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  • 1. Borg, Christel
    et al.
    Fagerström, Cecilia
    Balducci, Cristian
    Burholt, Vanessa
    Ferring, Dieter
    Weber, Germain
    Wenger, Clare G.
    Holst, Göran
    Hallberg, Ingalill R
    Life satisfaction in 6 European Countries: The Relationship to health, Self-Esteem, and Social and Financial Resources among People (Aged 65-89) with Reduced Functional Capacity2008In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 29, no 1, p. 48-57Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate how overall health, participation in physical activities, self-esteem and social and financial resources are related to life satisfaction among people (65+) with reduced Activities of Daily Living (ADL) capacity in six European countries. A subsample of the European Study of Adults’ Well-Being (ESAW), consisting of 2195 people with reduced ADL capacity from Sweden, the UK, the Netherlands, Luxembourg, Austria, and Italy, was included. The Older Americans’ Resources Schedule (OARS), the Life Satisfaction Index Z, and the Self-esteem scale were used. In all national samples, overall health, self-esteem and feeling worried, rather than ADL capacity, were significantly associated with life satisfaction. The findings indicate the importance of not only taking the reduction in functional capacity into account, but also the individual’s perception of health and self-esteem, when outlining health care and nursing aimed at improving life satisfaction. The study thus suggests that personal, rather than environmental, factors are important for life satisfaction among people with reduced ADL capacity living in Europe.

  • 2.
    Borglin, Gunilla
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Fagerström, Cecilia
    Blekinge Institute of Technology, School of Health Science.
    Nursing students understanding of critical thinking and appraisal and academic writing: A descriptive qualitative study2012In: Nurse Education in Practice, ISSN 0260-6917, Vol. 12, no 6, p. 356-360Article in journal (Refereed)
    Abstract [en]

    In Sweden, regulations from the National Agency for Higher Education advocate an education that equips students with independence as well as critical, problem-based thinking, i.e. academic literacy skills. However, some research findings indicate that students may leave higher education without mastering these skills effectively. As part of quality-assuring a nursing programme at a university college in south-east Sweden we explored the nursing student's view of crucial academic literacy skills, such as critical thinking and appraisal and academic writing, by conducting a descriptive, qualitative study. Informants were recruited through an advertisement posted on the university's e-learning tool. Eight focused interviews were conducted during autumn 2010. The transcribed interviews were analysed – inspired by content analysis – and two categories became apparent: constantly questioning and formality before substance. The latter revealed a gap between the student's perception of academic writing and that of the educators, thus implying that nursing students might not be equipped with the tools they need to develop within academia. We suggest that students could benefit in their academic endeavours from theoretical educational models that integrate several academic skills simultaneously and which could be incorporated into the development of syllabuses and curriculums.

  • 3. Burholt, Vanessa
    et al.
    Windle, Gill
    Ferring, Dieter
    Balducci, Cristian
    Fagerström, Cecilia
    Thissen, Frans
    Weber, Germain
    Wenger, Clare G.
    Reliability and Validity of the Older Americans Resources and Services (OARS) Social Resources Scale in six European Countries2007In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 62B, no 6, p. 371-379Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This paper documents the applicability of the Older Americans Resources and Services (OARS) Social Resources Scale in six European Countries (the Netherlands, Luxembourg, Italy, Austria, the United Kingdom and Sweden). METHOD: A questionnaire was administered through face-to-face interviews in five countries, and postal interview in the sixth, to representative populations of adults aged 50-90 living independently (N=12478). The paper examines the missing values and distribution of the items in the social resources scale, and the consistency of skew and kurtosis across the countries. Item-total correlations are performed. Confirmatory factor analyses (CFA) are run to test a three factor model which was obtained in USA and Spanish analyses. Cronbach’s Alpha determines the reliability of the social resources sub-scales. RESULTS: Relatively large proportion of missing data is observed for one item (have someone who would help you). All items correlate with a score equal to or greater than 0.20. Although the CFA generally support the acceptability of the three factor structure in the European data, the reliability of two of the sub-scales (dependability and affective) is unacceptably low. DISCUSSION: Differences across countries makes it unlikely a single social resources scale can be developed that would have item equivalence in multiple countries.

  • 4.
    Christiansen, Line
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Fagerstrom, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Nilsson, Lina
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Nurses' Use and Perception of an Information and Communication Technology System for Improving Coordination During Hospital Discharges A Survey in Swedish Primary Healthcare2017In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 35, no 7, p. 358-363Article in journal (Refereed)
    Abstract [en]

    To facilitate communications between care levels and improve coordination during hospital discharges, there is great potential in using information and communication technology systems, because they can significantly help to deter unnecessary readmissions. However, there is still a lack of knowledge about how often nurses use information and communication technology and the indicators related to its use. The aims of this study were to describe the indicators related to nurses' use of an information and communication technology system for collaboration between care levels and to estimate whether the level of use can be related to nurses' perceptions of the information and communication technology system's contribution to improve coordination during hospital discharges. A quantitative survey of 37 nurses from 11 primary healthcare centers was performed in a county in southern Sweden. The data were analyzed using descriptive and comparative analyses. The results showed that perceptions concerning the information and communication technology system's usability and time consumption differed between nurses who used the system and those who did not. Simultaneously, the nurses were rather unaware of the ability of the information and communication technology system to improve coordination during patient discharges.

  • 5. Fagerström, Cecilia
    Healthy aging: positive health among older people with focus on sleep habits and falls2010In: Journal of Clinical Nursing, Wiley-Blackwell , 2010, Vol. 19, no suppl. 1Conference paper (Refereed)
    Abstract [en]

    Introduction: Satisfactory sleep has many positive benefits for older adults1,2; it may produce daytime wakefulness and reduce the risk of falls3. Sleep complaints and falls are both common with advancing age and negative determinants for health4. However, their relationship with good health or improving health has not been clearly established. The aim of this presentation is to discuss sleep and fall predictors of positive self-rated health among people (n=656, > 78 years), who participated in the longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC), in 2001 and 20045. Positive odds ratio is used in the logistic regression analyses instead of commonly used Odds ratio. Method: Research synthesis from a longitudinal, multi-centre cohort study, 2001 and 2004. Results: Findings indicate that younger age, no fear of falling, no problem with balance, or no difficulties sleeping because of mood were associated with positive health, in the model that was adjusted for age, gender and co-morbidity. Conclusion: It is important to target older adults who are at risk of losing their balance and have low mood to prevent future health problems with advancing age. Also, the use of positive odds ratios appears to be useful when identifying positive health among older people.

