What makes older adults feel good?

BACKGROUND AND AIM: To inform health promotion interventions, there is a need for large studies focusing specifically on what makes older adults feel good, from their own perspective. The aim was to explore older adults' views of what makes them feel good in relation to their different characteristics. METHODS: A qualitative and quantitative study design was used. Independently living people (n = 1212, mean age 78.85) answered the open-ended question, 'What makes you feel good?' during preventive home visits. Following inductive and summative content analysis, data was deductively sorted, based on The Canadian model of occupational performance and engagement, into the categories leisure, productivity, and self-care. Group comparisons were made between: men/women; having a partner/being single; and those with bad/good subjective health. RESULTS: In total, 3117 notes were reported about what makes older adults feel good. Leisure activities were the most frequently reported (2501 times), for example social participation, physical activities, and cultural activities. Thereafter, productivity activities (565 times) such as gardening activities and activities in relation to one's home were most frequently reported. Activities relating to self-care (51 times) were seldom reported. There were significant differences between men and women, having a partner and being single, and those in bad and good health, as regards the activities they reported as making them feel good. DISCUSSION AND CONCLUSIONS: To enable older adults to feel good, health promotion interventions can create opportunities for social participation and physical activities which suit older adults' needs. Such interventions should be adapted to different groups.

Exploring housing policies in five Swedish municipalities: alternatives and priorities.

INTRODUCTION: Housing shortage due to population growth within metropolitan areas, combined with an ageing population, has put pressure on current housing provision in Sweden. Thus, there is an urgent need to develop sustainable housing policies to accommodate the growing number of seniors in accessible home environments. This study aimed to gain an in-depth understanding of how municipalities currently address housing accessibility issues and to explore what types of policy solutions they consider for the future. MATERIAL AND METHODS: Five Swedish municipalities were selected to represent a diversity of the population, housing provision approaches, and geographical areas. To understand current housing policies, two key actors (e.g. public officials, housing adaptation grant managers, city architects, etc.) from each municipality participated in semi-structured interviews (N = 10). Subsequently, those key actors, two senior citizens, and three researchers participated in a research circle to explore future policy solutions. Data were analyzed using content analysis. RESULTS: The interviews revealed common approaches to deal with housing accessibility issues such as regular renovations and maintenance, individual adaptations based on specific needs, and seeking collaboration with private housing actors on housing provision matters. Possible measures suggested for the future included increasing the national coordination of housing accessibility policies, amending legislation to only allow the construction of housing according to strengthened accessibility standards, and introducing economic incentives for seniors to move from housing with poor accessibility to more accessible accommodations. CONCLUSIONS: Municipalities struggle with the lack of accessible and affordable housing for their ageing population, despite a large variety of policies from economic incentives to research and development policies. The results suggest that collaboration needs to be improved between all actors involved in housing policies. Preventive measures within the current laws may be needed to strengthen the construction of more accessible and affordable housing for populations ageing in place.

Involvement of professionals in research: knowledge integration, development of practice, and challenges: a group concept mapping study.

BACKGROUND: Research and practice are often considered as two different worlds with different values, which causes a gap between them. Involving professionals such as practitioners, managers, decision-makers, and policy-makers in research on ageing and health might address the gap between research and practice, strengthen the healthcare system, and increase older people's possibilities for healthy ageing. The aim of this study was to conceptualize professionals' involvement in research on ageing and health from the perspective of the professionals themselves. METHODS: A mixed method called group concept mapping was used. Professionals with experience being involved in research on ageing and health participated in qualitative data collection through brainstorming sessions (n = 29) and by sorting statements (n = 29). Afterwards, they participated in a quantitative data collection by rating statements according to how much each statement strengthened practice (n = 30) and strengthened research (n = 28). Multidimensional scaling analysis and hierarchical cluster analysis were used to conduct quantitative analysis. Latent qualitative analysis was also conducted. RESULTS: Analysis resulted in eight clusters which illustrated conceptual areas of professionals' involvement in research projects. The qualitative latent construct of the cluster map resulted in the themes: challenges for professionals; prerequisites and professionals' learning can contribute to development of practice; and integrated knowledge benefits older people. There was a strong correlation between what strengthens practice and research (r = 0.92). CONCLUSIONS: This study illustrates conceptual areas of professionals' own perspectives on what their involvement in research can lead to. Their involvement may lead to knowledge being integrated, and the professionals may learn through their involvement, which can contribute to the development of practice. However, there can also be challenges that need to be handled when professionals are involved in research. The study can be useful for improving the understanding of and actual involvement of professionals in research, and for optimizing the involvement of professionals.

