'Hammering nails with a screwdriver': how GPs perceive video consultations.

BACKGROUND: Early in the Covid-19 pandemic, the use of video consultation (VC) expanded considerably, with GPs indicating high satisfaction with it. However, use of VC declined as lock-down measures were eased. AIM: To explore reasons why VC use has declined in Norwegian general practice by investigating GPs' experiences with VC since the start of the pandemic and their attitudes towards it in a post-pandemic setting. DESIGN & SETTING: Qualitative study design. Semi-structured interviews with 13 GPs in southern Norway. METHOD: The method of data analysis was Braun & Clarke's reflexive thematic analysis. RESULTS: Although the implementation of VCs was unplanned, most participants were able to use this modality without much problem. Several GPs initially envisioned long-term VC use. However, despite certain positives, VCs were largely sidelined in favour of face-to-face and telephone consultations due to their practicality and VC's limited usefulness when considering the extra effort required. Nonetheless, GPs recognised ways of using VC that might exploit its strengths, but they highlighted how its sustained use would require them to replace other consultation modalities. They also identified extrinsic factors that might lead to the increased use of VC, including improved VC technology and patient demand. CONCLUSION: Although VC is now part of many GPs' consultation toolbox, its perceived relative lack of usefulness and extra effort compared to other remote consultation modalities mean that most GPs have chosen to abandon it as a routine consultation modality.

Video consultation in general practice: a scoping review on use, experiences, and clinical decisions.

BACKGROUND: The coronavirus disease 2019 pandemic forced healthcare workers to use alternative consultation approaches. In general practice, the use of video consultations (VCs) increased manyfold as countries were locked down. This scoping review aimed to summarize scientific knowledge concerning the use of VC in general practice and focused on (1) the utilization of VC in general practice, (2) the experiences of the users of VC in general practice, and (3) how VC affected the clinical decision-making of general practitioners (GPs). METHODS: A scoping review was conducted in accordance with the methodology of Joanna Briggs Institute. Review questions were formulated to match each focus area. A three-step search strategy was employed to search scientific and gray literature sources. MEDLINE, Embase, Scopus, OpenGrey, Google Scholar, and ClinicalTrials.gov were searched from 2010 to March 11th, 2021, and the search was re-run on August 18th, 2021. The extracted data were deductively coded into pre-defined main themes, whereas subthemes were inductively synthesized. The data within each subtheme were analysed through descriptive content analysis and presented in a narrative synthesis. RESULTS: Overall, 13 studies were included after screening 3,624 studies. Most patients were satisfied with VCs. VCs were most suitable for simpler issues, often shorter than face-to-face consultations, and were more likely to be used by younger patients. GPs enjoyed the flexibility and shorter duration of VCs; however, they felt an unsatisfactory deterioration in the GP-patient relationship. Despite the loss of clinical examination, diagnostic assessment was mostly successful, with little fear of missing serious illness. Prior clinical experience and a preexisting relationship with the patient were important factors for successful assessment via VC. CONCLUSIONS: Both GPs and patients can be satisfied with VC in general practice in specific contexts, and adequate clinical decision-making is possible. However, disadvantages such as a diminishing GP-patient relationship have been highlighted, and the use of VC in non-pandemic settings is limited. The role of VC in the future of general practice remains unclear, and further research is needed on the long-term adoption of VC in general practice.

Digitalisation of municipal healthcare collaboration with volunteers: a case study applying normalization process theory.

