Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings (CGA-Swed): A Randomised Controlled Study.

The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) for frail older people in Swedish acute hospital settings - the CGA-Swed study. In this study protocol, we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. The study is a randomised controlled trial with an intervention group receiving the CGA and a control group receiving medical assessment without the CGA. Follow-ups were conducted after 1, 6 and 12 months, with dependence in activities of daily living (ADL) as the primary outcome measure. The study group consisted of frail older people (75 years and older) in need of acute medical hospital care. The study design, randomisation and process evaluation carried out were intended to ensure the quality of the study. Baseline data show that the randomisation was successful and that the sample included frail older people with high dependence in ADL and with a high comorbidity. The CGA contributed to early recognition of frail older people's needs and ensured a care plan and follow-up. This study is expected to show positive effects on frail older people's dependence in ADL, life satisfaction and satisfaction with health and social care.

Understanding User Involvement in Research in Aging and Health.

User involvement in research is advocated as an avenue for efficient societal developments. In this article, we identify potentials, problems, and challenges related to research on aging and health, and identify and illustrate research priorities using an evolving research program as an example. Involving user representatives in the development phase, the UserAge program engages researchers at four universities in Sweden. The program builds upon previous and ongoing research with user involvement. The goals are to maximize the impact of user involvement, enhance the execution of high-quality research, increase the knowledge about what difference user involvement can make, and evaluate the impact of research about and with user involvement. Taken together and communicated in the international scientific community as well as in a wide range of public arenas, the empirical results, capacity-building, and modeling efforts of UserAge will have an impact not only on the present situation but also on the future.

Comprehensive geriatric assessment of frail older people: ideals and reality.

We explored different professionals' views on and experiences of comprehensive geriatric assessment (CGA) of frail older people. Forty-six professionals working in hospitals, primary care, or municipal health and social care participated in 10 focus groups. Professional groups comprised of occupational therapists, physiotherapists, nurses, physicians, and social workers. Participants shared an ideal image of how the CGA of frail elderly people should be conducted. Experience-based competence was more often used as an assessment tool than standardized tests. The ideal image contrasted with reality, listening to the needs expressed, with the person's problems, needs, and priorities in the foreground, as described by the categories: a need that can be met; different perspectives on needs; needs can be hidden; and needs assessment is affected by the collaboration around the person, by the context, and by the dialogue. The health and social care professionals' first priority is to make a person-centred tailor-made comprehensive geriatric assessment and not be bound to instruments. Clear guidelines need to be developed, stating which profession assesses what, when and how in order to ensure that person-centred needs are assessed including structures and procedures for how communication and collaboration within the team as well as between the organizations are achieved in order to perform a good person-centred CGA.

Health-promotion in the context of ageing and migration: a call for person-centred integrated practice.

OBJECTIVE: For the aim of improving the implementation of a health-promoting intervention for older persons who are born abroad, this study aimed to explore health care professionals' experiences of facilitators and barriers for their possibilities to support a healthy ageing in the context of migration. METHODS: Qualitative data were collected from four focus groups with health professionals who all had experience of working with older persons who are born abroad. Data were analysed with the guidance from the method developed by Krueger and Casey, progressing from an empirical to an abstract level. RESULTS: FIVE DIFFERENT CONDITIONS WERE FOUND TO INFLUENCE SUPPORTING HEALTHY AGEING IN THE CONTEXT OF MIGRATION: Sense of belonging through significant others, Emotional bonds to a place called home, Expectations on health and support during the ageing process, Mutual understanding as a means for communication and Heterogeneity as a point of departure. The one comprehensive theme complexity describes how those aspects are interrelated in a complex and unpredictable way. CONCLUSIONS: The results point at the need for focusing on each person's experiences and health expectations, and the study provides a foundation for future research on the integration of whole-system and person-centred practice.

Preventive home visits and health--experiences among very old people.

