care Services
Humans
Male
Paternalism
Personal Autonomy
Sweden
Abstract
To describe the meaning of the phenomenon home care from the perspective of older persons who live alone with multimorbidity.
In line with worldwide changing demographics, conditions for older people in need of home care are changing. In Sweden there is a stay-in-place policy and older people are expected to live and be cared for in their own home as long as possible. Home care, instituted by different laws, is a challenge affecting the older person when the private home becomes a workplace.
This study uses a qualitative design with a lifeworld approach.
The study having been conducted in Sweden in 2016, the researchers interviewed 12 older persons that live alone and receive home care. Data were analysed using qualitative content analysis.
The findings illustrate four sub-themes: adapting to a caring culture, feeling exposed, unable to influence care and forced relations. The overall theme reveals that older people experience a life-changing situation when receiving home care and they become a guest in their own home.
Becoming older with increased needs means to disrupt one's life when one's private home becomes a public arena. The gap between an older person's rights by law and the older person's experiences of receiving home care needs to be highlighted to meet the oncoming challenges in providing a home care that includes participation of the older themselves. Only then can care be offered that enables older people to have a sense of control and experience their home as their own.
The findings emphasise the need to view older people as being self-determinant and independent. Older people receiving home care need to be seen as individuals, and their entire life situation should be considered by also acknowledging the important role played by relatives and caregivers.
PubMed ID
29603651 View in PubMed
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Body mass index, change in body mass index, and survival in old and very old persons.

https://arctichealth.org/en/permalink/ahliterature115928
Source
J Am Geriatr Soc. 2013 Apr;61(4):512-8
Publication Type
Article
Date
Apr-2013
Author
Anna K Dahl
Elizabeth B Fauth
Marie Ernsth-Bravell
Linda B Hassing
Nilam Ram
Denis Gerstof
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden.
Source
J Am Geriatr Soc. 2013 Apr;61(4):512-8
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aging - physiology
Body mass index
Cause of Death
Female
Health status
Health Status Indicators
Humans
Life Style
Male
Population Surveillance
Risk factors
Sweden
Weight Gain
Weight Loss
Abstract
To examine how body mass index (BMI) and change in BMI are associated with mortality in old (70-79) and very old (=80) individuals.
Pooled data from three multidisciplinary prospective population-based studies: OCTO-twin, Gender, and NONA.
Sweden.
Eight hundred eighty-two individuals aged 70 to 95.
BMI was calculated from measured height and weight as kg/m(2) . Information about survival status and time of death was obtained from the Swedish Civil Registration System.
Mortality hazard was 20% lower for the overweight group than the normal-underweight group (relative risk (RR)?=?0.80, P?=?.011), and the mortality hazard for the obese group did not differ significantly from that of the normal-underweight group (RR?=?0.93, P?=?.603), independent of age, education, and multimorbidity. Furthermore, mortality hazard was 65% higher for the BMI loss group than for the BMI stable group (RR?=?1.65, P?
Notes
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PubMed ID
23452127 View in PubMed
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Concurrent validity of the Swedish version of the life-space assessment questionnaire.

https://arctichealth.org/en/permalink/ahliterature282982
Source
BMC Geriatr. 2016 11 08;16(1):181
Publication Type
Article
Date
11-08-2016
Author
Sofi Fristedt
Ann-Sofi Kammerlind
Marie Ernsth Bravell
Eleonor I Fransson
Source
BMC Geriatr. 2016 11 08;16(1):181
Date
11-08-2016
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Architectural Accessibility - methods - standards
Female
Humans
Independent Living - standards
Male
Mobility Limitation
Reproducibility of Results
Social Support
Surveys and Questionnaires
Sweden - epidemiology
Translating
Abstract
The Life-Space Assessment (LSA), developed in the USA, is an instrument focusing on mobility with respect to reaching different areas defined as life-spaces, extending from the room where the person sleeps to mobility outside one's hometown. A newly translated Swedish version of the LSA (LSA-S) has been tested for test-retest reliability, but the validity remains to be tested. The purpose of the present study was to examine the concurrent validity of the LSA-S, by comparing and correlating the LSA scores to other measures of mobility.
The LSA was included in a population-based study of health, functioning and mobility among older persons in Sweden, and the present analysis comprised 312 community-dwelling participants. To test the concurrent validity, the LSA scores were compared to a number of other mobility-related variables, including the Short Physical Performance Battery (SPPB) as well as "stair climbing", "transfers", "transportation", "food shopping", "travel for pleasure" and "community activities". The LSA total mean scores for different levels of the other mobility-related variables, and measures of correlation were calculated.
Higher LSA total mean scores were observed with higher levels of all the other mobility related variables. Most of the correlations between the LSA and the other mobility variables were large (r?=?0.5-1.0) and significant at the 0.01 level. The LSA total score, as well as independent life-space and assistive life-space correlated with transportation (0.63, 0.66, 0.64) and food shopping (0.55, 0.58, 0.55). Assistive life-space also correlated with SPPB (0.47). With respect to maximal life-space, the correlations with the mobility-related variables were generally lower (below 0.5), probably since this aspect of life-space mobility is highly influenced by social support and is not so dependent on the individual's own physical function.
LSA was shown to be a valid measure of mobility when using the LSA total, independent LS or assistive LSA.
Notes
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PubMed ID
27821138 View in PubMed
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Factors associated with grip strength decline in older adults.

