Older migrants' perceptions of places to meet: Insights for social work practice.

This study aimed to explore the experiences of older migrants' (70+) access to and participation in different meeting places. Qualitative interviews were conducted with participants originating from Finland and four countries in the Western Balkans: Bosnia- Herzegovina, Croatia, Montenegro, and Serbia. The participants used everyday places in the neighborhood, which were not primarily meant to be meeting places, to create and uphold social contacts. These meeting places contributed to experiences of community and trust. Both everyday meeting places and organized meeting places were used to establish and develop relationships that could result in an exchange of both practical and emotional support. Perceptions of "not belonging", limited proficiency in Swedish, and a strained financial situation created barriers to accessing some meeting places. The results of this study demonstrate the significance of meeting places that are not purposefully aimed at older people in general or older people from a specific country.

Older adults' occupations in heat waves: A scoping review.

BACKGROUND: Heat waves impact the health of older adults, and occupations are important for health. An overview of research focussed on older adults' occupations in heat waves can be useful for occupational therapy practice. OBJECTIVE: To identify what the literature shows about older adults' experience and performance of, and participation in, occupations in heat waves. MATERIAL AND METHOD: This scoping review included a literature search in five academic databases, four databases for grey literature, and a manual search. Literature in English regarding older adults 60+ and their occupations in heat waves were eligible. FINDINGS: Twelve studies were included. Findings showed that older adults adapt their occupations using bodily, environmental, and social interaction strategies and by changing their daily routines. Personal, environmental, social, and economic factors facilitate and maintain occupations in heat waves. CONCLUSION: Older adults adapt their occupations in heat waves and different factors impact how they can be adapted. Future research is needed to explore how older adults experience their occupations in heat waves, and to deepen the knowledge about their heat-adaptive strategies. SIGNIFICANCE: The findings support the role of occupational therapists in the design and practice of interventions managing the impact of heat waves in daily life.

A validated search filter for the identification of endocrine disruptors based on the ECHA/EFSA guidance recommendations.

A guidance document for the identification of endocrine disruptors (EDs) in the regulatory assessment of plant protection products (PPP) and biocidal products (BP) has been published by the European Chemical Agency (ECHA) and the European Food Safety Authority (EFSA). The ECHA/EFSA guidance, mainly addressing EATS (estrogen, androgen, thyroid, steroidogenesis) modalities, is intended to guide applicants and assessors of the competent regulatory authorities on the implementation of the scientific criteria for the determination of ED properties pursuant to the recently implemented PPP (EU 2018/605) and BP (EU 2017/2100) EU Regulations. In this study, a search filter for targeted literature search in context of assessing if a substance can be identified as an ED relevant for human health was developed and validated. Development of the search filter was based on the search strategy presented in the ECHA/EFSA guidance and using the estrogenic chemical Bisphenol AF (BPAF) as a model substance. Information specialists from two independent institutions developed refined search filters based on the suggested original search strategy published (ECHA/EFSA guidance - Appendix F). Articles identified by a systematic literature search for BPAF were screened for relevance with inclusion and exclusion criteria by two independent reviewers obtaining positive (relevant) and negative (irrelevant) controls. The developed search filter was quantitatively evaluated in terms of sensitivity, specificity and precision based on the positive and negative controls. The developed filter was then validated for T modality by its application to the known thyroid-disruptor perchlorate. The result is a sensitive search filter with sufficient specificity, which can be applied for all chemicals where a targeted literature search is needed to assess and identify ED properties of chemicals with relevance for humans. Future application of the filter to a broader range of chemicals may identify further points of improvement.

Evaluation of an interactive showroom to increase general knowledge about welfare technology and its potential in municipal care settings.

Background: Welfare Technology (WT) can promote participation in activity. Thus, initiatives to support the implementation of WT products and services in municipality care settings needs to be developed and evaluated to benefit end-users.Objective: To evaluate an interactive showroom of WT.Material and method: Municipal employees (n = 217) filled in a questionnaire before and after they visited an interactive showroom of WT.Findings: The number of participants confirming WT's potential to contribute to municipal operation areas increased in seven out of eight areas after their visits (p < 0.05). A statistically significant increase was also found regarding general knowledge of and confidence in WT and its potential value.Conclusion: A visit to the interactive showroom increased the perceived general knowledge and appreciated value of WT. The perception of the possibility of implementing WT in various municipal operation areas also increased, which may contribute to the implementation of WT in municipal care settings.

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.

An analysis of cyclists' speed at combined pedestrian and cycle paths.