BACKGROUND: As more people reach older age, there is a growing interest in improving old person's health, activity, independence and social participation, thereby adding quality to the extended years. Preventive home visits (PHV) programs for old people have received much attention in recent decades. A large body of research shows mixed effects, and argues that a home visit is a complex social process influenced by numerous factors. To evaluate the impact of PHV, as well as making decisions on whether, how, and to whom the service should be provided, requires a deeper understanding of PHV than we have now. Consequently, the aim of the study was to describe the variations in older people's (80+) experiences of a single preventive home visit and its consequences for health. METHODS: Seventeen participants between 80 and 92 years of age who had all received a structured PHV were interviewed in their own homes. The interviews were analyzed using the phenomenographic method, looking at the variations in the participants' experiences. RESULTS: The interviews revealed four categories: "The PHV made me visible and proved my human value"; "The PHV brought a feeling of security"; "The PHV gave an incentive to action"; and "The PHV was not for me". CONCLUSIONS: The experiences of a PHV were twofold. On one hand, the positive experiences indicate that one structured PHV was able to empower the participants and strengthen their self-esteem, making them feel in control over their situation and more aware of the importance of keeping several steps ahead. Together this could motivate them to take measures and engage in health-promoting activities. On the other hand, the PHV was experienced as being of no value by a few. These findings may partly explain the positive results from PHV interventions and emphasize that one challenge for health care professionals is to motivate older people who are healthy and independent to engage in health-promoting and disease-preventive activities.

Assistive technology and home modification for people with neurovisual deficits.

People with neurovisual deficits from acquired brain injuries and other neurological disabilities can benefit from the array of assistive technologies and home modifications available to the larger vision impairment population, especially when symptoms are mild and associated neurological conditions are few. Optics, proper lighting, and magnification to increase the perceived size of both objects and reading material and to improve contrast sensitivity have been shown to be beneficial. Innovative technologies, universally designed for safe independent living and community participation are gradually developing and show promise for addressing the needs of this population. This article highlights technologies that may be useful for people with neurovisual deficits and describes the evidence to support their training and use. The use of various types of eyewear to reduce falls; prisms and telescopic lenses to improve visual attention and minimize the impact of visual field deficits; and technologies to improve computer use, wayfinding, and home safety are discussed. While there remains substantial need for further research and development focusing on the needs of people with vision impairments from neurological conditions, practitioners can use technology with caution to improve functional outcomes.

Experiences of physical strain during person transfer situations in dementia care units.

UNLABELLED: Caring for residents with dementia impose a higher challenge and workload on the nursing staff because of a higher degree of motor function and cognitive decline among the residents. Training in person transfer tasks for nursing staff has mostly been concentrated on ergonomics irrespective of the nature of the resident's functional decline. An increased knowledge about the nursing staffs' experiences of physical workload in dementia care and in how to reduce their physical strain is needed. AIM: The aim of the study was to describe nurse's aids' experiences of physical strain during person transfer tasks at dementia care units. METHOD: Four focus group interviews with altogether 16 nurses' aids, working at special care units for people with dementia, were performed. RESULTS: The results show that knowledge about the disease and personality of residents in dementia care units can help to decrease the physical strain on nurses' aids in person transfer situations. Nurse's aids need to be flexible when performing transfer tasks to accommodate variations in the resident's functional ability. Physical strain associated with person transfer tasks is not related to the weight of the resident. Misunderstandings because of cognitive decline and communication problems increase physical strain on nurses' aids. Specialized training in person transfer tasks is needed for nurse's aids working in dementia care. CONCLUSIONS: These results may serve to guide physiotherapists working in dementia care units in assessing residents' functional ability, in when to use assistive devices and mobility aids and in training and supervising nurse's aids in person transfer tasks.

Integrating research into practice: a challenge for local authority occupational therapy.

The aim of this qualitative study was to identify and analyse the experiences of Swedish local health authority occupational therapists with regard to their participation in, and the implementation of, research. Data were collected from three focus-group interviews, with five different occupational therapists in each. The interviews were taped and transcribed and thereafter analysed using broad coding. One core category-"feeling professionally competent"-emerged, comprising three subcategories: "perceiving congruence between research and practice", "having the necessary skills", and "making a contribution". Feeling professionally competent embraces the occupational therapists' definition and delimitation of their professional domain and the obligations related to this. It also embraces the perception of having the skills necessary for participating in research projects and implementing research findings in a scientific manner. The implementation of research was not only perceived as contributing to the knowledge base of the profession, but personal gains could also be made. The knowledge gained from this study can help in the development of strategies to promote the integration of research in local authority occupational therapy practice. This is necessary; otherwise the occupational therapy provided will be based on the knowledge and perceptions of individual professionals, rather than on state-of-the-art knowledge gained through research.