https://arctichealth.org/en/permalink/ahliterature270056
Source
Age Ageing. 2015 Mar;44(2):269-74
Publication Type
Article
Date
Mar-2015
Author
Ola Sternäng
Chandra A Reynolds
Deborah Finkel
Marie Ernsth-Bravell
Nancy L Pedersen
Anna K Dahl Aslan
Source
Age Ageing. 2015 Mar;44(2):269-74
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Aging
Female
Geriatric Assessment
Hand Strength
Health Status Disparities
Humans
Longitudinal Studies
Male
Middle Aged
Risk factors
Sarcopenia - diagnosis - epidemiology - physiopathology
Sex Factors
Sweden - epidemiology
Abstract
Few studies have examined associations of multi-faceted demographic, health and lifestyle factors with long-term change in grip strength performance across the adult lifespan. The aim of this study was to examine the associations of risk factors in specific parts of the adult lifespan (e.g. in early midlife, in late midlife and in old adulthood) separately for women and men.
Data came from the longitudinal Swedish Adoption/Twin Study of Aging (SATSA). Grip strength performance was followed in 849 participants who were 50-88 years of age at baseline. The follow-up period with seven waves of data of grip strength was 22 years, and the risk factors were measured up to 20 years before the assessment of grip strength. Latent growth modelling was used for the longitudinal analyses.
A gender difference in the type of factors associated with grip strength performance and development across the adult lifespan was found. Significant factors for the age slopes for women were stress, smoking and dementia. For men, marital status, mean arterial pressure, physical activity at work and having a chronic disorder were of importance. These factors varied in their associations with grip strength across the adult lifespan.
Factors measured earlier in adulthood were associated with grip strength decline in late midlife and old adulthood. Gender-specific patterns of risk factors suggest that it may be worthwhile to conduct research on grip and muscle strength (and biological vitality) separately for men and women.
Notes
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PubMed ID
25362503 View in PubMed
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Factors associated with increased hospitalisation risk among nursing home residents in Sweden: a prospective study with a three-year follow-up.

https://arctichealth.org/en/permalink/ahliterature285280
Source
Int J Older People Nurs. 2016 Jun;11(2):130-9
Publication Type
Article
Date
Jun-2016
Author
Jenny Hallgren
Marie Ernsth Bravell
Sigvard Mölstad
Carl Johan Östgren
Patrik Midlöv
Anna K Dahl Aslan
Source
Int J Older People Nurs. 2016 Jun;11(2):130-9
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Accidental Falls - statistics & numerical data
Aged
Aged, 80 and over
Cardiovascular Diseases - epidemiology
Comorbidity
Female
Follow-Up Studies
Hospitalization - statistics & numerical data
Humans
Male
Malnutrition - epidemiology
Nursing Homes
Polypharmacy
Proportional Hazards Models
Prospective Studies
Risk assessment
Risk factors
Sweden - epidemiology
Abstract
Hospitalisation of nursing home residents might lead to deteriorating health.
To evaluate physical and psychological factors associated with hospitalisation risk among nursing home residents.
Prospective study with three years of follow-up.
Four hundred and twenty-nine Swedish nursing home residents, ages 65-101 years, from 11 nursing homes in three municipalities were followed during three years. The participants' physical and psychological status was assessed at baseline. A Cox proportional hazards model was used to evaluate factors associated with hospitalisation risk using STATA.
Of the 429 participants, 196 (45.7%) were hospitalised at least once during the three-year follow-up period, and 109 (25.4%) during the first six months of the study. The most common causes of hospitalisation were cardiovascular diseases or complications due to falls. A Cox regression model showed that residents who have had previous falls (P 
PubMed ID
26663380 View in PubMed
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Factors related to falls, weight-loss and pressure ulcers--more insight in risk assessment among nursing home residents.