  • 6. Fagerström, Cecilia
    Life Satisfaction and Feeling Hindered by Health Problems at 60 Years and Above2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to investigate how older people’s capacity to perform activities of daily living (ADL), health, social and financial resources, and self-esteem can be related to their life satisfaction. The aim was also to investigate how people feel hindered by health problems in relation to their ADL capacity, health problems, social and financial resources, self-esteem, sense of coherence, and life satisfaction. The thesis focused on people 60–96 years of age in six European countries, living at home. The data were collected in two cross-sectional studies, using standardised self-reported questionnaires and a medical examination. The first study (papers I, II and III) included people in six European countries (Sweden, the UK, the Netherlands, Luxembourg, Austria, and Italy) who participated in the European Study of Adult Well-being (ESAW) in 2001 to 2002. Paper I included people (n = 7699) aged 60−89 in all six countries, Paper II included people with reduced ADL capacity (n = 2195), and Paper III included people living in Sweden (n = 1297) with at least one health problem. In the ESAW, questions from the Older Americans Resources and Services schedule, (OARS), the Life Satisfaction Index Z (LSIZ) and Rosenberg’s Self-Esteem Scale were used. The other study (Paper IV) included people (n = 958) aged 60−96 years of age who participated in a baseline survey in one of the four centres (Blekinge) of the longitudinal multi-centre cohort study named The Swedish National study on Aging and Care (SNAC) in 2001. Established questions and instruments were used to collect the data, and quantitative descriptive statistics, comparative statistics and multiple regressions were used when analysing the data. In all ESAW country samples, factors such as feeling hindered by health problems, low social and financial resources, and low self-esteem played a crucial role in creating conditions for low life satisfaction. It is also possible to identify both common and country-specific factors influential for life satisfaction in the six European countries. The analysis furthermore revealed that personal as well as environmental factors were important, though personal factors were more important for life satisfaction than environmental factors among people with impaired ADL capacity. Among those with impaired ADL capacity in the six national samples, people afflicted by poor overall health and people who were feeling worried and had low self-esteem suffered an increased risk of low life satisfaction in all countries. At the same time, social and financial resources had an impact on life satisfaction in four countries. Results suggest that self-esteem and perceived health are of universal importance for life satisfaction irrespective of ADL capacity, and these phenomena are thus essential to target in health care interventions. Furthermore, feeling hindered by health problems in daily living, rather than the impairment in ADL capacity, appears to increase the risk for low life satisfaction. In addition to this, people felt hindered by their problems although they had excellent ADL capacity. Several factors contributed to people feeling hindered, and the importance of these factors differed according to the level of the ADL capacity of the individual. The results suggest that people seemingly re-evaluate the importance of their resources when health declines, making certain activities in daily life more important than others.

  • 7. Fagerström, Cecilia
    et al.
    Borg, Christel
    Balducci, Cristian
    Burholt, Vanessa
    Wenger, Clare G.
    Ferring, Dieter
    Weber, Germain
    Holst, Göran
    Hallberg, Ingalill R
    Life satisfaction and associated factors among people aged 60 years and above in six European countries2007In: Applied Research in Quality of Life, ISSN 1871-2584, E-ISSN 1871-2576, Vol. 2, p. 33-50Article in journal (Refereed)
    Abstract [en]

    Life satisfaction is a concept frequently used to measure wellbeing of older people. However, there is still a lack of cross-national comparative research investigating factors associated with life satisfaction. There may be unique and common factors associated with life satisfaction across European countries. This study aimed to investigate life satisfaction among people aged 60–89 years in six European countries in relation to health problems, ADL capacity, self-esteem, social and financial resources. A cross-sectional study was performed, including 7699 people aged 60–89 years, in Sweden, the UK, the Netherlands, Luxemburg, Austria and Italy, participating in the European Study of Adult Wellbeing, using questions from the Older Americans Resources and Services schedule, Multidimensional Functional Assessment Questionnaire, Life Satisfaction Index Z and Rosenberg’s Self-Esteem Scale. Logistic regression analysis was performed to determine factors associated with life satisfaction in the six national samples. In cases where people were less satisfied with their life it was fairly satisfactory and unsatisfactory social contacts (Odds Ratio (OR) 1.5–13.8), poor financial resources (OR 1.7–15.1), feeling greatly hindered by health problems (OR 2.2–5.4) and self-esteem (OR 2.1–5.1) rather than the ability to perform activities of daily living and the extent of social contacts that gave the greatest risk of low life satisfaction in all the six European countries. There were both common and country-specific factors important for life satisfaction in the six European countries. However, the importance of satisfactory social contacts, financial resources, self-esteem and feeling hindered by health problems seems universal in the six included countries and thus important to target in preventive interventions.

  • 8. Fagerström, Cecilia
    et al.
    Borglin, Gunilla
    Mobility, functional ability and health-related quality of life among people 60 years and older2010In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 22, no 5, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Knowledge about Health-Related Quality of Life (HRQoL) in advanced age is sparse. This study investigated to what extent mobility factors explained older people’s HRQoL when age, gender and functional ability (ADL) were controlled for. Methods: Subjects were 1128 people aged 60-96 participating in a Swedish longitudinal multi-center cohort study. Besides descriptive and correlation statistics, a three-tier multiple logistic regression analysis was performed, which included the ADL scale, mobility tests and items, with physical and mental HRQoL as outcome variables. Results: In the models containing the control variables, functional ability was found to be associated with both physical and mental HRQoL. In the models including both functional ability and mobility factors, the importance of functional ability remained for mental but not for physical HRQoL. The mobility factors were found to have a stronger negative influence on HRQoL, i.e., physical and mental, than functional ability in itself. Conclusions: For optimal identification of various types of disabilities and their impact on older people’s HRQoL, the ADL scale should be used together with more targetspecific tests of disabilities. However, in certain situations, it appears that one mobility factor alone – the ability to walk – has the capacity to pick up changes in both physical and mental HRQoL. Thus, it is important that healthcare professionals should focus activities toward maintaining older people’s mobility as a means of enhancing their HRQoL.

  • 9. Fagerström, Cecilia
    et al.
    Borglin, Gunilla
    Mobility, functional ability and quality-of-life among people of 60 years or older2009Conference paper (Refereed)
    Abstract [en]

    It is well known that reduced ability to perform activities of daily living (ADL) and declining mobility are both related to advanced age. This relation is also valid for low quality-of-life. It is not, however, the advanced age per se that causes the low quality-of-life. Rather, it seems that it is the declining mobility that unable people to manage their daily lives satisfactory - a circumstance that is often overlooked, since the most frequently used measuring method, the ADL-scale, is mainly focusing on people's functional ability and not their mobility. Hence, the assumption and aim for this study has been to investigate to which extent mobility factors, in comparison to the control factors age, gender and ability to perform ADL, may explain low (physical) quality-of-life (SF-12, PCS-12). The study includes people (n=1402) aged 60-96, who participated in a baseline survey in one (Blekinge) of four included centres of the longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC), in 2001, a study with a 61% response rate. Collected data indicated that mobility factors such as reduced ability either to walk a distance of 200 metres or less without stopping, or walking in stairs, or rising from a chair or opening a bottle played a crucial part when developing conditions of low (physical) quality-of-life (PCS-12), while control factors such as gender, age and ability to perform ADL, did not. The results suggest that multiple factors of reduced mobility, rather than impairment in ability to perform ADL, appear to increase the risk for low (physical) quality-of-life, and that targeting these phenomena in health care interventions, are essential.