Conceptualizing researchers' perspectives on involving professionals in research: a group concept mapping study.

BACKGROUND: Researchers have shown an increased interest in involving professionals from outside academia in research projects. Professionals are often involved in research on ageing and health when the purpose is to address the gap between research and practice. However, there is a need to acquire more knowledge about what the involvement might lead to by exploring researchers' experiences of involving professionals in research on ageing and health and developing conceptual areas. Therefore, the aim of this study was to identify conceptual areas of professionals' involvement in research on ageing and health, from the perspective of researchers themselves. METHODS: Group concept mapping, a participatory and mixed method, was used to conceptualize areas. Researchers with experience of involving professionals in research projects on ageing and health participated in qualitative data collection through brainstorming sessions (n = 26), and by sorting statements (n = 27). They then took part in quantitative data collection, where they rated statements according to how much a statement strengthened research (n = 26) and strengthened practice (n = 24). Data were analysed using multidimensional scaling analysis and hierarchical cluster analysis. In addition, a qualitative analysis of the latent meaning of the cluster map was conducted. RESULTS: Analysis of the sorting stage generated five clusters illustrating conceptual areas of professionals' involvement in research projects on ageing and health. The five clusters are as follows: complex collaboration throughout the research process; adaptation of research to different stakeholders, mutual learning through partnership; applicable and sustainable knowledge; legitimate research on ageing and health. The qualitative latent meaning of the cluster map showed two themes: the process of involvement and the outcome of involvement. A positive strong correlation (0.87) was found between the rating of strengthened research and practice. CONCLUSIONS: This study reveals conceptual areas on a comprehensive and illustrative map which contributes to the understanding of professionals' involvement in research on ageing and health. A conceptual basis for further studies is offered, where the aim is to investigate the processes and outcomes entailed in involving professionals in research on ageing and health. The study also contributes to the development of instruments and theories for optimizing the involvement of professionals in research.

Older person's experiences of benefits gained from the support and advice given during preventive home visits.

BACKGROUND: Life expectancy is increasing all over the world. To be able to support this positive development, health interventions focusing on promotion and prevention are crucial. Preventive home visits represent one example of a health intervention which addresses both promotion through a supportive dialogue and prevention by giving advice. However, to give support and advice that older persons experience as beneficial, there is a need for more research. AIM: The aim of this study was to explore older person's experiences of the benefits gained from the support and advice given during the preventive home visit. METHOD: Individual semi-structured interviews were conducted with 13 older persons, median age 77 years old, living at home, who had received a preventive home visit. The interviews were analysed with content analysis. FINDINGS: The overarching theme Becoming empowered and recognised as a person was experienced as the major benefit of the support and advice given during the preventive home visit. The support and advice generated conditions for the person to become empowered, by contributing to a feeling of control and preparedness for the future. Furthermore, the support and advice given contributed to a feeling of becoming recognised as a person, as an outcome of the supportive dialogue and the assessment of their health, behaviour and their surrounding environment. CONCLUSION: The support and advice given during the preventive home visit were experienced as person-centred, and conditions for becoming empowered were created. In order to create a positive outcome from the support and advice given during the preventive home visit, it seems important to focus on providing both a supportive dialogue and a structured assessment.

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

BACKGROUND: User involvement of people outside academia in research is argued to increase relevance of research for society and to empower the involved lay persons. Frail older people can be a hard to reach group for research and thus an underrepresented group in research. There is a lack of knowledge how collaboration with frail older people should be best performed. Therefore, the aim of this study was to explore frail older people's experiences of involvement in research. METHODS: In this study we have invited people, 75 years of age or older screened as physically frail and who have previously participated in a study as data sources, to share their experiences by intensive interviewing. Data was collected and analysed in parallel inspired by a constructivist grounded theory approach. RESULTS: The results demonstrate how frail older people have different incentives, how their context of ageing and the unusual position of being involved in research altogether influenced how, where and in what way they wished to be involved in research. This is described in three categories: Contributing to making a difference for oneself and others, Living a frail existence and Being on somebody else's turf. The categories compose the core category, Challenging oneself on the threshold to the world of research, which symbolises the perceived distance between the frail older people themselves and the research world, but also the challenges the frail older people could go through when choosing to be involved in research. CONCLUSIONS: Frail older people have a varied capacity to participate in research, but in what way and how is difficult to know before they have been involved in the process of research. Our results advocate that it is problematic to exclude frail older people a priori and that there is a potential for new perspectives and knowledge to be shaped in the encounter and in the relationship between the researcher and the frail older person. For research to be able to cater for frail older people's needs of health services, their voices need to be heard and taken into consideration.