https://arctichealth.org/en/permalink/ahliterature278371
Source
J Clin Nurs. 2016 Apr;25(7-8):940-50
Publication Type
Article
Date
Apr-2016
Author
Christina Lannering
Marie Ernsth Bravell
Patrik Midlöv
Carl-Johan Östgren
Sigvard Mölstad
Source
J Clin Nurs. 2016 Apr;25(7-8):940-50
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Accidental Falls
Aged
Aged, 80 and over
Cognition Disorders - complications
Female
Humans
Longitudinal Studies
Male
Middle Aged
Nursing Homes
Pressure Ulcer - etiology - nursing
Risk assessment
Risk factors
Sweden
Weight Loss
Abstract
To describe how the included items in three different scales, Downton Fall Risk Index, the short form of Mini Nutritional Assessment and the Modified Norton Scale are associated to severe outcomes as falls, weight loss and pressure ulcers.
Falls, malnutrition and pressure ulcers are common adverse events among nursing home residents and risk scoring are common preventive activities, mainly focusing on single risks. In Sweden the three scales are routinely used together with the purpose to improve the quality of prevention.
Longitudinal quantitative study.
Descriptive analyses and Cox regression analyses.
Only 4% scored no risk for any of these serious events. Longitudinal risk scoring showed significant impaired mean scores indicating increased risks. This confirms the complexity of this population's status of general condition. There were no statistical significant differences between residents categorised at risk or not regarding events. Physical activity increased falls, but decreased pressure ulcers. For weight loss, cognitive decline and the status of general health were most important.
Risk tendencies for falls, malnutrition and pressure ulcers are high in nursing homes, and when measure them at the same time the majority will have several of these risks. Items assessing mobility or items affecting mobility were of most importance. Care processes can always be improved and this study can add to the topic.
A more comprehensive view is needed and prevention can not only be based on total scores. Mobility is an important factor for falls and pressure ulcers, both as a risk factor and a protective factor. This involves a challenge for care--to keep the inmates physical active and at the same time prevent falls.
PubMed ID
26813994 View in PubMed
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Home healthcare teams' assessments of pain in care recipients living with dementia: a Swedish exploratory study.

https://arctichealth.org/en/permalink/ahliterature273273
Source
Int J Older People Nurs. 2015 Sep;10(3):190-200
Publication Type
Article
Date
Sep-2015
Author
Christina Elisabeth Karlsson
Marie Ernsth Bravell
Kristina Ek
Ingrid Bergh
Source
Int J Older People Nurs. 2015 Sep;10(3):190-200
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Dementia - nursing
Female
Humans
Interviews as Topic
Male
Middle Aged
Nursing Assessment
Pain Measurement - methods
Qualitative Research
Sweden
Abstract
Pain assessment in people living with dementia is a challenge due to the complexity of pain and dementia and the difficulties in self-reporting. In home healthcare, nurses are frequently involved in pain assessment situations and there is a need to explore how home healthcare teams' manage pain assessment in this setting.
The study aimed to explore home healthcare teams' experiences of pain assessment among care recipients with dementia.
An exploratory qualitative design was used.
Open-ended individual interviews were conducted with thirteen registered nurses and ten nursing assistants, working in three different home healthcare teams in one municipality in western Sweden. Philosophical hermeneutics was utilised to interpret the home healthcare teams' experiences.
Four interpretations emerged: the need for trusting collaboration, the use of multiple assessment strategies, maintenance of staff continuity in care and assessment situations, and the need for extended time to assess pain.
The home healthcare teams recognise pain assessment in people with dementia as involving a complex interaction of sensory, cognitive, emotional and behavioural components in which efforts to acquire understanding of behavioural changes mainly guides their assessments. The solid team coherence between registered nurses and nursing assistants aided the assessment procedure. To assess pain, the teams used multiple methods that complemented one another. However, no systematic routines or appropriate evidence-based pain tools were used.
The team members'concern for care recipients when assessing pain is evident and needs to be acknowledged by the organisation which is responsible for the quality of care. Future studies should focus on further exploration of nurses' experiences with pain and dementia in home healthcare settings and address what nurses identify and how they deal with their findings. It is imperative to investigate how organisations and nurses can ensure best practices and how the implementation of evidence-based routines for assessing pain may aid in pain assessment situations.
PubMed ID
25399656 View in PubMed
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How to assess frailty and the need for care? Report from the Study of Health and Drugs in the Elderly (SHADES) in community dwellings in Sweden.