  • 10. Fagerström, Cecilia
    et al.
    Burholt, Vanessa
    Wenger, Clare G.
    ,
    Meer, M. van der
    Ferring, Dieter
    Glück, J.
    Sources of Social Support in Six European Countries2004Conference paper (Refereed)
  • 11. Fagerström, Cecilia
    et al.
    Hellström, Amanda
    Sleep complaints and their association with comorbidity and health-related quality of life in an older population in Sweden2011In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 15, no 2, p. 204-213Article in journal (Refereed)
    Abstract [en]

    Objective: The relationship between sleep complaints, comorbidity and health-related quality of life (HRQoL) in advanced age has not been clearly established. The aim of this study is therefore to investigate the presence of sleep complaints and discuss their association with morbidity and the HRQoL among the people aged 60 years and above. Methods: Data regarding demography, sleep, comorbidity and HRQoL were collected through questionnaires and interviews among 1128 people in Sweden. The Johns Hopkins adjusted clinical groups (ACG®) Case-Mix System 6.0 and the Short-Form Health Survey-12 were used to assess morbidity and HRQoL, respectively. Results: There was a divergence in the number of sleep complaints between those with no morbidity and those who had a high degree of comorbidity. Most of the sleep complaints related to low HRQoL were found among those with a high degree of comorbidity. Conclusions: People with a high degree of comorbidity appear to be a group with a high risk of having both sleep complaints and a low HRQoL. Thus, this study suggests that even if sleep complaints appear to be difficult to identify and treat successfully, it is important to pay particular attention to those people who suffer from a high degree of comorbidity if their HRQoL is to be maintained.

  • 12. Fagerström, Cecilia
    et al.
    Hellström, Amanda
    Sleep complaints and their relationship with Comorbidity and Health Related Quality of Life among people aged 60 years and above.2010Conference paper (Refereed)
    Abstract [en]

    Background: The relationship between comorbidity, sleep complaints and Health Related Quality of Life (HRQoL) is not yet clearly confirmed. Few published studies exist investigating the relationship between sleep complaints, the degree of comorbidity and HRQoL among those 60 years and older. This study therefore aims to investigate the frequency of sleep complaints and to discuss their relationship with comorbidity as well as HRQoL in a population aged 60+. Method: This study contained of 1128 people aged 60-96 who participated at baseline (2001) in one out of four centres of the Swedish longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC). Result: Our findings indicate that some of the investigated sleep complaints such as having difficulties sleeping because of pain or itch and being dependent on drugs to fall asleep are related to comorbidity whilst others such as waking up early in the morning, feeling tired daytime and waking up during the night might rather be related to conditions associated with the aging process. The women in this study showed to have a higher risk of suffering from sleep complaints and from comorbidity than the men. Their mental and physical HRQoL scores were additionally lower than the men’s and they were also more frequent users of sleeping drugs in comparison with the men. The findings also showed that the higher degree of comorbidity the more sleep complaints were also reported. Discussion: Consequently, older women with a high degree of comorbidity appear to be a vulnerable group and worth paying attention to. They may not only have several diseases at the same time they may also have several sleep complaints which are linked to conditions related to the actual diseases. Circumstances, which all, mean an increased risk of developing a low HRQoL.

  • 13. Fagerström, Cecilia
    et al.
    Holst, Göran
    Hallberg, Ingalill R
    ADL capacity and feeling hindered by health problems at 60 years and above2006Conference paper (Refereed)
    Abstract [en]

    A common consequence of health problems such as diseases is a reduced ability to manage activities in daily living (ADL). Despite ADL capacity is frequently used to identify the impact of health problems on daily living it is still not well known what make people feel hindered in daily life with more or less inability to perform ADL. Such knowledge about feeling hindered by health problems can be useful when planning for interventions in an early stage already when people, regarding to ADL-rating scales have modest impaired ability to perform ADL or even not captured by ADL-scales. The aim of this study was to investigate feeling hindered by health problems among people (n=958) age 60-96 years living in ordinary home in relation to ADL capacity, health problems as well as social and financial resources, sense of coherence and life satisfaction. The data is taken from a questionnaire and a medical examination which were carried out in a baseline survey in one of the four including centres (Blekinge) of the longitudinal multi-centre cohort study The Swedish National study on Ageing and Care (SNAC) (Lagergren et al., 2004). Data indicated that people feel hindered by their health problems before they became impaired in ADL capacity. Feeling greatly hindered by health problems was mainly associated with factors linked to the person’s musculoskeletal system but also to fatigue as well as avoiding being outdoors afraid to fall and had a varying association with feeling hindered in various levels of ADL capacity. The broader question about feeling hindered by health problems used in this study might be an early marker of the impact of functional limitations in daily activities. Combining people’s ADL capacity with the question of feeling hindered may also be a more sensitive way to identify those in need of rehabilitation or other interventions, especially at early stages of health decline compared to investigate ADL capacity solely.

  • 14.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Holst, Göran
    Blekinge Institute of Technology, School of Health Science.
    Hallberg, Ingalill R
    Blekinge Institute of Technology, School of Health Science.
    Feeling hindered by health problems and functional capacity at 60 years and above2007In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 44, no 2, p. 181-201Article in journal (Refereed)
    Abstract [en]

    It is common to use activities of daily living (ADL) rating scales to identify the impact of health problems such as diseases, impaired eyesight or hearing on daily life. However, for various reasons people with health problems might feel hindered in daily life before limitations in ability to perform ADL have occurred. In addition, there is sparse knowledge of what makes people feel hindered by health problems in relation to their ADL capacity. The aim was to investigate feeling hindered by health problems among 1297 people aged 60–89 living at home in relation to ADL capacity, health problems, life satisfaction, self-esteem, and social and financial resources, using a self-reported questionnaire, including questions from OARS (Older Americans’ Resources and Services schedule), Rosenberg’s self-esteem and Life Satisfaction Index Z. People feeling greatly hindered by health problems rarely had anyone who could help when they needed support, had lower life satisfaction and self-esteem than those not feeling hindered. Feeling hindered by health problems appeared to take on a different meaning depending on ADL capacity, knowledge that seems essential to include when accomplishing health promotion and rehabilitation interventions, especially at the early stages of reduced ADL capacity.