BACKGROUND: Increasing use of volunteers in healthcare requires structured collaboration between healthcare services and volunteers. The aim of this research was to explore critical issues and strategies in the implementation process of a digital solution for collaboration with and coordination of volunteers in municipal healthcare services. METHODS: Qualitative data collection was used to study implementation of a digital system for collaboration with volunteers in three Norwegian municipalities. Three rounds of interviews were conducted with healthcare employees from a volunteer centre and from municipality healthcare units in three municipalities: before implementation, and 6 and 12 months after deployment. Observations of healthcare employees training and use of the system were also done. RESULTS: An inductive analysis resulted in eleven themes that were grouped based on the four constructs of the normalisation process theory (NPT), plus two themes that fall outside those constructs. Coherence (understanding of the intervention) was high among the employees prior to the intervention. They expected the system to meet several of their needs and increase efficiency, structure and overview. In addition, they expected the system to benefit recruitment strategies along with their matching processes. Cognitive participation (engagement and commitment towards the intervention): employees from two of the municipalities reported absence of leadership and management guidance during the process, management of expectations and clarification of their roles. In the third, there was high engagement and management involvement in the implementation process. Collective action (whether the intervention is carried out): the employees reported time-consuming preparations. Engagement varied between the municipalities. There was a lack of commitment in two due to ongoing reorganisation, in these, the system was partly or not implemented. The third municipality implemented and fully piloted the system. Reflexive monitoring (appraisal towards the system and its impact on practice): the employees learned throughout testing of the system and realised that there were several benefits that could improve their working routines. CONCLUSION: Crucial aspects for implementation of the digital tool for collaboration with volunteers include having structure "in place", establishing policies for involving volunteers, defining clear roles and expectations and involving management and key people ("champions") to drive the implementation.

Key challenges and best practices in the coordination of volunteers in healthcare services: A qualitative systematic review.

Cooperation between voluntary organisations and volunteers within healthcare services contributes to the development of public welfare. The coordination process between healthcare services and volunteers must therefore be studied to understand associated challenges and best practices. This paper presents a systematic literature review of studies that have used qualitative methods. The review was conducted to identify the knowledge base concerning these issues. The search was performed in 4 April 2019 on five databases: EbscoHost, Ovid, Scopus, Emerald and Svemed+. The selection criteria included papers published between 1 January 2009 and 4 April 2019. In total, 5,340 papers were extracted; after removing duplicates and screening titles and abstracts, 49 papers were independently read by two of the authors. Ten papers addressed the research question and were thus included for further investigation. The Critical Appraisal Skills Programme (CASP) checklist was used to check the eligibility of the papers, all of which were found to be of sufficient quality for analysis. A thematic analysis for synthesising qualitative research was used to identify key challenges in the coordination process and the best practices needed to deal with these challenges. The findings demonstrated the pursuit of a common understanding between employees and volunteers and described challenges in organising the associated work. The main solution applied to these challenges was the involvement of a volunteer coordinator. Although several identified challenges remained unresolved, the papers selected for this review provide an overall picture of volunteer cooperation in health services.

Communication and information exchange between primary healthcare employees and volunteers - Challenges, needs and possibilities for technology support.

In light of the challenges posed by an ageing population and tighter public budgets, governments worldwide are seeking innovative ways of improving health service delivery. Volunteers can contribute to such improvement, but this requires effective coordination and communication between volunteers and healthcare employees. In this case study, conducted in two Norwegian municipalities during September-October 2017, the aim was to understand how collaboration and coordination is carried out between several stakeholders: volunteers, volunteer family members of healthcare service users and healthcare employees. Our results show that daily cooperation was largely unsystematic, and stakeholders employed various informal communication procedures. Recruitment of volunteers was based on word of mouth and was coordinated by telephone and email. All processes were paper based, including contracting and confidential agreements. This unsystematic approach resulted in uncoordinated activities characterised by time-consuming processes, with no quality assurance. We concluded that stakeholders would benefit from a technology solution that supports more systematic processes of recruitment, management and monitoring. This article outlines the challenges and needs for information exchange and communication between stakeholders. Furthermore, it describes possible functionality in a digital system that can address these needs, and hence improve coordination, quality of services and resource use.

A sense of belonging: A meta-ethnography of the experience of patients with chronic obstructive pulmonary disease receiving care through telemedicine.