Factors associated with good health among older persons who received a preventive home visit: a cross-sectional study.

BACKGROUND: The ageing population is increasing worldwide, and this trend is bringing challenges both for the older person and for society. In order to meet the challenges a comprehensive approach is needed involving both health promotion and risk prevention. The preventive home visit is a public health intervention used around the world with the purpose of promoting health and preventing risk among older persons. However, most preventive home visits are focused on questions asking about risks. In order to strengthen the health promotion perspective during the preventive home visits, factors associated with good health need to be identified. The aim of this study was therefore to determine which factors were associated with good self-rated health among older persons who received preventive home visit. METHODS: This was a register study with a cross-sectional design, including older persons (≥75 years old), living in their own homes, and that had received preventive home visit. Data were collected during a period of 9 months, in two municipalities in the south of Sweden. A questionnaire covered mental, physical and lifestyle factors were used at home visit. Binary logistic regression was used to analyse the data. RESULTS: In total, 619 older persons were included in the study; 55.4% were women, and the mean age was 80.6 years (standard deviation 2.2 years). The following items were significantly associated with good health (after adjustment for age and gender): being able to do things that make one feel valuable, having no physical problems affecting participation in social activities, not feeling sad, not having reduced energy, and not having impaired endurance. CONCLUSIONS: The main conclusion of this study is that questions focusing on risks could be seen from a health promotion perspective and could thus be turned into assets with a positive impact on older persons' health. Furthermore, the mental and physical factors identified in the results as associated with good health have implications for the person's ability to feel valuable and participate in social activities. The results suggest that issues regarding both health promotion as well as risk prevention must be brought up during the preventive home visit.

The influence of participation on mortality in very old age among community-living people in Sweden.

BACKGROUND: Participation in everyday life and society is generally seen as essential for health-related outcomes and acknowledged to affect older people's well-being. AIMS: To investigate if aspects of performance- and togetherness-related participation influence on mortality among very old single living people in Sweden. METHODS: ENABLE-AGE Survey Study data involving single-living participants in Sweden (N = 314, aged 81-91 years), followed over 10 years were used. Multivariate Cox regression models adjusted for demographic and health-related variables were used to analyse specific items influencing mortality. RESULTS: Participation in performance- or togetherness-oriented activities was found to significantly influence mortality [HR 0.62 (0.44-0.88), P value 0.006, and HR 0.72 (0.53-0.97), P value 0.031, respectively]. Talking to neighbours and following local politics had a protective effect on mortality, speaking to relatives on the phone (CI 1.10-2.02) and performing leisure activities together with others (CI 1.10-2.00) had the opposite influence. That is, those performing the latter activities were significantly more likely to die earlier. DISCUSSION: The main contribution of this study is the facet of the results showing that aspects of performance- and togetherness-related participation have a protective effect on mortality in very old age. This is important knowledge for designing health promotion and preventive efforts for the ageing population. Moreover, it constitutes a contribution to the development of instruments capturing aspects of participation influencing on mortality. CONCLUSION: In the development of health promotion and preventive efforts the inclusion of participation facets could be considered in favour of potential positive influences on longevity.

Changes in Home and Health over Nine Years among very Old People in Latvia - Results from the ENABLE-AGE Project.

To meet the needs of an increasing, heterogeneous, ageing population it is imperative to understand links between home and health. In Latvia, only limited research targeting the health and home situation of very old people is available. Consequently, the aim of this study was to describe how the home environment and aspects of health have changed over nine years between 2002 and 2011 for very old people in Latvia, living in their home environment. This study is based on the Latvian part of the cross-national European ENABLE-AGE Project comprising data on objective, as well as perceived, aspects of home and health. Longitudinal data from those involved on both data collection occasions (N = 59) was used. At the nine-year follow-up, participants were between 86 and 90 years of age, still living in their own homes. The results show that not only health aspects varied along the ageing process, objective and perceived aspects of home also changed. The physical as well as the cognitive and emotional bonding to the home significantly increased i.e. aspects of meaning such as familiarity and feeling safe in your home, privacy and independence became more important for the very old participants over time. Life satisfaction increased over the years even though objective health factors decreased. Since aspects of home as well as health can be assumed to impact on the outcome of ageing, the situation for this age group in Latvia must be further studied in order to develop suitable and appropriate social and health services, policies and living conditions.