  • 15. Fagerström, Cecilia
    et al.
    Holst, Göran
    Hallberg, Ingalill R
    Feeling hindered by health problems in relation to ADL capacity at 60 years and above2005Conference paper (Refereed)
    Abstract [en]

    Health problems as impaired mobility, eyesight or hearing problems in old age are often associated with reduced ADL (activities of daily living) capacity and as a result people may give up activities that contribute to well-being. However, the knowledge is sparse about the relation between feeling hindered by health problems in relation to ADL capacity, decreased or not. Such knowledge may be useful when outlining interventions to people already when people have no or modest impaired ability to perform ADL. Such information can not be captured through ADL-scales but by an overarching question about feeling hindered in daily living by health problems. Purpose: This study presents data on people’s (n=1524) 60-89 years feeling hindered by health problems in relation to their ability to perform ADL, health problems, social and financial resources, self-esteem and life satisfaction. Method: OARS (Older Americans Resources and Services schedule), Rosenberg’s self-esteem and Life Satisfaction Index Z. Results: People who felt greatly hindered by health problems had rarely someone who could help them when needing support, had lower life satisfaction and self-esteem compared to those not. Different factors were associated with feeling greatly hindered by health problems at different levels of ADL ability. Conclusions: Data from this study suggest that feeling hindered in daily living takes on a different meaning depending on functional capacity and thus preventive and visiting work should start early and be outlined differently depending on their ADL capacity. Also such an overarching question may be useful in detecting those in need of interventions.

  • 16.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Lindwall, Magnus
    Berg, Anne
    Rennemark, Mikael
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Factorial validity and invariance of the Life Satisfaction Index in older people across groups and time: Addressing the heterogeneity of age, functional ability, and depression2012In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 55, no 2, p. 349-56Article in journal (Refereed)
    Abstract [en]

    In the last decades, extensive research efforts have been directed at exploring life satisfaction in old age, and the Life Satisfaction Index A (LSIA) scale, developed by Neugarten et al. in the 1960s, is one of the most commonly used instruments. However, studies have focused on predicting and comparing changes in people's life satisfaction without testing if the LSIA instrument is equally valid for different subgroups of people. The present study investigated the underlying dimensions of the LSIA in a Swedish population (n = 1402) of people 60-96 years of age. The study also examined factorial invariance across age, gender, functional ability and depression during a six-year period. The results showed that while a five-factor solution of the LSIA did not exhibit an acceptable fit to the data, a three-factor solution did show a close fit. The two three-factor models that demonstrated the best fit showed invariance across gender and across time, but noninvariance across groups with different levels of reduced functional ability, depressive symptoms and age. These findings suggest that the psychometric properties of life satisfaction instruments like the LSIA need to be taken into consideration before drawing conclusions about life satisfaction when comparing older people of different ages and with different depression and function levels.

  • 17. Fagerström, Cecilia
    et al.
    Palmqvist, Roger
    Carlsson, Johanna
    Hellström, Ylva
    Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: A population-based cohort study2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 7, p. 863-871Article in journal (Refereed)
    Abstract [en]

    Background: Malnutrition is a common problem among older people and associated with reduced functional and cognitive ability. Furthermore, malnutrition among people living in special housing, i.e. in nursing homes or sheltered accommodation, appears to be more common than among those living in regular housing, i.e. in their own homes. However, it is still unclear if the relationship between malnutrition and impaired cognitive ability is connected to living arrangement, i.e. if the relationship is stronger among those who live alone compared to those who cohabit in regular housing. Objectives: The purpose with the present study was to describe the relationship between nutritional status and cognitive ability among people 60 years of age and above in Sweden, with a focus on housing and living arrangement. Design: Population-based cohort study. Setting and participants: The study focused on people living in regular or in special housing and comprised 1402 randomly selected individuals (60-96 years of age) who lived in one municipality in south-eastern Sweden and participated in SNAC-B (the Swedish study on Aging and Care - Blekinge), 2001-2003. Methods: Data regarding demography, nutrition and functional and cognitive ability were collected through questionnaires, medical examinations and structured interviews. Results: The relationship was the strongest between cognitive ability and nutritional status among those living in special housing. Regardless of housing and living arrangement, older people with a moderate or severe cognitive impairment risked (OR 2.59-16.00) being malnourished, irrespective of functional ability. Conclusion: This study highlights that those with a moderate and severe cognitive impairment suffer a risk of developing malnutrition, irrespective of living and housing arrangement. The findings suggest that nurses in the social service and health care system need to consider changes in weight and nutritional intake as well as the individual needs of older people with cognitive impairment to avoid malnutrition

  • 18. Fagerström, Cecilia
    et al.
    Persson, Helen
    Feeling hindered by health problems at age of 60 and above2008Conference paper (Refereed)
    Abstract [en]

    Reduced capacity to perform activities in daily living (ADL capacity) is not the only thing significant for people and their life satisfaction, the importance people attach to being able to perform a specific activity is also crucial. Personal interests may have an impact on the importance of an activity. The ADL scale provides information about functional impairment, but it provides no understanding of the time or effort it takes to perform a certain activity or if a specific individual has to give up valuable activities. More knowledge is therefore needed about what makes people to feel hindered by their health problems in daily living. The aim of this study was to investigate how people (n=958) aged 60–96 years feel hindered in daily living in relation to their ADL capacity, health problems, social and financial resources, sense of coherence, and life satisfaction. The data is taken from a questionnaire and a medical examination which were carried out in a baseline survey in one of the four including centres (Blekinge) of the longitudinal multi-centre cohort study The Swedish National study on Ageing and Care (SNAC). Response rate was 61%. Data indicated that in people with preserved ADL capacity, feeling hindered in daily living meant, above all, fatigue. At the same time, for people with impaired ADL capacity, feeling insecure about available help and about going outdoors were factors that contributed to people feeling hindered by health problems. Accordingly, when nurses, as well as other health professionals, plan to carry out interventions for preventive and rehabilitative purposes, as well as when making follow ups as ADL capacity declines, they should be aware of the fact that different factors are associated with the feeling of being hindered in daily life in people with or without impaired ADL capacity.