Objective: In Sweden, cyclists, pedestrians, and moped riders share the space on combined pedestrian and cycle paths, and their speeds may differ greatly. Both actual speed and speed differences can potentially influence the number of accidents on the shared paths. As a starting point, this article studies the speed component and how cyclists' speed varies at pedestrian and cycle paths depending on the day, week, and year; road user composition; and road design.Methods: Three data sources were used: Existing measurements of cycle speed and flow in 3 different Swedish municipalities, Eskilstuna (1 site, January-December 2015), Linköping (6 sites, 4 weeks in September-October 2015), and Stockholm (10 sites, 1-5 days in August-September 2015); complementary measurements of cycle speed and flow in Linköping (4 sites, 1-10 days in August-September 2016) and Stockholm (1 site, only part of 2 days in August 2016) were also conducted within the project, in addition to roadside observations of bicycle types at the 5 new sites.Results: The average speed of cyclists on the paths varied between 12.5 and 26.5 km/h. As expected, the lower average speeds were found in uphill directions, near intersections, and on paths with high pedestrian flows. The higher speeds were found in downhill directions and on commuter routes. In all, 70%-95% of road users observed on pedestrian and cycle paths were cyclists, and 5%-30% were pedestrians. The most common type of bicycle was a comfort bike, followed by a trekking bike. Electric-assisted bicycles and racer bikes occurred at all sites, with proportions of 1%-10% and 1%-15%, respectively. The 2 sites with the highest proportion of electric-assisted bicycles and racer bicycles also had the highest average speeds. The differences in average speed throughout the day, week, and year could only be assessed at one of the sites. Only small differences were found, with the most noticeable being that the average speed was lower in January and February (13.8 km/h) compared to the rest of the year (15.3-16.1 km/h). The average speed was also lower during daytime (14.7 km/h) than during other parts of the day (15.4-15.8 km/h).Conclusions: The relationship between bicycle type and measured speed was not entirely clear, but the results suggest that paths with higher proportions of electric and racer bicycles have higher average speeds. There also appears to be a connection between average speed and the width of the distribution; that is, the higher the average speed, the wider the speed distribution. More research is needed on how speed levels and speed variance affect accident risk.

Effect of a care process programme on frail older people's life satisfaction.

AIM: The aim of this study was to analyse the effects of a full-scale implementation of a care process programme on life satisfaction among frail older people, as compared with those receiving usual care. DESIGN: The study includes participants from a full-scale care process programme (N = 77) and participants from a historical control group (N = 66). The care process programme establishes a comprehensive continuum of care through components including case management, interprofessional teamwork and care-planning meetings in the older people's own homes. METHODS: Questionnaires were used and data were collected at baseline, with follow-ups at three, six and 12 months. RESULTS: The implementation of the full-scale care process programme had a positive effect on life satisfaction among frail older people. From 6-month-12-month follow-ups, a higher proportion of participants in the care process programme had positive life satisfaction outcomes, as compared with the historical control group.

Meal frequency and vegetable intake does not predict the development of frailty in older adults.

BACKGROUND:: Frailty is considered highly prevalent among the aging population. Fruit and vegetable intake is associated with positive health outcomes across the life-span; however, the relationship with health benefits among older adults has received little attention. AIM:: The aim was to examine if a relationship exists between meal frequency or frequency of vegetable intake and the development of frailty in a population of older adults. METHODS:: A total of 371 individuals, 80 years or older, from the study 'Elderly Persons in the Risk Zone' were included. Data was collected in the participants' home by face-to-face interviews up to 24 months after the intervention. Baseline data were calculated using Chi2-test; statistical significance was accepted at the 5% level. Binary logistic regression was used for the relationship between meal frequency or vegetable intake and frailty. RESULTS:: Mean meal frequency was 4.2 ± 0.9 meals per day; women seem to have a somewhat higher meal frequency than men (p=0.02); 57% of the participants had vegetables with at least one meal per day. No significant relationship was found between meal frequency or vegetable intake and frailty at 12 or 24 months follow-ups. CONCLUSIONS:: Among this group of older adults (80+), meal frequency was slightly higher among women than men, and just over half of the participants had vegetables with at least one meal a day. The risk of developing frailty was not associated with meal frequency or vegetable intake. The questions in this study were meant as indicators for healthy food habits.

Life filming as a means of participatory approach together with older community-dwelling persons regarding their local environment.

BACKGROUND: The potential to influence the design of one's local environment is especially important to older people since age-related problems, in combination with a less supportive environment, can prevent the performance of meaningful activities. It is unclear how best to tailor a participatory approach to support the task of collaborating with older persons about their local environment. Life filming was used in such a project. OBJECTIVE: To describe Life filming as a means of participatory approach in relation to older community-dwelling persons and the design of their local environment. MATERIAL AND METHOD: A descriptive single case study. Data were generated through field notes and memos, and analyzed utilizing thematic analysis. Participants have validated the findings. FINDINGS: Five themes describe central aspects of Life filming in the given context: Anchoring the concept of participation, Practical application of Life filming, The film as a product, Making a real difference, and An identity as a capable older person. CONCLUSION: Life filming supported participation, both as a process and an outcome. It had benefits on multiple levels: for the individual person, for older persons as a group, and for the municipality. Life filming could constitute a useful digital tool for practice when a participatory approach is desired.

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.

Face and content validity and acceptability of the Swedish ICECAP-O capability measure: Cognitive interviews with 70-year-old persons.