Patterns of functional decline in very old age: an application of latent transition analysis.

BACKGROUND AND AIMS: There is a scarcity of longitudinal studies examining how functional decline develops among very old people. The aim of the current study was to detect and characterize typical patterns of functional decline in a sample of very old people. METHODS: We utilized longitudinal data from a sample of people aged 80-89 at baseline from Sweden and Germany (N = 847). Three follow-up assessments were completed and 159 participants completed the last assessment 9 years after baseline. Death (45 %) and contact no longer possible (40 %) were main reasons for dropout. We used latent transition analysis (LTA) to estimate the probabilities of latent class membership at each measurement point, as well as the transition probabilities of moving from one class to another. RESULTS: Three latent classes were revealed, labeled Mobility Problem Stayers, Hearing Problem Advancers and Visual Problem Advancers. The first class had a low probability of additional problems throughout the study period, while the two latter had increased probabilities of additional limitations. In terms of class membership change, Mobility Problem Stayers moved either towards Hearing Problem Advancers or towards Visual Problem Advancers. DISCUSSION AND CONCLUSIONS: The results suggest that mobility problems are most common when people reach the age of 80+. Further decline is typically characterized by the addition of either visual problems or hearing problems, which are both associated with an increased risk of limitations in upper extremities. These findings warrant further research to analyze the association between the detected typical patterns of functional decline and health-related outcomes.

Recommendations for healthy aging as documented by health professionals: a summative content analysis of health records.

AIM: To identify what type of recommendations were recorded in older adults' health records by health professionals during preventive home visits. BACKGROUND: To promote health and prevent ill health, health professionals can give support and recommendations to older adults. The preventive home visit for older adults is one example of an intervention where health professionals such as nurses, social workers, and assistant nurses can give recommendations. By exploring what recommendations are recorded and within what areas, we can also gain knowledge about areas where provision of recommendations seems lacking. This knowledge would provide health professionals with guidance in their counseling with the older adult. METHODS: Records from preventive home visits (n = 596; mean age 78.71) were qualitatively and quantitatively analyzed. FINDINGS: The most frequently recorded recommendations were related to physical or mental illness, falls, and then nutrition. The results showed that recommendations could be sorted into ten sub-categories related to physical or mental illness, falls, nutrition, physical activity, preparation for the future, social participation, finances, getting help from others, municipal services, and security at home. These ten sub-categories were classified into the International Classification of Functioning, Disability, and Health categories body functions & structure (including one sub-category), activity (including four sub-categories), participation (including three sub-categories), and environmental factors (including two sub-categories). From the results, we could conclude that the major focus was on risk prevention and less focus was on health promotion. Thus, the visitor's recommendations most likely mirror the older adult's explicit needs 'here and now' to a great extent. However, health visitors also need to focus on intrinsic capacities to promote health. Besides recommendations relating to the person's intrinsic capacities, environmental aspects should be focused upon, to improve healthy aging.

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

BACKGROUND: Society is placing increasing demands on collaboration with actors outside the academia to be involved in the research process, and the responsibility for turning this into reality lies with the researchers. As research collaboration is a way to increase the societal relevance of research and since older people have the right to be actively involved in research that concerns them, this study is addressed to researchers who work with and for older people. The purpose of this article is to explore researchers' experiences of research collaboration with the heterogeneous group of older people, from healthy to frail. METHODS: The focus group method was applied based on a qualitative approach that is based on a social constructivist research tradition. It differs from other qualitative methods, such as interviews, in that it encourages interaction between research participants and contributes to shedding light on a collective understanding of the world. A total of 14 researchers participated in four focus groups (three to five participants/group). RESULTS: The results provided support for the overall theme: "Good scientific quality and ethics are balanced against the needs and abilities of older people". This means a balance between the researcher and the older people collaborating with them to receive the best possible scientific quality. This is highlighted in the core category "Positioning for research collaboration" with the subcategories "Involvement or not", "Traditional or innovative thinking" and "Selectivity or representativeness", and the core category "Research collaboration - an ethical issue of power" with the subcategories "Research collaboration a risk for freedom of research", "Research collaboration a risk of abuse of power" and "Discriminatory academic power structures create ethical issues". CONCLUSIONS: Addressing the balancing act of collaborating with older people in research, the findings contribute with an understanding of the importance of researchers' awareness of social and academic structures to minimise the risk of epistemic injustices in research on ageing and health. We want to highlight the researchers' voice and clarify the role that researchers have in terms of the opportunities for older people to become part of the collective understanding of ageing and health and make their voices heard.