Restriction in social participation and lower life satisfaction among fractured in pain: results from the population study "Good Aging in Skåne".

The aim of this study was to describe social participation expressed as accomplished ordinary activities, health-related quality of life (HRQoL) and life satisfaction (LS), among elderly men and women with osteoporosis-related fractures with and without pain, compared to non-fractured controls. The study was a population-based case-control study conducted at a university hospital, including 408 subjects from the Good Ageing in Skåne investigation. Fractured men and women of age 60-93 years were divided into two groups: one with pain (FP; n=87) and one without pain (FnP; n=82). Fractures included vertebrae, hip, pelvis or ankle according to International Classification of Diseases version 10 (ICD-10). A third group of non-fractured subjects without pain (n=239) was used as controls (CnP). Questionnaires were used to collect information about HRQoL, LS, social participation in ordinary activities such as social, cultural and leisure time activities, pain during past month, co-morbidity, alcohol and tobacco consumption, medication, exercise earlier in life, walking-aid, and socio-demographic variables. The results showed that FP scored significantly lower than CnP in HRQoL and LS. In general, fractured were more restricted in participation and in 12 out of 21 activities FP had a significant lower participation compared to CnP. In a regression model, participation in social and leisure activities as well as fracture predicted independently levels of HRQoL and LS.

Home as a signification of independence and autonomy: experiences among very old Swedish people.

The aim of this study was to explore independence in the home as experienced by very old single-living people in Sweden. A grounded theory approach was used and interviews were conducted with 40 men and women aged 80-89. Data analysis revealed the core category "Home as a signification of independence" with two main categories: "Struggle for independence" and "Governing daily life". The findings showed that home is strongly linked to independence, and being independent is extremely valued. Explicit descriptions of the ageing process as an individual process of changing living conditions within the home emerged from the findings. Hence, the ageing process influences the participants' perception of themselves as independent persons. Along the ageing process the participants' view of independence changed from being independent in activity performance without help from others to experiencing independence in being able to make autonomous decisions concerning daily life at home. Consequently, there is a need to develop strategies to support very old people in staying as active and independent as possible in their own homes. In addition, since the findings highlight that independence is a complex construct, there is a need for conceptual differentiation between independence and a construct often used synonymously, namely autonomy.

Supervisors' views on employer responsibility in the return to work process. A focus group study.

BACKGROUND: Supervisors' attitudes and measures have been pointed out by employees to influence the return to work process. The purpose of this study was to explore supervisors' views on employer responsibility in the return to work process and factors influencing the support of sick-listed employees. METHOD: The focus group method was used. Six groups were conducted and each group met on one occasion. Twenty-three supervisors experienced in managing sick-listed employees participated. RESULT: Two different themes emerged; In "The Supervisor is the Key Person" the participants found themselves as being key persons, carrying the main responsibility for the rehabilitation of the sick-listed employees and for creating a good working environment, thus preventing ill health and sick-listing among the employees. In the second theme "Influential Factors in Rehabilitation Work" the participants described the rehabilitation work as a part of a greater whole influenced by society, demands and resources of the workplace and the interplay between all parties involved. CONCLUSION: The study gives us the supervisors' perspective on the complexity of the return to work rehabilitation. This knowledge could be invaluable and be used to improve the possibilities for developing successful collaboration in occupational rehabilitation.

Experiences among older persons using mobility devices.

OBJECTIVES: The aim of the study was to investigate older persons' experiences of using mobility devices. METHODS: In this qualitative study, focus group interviews were carried out with participants living in two municipalities in the south of Sweden. Occupational therapists and physiotherapists identified interested participants, 65 years or older. A total of 22 persons participated once in the seven focus group interviews that were arranged. RESULTS: Five main categories of participant experiences emerged from the data: 'Municipal supply and non-supply of devices', 'Acceptance or non-acceptance of mobility devices', 'Different use of mobility devices supports everyday and social activities', 'Different kinds of obstacles constrain everyday and social activities' and 'Adaptive strategies in order to use mobility devices'. CONCLUSION: Since the participants experienced non-acceptance and obstacles related to the use of mobility devices, this highlights the needs for quality development concerning more efficient data-collecting in community-based rehabilitation.