AIM: To synthesize the qualitative research in the literature addressing how patients with chronic obstructive pulmonary disease experience care received by telemedicine. DESIGN: Meta-ethnography. DATA SOURCES: Twelve studies, published from 2013 - 2018, were identified by a search of relevant systematic databases in June 2017, including updated searches performed in June 2018. REVIEW METHODS: The studies were reviewed and critically appraised independently by three researchers. The review followed the seven steps of meta-ethnography developed by Noblit and Hare, including a line-of-argument synthesis. RESULTS: The synthesis revealed three second-order constructs: presence, transparency, and ambivalence. Using a line-of-argument synthesis, a model was developed that showed patients' experience of a sense of belonging when receiving care by telemedicine. CONCLUSION: This meta-ethnography contributes to the existing and contradictory evidence base of telemedicine to chronic obstructive pulmonary disease patients. It addresses and adds renewed understanding of who would benefit from telemedicine and why, by illustrating the interrelationship between the conditions of telemedicine care, the severity of COPD, and the need for connectedness and emphasizes that the need to belong in telemedicine care increases with the progression of illness burden and severity. IMPACT: The present study endorses the view that the patients with a severe illness burden are likely to benefit the most when receiving care by telemedicine. However, the benefits rely on the fact that the telemedicine interventions involve emotional, social, and clinical support, including regular contact with healthcare professionals, to meet the requirements to belong.

Caring by telecare? A hermeneutic study of experiences among older adults and their family caregivers.

AIMS AND OBJECTIVES: To obtain a deeper understanding of the persistent use of telecare for older adults and their family caregivers. BACKGROUND: Telecare is seen as part of the solution in home care services for ageing in place. Previous studies have shown that telecare is a complex intervention, and there is still a poor understanding of older adults' and their family caregivers' experience with the use of telecare. DESIGN: This study used a qualitative hermeneutic research approach. METHOD: Interviews were conducted with 18 older adults and follow-up interviews were conducted with 15 participants after 5-6 months of use. In addition, interviews were conducted with seven close family caregivers. The COREQ checklist was used. RESULTS: The older adults expressed increased safety, security and independence. Although some of them experienced challenges, they continued to use the services. Furthermore, the findings revealed needs that telecare could not cover. Family caregivers reported that telecare eased their concern for a time. However, they felt increased responsibility which led to ambivalent feelings between wanting to comply with the older adults' desire to live at home and the stress and concern this caused. CONCLUSION: Telecare does improve care offered by home care services. However, it must be considered in the context of assistance and other measures and be provided in response to each individual's specific needs. Family caregivers may benefit from telecare, but telecare may also add to their care burden. RELEVANCE TO CLINICAL PRACTICE: There is a need for increased knowledge and information about telecare and for follow-up from home care services. Family caregivers are important for promoting sustainable use, but a support system and better cooperation with home care services is needed.

Barriers to exchanging healthcare information in inter-municipal healthcare services: a qualitative case study.

BACKGROUND: In recent years, inter-municipal cooperation in healthcare services has been an important measure implemented to meet future demographic changes in western countries. This entails an increased focus on communication and information sharing across organisational borders. Technology enables efficient and effective solutions to enhance such cooperation. However, the systems in the healthcare sector tend not to communicate with one another. There is a lack of literature focusing on communication and information sharing in inter-municipal healthcare services. The aim of this article is to investigate both the characteristics of communication and information sharing, and the factors that serve as barriers to communication and information sharing for employees in inter-municipal healthcare services. METHODS: In this study, a qualitative case study approach is used to investigate both characteristics of communication and information sharing, and factors enabling barriers to communication and information sharing for employees in newly established inter-municipal healthcare services. Data collection methods were individual interviews, focus group interviews, observation studies and a workshop. A total of 18 persons participated in the study. The interviews, observations and workshop were conducted over a period of ten months. RESULTS: Communication and information sharing practices were found to be complex and characterised by multiple actors, information types and a combination of multiple actions. Findings indicate that 1. IT capability and usability 2. Differences 3. Privacy, confidentiality and security and 4. Awareness are all factors enabling barriers to communication and information sharing in inter-municipal healthcare services. Specifically, these barriers were related to lack of EHR usability, inadequate workflow processes, digital systems incompatibility, the understanding of needs in different systems and knowledge and practices regarding privacy and confidentiality. CONCLUSION: By focusing on the context of inter-municipal cooperation when assessing communication and information sharing in healthcare services, this article contributes to close a gap in existing knowledge. The perspective of the employees provides useful insight, and findings can be relevant for future theory development and for managers and policymakers in inter-municipal services.

Critical issues for employees in inter-municipal health care services: a multiple case study.

