Background: Family members of older persons (75+) with multi-morbidity are likely to benefit from utilising case management services performed by case managers. However, research has not yet explored their experiences of case managers. Objectives: The aim of the study was to deepen the understanding of the importance of case managers to family members of older persons (75+) with multi-morbidity. Design: The study design was based on an interpretive phenomenological approach. Method: Data were collected through individual interviews with 16 family members in Sweden. The interviews were analysed by means of an interpretive phenomenological approach. Results: The findings revealed one overarching theme: “Helps to fulfil my unmet needs”, based on three sub-themes: (1) “Helps me feel secure – Experiencing a trusting relationship”, (2) “Confirms and strengthens me – Challenging my sense of being alone” and (3) “Being my personal guide – Increasing my competence”. Conclusion and discussion: The findings indicate that case managers were able to fulfil unmet needs of family members. The latter recognised the importance of case managers providing them with professional services tailored to their individual needs. The findings can contribute to the improvement of case management models not only for older persons but also for their family members.

Background

Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers.

Methods

The study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013.

Results

The data revealed four themes illustrating the older persons’ experiences of case managers:

1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present.

Conclusions

This study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

Introduction.– Today, there is an interest in how Case Management (CM) should be designed to best suit the complex needs of the older people with multi-morbidity. Current research on CM has mainly focused on health care costs and consumption, but the results have been inconsistent and ranging from positive outcomes to no effect. To improve CM, there is need to investigate what mechanisms are important for a successful intervention. To advance this knowledge, there is a necessity for studies investigating the experiences of those practicing CM i.e. Case Managers. There might be unknown factors or interpersonal factors that can contribute to a CM intervention's success or failure. Therefore, the aim of this study was to explore the Case Managers’ experiences of their everyday practice. Methods.– The study design was qualitative and descriptive utilizing an ethnographic approach, consisting of participant observations, a focus group interview and individual interviews with nine Case Managers conducted during 2012/2013. The interviews were recorded and transcribed verbatim and then subjected to content analysis. Results.– Three main themes described Case Managers’ experience of their everyday practice: navigating the older person, working to improve the health care system and being the older persons advocate. Conclusions.– Findings from this study sheds light on the complexity of CM for older people with multi-morbidity, from the experiences of Case Managers. These findings could help in the development of CM models designed for older people with complex health needs.

Background Modern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences. Methods The study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis. Results An overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy. Conclusions Findings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.

Abstract: Objectives: To investigate the prevalence and predictors of loneliness in older people (aged 78+) over a sixyear period. Method: The sample (n=828) was drawn from the Swedish National Study on Aging and Care and the respondents were followed up at three and six years. Data were collected by means of structural interviews with supplementary questionnaires. Results: Half of the respondents reported that they felt lonely sometimes or more often. Women, widows/-ers living alone were more prone to report loneliness. Both independent associated factors and predictors were identified showing that loneliness is associated with and predicted by both physical and psychosocial outcomes. Discussion: Loneliness is common among older people and seems to be a steady state affected mainly by psychological and psychosocial factors such as personality, satisfaction with life, risk of depression, lack of friends and loss of spouse. Psychosocial interventions targeting emotional loneliness and social isolation are suggested.

Background/Objectives: Sleep problems and pain are common among the elderly and have been shown to affect quality of life. The objectives were to determine the prevalence of sleep problems and pain among the elderly and to compare the two factors in relation to age and gender. Design: A cross-sectional study based on baseline material collected by the Swedish National Study on Aging and Care in Blekinge (SNACBlekinge). Setting: The data were gathered from questionnaires distributed between the years 2001 and 2003 in the municipality of Karlskrona, Sweden. Participants: The participants comprised 1402 Swedish men and women aged 60-96. Results: Of all the participants 70 percent met the criteria for sleep problems and 62 percent indicated some experience of pain during the preceding 4 weeks. Both sleep problems and pain were more frequent among women than men and sleep problems tended to be more common with increasing age. Among the participants who experienced pain during the preciding 4 weeks 77 percent suffered from sleep problems. Conclusions: Sleep problems and pain are common among older people. Furthermore it is common to suffer from sleep problems when pain has been experienced during the preciding 4 weeks.