  • 19.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Persson, Helen
    Blekinge Institute of Technology, School of Health Science.
    Holst, Göran
    Blekinge Institute of Technology, School of Health Science.
    Hallberg, Ingalill R
    Determinants of Feeling Hindered by Health Problems in Daily Living at 60 Years and Above2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 3, p. 410-421Article in journal (Refereed)
    Abstract [en]

    Although the ability to perform activities of daily living (ADL) is frequently used to identify the impact on daily living caused by health problems such as diseases, impaired eyesight or hearing, it is still not well known what makes people feel hindered in daily living with more or less inability to perform ADL. The aim of this study was to investigate feeling hindered by health problems in daily living among people (n = 958, 60-96 years) in relation to ADL capacity, health problems as well as social and financial resources, sense of coherence and life satisfaction. The data are taken from a baseline survey in one of the four included centres (Blekinge) of the longitudinal multicentre cohort study, The Swedish National Study on Aging and Care. The result showed that people felt hindered by their health problems despite no impairment in ADL capacity. Feeling greatly hindered by health problems was associated with factors linked to mobility but also to fatigue, no help when needed, and avoiding being outdoors due to fear of falling. Factors associated with feeling greatly hindered differed depending on whether people were impaired in ADL capacity or not. In people with excellent ADL capacity feeling hindered was associated with picking up things from the floor and rising from a chair and fatigue, whereas avoiding being outdoors, no help when needed and rising from a chair were found to be associated with feeling hindered by health problems among people with impaired ADL capacity. Combining people's ADL capacity with questions about feeling hindered may provide knowledge of determinant factors of feeling hindered in relation to ADL capacity, impaired or not, to identify people in need of rehabilitation or other interventions.

  • 20.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Tuvesson, Hanna
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Axelsson, Lisa
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Nilsson, Lina
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The role of ICT in nursing practice: An integrative literature review of the Swedish context2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, p. 434-448Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish healthcare system employs information and communication technologies (ICT) in nursing practice to meet quality-, security- and efficiency-related demands. Although ICT is integrated with nursing practices, nurses do not always feel that they are convenient to use it. We need to improve our knowledge of the role of ICT in healthcare environments and so we decided to complement existing experience of how ICT influences nursing practice. Aim: This study aimed to review and synthesise the available literature on the role of ICT in nursing practice in Swedish healthcare settings. Method: To consolidate previous studies based on diverse methodologies, an integrative literature review was carried out. Three databases were used to search for literature, 20 articles met the inclusion criteria. Results: The literature review indicates that ICT integration into nursing practice is a complex process that impacts nurses’ communication and relationships in patient care, working conditions, and professional identities and development. Nurses are found to express ambiguous views on ICT as a usable service in their everyday practice since it impacts both positively and negatively. Discussion and conclusion: Although ICT cannot replace physical presence, it can be considered a complementary service that gives rise to improved patient care. However, nonverbal communication cues may be missed when ICT is used as mediating tool and ICT can be limiting because it is not always designed to meet nurse and patient needs. The meaning of an encounter appears to change when ICT is used in nursing practice, not only for patient relationships but also for interpersonal communication.

  • 21.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Willman, Ania
    Blekinge Institute of Technology, School of Health Science.
    Home Care in Denmark2012In: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., European Obseravatory on Health Systems and Policies , 2012, p. 60-66Chapter in book (Refereed)
  • 22.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Willman, Ania
    Blekinge Institute of Technology, School of Health Science.
    Home Care in Norway2012In: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., European Obseravatory on Health Systems and Policies , 2012, p. 207-213Chapter in book (Refereed)
  • 23.
    Fagerström, Cecilia
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Willman, Ania
    Blekinge Institute of Technology, School of Health Science.
    Home Care in Sweden2012In: Home care across Europe: case studies / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., European Obseravatory on Health Systems and Policies , 2012, p. 272-279Chapter in book (Refereed)
  • 24. Garms-Homolová, V
    et al.
    Naiditch, M
    Fagerström, Cecilia
    Blekinge Institute of Technology, School of Health Science.
    Lamoura, G
    Melchiorre, C
    Gulàcsi, L
    Hutchinson, A
    Clients in focus2012In: Home Care across Europe. Current structure and future challenges / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelon; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2012, p. 55-70Chapter in book (Refereed)
    Abstract [en]

    For every person over the age of 65 in today’s European Union, there are four people of working age but, by 2050, there will only be two. Demand for long-term care, of which home care forms a significant part, will inevitably increase in the decades to come. Despite the importance of the issue, however, up-to-date and comparative information on home care in Europe is lacking. This book attempts to fill some of that gap by examining current European policy on home care services and strategies. Home care across Europe probes a wide range of topics including the links between social services and health-care systems, the prevailing funding mechanisms, how service providers are paid, the impact of governmental regulation, and the complex roles played by informal caregivers. Drawing on a set of Europe-wide case studies (available in a second, online volume), the study provides comparable descriptive information on many aspects of the organization, financing and provision of home care across the continent. It is a text that will help frame the coming debate about how best to serve elderly citizens as European populations age.

  • 25. Genet, N
    et al.
    Ersek, K
    Boerma, W
    Hutchinson, A
    Garms-Homolova, V
    Naiditch, M
    Lamura, G
    Chablicz, S
    Gulacsi, L
    Fagerström, Cecilia
    Integrating home care services in Europe.2010In: Journal of Clinical Nursing, Wiley-Blackwell , 2010, Vol. 19, no Suppl. 1Conference paper (Refereed)
  • 26. Genet, N
    et al.
    Gulacsi, L
    Boerma, W
    Hutchinson, A
    Garms-Homolova, V
    Naiditch, M
    Lamura, G
    Chablicz, S
    Ersek, K
    Fagerström, Cecilia
    Financing home care in Europe2010In: Journal of Clinical Nursing, Rotterdam, the Netherlands: Wiley-Blackwell , 2010, Vol. 19, no Suppl. 1Conference paper (Refereed)
    Abstract [en]

    Despite the assumption that care delivered at home is more cost-effective than care provided in institutions, such as nursing homes, the pressure on expenditures for home care will remain. Financial incentives are widely used to get better value for money. Incentives can be applied to authorities responsible for home care, or to agencies that provide services or to clients who receive care. Details of the financing system of home care services very much determine the possibilities for financial incentives. At present, there is a need for comparative information on financing mechanisms for home care. This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been developed in this project to map the home care systems in Europe, including details of financing. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation. Prevailing models of financing for home care will be presented as well as information of the extent to which home care across Europe is pressured by financial restraints. Especially in Eastern European countries, where home care is not well developed yet, funding is a major problem. Co-payments are applicable in most countries to reduce expenditures and to prevent over-utilisation of services. Usually, financing mechanisms for social community based services differ from the mechanisms in place for home health care services. Consequently, modes of reimbursement for providers of different sorts of home care services and the financial implications for clients differ. Co-payments are more prevalent with social services than with health care. Another financial allocation mechanism is means testing, which is frequently used with publicly financed home care services. There is a large diversity in the type of financing mechanism, both between and within countries in Europe. Budgetary restraints are one of the main problems with regard to home care in almost all countries. Usually, access to home care services is restricted in some way by financial restrictions.

