Trust and easy access to home care staff are associated with older adults' sense of security: a Swedish longitudinal study.

AIM: Older adults are increasingly encouraged to continue living in their own homes with support from home care services. However, few studies have focused on older adults' safety in home care. This study explored associations between the sense of security and factors related to demographic characteristics and home care services. METHODS: The mixed longitudinal design was based on a retrospective national survey. The study population consisted of individuals in Sweden (aged 65+ years) granted home care services at any time between 2016 and 2020 (n=82,834-94,714). Multiple ordinal logistic regression models were fitted using the generalised estimation equation method to assess the strength of relationship between the dependent (sense of security) and independent (demographics, health and care-related factors) variables. RESULTS: The sense of security tended to increase between 2016 and 2020, and was significantly associated with being a woman, living outside big cities, being granted more home care services hours or being diagnosed/treated for depression (cumulative odds ratio 2-9% higher). Anxiety, poor health and living alone were most strongly associated with insecurity (cumulative odds ratio 17-64% lower). Aside from overall satisfaction with home care services, accessibility and confidence in staff influenced the sense of security most. CONCLUSIONS: We stress the need to promote older adults' sense of security for safe ageing in place, as mandated by Swedish law. Home care services profoundly influence older adults' sense of security. Therefore, it is vital to prioritise continuity in care, establish trust and build relationships with older adults. Given the increasing shortage of staff, integrating complementary measures, such as welfare technologies, is crucial to promoting this sense of security.

Anxiety and loneliness among older people living in residential care facilities or receiving home care services in Sweden during the COVID-19 pandemic: a national cross-sectional study.

BACKGROUND: Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people's experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences. METHODS: A retrospective cross-sectional design using data from the national user satisfaction survey (March - May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables. RESULTS: Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS. CONCLUSION: Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people' mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.

No thank you to humanized robots: attitudes to care robots in elder care services.

The growing older population will increase the demands on the health and welfare systems, including elder care services. One way of meeting these growing service needs is to shift from traditional care services to technologically oriented services. Robotic innovations are gradually being introduced to elder care services. The aim was to explore attitudes toward the use of care robots in elder care services - specifically focusing on situations and interaction, influence, and emotions in interaction with care robots. Data were obtained from visitors at a welfare technology fair (n = 124). The results show that the most negative attitudes concerned if the care robots were humanized and had emotions. The attitudes toward interacting with care robots in general were predominately positive. In conclusion, concrete usage scenarios in elder care services need to be detected, based both on users' needs, digital literacy and on the maturity of the technology itself.

Informal Caregivers' Experiences and Needs When Caring for a Relative With Heart Failure: An Interview Study.

BACKGROUND: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden. OBJECTIVE: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home. METHODS: The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis. RESULTS: Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals. CONCLUSIONS: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.

Healthcare and social care professionals' experiences of respite care: a critical incident study.

INTRODUCTION: Aging in place is favoured among older persons and supported by research in Sweden, although it poses challenges for overburdened informal caregivers. While respite care can offer support, its accessibility is hindered by organizational challenges and informal caregivers' delays in using it. The experiences of informal caregivers are well-studied, but the professionals' experiences of respite care quality and critical incident management are underexplored. AIM: To explore professionals' experiences of critical incidents in respite care, consequences for the persons being cared for, and strategies to manage critical incidents. MATERIALS AND METHODS: A qualitative, critical incident technique was used, and three group interviews with a total of 16 professionals were conducted. RESULTS: Barriers to quality respite care included communication gaps during care transitions, environmental shortcomings in respite care facilities, lack of support for informal caregivers, and inadequacies in respite care decisions. Strategies to manage critical incidents included individualized care, continuity and communication in care transitions, a conducive environment, support for informal caregivers, and care professionals' positive approach. CONCLUSIONS: The study emphasizes the need for focused efforts on communication, continuity, and a supportive environment. Addressing identified challenges and applying suggested strategies will be key to maximizing the potential of respite care as a vital support for care recipients and their informal caregivers.

Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives.

BACKGROUND: Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. OBJECTIVE: This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. METHODS: This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. RESULTS: The results included 7 categories of determinants for implementing the ICT tool. Being able to introduce the ICT tool in an appropriate manner concerns the personnel's options for introducing and supporting the ICT tool, including their competencies in using digital equipment. Organizational structure concerns a structure for communication within the organization. Leadership concerns engagement and enthusiasm as driving forces for implementation. The digital maturity of the social services personnel concerns the personnel's skills and attitudes toward using digital equipment. Resources concern time and money. IT support concerns accessibility, and legal liability concerns possibilities to fulfill legal responsibilities. CONCLUSIONS: The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results.

A codesigned web platform for reducing social isolation and loneliness in older people: a feasibility study.

Social isolation and loneliness are associated with negative health outcomes, physical as well as cognitive. Information and communication technology (ICT) can be effective tools for preventing and tackling social isolation and loneliness among older people. Our objective was to evaluate the feasibility of the Fik@ room, a web platform for social interaction designed for older people. A mixed methods design was applied, where both quantitative and qualitative data were collected during a 12-week period (n = 28, Md age 74). Experiences of loneliness were reduced using the Fik@ room. The results highlight the feasibility issues surrounding the recruitment process, adoption, pattern of use, usability, support service, and technical infrastructure. In particular, the importance of offering ICT solutions with few technical issues, and to provide easily accessible and appropriate support. The Fik@ room is a feasible tool for older people to develop new friendships, reduce loneliness, and grow their social networks. However, it is not a communication option that fits all. The results offer a compilation of feasibility issues that can serve as an inspirational guide in the design and implementation of similar technologies.

Older Adults' Use of a Research-Based Web Platform for Social Interaction.

Loneliness and social isolation are triggers for unfavorable changes in older adults' health and well-being. Information and communication technology (ICT) can be used by older adults to mitigate the negative effects of loneliness and social isolation. However, ICT needs to be customized to the specific needs and conditions of older adults. The aim of this study was to explore older adults' use of a new, co-designed and research-based web platform for social interaction from the perspectives of older adults, researchers, and social services personnel. The study is an intervention study with a multimethod approach in which 20 older adults used the web platform for social interaction "the Fik@ room" for eight weeks. Quantitative and qualitative data were collected pretest, during the test, and posttest. The Fik@ room met the expectations of those older adults who completed the study. It enabled them to expand their social network and develop new friendships, but their experiences of loneliness were not reduced. The involvement of social services personnel in recruitment and support was important in facilitating older adults' use of the Fik@ room. Our study contributes knowledge about a new, co-designed and research-based web platform, customized specifically for older adults, which is valuable in guiding the design and delivery of future web platforms for social interaction among older adults.

Peer counselors' role in supporting patients' adherence to ART in Ethiopia and Uganda.

Our aim was to explore peer counselors' work and their role in supporting patients' adherence to antiretroviral treatment (ART) in resource-limited settings in Ethiopia and Uganda. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Two main categories with related subcategories emerged from the analysis. The first main category, peer counselors as facilitators of adherence, describes how peer counselors played an important role by acting as role models, raising awareness, and being visible in the community. They were also recognized for being close to the patients while acting as a bridge to the health system. They provided patients with an opportunity to individually talk to someone who was also living with HIV, who had a positive and life-affirming attitude about their situation, and were willing to share personal stories of hope when educating and counseling their patients. The second main category, benefits and challenges of peer counseling, deals with how peer counselors found reward in helping others while at the same time acknowledging their limitations and need of support and remuneration. Their role and function were not clearly defined within the health system and they received negligible financial and organizational support. While peer counseling is acknowledged as an essential vehicle for treatment success in ART support in sub-Saharan Africa, a formal recognition and regulation of their role should be defined. The issue of strategies for disclosure to support adherence, while avoiding or reducing stigma, also requires specific attention. We argue that the development and implementation of support to peer counselors are crucial in existing and future ART programs, but more research is needed to further explore factors that are important to sustain and strengthen the work of peer counselors.

