Traumatic brain injury in Denmark 2008-2012.

Aims: To examine the epidemiology of traumatic brain injury (TBI) in Denmark, including the relative frequency, distribution of injuries and the external causes across the days of the week, sex and age. Methods: I carried out a nationwide register-based study of the full population aged 16-65 years with a diagnosis of TBI between 2008 and 2012, a total of 27,030 hospital contacts. I calculated the average annual relative frequency and the sex risk ratio for four TBI diagnoses across age. I report the distribution of five external causes and the odds ratio of acquiring a TBI during the weekend. Results: The relative frequency of TBI peaked among 16- to 35-year-olds for all diagnosis except for haemorrhages, which increase with age. During weekends, the relative frequency of concussions increases for men, whereas the relative frequency of severe TBI increases for young men and decreases for older men. The relative frequency of TBI is stable throughout the week for women aged 16-35 years, but decreases for women aged 36-65 years. For 16- to 35-year-olds, the main external causes of TBI are falls and road traffic accidents. During the weekend, the risk of violence-, sport- and fall-related TBI increases for 16- to 35-year-olds, whereas the risk of TBI related to road traffic accidents decreases for women and older men. The risk of sports-related TBI increases during weekends for older men. Conclusions: Injury patterns and external causes across TBI diagnoses differ substantially across sex, age and the day of week, indicating differences in the behavioural patterns that result in a TBI.

A Cross-European Study of Informal Carers' Needs in the Context of Caring for Older People, and their Experiences with Professionals Working in Integrated Care Settings.

INTRODUCTION: Informal carers are increasingly relied on for support by older people and the health and social care systems that serve them. It is therefore important that health and social care professionals are knowledgeable about and responsive to informal carers' needs. This study explores informal carers' own needs within the context of caregiving; and examines, from the informal carers' perspective, the extent to which professionals assess, understand and are responsive to informal carers' needs. METHODS: We interviewed (2016-2018) 47 informal carers of older people being served by 12 integrated care initiatives across seven countries in Europe. The interviews were thematically coded inductively and analysed. RESULTS: Informal carers reported that professionals treated them with respect and made efforts to assess and respond to their needs. However, even though professionals encouraged informal carers to look after themselves, informal carers' needs (e.g., for respite, healthcare) were insufficiently addressed, and informal carers tended to prioritize older people's needs over their own. DISCUSSION AND CONCLUSION: Informal carers need better support in caring for their own health. Health professionals should have regular contact with informal carers and proactively engage them in ongoing needs assessment, setting action plans for addressing their needs, and identifying/accessing appropriate support services. This will be important if informal carers are to continue their caregiving role without adverse effects to themselves.

Exploring the Team Climate of Health and Social Care Professionals Implementing Integrated Care for Older People in Europe.

BACKGROUND AND PROBLEM STATEMENT: Team climate describes shared perceptions of organisational policies, practices and procedures. A positive team climate has been linked to better interprofessional collaboration and quality of care. Most studies examine team climate within health or social care organisations. This study uniquely explores the team climate of integrated health and social care teams implementing integrated care initiatives for older people in thirteen sites across seven European countries, and examines the factors which contribute to the development of team climate. THEORY AND METHODS: In a multiple case study design, data collected as part of the European SUSTAIN (Sustainable Tailored Integrated Care for Older People in Europe) project were analysed. The short-form Team Climate Inventory (TCI-14) was administered before and after implementation of the integrated care initiatives. Qualitative data was used to explain the changes in TCI-14 scores over time. RESULTS AND DISCUSSION: Overall, team climate was found to be high and increased over time in eight of the thirteen sites. The development of a shared vision was associated with a strong belief in the value and feasibility of the initiative, clear roles and responsibilities, and a reflective approach. Strong inter-personal relationships, shared decision-making, and high levels of commitment and motivation contributed to the development of participative safety. Support for innovation increased when staff had the 'space' and time to work together. CONCLUSION: This mixed methods study offers significant insights into the development and maintenance of team climate in complex, integrated care systems in Europe.

Supporting Older People to Live Safely at Home - Findings from Thirteen Case Studies on Integrated Care Across Europe.

INTRODUCTION: While many different factors can undermine older people's ability to live safely at home, safety as an explicit aspect of integrated care for older people living at home is an underexplored topic in research. In the context of a European project on integrated care, this study aims to improve our understanding of how safety is addressed in integrated care practices across Europe. METHODS: This multiple case study included thirteen integrated care sites from seven European countries. The Framework Method guided content analyses of the case study reports. Activities were clustered into activities aimed at identifying and managing risks, or activities addressing specific risks related to older people's functioning, behaviour, social environment, physical environment and health and social care receipt. RESULTS: Case studies included a broad range of activities addressing older people's safety. Although care providers felt they sufficiently addressed safety issues, older people were often concerned and insecure about their safety. Attention to the practical and social aspects of safety was often insufficient. CONCLUSIONS AND DISCUSSION: Integrated care services across Europe address older people's safety in many ways. Further integration of health and social care solutions is necessary to enhance older people's perceptions of safety.