BACKGROUND: Traditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand. When healthcare services become fragmented and decentralised, they require redesign. Inter-municipal cooperation is a strategy to deal with current challenges and future demographic changes. Few studies exist that can help us conceptualize challenges regarding employment in this context and inform managers in the involved municipalities. This study aims to identify critical issues for employees in inter-municipal health care services and to elaborate on how and why these issues are experienced. METHODS: A multiple qualitative case study was conducted with data from interviews, observation studies, a participant workshop and inter-municipal healthcare service project documents and reports. The study involved two districts in Norway and six cases including 17 informants. First, a within-case analysis was conducted for all cases; second, a cross-case analysis was conducted in each district to examine replication, contrasts and extension to emergent findings; and, eventually, replicated findings in Districts 1 and 2 were analysed across districts. RESULTS: Three critical issues were identified: support, differences, and geographical distances. Employees working in teams experienced fewer challenges than did those working as isolated individuals. CONCLUSIONS: Critical issues for employees represent an important aspect of inter-municipal cooperation, and additional research should be undertaken to inform future policy and practice.

Unlocking the limitations: Living with chronic obstructive pulmonary disease and receiving care through telemedicine-A phenomenological study.

AIMS AND OBJECTIVES: To describe the lived experiences of quality of life among a group of patients living with chronic obstructive pulmonary disease who were included in a telemedical intervention after hospitalisation for disease exacerbation. BACKGROUND: Patients with chronic obstructive pulmonary disease have high symptom burden, poor control of symptoms and a need for greater requirements in care. Telemedicine can provide benefits for patients with chronic obstructive pulmonary disease by improving self-management. DESIGN: Descriptive phenomenological approach. METHODS: Ten in-depth interviews were conducted with chronic obstructive pulmonary disease patients participating in a telemedical intervention. The collected data were analysed using a descriptive phenomenological research method. RESULTS: Living with chronic obstructive pulmonary disease was experienced as creating physical and mental limitations of the diseased body and an increasing identity as a patient, which led to impaired quality of life. Being included in the telemedicine intervention increased accessibility to healthcare services and support from telemedicine nurses. Self-measurement of health data increased participants' clinical insight and created a mutual clinical language in dialogue with telemedicine nurses, which led to increased quality of life. However, receiving care through telemedicine was also experienced as a dual chore. CONCLUSIONS: Telemedicine can reduce the perceived limitations imposed by chronic obstructive pulmonary disease through four key elements: (i) improving accessibility to healthcare services, (ii) increasing support from health professionals, (iii) strengthening clinical insight and (iv) developing a mutual clinical language, thus increasing quality of life. The transparency facilitated through telemedicine in this healthcare context encourages open decision-making, where the participants can increase their knowledge and improve acknowledgement of and collaboration with telemedicine nurses. RELEVANCE TO CLINICAL PRACTICE: Telemedicine can be beneficial when rethinking care for chronic obstructive pulmonary disease by providing knowledge on how living with chronic obstructive pulmonary disease can affect the experience of receiving care through telemedicine and further determine for whom telemedicine is useful.

Experiences of community-dwelling older adults with the use of telecare in home care services: a qualitative systematic review.