District nurses' use for an assessment tool in their daily work with elderly patients' medication management.

AIM: To explore the capability of the Safe Medication Assessment (SMA) tool in identifying factors highly related to unsafe medication management among elderly patients and to investigate the district nurses' (DNs) opinions of the SMA's usefulness as a tool in their daily primary healthcare practice. INTRODUCTION: Elderly patients who experience many medical conditions often use multiple drugs. As well as the combined decline in physical and cognitive functions, the elderly are at high risk for medication-related problems. It is essential to develop a screening procedure to distinguish elderly at risk of an unsafe medication management. METHODS: An explorative study. During a 3-6-month period, 25 voluntary DNs used SMA with 160 patients (consecutively chosen and meeting four specified criteria) in their daily practice. Furthermore, DNs responded to questions regarding SMA's usefulness. RESULTS: The result showed that SMA had the capability to identify factors highly related to unsafe medication management among the elderly included in the study. In 64% of assessments DNs identified areas of new information and in 23% of the assessments DNs intervened. They found SMA to be satisfactory regarding its level of simplicity, relevance, completeness, intelligibility, and time for implementation. CONCLUSIONS: SMA alerted the DNs to patients' attitudes about medication and empowered them in identifying elderly patients who had unsafe medication management. SMA was also perceived as a useful assessment tool by the DNs.

Preventing Falls and Malnutrition among Older Adults in Municipal Residential Care in Sweden: A Registry Study.

INTRODUCTION: Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions. OBJECTIVES: The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk. METHODS: A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included. RESULTS: Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff's least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations. CONCLUSIONS: This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, which requires educational training for care staff and supportive leadership.

Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option?

This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: "Patients' competing costs and systems' resource constraints" and "Patients' trust in ART and quality of the patient-provider encounters." The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling.

Family Health Conversations Conducted by Telephone in Heart Failure Nursing Care: A Feasibility Study.

Registered nurses (RNs) in heart failure (HF) nursing care have a key role in providing family support, which positively affects the outcome for the patient. Telephone interventions conducted by RNs have been reported to be successful in HF nursing care, but Family Health Conversations (FamHCs) involving the patient and the family, have not previously been tested. The purpose of the current study was to explore the experiences and feasibility of nurse-led FamHCs conducted by telephone with patients and their family caregivers. A single-group intervention study with a pretest-posttest design was conducted in three regional hospitals that had a nurse-led HF clinic. Five RNs, eight patients, and eight family caregivers participated. Three FamHCs were conducted by telephone with each family every 2 weeks. Qualitative and quantitative data were collected through semistructured interviews and questionnaires. FamHCs improved the nurse-family relationships and relationships within the families and provided RNs with new knowledge about the families. FamHCs conducted by telephone were considered to be feasible for both families and RNs, although RNs preferred fewer and shorter FamHCs. The RNs preferred meeting face-to-face with the families as nonverbal communication between the family members could be missed because of lack of visual input. On the other hand, RNs appreciated to focus entirely on the conversation without the need to perform illness-related routine checks. In conclusion, the advantages of FamHCs conducted by telephone outweighed the disadvantages. Visual contact, provided by video telephony, and a shorter version of the tested FamHC would facilitate the use in HF nursing care.

Nurses' attitudes toward family importance in heart failure care.