  • 27. Genet, N
    et al.
    Lamura, G
    Boerma, W
    Hutchinson, A
    Garms-Homolova, V
    Naiditch, M
    Chablicz, S
    Ersek, K
    Gulacsi, L
    Fagerström, Cecilia
    Human resources in home care in Europe.2010In: Journal of Clinical Nursing, Wiley-Blackwell , 2010, Vol. 19, no suppl. 1Conference paper (Refereed)
  • 28. Genet, N
    et al.
    Naiditch, M
    Boerma, W
    Hutchinson, A
    Garms-Homolova, V
    Lamura, G
    Chablicz, S
    Ersek, K
    Gulacsi, L
    Fagerström, Cecilia
    Recipients of home care and the role of informal care in Europe.2010In: Journal of Clinical Nursing, Wiley-Blackwell , 2010, Vol. 19, no Suppl. 1Conference paper (Refereed)
    Abstract [en]

    In many cases home care is no viable option without the efforts of clients and informal carers. So, an understanding of home care systems would not be complete without taking into account the role of clients and informal carers. As resources and criteria of eligibility are very different across countries, clients differ in their dependency, frailty and availability of informal care. In some countries recipients of home care more behave like critical consumers knowing their rights than those in other countries. Henceforth, systems may differ in the way clients are informed, can choose and, if necessary, can submit complaints. Another difference concerns the acknowledgement and role of informal carers, which is reflected, for instance, in the possibility for informal carers to be supported (e.g. with respite care). Here again, it turns out that very little comparative information is available at this point. On the basis of results of a literature review and from consultations with experts across Europe, the EC-financed EURHOMAP project has developed an extensive set of indicators to map home care systems, including the position and situation of clients and informal carers. EURHOMAP partners collected the data in 2009 and early 2010, in collaboration with experts in 31 European countries. Results were described in uniformly structured country reports and fed back to national experts for validation. An additional source of information was the answers on questions related to four ‘vignettes’ (hypothetical case descriptions of home living people in need of care). These questions were answered by a panel of key informants in each country. In most countries the largest share among recipients of home care consists of people above the age of 65 years. The number of recipients of home care varied enormously. In some countries home is almost limited to the elderly, while in other countries a wider range of services is provided to a wider vaiety of client and patient groups, including those in need of palliative (end-of-life) care and those in need of post-hospital care. Great differences were found in empowering recipients of home care (such as: offering choice of provider, type of provider; personal budget as an option; and availability of benchmark information to enable recipients to compare providers). The 31 countries will be compared on the availability of payment of informal carers; whether the tasks of informal carers have been laid down in a care protocol; whether the availability of informal care is taken into account in the needs assessment. Countries strongly differ in the number of home care recipients, their position in the system and the role of informal carers in the allocation and provision of formal care.

  • 29. Genet, Nadine
    et al.
    Boerma, Wienke G. W.
    Kringos, Dionne S.
    Bouman, Ans
    Francke, Anneke L.
    Fagerström, Cecilia
    Melchiorre, Maria Gabriella
    Greco, Cosetta
    Devillé, Walter
    Home care in Europe: a systematic literature review2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 207Article, review/survey (Refereed)
    Abstract [en]

    Background: Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need, by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods: A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care ‘policy & regulation’, 'financing', ‘organisation & service delivery’, and ‘clients & informal carers’. Results: Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions: It can be concluded that home care systems appeared to differ not just between but also within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially papers comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires gathering of information using a uniform framework and methodology.

  • 30. Genet, Nadine
    et al.
    Hutchinson, Allen
    Naititch, Michel
    Garms-Homolová, Vjenka
    Fagerström, Cecilia
    Blekinge Institute of Technology, School of Health Science.
    Melchiorre, Maria Gabriella
    Kroneman, Madelon
    Greco, Cosetta
    Management of the care process2012In: Home Care across Europe. Current structure and future challenges / [ed] Genet, Nadine; Boerma, Wienke; Kroneman, Madelene; Hutchinson, Allen; Saltman, Richard B., World Health Organization , 2012, p. 71-104Chapter in book (Refereed)
    Abstract [en]

    For every person over the age of 65 in today’s European Union, there are four people of working age but, by 2050, there will only be two. Demand for long-term care, of which home care forms a significant part, will inevitably increase in the decades to come. Despite the importance of the issue, however, up-to-date and comparative information on home care in Europe is lacking. This book attempts to fill some of that gap by examining current European policy on home care services and strategies. Home care across Europe probes a wide range of topics including the links between social services and health-care systems, the prevailing funding mechanisms, how service providers are paid, the impact of governmental regulation, and the complex roles played by informal caregivers. Drawing on a set of Europe-wide case studies (available in a second, online volume), the study provides comparable descriptive information on many aspects of the organization, financing and provision of home care across the continent. It is a text that will help frame the coming debate about how best to serve elderly citizens as European populations age.

  • 31. Hellström, A.
    et al.
    Nilsson, C.
    Nilsson, A.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Leg ulcers in older people: A national study addressing variation in diagnosis, pain and sleep disturbance2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 25Article in journal (Refereed)
    Abstract [en]

    Background: Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. Methods: The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9 % were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. Results: We found the prevalence of pain intensity ≥ 5 on the NRS to be 34.8 % in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p < 0.001) and were found in 34.8 % of the total sample. Although more women than men reported pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venous-arterial ulcers increased the risk of sleep disturbances, as did higher pain scores. Conclusions: The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met. National guidelines in managing leg ulcers, which also consider consequences such as sleep disturbances, pain and discomfort, are needed. © 2016 Hellström et al.

  • 32. Hellström, Amanda
    et al.
    Fagerström, Cecilia
    Willman, Ania
    Promoting Sleep by Nursing Interventions in Health Care Settings: A Systematic Review2011In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X , Vol. 8, no 3, p. 128-142Article, review/survey (Refereed)
    Abstract [en]

    Background: Sleep disturbances are common problems among individuals in hospitals and institutions. Although several studies have explored this phenomenon, there is still a lack of knowledge about the effectiveness of sleep-promoting nursing interventions. This systematic review aims to describe and evaluate the effectiveness of sleep-promoting nursing interventions in health care settings. Approach: A systematic review was performed. In June 2009, a literature search was carried out in the following databases: Academic Search Elite, CINAHL, the Cochrane Library and MedLine/PubMed. Fifty-two references were identified and after critical appraisal, nine studies were selected. A compilation of the results and the outcomes of the interventions were carried out. Furthermore, the evidence strength of the interventions was assessed. Findings: Little evidence for the nursing interventions, sleep hygiene, music, natural sound and vision, stimulation of acupoints, relaxation, massage and aromatherapy is found. However, large effect size of interventions were found when using massage, acupuncture and music, natural sounds or music videos. The use of sleep hygiene and relaxation, on the other hand, produced only small effects. Conclusion: The lack of high evidence strength for the nursing interventions together with the uncertainty about their effects calls for more research before implementing these interventions into clinical practice.