BACKGROUND: The aging population will lead to a rise in the number of people with age-related diseases, and increasing demand for home care services. Telecare is seen as a solution to this challenge by promoting aging in place. Nevertheless, there is still a poor understanding of older adults' experiences with the actual use of telecare. OBJECTIVE: The aim of this review was to identify and synthesize the best available qualitative evidence of community-dwelling older adults' experience with the use of telecare in home care services. INCLUSION CRITERIA: This review considered studies that focused on qualitative data, examining older adults' experiences with the use of active and passive technology devices, such as personal alarms and sensor technology, in the context of home care services. SEARCH STRATEGY: This review systematically searched the databases Scopus, CINAHL, PsycINFO, and SveMed+ to find both published and unpublished studies in English, Norwegian, Swedish and Danish, from 2005 to 2017. METHODOLOGICAL QUALITY: Methodological quality of the included studies was assessed independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA EXTRACTION: Qualitative data were extracted from papers included in the review using the standardized Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. DATA SYNTHESIS: Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument, and involved aggregation and synthesis of findings. RESULTS: A total of 118 findings from 11 studies were aggregated into 20 categories. The categories generated seven synthesized findings: 1) Aging in place is desired; however, it may also be related to feeling isolated and lonely. 2) Telecare contributes to safety, security, and aging in place. 3) Privacy is not seen as a problem by most older adults because the technology is intended to help them live safely in their own home. 4) Some telecare devices have side effects, especially new technology. Some devices do not work outside the home, thus limiting active aging. 5) Some older adults experience a misfit between technology and needs. They must see the value of a telecare device to use it. 6) Telecare may enforce an identity with negative connotations on older adults, as frail and helpless people. Autonomy is considered important. 7) Lack of understanding can hamper the correct use of telecare. Specific strategies may be needed. CONCLUSIONS: The experiences with the use of telecare are diverse. Findings indicate telecare systems can promote safety and security to age in place that is a wish of many older adults. However, "one size does not fit all"- Telecare systems must fit individual needs, and be supported by service providers to accommodate sustainable use over time.

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

BACKGROUND: Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. METHODS: In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. RESULTS: When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. CONCLUSION: In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process.

Experiences of the home-dwelling elderly in the use of telecare in home care services: a qualitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify and synthesize the best evidence on the home-dwelling elderly's experiences with the use of telecare in home care services. Furthermore, the study will identify experiences with telecare devices and examine what beliefs the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place.Review question 1: How do the home-dwelling elderly experience the use of telecare in the context of home care services?Review question 2: How do the home-dwelling elderly experience telecare devices?Review question 3: What beliefs do the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place?

Telemedicine to support coping resources in home-living patients diagnosed with chronic obstructive pulmonary disease: Patients' experiences.

Introduction The way in which telemedicine contributes to promote coping and independence might be undervalued in the development of telemedicine solutions and the implementation of telemedicine interventions. This study explored how home-living patients diagnosed with chronic obstructive pulmonary disease (COPD) experienced follow-up using telemedicine, and the extent to which the implemented technology was able to support and improve the patients' coping resources and independence. Methods A qualitative approach with individual semi-structured interviews was used. Ten patients diagnosed with COPD participated. The data were transcribed verbatim and a qualitative content analysis method was used, including analyses of the manifest and latent content of the texts. Results The participants' positive attitude to handling and understanding the technology and the positive and negative feelings related to use the technology derived the theme: "The telemedicine solution is experienced as comprehensible and manageable and provides meaning in daily life". The importance of telemedicine services that provided trust and confidence, the intervention's impact on independence and self-management and the intervention's ability to support integrity and meaning in life, derived the theme: "The telemedicine intervention contributes to stress reduction caused by illness burden and facilitates living as normally as possible". Discussion The impact of a telemedicine intervention might be influenced by the experience of a technological solution that requires little effort to deal with, while it must also provide meaning in life. Furthermore, the telenurses' expertise and the intervention's flexibility, i.e. possibilities for individual adaption, might promote coping to facilitate living as normally as possible despite illness.

Living with Chronic Obstructive Pulmonary Disease and Being Followed Up Through Telemedicine - A Phenomenological Approach.

Chronic obstructive pulmonary disease (COPD) provides substantially reduced health related quality of life (HQoL). Telemonitoring on COPD patients appears to have a positive effect on improving HQoL. This study has a phenomenological approach, and ten informants, who were followed-up between 1 and 3 months in their own homes through telemonitoring of COPD symptoms, narrated their lived experiences of HQoL. The results show that the informants experienced safety and increased knowledge through the digital dialog (telemedicine) with expertise nurses, which indirectly improved their HQoL, and in term lead to increased mastery and control in managing their disease. Several studies show an increased HQoL, but the benefits are still limited and there is a need for further research.

Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study.

BACKGROUND: Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice. METHODS: A Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed. RESULTS: Nineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change. CONCLUSIONS: This study identified several important challenges for coordination and it supports previous research. IMC in health care services deals with challenges other than coordination, and these must be addressed specifically. Our study contributes to extended knowledge of theoretical and practical implications in the field of coordination and IMC in health care sector.