https://arctichealth.org/en/permalink/ahliterature96220
Source
Arch Gerontol Geriatr. 2010 Jul 31;
Publication Type
Article
Date
Jul-31-2010
Author
Marie Ernsth Bravell
Björn Westerlind
Patrik Midlöv
Carl-Johan Ostgren
Lars Borgquist
Christina Lannering
Sigvard Mölstad
Author Affiliation
Institute of Gerontology, School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden.
Source
Arch Gerontol Geriatr. 2010 Jul 31;
Date
Jul-31-2010
Language
English
Publication Type
Article
Abstract
Knowledge about the need for care of elderly individuals in community dwellings and the factors affecting their needs and support is limited. The aim of this study was to characterize the frailty of a population of elderly individuals living in community dwellings in Sweden in relation to co-morbidity, use of drugs, and risk of severe conditions such as malnutrition, pressure ulcers, and falls. In 2008, 315 elderly individuals living in community dwellings were interviewed and examined as part of the SHADES-study. The elderly demonstrated co-morbidity (a mean of three diseases) and polypharmacy (an average of seven drugs). More than half the sample was at risk for malnutrition, one third was at risk for developing pressure ulcers, and nearly all (93%) had an increased risk of falling and a great majority had cognitive problems. Age, pulse pressure, body mass index, and specific items from the modified Norton scale (MNS), the Downton fall risk index (DFRI), and the mini nutritional assessment (MNA-SF) were related to different outcomes, defining the need for care and frailty. Based on the results of this study, we suggest a single set of items useful for understanding the need for care and to improve individual based care in community dwellings.
PubMed ID
20678818 View in PubMed
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In Hospital We Trust: Experiences of older peoples' decision to seek hospital care.

https://arctichealth.org/en/permalink/ahliterature280309
Source
Geriatr Nurs. 2015 Jul-Aug;36(4):306-11
Publication Type
Article
Author
Jenny Hallgren
Marie Ernsth Bravell
Anna K Dahl Aslan
Iréne Josephson
Source
Geriatr Nurs. 2015 Jul-Aug;36(4):306-11
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude of Health Personnel
Decision Making
Female
Health services needs and demand
Home Care Services
Hospitalization
Humans
Interviews as Topic
Male
Patient transfer
Qualitative Research
Quality of Life
Sweden
Abstract
The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People's Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples' arguments for seeking hospital care may have implications for how home care staff address individuals' perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life.
PubMed ID
25971421 View in PubMed
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Leadership and the psychosocial work environment in old age care.

https://arctichealth.org/en/permalink/ahliterature278189
Source
Int J Older People Nurs. 2016 Mar;11(1):44-54
Publication Type
Article
Date
Mar-2016
Author
Dan Lundgren
Marie Ernsth-Bravell
Ingemar Kåreholt
Source
Int J Older People Nurs. 2016 Mar;11(1):44-54
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cross-Sectional Studies
Female
Geriatric Nursing
Home Care Services
Humans
Leadership
Male
Middle Aged
Nursing Homes
Sweden
Workplace
Young Adult
Abstract
To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services.
Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services.
Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed.
The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2.
Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services.
Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services.
Due to the differences in organisational settings, it is important to consider the differences in prerequisites in conducting leadership. To influence nursing assistants' performance and to increase quality in old age care in the long term, appropriate leadership is necessary.
PubMed ID
26073426 View in PubMed
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13 records – page 1 of 2.