  • 33. Hellström, Amanda
    et al.
    Hagell, Peter
    Fagerström, Cecilia
    , Ania Willman
    How to measure and classify insomnia in elderly persons2010In: Journal of Clinical Nursing, Rotterdam: Wiley-Blackwell , 2010, Vol. 19, no suppl. 1Conference paper (Refereed)
    Abstract [en]

    Introduction: Since sleep is found to be a fundamental part in experiencing quality of life and health it is of importance that nurses and other health care personnel strive to improve sleep and prevent sleep disturbances. Insomnia, which is the most common form of sleep disturbances, has also been found to be related with cardiac disorders. Elderly people are especially vulnerable for poor sleep; prevention of sleep disturbances should be of regard when caring for older persons. The Minimal Insomnia Symptom Scale (MISS) is a three item screening instrument previously found to be psychometrically sound and capable of identifying insomnia in the general population (20-64 years). However, its measurement properties have not been studied in an elderly population. Our aim was to test the measurement properties of the MISS among people aged 65+ in Sweden. Methods and materials: Data from a cross-sectional survey of 548 elderly individuals were analyzed in terms of assumptions of summation of items, reliability and optimal cut-off score by means of ROC-curve analysis and compared with self-reported insomnia criteria. The items of MISS describes the major features of insomnia, i.e. difficulties initiating sleep, waking at night and not feeling refreshed by sleep. A total score ranging between 0 and 12 is calculated, where higher scores indicate more severe insomnia. Results: Reliability was found to be 0.81. ROC analysis where MISS was compared with self-reported insomnia criteria (i. e. day-time sleepiness, not feeling refreshed by sleep, experiencing sleep difficulties). Optimal cut-off score was identified as more or equal to 7, and sensitivity 93%, specificity 84%. Conclusions: Data support the measurement properties of MISS as an insomnia screening instrument among elderly persons and its brevity as well as the easy scoring system makes it appealing in clinical practice.

  • 34. Hellström, Amanda
    et al.
    Hagell, Peter
    Fagerström, Cecilia
    Willman, Ania
    Measurement properties of the Minimal Insomnia Symptom Scale (MISS) in an elderly population in Sweden.2010In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 10:84Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia is common among elderly people and associated with poor health. The Minimal Insomnia Symptom Scale (MISS) is a three item screening instrument that has been found to be psychometrically sound and capable of identifying insomnia in the general population (20-64 years). However, its measurement properties have not been studied in an elderly population. Our aim was to test the measurement properties of the MISS among people aged 65 + in Sweden, by replicating the original study in an elderly sample. Methods: Data from a cross-sectional survey of 548 elderly individuals were analysed in terms of assumptions of summation of items, floor/ceiling effects, reliability and optimal cut-off score by means of ROC-curve analysis and compared with self-reported insomnia criteria. Results: Corrected item-total correlations ranged between 0.64-0.70, floor/ceiling effects were 6.6/0.6% and reliability was 0.81. ROC analysis identified the optimal cut-off score as ≥7 (sensitivity, 0.93; specificity, 0.84; positive/negative predictive values, 0.256/0.995). Using this cut-off score, the prevalence of insomnia in the study sample was 21.7% and most frequent among women and the oldest old. Conclusions: Data support the measurement properties of the MISS as a possible insomnia screening instrument for elderly persons. This study make evident that the MISS is useful for identifying elderly people with insomnia-like sleep problems. Further studies are needed to assess its usefulness in identifying clinically defined insomnia.

  • 35. Hellström, Amanda
    et al.
    Hagell, Peter
    Fagerström, Cecilia
    Willman, Ania
    Usefulness of the Minimal Insomnia Symptom Scale (MISS) in elderly persons2010Conference paper (Refereed)
    Abstract [en]

    Sleep is found to be a fundamental part in experiencing health. Sleep is needed for memory consolidation, metabolic balance, immune functioning and alertness at day time and experiencing quality of life. Insomnia has also been found to be associated with cardiac disorders. Elderly people are especially vulnerable for poor sleep, why prevention of sleep disturbances should be of regard when caring for older persons. MISS is a 3 item questionnaire, with a total-score of 0-12 that could be used to find insomnia in elderly persons. Aim: To test of the measurement properties of the Minimal Insomnia Symptom Scale in an elderly sample ≥65 years in Sweden. Study sample Persons participating in the Swedish National Study on Ageing and Care – Blekinge were invited. ● 548 participated (response-rate 61.4%) ● Mean age 77.8 (SD 8.63) years ● Female 57.5% Results Reliability was found to be 0.81. ROC analysis where MISS was compared with self-reported insomnia criteria (i.e. day-time sleepiness, not feeling refreshed by sleep, experiencing sleep difficulties) identified optimal cut-off score as ≥7, and sensitivity 93%, specificity 84%. Area under curve = 0.93. Conclusion Data support the measurement properties of MISS as an insomnia screening instrument among elderly persons and its brevity makes it appealing. Through insomnia-screening, older persons at risk of health problems can be found and offered treatment and thereby health and quality of life can be restored.

  • 36.
    Hellström, Amanda
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Hellström, Patrik
    Willman, Ania
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Association between Sleep Disturbances and Leisure Activities in the Elderly: A Comparison between Men and Women.2014In: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, Vol. 2014, no Article ID 595208Article in journal (Refereed)
    Abstract [en]

    It has been suggested that physical or social activity is associated with fewer sleep disturbances among elderly people. Women report more sleep disturbances than men, which could indicate a variation in activity patterns between the genders. The aim of this study was to investigate associations between sleep disturbances and leisure activities in men and women (n = 945) aged ≥60 years in a Swedish population. Sleep disturbances were measured using eight dichotomous questions and seventeen variables, covering a wide range of leisure activities. Few leisure activities were found to be associated with sleep disturbances and their importance decreased when the models were adjusted for confounders and gender interactions. After clustering the leisure activities and investigating individual activities, socio-intellectual activities were shown to be significant for sleep. However, following adjustment for confounders and gender interactions, home maintenance was the only activity significant for sleep. Being a female increased the effect of home maintenance. Besides those leisure activities, poor/fair self-rated health (OR 7.50, CI: 4.27-11.81) and being female (OR 4.86, CI: 2.75-8.61) were found to have the highest association with poor sleep. Leisure activities pursued by elderly people should focus on activities of a socio-intellectual nature, especially among women, to promote sleep.

  • 37. Holst, Göran
    et al.
    Willman, Ania
    Fagerström, Cecilia
    Borg, Christel
    Hellström, Ylva
    Borglin, Gunilla
    Quality of care: Prevention of pressure ulcers – Nursing students facilitating evidence-based practice2010In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 30, no 1, p. 40-42Article in journal (Refereed)
    Abstract [en]

    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.