Association between self-reported care needs and the allocation of care in Norwegian home nursing care recipients.

OBJECTIVES: This study investigated the relationship between patients' self-reported illness, daily afflictions, and the frequency of home nursing care, and whether patients' coping resources influenced the allocation of care. DESIGN, SAMPLE AND MEASUREMENTS: A cross-sectional survey was adopted. Two hundred and forty-two people aged 75 years and above receiving home nursing care participated in the study. Binary logistic regression model was used to test the effects of the independent variables on home nursing care. RESULTS: Poor capacity to perform activities of daily living and high level of education were directly associated with a high frequency of home nursing care. Lack of perceived social support affected the amount of home nursing care allocated only when feelings of loneliness were connected with poor activities of daily living functioning. Interaction effects revealed that perceived social support influenced the amount of home nursing care in persons with higher education, in persons with low education, no such association were found. No associations were found between coping resources and home nursing care. CONCLUSIONS: Impaired capacity to perform activities of daily living was the main reason for care allocation. Education was associated with more formal care. Patients with low perceived social support combined with a low education level was a particularly vulnerable group.

The Subjective Health Complaints Inventory: a useful instrument to identify various aspects of health and ability to cope in older people?

AIMS: The aims were to investigate the factor structure of the Subjective Health Complaints Inventory (SHC) in a population of 75 years and above and to identify whether somatic, psychosocial, and coping factors were associated with the SHC factors. METHODS: Data from 242 elderly persons were analyzed. The measures were: the SHC Inventory, Sense of Coherence, Social Provision Scale, Self-Rated Health, General Health Questionnaire, Clinical Dementia Rating, Reported Illness, Barthel ADL Index, sex, age, and education. RESULTS: The factor analysis resulted in four subgroups: musculoskeletal pain (15% of variance), gastrointestinal problems (12% of variance), respiratory/allergy complaints (11% of variance), and pseudoneurology (11% of variance). The occurrence of complaints was 76% for musculoskeletal complaints, 51% for gastrointestinal complaints, 30% for flu, 43% for allergy, and 93% for pseudoneurology. Self-rated health and reported illness were significantly associated with musculoskeletal complaints (15% of variance), impairment in activities of daily living (ADL) with gastrointestinal complaints (3% of variance), and finally sense of coherence, self-rated health, and psychological distress were associated with pseudoneurology (32% of variance). No variables were associated with respiratory/allergy complaints. CONCLUSIONS: This study supports the stability of the SHC's factor structure. The low occurrence of health complaints could possibly be due to survival effects, or that old people to a greater extent than younger people compare themselves with aged peers. The subscales focusing on somatic symptoms were explained by reported illnesses and functional impairments to a limited degree only. The pseudoneurology subscale score was associated with psychological measures, particularly ability to cope.

Psychological distress and its correlates in older care-dependent persons living at home.

OBJECTIVES: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined. METHOD: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale. RESULTS: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis. CONCLUSION: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.

Predicting needs for nursing home admission - does sense of coherence delay nursing home admission in care dependent older people? A longitudinal study.

Objectives. This study examined predisposing, enabling and need variables (Andersen's Behavioral Model) influencing the need for nursing home admission (NHA) in older people receiving home nursing care. In particular, the potential role of coping ability, measured as 'sense of coherence' (SOC), was studied. Design, sample, and measurements. A survey with baseline- and follow-up data after a 2-year period was undertaken with 208 patients aged 75+. The measures used were: gender, education, age, social visits, SOC, social provision scale (SPS), self-rated health (SRH), general health questionnaire (GHQ), clinical dementia rating (CDR), Barthel activities of daily living (ADL) index, and registered illnesses (RI). A Cox proportional model was used to examine factors that could explain risk of NHA. Results. Measures with predictive properties were Barthel ADL index, SPS, SRH, and gender. SOC, along with subjective health complaints, general health questionnaire, RI and social visits did not predict NHA. Conclusions. It is concluded that the patients' subjective evaluations of both their health and perceived social support were important predictors of future NHA needs, and should be seriously taken into consideration, along with the more commonly used objective measures of ADL and CDR.