BACKGROUND: Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure. To involve family members in heart failure care is thus valuable for the patients. Registered nurses frequently meet family members of patients with heart failure and the quality of these encounters is likely to be influenced by the attitudes registered nurses hold toward families. AIMS: To explore registered nurses' attitudes toward the importance of families' involvement in heart failure nursing care and to identify factors that predict the most supportive attitudes. METHODS: Cross-sectional, multicentre web-survey study. A sample of 303 registered nurses from 47 hospitals and 30 primary health care centres completed the instrument Families' Importance in Nursing Care - Nurses' Attitudes. RESULTS: Overall, registered nurses were supportive of families' involvement. Nonetheless, attitudes toward inviting families to actively take part in heart failure nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a primary health care centre, a heart failure clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and/or heart failure nursing care, and a competence to work with families. CONCLUSIONS: Experienced registered nurses in heart failure nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. Registered nurses who have designated consultation time with patients and families, as in a nurse-led heart failure clinic, may have the most favourable condition for implementing a more supportive approach to families.

Registered Nurses' Perceptions about the Situation of Family Caregivers to Patients with Heart Failure - A Focus Group Interview Study.

INTRODUCTION: Heart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes. AIMS: The aims of this study are to explore registered nurses' perceptions about the situation of family caregivers to patients with heart failure, and registered nurses' interventions, in order to improve family caregivers' situation. METHODS: The study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis. RESULTS: Two content areas were identified by the a priori study aims. Four categories and nine sub-categories emerged in the analysis process. The content area "Family caregivers' situation" includes two categories: "To be unburdened" and "To comprehend the heart failure condition and its consequences". The content area "Interventions to improve family caregivers' situation" includes two categories: "Individualized support and information" and "Bridging contact". CONCLUSIONS: Registered nurses perceive family caregivers' situation as burdensome, characterized by worry and uncertainty. In the PHCCs, the continuity and security of an RN as a permanent health care contact was considered an important and sustainable intervention to better care for family caregivers' worry and uncertainty. In the nurse-led heart failure clinics in hospitals, registered nurses can provide family caregivers with the opportunity of involvement in their relative's health care and address congruence and relationship quality within the family through the use of "Shared care" and or Family-centred care. Registered nurses consider it necessary to have a coordinated individual care plan as a basis for collaboration between the county council and the municipality.

Multiple ART Programs Create a Dilemma for Providers to Monitor ARV Adherence in Uganda.

BACKGROUND: Increased availability and accessibility of antiretroviral therapy (ART) has improved the length and quality of life amongst people living with HIV/AIDS. This has changed the landscape for care from episodic to long-term care that requires more monitoring of adherence. This has led to increased demand on human resources, a major problem for most ART programs. This paper presents experiences and perspectives of providers in ART facilities, exploring the organizational factors affecting their capacity to monitor adherence to ARVs. METHODS: From an earlier survey to test adherence indicators and rank facilities as good, medium or poor adherence performances, six facilities were randomly selected, two from each rank. Observations on facility set-up, provider-patient interactions and key informant interviews were carried out. The strengths, weaknesses, opportunities and threats identified by health workers as facilitators or barriers to their capacity to monitor adherence to ARVs were explored during group discussions. RESULTS: Findings show that the performance levels of the facilities were characterized by four different organizational ART programs operating in Uganda, with apparent lack of integration and coordination at the facilities. Of the six facilities studied, the two high adherence performing facilities were Non-Governmental Organization (NGO) programs, while facilities with dual organizational programs (Governmental/NGO) performed poorly. Working conditions, record keeping and the duality of programs underscored the providers' capacity to monitor adherence. Overall 70% of the observed provider-patient interactions were conducted in environments that ensured privacy of the patient. The mean performance for record keeping was 79% and 50% in the high and low performing facilities respectively. Providers often found it difficult to monitor adherence due to the conflicting demands from the different organizational ART programs. CONCLUSION: Organizational duality at facilities is a major factor in poor adherence monitoring. The different ART programs in Uganda need to be coordinated and integrated into a single well resourced program to improve ART services and adherence monitoring. The focus on long-term care of patients on ART requires that the limitations to providers' capacity for monitoring adherence become central during the planning and implementation of ART programs.