Society is increasingly expecting researchers to involve people who are not researchers in their research. To understand how such collaboration could become a reality, this study aimed to explore researchers' experiences of collaborating with older people in research on ageing and health. A total of four focus groups consisting of 14 researchers from two universities were conducted to discuss experiences, approaches, opportunities and obstacles for research collaboration with older people. The results revealed an overarching theme that describes research collaboration as a balancing act with scientific quality and ethics on one side, and the needs and abilities of older people on the other side. This means that researchers need to strike a balance between achieving the highest scientific quality and considering the needs and abilities of older people they are collaborating with. To understand how unethical, it is to not involve older people in research, the concept epistemic injustice has been used. It refers to the systematic exclusion of certain groups from knowledge production and dissemination which can lead to the exploitation of vulnerable populations and the perpetuation of harmful stereotypes. In addressing the challenges of collaborating with older people in research, this study emphasises the importance of researchers being aware of both social and academic structures that might affect whose voices are heard in research. This awareness could help researchers clarify their role in giving older people the opportunity to be part of the collective understanding of ageing and health.

The Relationship Between Physical Housing Characteristics, Housing Accessibility and Different Aspects of Health Among Community-Dwelling Older People: A Systematic Review.

Objectives: To synthesize the evidence on the relationships between physical housing characteristics or housing accessibility and different aspects of health among community-dwelling people 60 years and older. Methods: A systematic review of recent evidence with a narrative synthesis was conducted. Results: We included 15 studies and found three themes covering physical housing characteristics or housing accessibility that are associated with aspects of health among community-dwelling older adults: (1) interventions by home modifications targeting housing features both at entrances and indoors; (2) non-interventions targeting indoor features; (3) non-interventions targeting entrance features, that is, the presence of an elevator or stairs at the entrance. The overall quality of evidence across studies was assessed as very low. Discussion: The findings highlight the need for studies with a stronger research design and higher methodological quality that address the physical housing environment in relation to health among older adults to strengthen the body of evidence.

Environmental barriers, person-environment fit and mortality among community-dwelling very old people.

BACKGROUND: Environmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80- to 89-year-old single-living people. METHODS: This longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002-2003, and 393 were followed up for mortality until May 15, 2012.Environmental barriers and functional limitations were assessed with the Housing Enabler instrument, which is intended for objective assessments of Person-Environment (P-E) fit problems in housing and the immediate outdoor environment. Mortality data were gathered from the public national register. Cox regression models were used for the analyses. RESULTS: A total of 264 (67%) participants died during follow-up. Functional limitations increased mortality risk. Among the specific environmental barriers that generate the most P-E fit problems, lack of handrails in stairs at entrances was associated with the highest mortality risk (adjusted RR 1.55, 95% CI 1.14-2.10), whereas the total number of environmental barriers at entrances and outdoors was not associated with mortality. A higher number of environmental barriers indoors showed a slight protective effect against mortality even after adjustment for functional limitations (RR 0.98, 95% CI 0.96-1.00). CONCLUSION: Specific environmental problems may increase mortality risk among very-old single-living people. However, the association may be confounded by individuals' health status which is difficult to fully control for. Further studies are called for.

The Content of Physiotherapy and Factors Impacting on Reablement - A National Study.

Purpose: Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions' actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods: Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results: Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95-4.49). About 50% (n=517) of the cases involved 1-2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion: Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients' needs and wishes, or conversely an expression of limited resources, remains to be investigated.

The influence of the Covid-19 pandemic on municipal meeting places arranging group exercise for older persons.

