Zest for life among 65- and 75-year-olds in Northern Finland and Sweden--a cross-sectional study.

BACKGROUND: Zest for life refers to being satisfied with life and having the energy and courage to look for new experiences. Research into zest for life among older people is scarce, even though it is an important topic. Similarly related concepts such as life satisfaction, quality of life and purpose in life have received more attention. AIM: The aim of this study was to investigate zest for life and factors and variables associated with zest for life among 65- and 75-year-olds. METHOD: A descriptive cross-sectional design was used, employing data from a cross-sectional survey in Northern Finland and Sweden with a total of 3372 respondents. Sociodemographic data were gathered: social contacts; helping relatives; activities; involvement in society; health; use of social services; economic situation; ageism; crises in life; and well-being. Logistic regression analysis was employed to examine independent factors associated with zest for life. RESULTS: A total of 2854 respondents (nearly 85%) reported having zest for life, with only 47 (1.4%) having no zest for life. Several factors were significantly associated with zest for life. Using logistic regression analysis, the following factors were found to be determinants of zest for life: no diseases (OR = 9.1), general health (OR = 6.1), not discriminated against due to age (OR = 5.4), no crises in life last year (OR = 7.0), experienced depression never/seldom (OR = 88.4) and experienced meaning in life (OR = 10.4). CONCLUSIONS: In general, 65- and 75-year-olds in Finland and Sweden have a zest for life. Even though the study sample shows that only a small number of respondents have no zest for life, zest for life is a concept worth investigating in that there exists a strong association between no zest for life and depression. Physical and psychological health and well-being are important determinates of zest for life and, seemingly, a determinate for successful ageing.

Physical restraint use in institutional care of old people in Sweden in 2000 and 2007.

BACKGROUND: Physical restraint use is common in institutional care for old people and mainly used to prevent falls, despite the fall-preventive effect of physical restraints being questioned in previous research. The aim of the study was to investigate the use of physical restraints in Sweden in 2000 and 2007. METHODS: Data were collected from two comparable census surveys conducted in all institutional care units for old people in 2000 (n = 3,669) and 2007 (n = 2,914). Information on residents' characteristics and physical restraint use was collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). RESULTS: In 2000 16.0% (95% confidence interval (CI) 14.8%-17.2%) of the residents were restrained compared to 18.2% (95% CI 16.8%-19.6%) in 2007 (p = 0.017). Adjusting for residents' characteristics showed that residents in 2007 were more likely to be physically restrained, relative to the residents in 2000 (odds ratio (OR) 1.031, 95% CI 1.005-1.058, p = 0.017). In 2007 the residents had been restrained longer, and a higher proportion were restrained for unknown reasons. CONCLUSIONS: Physical restraint use is still common. Moreover, the findings of this study suggest a small increase (OR 1.031) in the prevalence of physical restraint use from 2000 to 2007 adjusted for residents' characteristics.

Effects of a restraint minimization program on staff knowledge, attitudes, and practice: a cluster randomized trial.

OBJECTIVES: To evaluate the effects of a restraint minimization education program on staff knowledge and attitudes and use of physical restraints. DESIGN: Cluster-randomized controlled trial with nursing units as the basis for randomization. SETTING: Forty group dwelling units for people with dementia. PARTICIPANTS: At baseline, there were 184 staff and 191 residents in the intervention group and 162 staff and 162 residents in the control group. At the 6-month follow-up, there were 156 staff and 185 residents (36 newly admitted) in the intervention group and 133 staff and 165 residents (26 newly admitted) in the control group. INTERVENTION: A 6-month education program for all nursing staff. MEASUREMENTS: Staff knowledge and attitudes and physical restraint use were measured before and after the education program. RESULTS: In the intervention group, staff knowledge about and attitudes toward restraint use changed, and the overall use of physical restraints decreased. A comparison including only residents present during the whole study period showed that the level of use was similar between the groups at baseline, whereas it was significantly lower in the intervention group at follow-up. Adjusted analyses showed that the odds of being restrained at follow-up were lower in the intervention group than in the control group. There was no significant change in the number of falls or use of psychoactive medication. CONCLUSION: The results indicate that staff education can increase knowledge, change attitudes, and reduce the use of physical restraints without any change in the incidence of falls or use of psychoactive drugs.

Risk factors for falls among residents with dementia living in group dwellings.

BACKGROUND: Falls are a major cause of morbidity and mortality among elderly people, and people with dementia run an increased risk of falling. The aim of this study is to identify risk factors for falls in people with dementia. METHOD: The study was performed over a six-month period in northern Sweden using a sample of 160 residents living in 20 group dwellings for people with dementia. RESULTS: Sixty-four residents (40%) sustained at least one fall during the period. The total number of falls during the study period was 191, and the fall incidence was 2.6 per person year (169 falls/130 residents). Using logistic regression analysis, the independent risk factors strongly associated with falling were: requiring help with hygiene, displaying verbally disruptive/attention-seeking behavior, able to rise from a chair, walking with assistive devices, and participating in outdoor walks. These factors explained 36.1% of the variance in falls with a concordance of 79.6%. Thirty-five percent of the falls occurred between 9 pm and 6 am, with a peak between 5 pm and 6 pm. Symptoms preceding the falls were anxiety (31.1%) and confusion (13.3%). CONCLUSION: Among residents with dementia it is important to identify those who run an increased risk of falling and need more careful supervision, especially in the evening and during the night. In addition, the causes of anxiety and confusion have to be prevented and treated.