Understanding the multiple realities of everyday life: basic assumptions in focus-group methodology.

In recent years, there has been a notable growth in the use of focus groups within occupational therapy. It is important to understand what kind of knowledge focus-group methodology is meant to acquire. The purpose of this article is to create an understanding of the basic assumptions within focus-group methodology from a theory of science perspective in order to elucidate and encourage reflection on the paradigm. This will be done based on a study of contemporary literature. To further the knowledge of basic assumptions the article will focus on the following themes: the focus-group research arena, the foundation and its core components; subjects, the role of the researcher and the participants; activities, the specific tasks and procedures. Focus-group methodology can be regarded as a specific research method within qualitative methodology with its own form of methodological criteria, as well as its own research procedures. Participants construct a framework to make sense of their experiences, and in interaction with others these experiences will be modified, leading to the construction of new knowledge. The role of the group leader is to facilitate a fruitful environment for the meaning to emerge and to ensure that the understanding of the meaning emerges independently of the interpreter. Focus-group methodology thus shares, in the authors' view, some basic assumptions with social constructivism.

Occupational therapy research on assistive technology and physical environmental issues: a literature review.

BACKGROUND: To determine future directions for research in the area of assistive technology and physical environmental issues, it is important to have an understanding of prior research. PURPOSE: This literature review examined how assistive technology and physical environmental issues have been studied in the research published in international peer-reviewed occupational therapy journals. METHOD: Five recent volumes of nine journals were manually searched utilizing specific criteria. The publications were classified according to their perspective, application of the Person-Environment-Occupation (PEO) model, and the research design. RESULTS: Both research fields demonstrated use of different research methods and they displayed equal needs with regard to improved research methodologies. PRACTICE IMPLICATIONS: There are a lack of studies involving all three PEO components indicating a lack of research in occupational performance issues. Further research on occupational performance is important for developing occupational therapy practice in the area of assistive technology and physical environmental issues. Furthermore, study designs reflecting the societal level in all three PEO components are required. Finally, there is a strong need for conceptual and theoretical development in both fields.

Health education for people with macular degeneration: learning experiences and the effect on daily occupations.

BACKGROUND: Discovering New Ways, a program for people with macular degeneration, was developed based on a health education model incorporating occupation. PURPOSE: The purpose of this study was to evaluate the participants' learning experience in the program and the significance for their daily occupations. METHOD: Within an experimental design format, a content analysis was performed. Ninety-two people with macular degeneration were interviewed 1 and 16 months after the intervention. RESULTS: Participants in the individual intervention program stated that they mastered occupational tasks as a result of the provision of assistive devices. Participants in the health education program stated that the problem-solving toolbox provided them with hope and confidence to master daily occupations. The participants'experience of learning within the health education program has provided important feedback regarding the structure of the health education model and its learning process. PRACTICE IMPLICATIONS: The health education model may be seen as a model to design early interventions for individuals with health conditions which can impact occupational performance.

Changes in the use of assistive devices among 90-year-old persons.

BACKGROUND AND AIMS: The growing numbers of elderly people are expected to lead to an increasing demand for assistive devices. The purpose of this study was to examine changes in the use of assistive devices over time and their relation to dependence in daily activities among 90-year-old persons living at home. METHODS: This retrospective longitudinal study examined the 90-year-old population at the ages of 85 and 90, and 195 persons participated. RESULTS: 92% of the 90-year-old population used assistive devices at the age of 90, compared with 74% at the age of 85. Between this interval, 19% became new users, 73% were permanent users, and 7% did not make any use of assistive devices. There was a significantly higher proportion of device-users among those who were dependent in both personal daily activities (PADL) and instrumental activities of daily living (IADL) (98.5%, p < 0.001) and among those who were dependent in IADL (94%, p < 0.001) compared with those who were independent in ADL (72%). At the age of 90, bathing and mobility devices were the most frequently used. Mobility devices such as walking-frames and wheel-chairs were the most widely distributed devices in this group. CONCLUSIONS: The use of assistive devices increases with age, very few 90-year-olds remain nonusers at age 90, and the multiple use of assistive devices at 90 years of age is very common. This complexity put great demands on health care services, and highly skilled professionals are needed to meet these demands.