Nurses sometimes fail to understand the behaviour of individuals with severe dementia. Information from a next of kin may help to bridge this communicative gap. One factor that influences a person’s reaction to a disease is their personality and ability to cope with stress. The aim of this study was to evaluate the inter-rater agreement between healthy elderly people’s self-assessment and the assessment made by a next of kin concerning personality and sense of coherence. The participants (n¼154) answered questions from the Eysenck Personality Inventory (EPI) and the Antonovsky Sense of Coherence (SOC) scale. The study shows high or moderate agreement in ratings when analysed by means of an intra-class correlation coefficient (range between r¼.57 and r¼.72) and the results indicate that in general a close relative is able to report on the personality of a next of kin. The inter-rater agreement was high on SOC and extraversion and somewhat lower on neuroticism. For neuroticism, length of time in the relationship increased the odds for a good inter-rater agreement. Thus, seemingly a next of kin is a reliable informant for the elderly in general and is probably also able to add information useful in the nursing care of people with dementia.

Little is known about the dyadic experience over time of people with dementia and their next of kin. The aim of this study was to investigate the state of mind of people with dementia, their next of kin’s experience of burden and satisfaction, and factors associated with these experiences over a 3-year period. The sample consisted of 32 people with dementia living at home with family caregivers in the south of Sweden. Data were collected during the period 2004–2007 and consisted of patients self reports (GDS), dementia nurse assessment (MMSE, Berger and ADL) and next-of-kin assessment (patient’s state of mind and care provision). Data also consisted of nextof- kin’s self reports concerning health, burden and satisfaction. The result showed that patients’ state of mind was mainly positive at baseline but a deterioration was seen over time in the patient’s mood and cognitive functioning together with an increase in ADLdependency and suspected depression. Dependency in personal ADL entailed a higher risk of being in a negative state of mind. For next of kin the experience of burden increased while satisfaction decreased over the 3 years. The inter-relationship between the patients’ mood and the caregiver’s satisfaction and burden seems to get stronger over time. At baseline caregiver burden was mainly related to the next of kins’ general health and to patient behaviours that were difficult to handle. During the progression of the disease caregiver satisfaction becomes increasingly related to patient state of mind and dependency. There is, however, a need for more research focusing on the specific inter-relational aspects as previous studies have mainly focused on either the situation for the person with dementia or on the caregiver.

Several studies have shown connections between personality and various kinds of behavioural and psychological symptoms in dementia. It has for example been found that personality traits such as introversion, rigidity, and a tendency to suppress emotions, as remembered retrospectively by a close family member, correlated positively with disturbed communicative behaviors in people with severe dementia. This finding indicates that personality characteristics should be considered in nursing care because they may help a caregiver to understand communicative attempts from a person not able to speak for themselves, i.e. express their feelings. Information from a next of kin about a sick person’s personality may help to bridge communicative gaps in care situations. However, the reliability of such information is not known. The aim of the present study was to evaluate the inter-rater agreement between healthy elderly people`s self-assessment and the assessment made by a next of kin concerning personality and Sense of Coherence (SOC). The participants (n=154) answered questions from the Eysenck personality scale and the Antonovsky SOC scale. The study shows high or moderate agreement in ratings when analysed by means of an intra-class correlation coefficient (range between r =.57 and r = .72) indicating that in general a close relative is able to report on the personality of a next of kin. The inter-rater agreement was high on SOC and Extraversion and somewhat lower on Neuroticism. For Neuroticism, length of time of relationship increased the odds for a good inter-rater agreement. Thus seemingly a next of kin is a reliable informant for the elderly in general and is probably also able to add information useful in the nursing care of people with a severe dementia disease.

This development project was aimed at engaging nursing students in a project targeting the prevention and reduction of pressure ulcers on an education based hospital ward. An intervention was implemented based on systematic assessment, skin observation, together with training and educational sessions, i.e. on how to make risk assessments and how to prevent and treat a pressure ulcer, were carried out. The project demonstrated the importance of offering nursing students an environment for clinical practice which supports them in participating and developing patient care starting from Evidence-Based Practice. During the project no patients developed pressure ulcers while on the ward. The opportunity to act as facilitators of evidence-based methods was found to enhance student ability to draw conclusions and make connections between quality of care and end result.