This study is part of a project that aims to culturally adapt the Investigating Choice Experiments for the Preferences of Older People-CAPability Index (ICECAP-O) for use in research and health and social care in Sweden. The objective was to evaluate face and content validity and acceptability. Eighteen 70-year-old community-dwelling persons participated in cognitive interviews. A standardized classification scheme was used to quantify any identified response problems, and a thematic analysis was applied to capture participants' perceptions of included attributes and experiences of completing the measure. The results show that three participants (18%) had problems completing ICECAP-O, and that judged problems occurred for five (6%) of participants responses in the standardized classification scheme. Most participants perceived the attributes as understandable even though the meaning of Control brought some uncertainty. ICECAP-O seems to measure what it is supposed to measure, quality of life (QoL) with a capability approach, and acceptability is satisfactory. ICECAP- O has potential for becoming a valuable addition to the supply of QoL measures in research and health and social care in Sweden. However, we recommend further research on more diverse groups of older persons.

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.

Minor positive effects of health-promoting senior meetings for older community-dwelling persons on loneliness, social network, and social support.

OBJECTIVE: The aim of this study was to evaluate the 1-year effect of the health-promoting intervention "senior meetings" for older community-dwelling persons regarding loneliness, social network, and social support. METHODS: Secondary analysis of data was carried out from two randomized controlled studies: Elderly Persons in the Risk Zone and Promoting Aging Migrants' Capabilities. Data from 416 participants who attended the senior meetings and the control group at baseline and the 1-year follow-up in the respective studies were included. Data were aggregated and analyzed with chi-square test and odds ratio (OR) to determine the intervention effect. RESULTS: The senior meetings had a positive effect on social support regarding someone to turn to when in need of advice and backing (OR 1.72, p=0.01). No positive intervention effect could be identified for loneliness, social network, or other aspects of social support. CONCLUSION: Health-promoting senior meetings for older community-dwelling persons have a minor positive effect on social support. The senior meetings might benefit from a revision to reinforce content focused on loneliness, social network, and social support. However, the modest effect could also depend on the lack of accessible social resources to meet participants' identified needs, a possible hindrance for a person's capability. This makes it necessary to conduct further research to evaluate the effect of the senior meetings and other health-promoting initiatives on social aspects of older community-dwelling people's lives, since these aspects are of high importance for life satisfaction and well-being in old age.

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.

Microalgal growth in municipal wastewater treated in an anaerobic moving bed biofilm reactor.

Nutrient removal from the effluent of an anaerobic moving bed biofilm reactor (AnMBBR) treated with microalgae was evaluated. Algal treatment was highly efficient in removal of nutrients and discharge limits were met after 3days. Extending the cultivation time from 3 to 5days resulted in a large increase in biomass, from 233.3±49.3 to 530.0±72.1mgL(-1), despite nutrients in the water being exhausted after 3days (ammonium 0.04mgL(-1), orthophosphate <0.05mgL(-1)). Biomass productivity, lipid content and quality did not differ in microalgal biomass produced in wastewater sampled before the AnMBBR. The longer cultivation time resulted in a slight increase in total lipid concentration and a significant decrease in linolenic acid concentration in all treatments. Differences were observed in chemical oxygen demand, which decreased after algal treatment in wastewater sampled before the AnMBBR whereas it increased after algal treatment in the effluent from the AnMBBR.

The Swedish joint action method against drink driving-a study of suspected drink drivers' own experiences.

OBJECTIVE: In Sweden, a joint action method called SMADIT is in use, where the police quickly offer help from the social services or the dependency care and treatment service to suspected drink drivers. The objective of this article is to analyze the experiences of suspected drink drivers who accepted the offer of help and what it meant for them. The knowledge can be used to improve procedures and consultations. Furthermore, it can allow the basic premises of the method to be examined; for example, the importance of offering help quickly. METHODS: To enable comparisons over time, in-depth interviews were conducted with 12 suspected drink drivers on 2 occasions with 1 year between. RESULTS: To varying degrees the informants knew about their alcohol problems but were unsure whether they would have sought help by themselves. Therefore, the original ideas of the method with an initial contact with the social services or the dependency care and treatment service within 24 h was found to be important. However, the results also showed that some of the informants needed some time before the first meeting because they were in shock from the drink driving incident or in need of sleep. Therefore, the drink driver's situation and individual wishes always have to be considered. The article also shows that an encouraging attitude among the police, the social services, and the dependency care and treatment service is important for the success of the SMADIT method. The informants are satisfied with the method and in retrospect the incident and the SMADIT offer of help are described as a turning point in their lives. One year after being offered help the informants were no longer focused solely on the personal consequences of drink driving, as they were shortly after the incident. Instead, they had gained insights into the harm they could have done to other road users when they drove while drunk. CONCLUSIONS: One conclusion from this article is that SMADIT, as an innovative method that can be deployed more rapidly than other alcohol-impaired driving countermeasures, should be considered as a good complement to conventional methods to deal with drink driving. Based on the results, we recommend a trial of the joint action method against drink driving in other jurisdictions.

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.

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.

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.