PURPOSE: Many municipalities today, together with other stakeholders, offer group exercises for the older population via municipal meeting places, focusing on promoting good health. During the Covid-19 pandemic, these group exercises either continued in a modified form or ceased. The aim of this study was to explore involved stakeholders' experiences of group exercises for older persons arranged via municipal meeting places during the Covid-19 pandemic. METHODS: Six online focus group interviews were conducted with 25 stakeholders, such as decision-makers and representatives from the non-profit sector, from seven municipalities in Sweden. Data were analysed using thematic analysis. FINDINGS: The collaboration around the group exercises was challenged due to affected communication and decision-making. The stakeholders described the importance of adapting and finding new ways to offer group exercise. Furthermore, the re-arranging of group exercises created concerns about the well-being of the older persons but also happiness with the older persons ability to act for their own well-being during the pandemic. CONCLUSIONS: This study highlights the importance of the municipalities exchanging experiences, making the older persons more involved in the decision-making process, enabling a person-centred encounter with the older persons when exercising in groups, and strengthening supportive environments by sharing the ownership of arranging the group exercises with the older persons.

The jigsaw puzzle of activities for mastering daily life; service recipients and professionals' perceptions of gains and changes attributed to reablement - A qualitative meta-synthesis.

BACKGROUND: Reablement services are intended to make a difference in the daily lives of older adults. Outcomes are often described in terms of independence, improving quality of life, improving ADL functioning, or reducing services. However, little is known if the older adults or next-of-kin experience these outcomes when talking about participating in reablement services. AIM: This study aims to explore how older adults, next-of-kin, and professionals narrate the reablement recipients' possible outcomes as gains and changes in everyday life during and after the reablement period. MATERIALS AND METHODS: This meta-synthesis included 13 studies. Data were analyzed with a meta-ethnographic approach, searching for overarching metaphors, in three stages. RESULTS: The metaphor 'the jigsaw puzzle of activities for mastering daily life again' illustrates that re-assembling everyday life after reablement is not a straightforward process of gains and changes but includes several daily activities that must be organized and fit together. To obtain a deeper understanding of the participants' gains, and changes after reablement, we use the theoretical framework of 'doing, being, becoming, and belonging'. CONCLUSION: The findings indicate the complexity of reablement services as well as the need for a holistic approach. SIGNIFICANCE: Outcome measures should be meaningful for reablement recipients.

Life satisfaction in older women in Latvia and Sweden-relations to standard of living, aspects of health and coping behaviour.

To study and compare associations between life satisfaction and standard of living, health, and coping behaviour in older single-living women in two countries with different political, economical and cultural situations: Latvia and Sweden. Cross sectional data included 260 Latvian and 288 Swedish women, aged 75-84 and 80-89, from the ENABLE-AGE Survey Study. Life satisfaction was assessed by the question: All in all, how satisfied are you with your life? Standard of living was assessed by economic and housing conditions, and health by perceived and objective health and activities in daily living. Three factors, Fight, Helplessness, and Distraction, were obtained from the Coping Patterns Schedule. Correlations between Life satisfaction and standard of living, health, and coping were calculated. The variance in Life satisfaction explained by these variables was obtained in each sample by ordinal regression models. Life satisfaction was significantly lower in the Latvian sample than in the Swedish. Standard of living was lower and health poorer in the younger Latvian sample than in the Swedish, but more of the variance in Life satisfaction was explained in the Latvian sample by standard of living (18% vs 2%) and less by health (6% vs 15%). Coping factors explained 29% of the variation in Life satisfaction in the Latvian sample as opposed to 15% in the Swedish. For single-living older women low standard of living seems to be a more serious obstacle than poor health, making it difficult to obtain a reasonable life satisfaction.

Enabling social participation for older people: The content of reablement by age, gender, and level of functioning in occupational therapists' interventions.

BACKGROUND: Social participation and the ability to build and maintain social relationships is emphasized as important for older people's health and well-being. AIM: To explore if social participation is addressed and whether age, gender and level of functioning are associated with the composition of occupational therapy interventions within the context of reablement. METHOD: In this cross-sectional study, invitations to participate were sent to 60 municipalities in Sweden. 318 occupational therapists participated and described the character of initiated interventions made during 3 weeks through web-based surveys. RESULT: 1392 cases were reported in the age span of 19-103 years, 61.7% were women. A higher proportion of persons having no home care and minor functional dependency got interventions with a focus on social participation to a higher extent than persons with major functional dependency. Occupational therapists' interventions vary as related to functional limitation, age, and gender. CONCLUSION: The results indicate that the severity of functional limitation impacts the focus of the intervention whereas age and gender do not. There is a need for social participation to be more clearly addressed within the context of reablement. SIGNIFICANCE: To develop a person-centred intervention, one needs to consider aspects of age, gender, and functions.