  • 38.
    Karlsson, Staffan
    et al.
    Lund Univ, SWE.
    Rahm Hallberg, Ingalill
    Lund Univ, SWE.
    Midlöv, Patrik
    Lund Univ, SWE.
    Fagerstrom, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia: a review of the Swedish context2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 251Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in nursing homes as reported in the most recent empirical studies on the topic, and to relate these trends to directives from the national authorities. Methods: The study included two scoping review studies based on searches of electronic databases as well as the Swedish directives in the field. Results: During the past decade, directives have been developed for antipsychotic medication in Sweden. These directives were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and in those with moderate cognitive impairment and living in nursing homes for people with dementia. A decreasing trend in antipsychotic use has been seen over the last 15 years. Conclusions: Directives from the authorities in Sweden may have had an impact on treatment with antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while treatment with combinations of psychotropic medications is common. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.

  • 39.
    Lagergren, Marten
    et al.
    Stockholm Gerontol Res Ctr, Stockholm, Sweden..
    Fagerstrom, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sjolund, Britt-Marie
    Karolinska Inst, Dept Neurobiol, Aging Res Ctr, Care Sci & Soc, Solna, Sweden.;Stockholm Univ, Solna, Sweden..
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Fratiglioni, Laura
    Stockholm Gerontol Res Ctr, Stockholm, Sweden.;Karolinska Inst, Dept Neurobiol, Aging Res Ctr, Care Sci & Soc, Solna, Sweden.;Stockholm Univ, Solna, Sweden..
    Nordell, Eva
    Lund Univ, Dept Hlth Sci, Div Geriatr Med, Malmo, Sweden.;Skane Univ Hosp, Malmo, Sweden..
    von Strauss, Eva
    Karolinska Inst, Dept Neurobiol, Aging Res Ctr, Care Sci & Soc, Solna, Sweden.;Stockholm Univ, Solna, Sweden.;Red Cross Hosp, Nonprofit Org, Stockholm, Sweden.;Red Cross Univ Coll, Stockholm, Sweden..
    Wimo, Anders
    Karolinska Inst, Dept Neurobiol, Alzheimers Dis Res Ctr, Care Sci & Soc, Solna, Sweden..
    Elmstahl, Solve
    Lund Univ, Dept Hlth Sci, Div Geriatr Med, Malmo, Sweden.;Skane Univ Hosp, Malmo, Sweden..
    Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden2016In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 28, no 1, p. 147-158Article in journal (Refereed)
    Abstract [en]

    The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

  • 40. Lagergren, Mårten
    et al.
    Sjölund, Britt-Marie
    Fagerström, Cecilia
    Blekinge Institute of Technology, School of Health Science.
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Fratiglioni, Laura
    Nordell, Eva
    Wimo, Anders
    Elmståhl, Sölve
    Horizontal and vertical target efficiency – a comparison between users and non-users of public long-term care in Sweden2014In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 34, no 4, p. 700-719Article in journal (Refereed)
    Abstract [en]

    The extent to which a system of services is in tune with the needs of the population can be expressed in terms of target efficiency, which includes horizontal target efficiency – the extent to which those deemed to need a service receive it – and vertical target efficiency – the corresponding extent to which those who receive a service actually need it. Vertical efficiency can be measured by looking only at those receiving services. To measure horizontal target efficiency in a population, one must have access to population surveys. Data were taken from the baseline survey of the Swedish National Study on Ageing and Care (SNAC study). The results show that more than 80 per cent of those dependent in personal activities of daily living in the studied geographic areas were users of public long-term care (LTC). Dependency in instrumental activities of daily living was identified as the most important predictor of using LTC. Vertical target efficiency was 83–95 per cent depending on age, gender and type of household, if need was defined as dependency in instrumental activities of daily living. It was considerably lower, 35–61 per cent when defined as dependency in personal daily activities. Overall, long-term target efficiency in Sweden must be regarded as high. Few persons who need public LTC services fail to receive them.

  • 41.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Fagerstrom, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Willman, Ania
    Malmo Univ., SWE.
    Sivberg, Bengt
    Lund Univ., SWE.
    Befriending Everyday Life When Bringing Technology Into the Private Sphere2017In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 27, no 6, p. 843-854Article in journal (Refereed)
    Abstract [en]

    We present the findings of our phenomenological interview study concerning the meaning of being an autonomous person while dependent on advanced medical technology at home. This was elucidated in the participants' narratives as befriending everyday life when bringing technology into the private sphere. We discovered four constituents of the phenomenon: befriending the lived body, depending on good relationships, keeping the home as a private sphere, and managing time. The most important finding was the overall position of the lived body by means of the illness limiting the control over one's life. We found that the participants wanted to be involved in and have influence over their care to be able to enjoy autonomy. We therefore stress the importance of bringing the patients into the care process as chronic illness will be a part of their everyday life for a long time to come, hence challenging patient autonomy.

  • 42.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Sivberg, Bengt
    Willman, Ania
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Concept analysis: patient autonomy in a caring context2014In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 10, p. 2208-2221Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of an analysis of the concept of patient autonomy. Background. Many problems regarding patient autonomy in healthcare contexts derive from the patient's dependent condition as well as the traditional authoritarian position of healthcare professionals. Existing knowledge and experience reveal a lack of consensus among nurses regarding the meaning of this ethical concept. Design. Concept Analysis. Data sources. Medline, CINAHL, The Cochrane Library and PsycINFO were searched (2005-June 2013) using the search blocks 'autonomy', 'patient' and 'nursing/caring'. A total of 41 articles were retrieved. Review Methods. The Evolutionary Method of Concept Analysis by Rodgers was used to identify and construct the meaning of the concept of patient autonomy in a caring context. Results. Five attributes were identified, thus creating the following descriptive definition: 'Patient autonomy is a gradual, time-changing process of (re-)constructing autonomy through the interplay of to be seen as a person, the capacity to act and the obligation to take responsibility for one’s actions’'. Patient vulnerability was shown to be the antecedent of patient autonomy and arises due to an impairment of a person's physical and/or mental state. The consequences of patient autonomy were discussed in relation to preserving control and freedom. Conclusion. Patient autonomy in a caring context does not need to be the same before, during and after a care episode. A tentative model has been constructed, thus extending the understanding of this ethical concept in a caring context.

  • 43.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Sivberg, Bengt
    Lunds universitet, SWE.
    Willman, Ania
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health. Malmö University, SWE.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    A trajectory towards partnership in care - Patient experiences of autonomy in intensive care: A qualitative study2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 5, p. 294-302Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to describe and elucidate patient experiences of autonomy in an intensive care context from a caring perspective. Background: Patients in intensive care units (ICUs) are critically ill and in a dependent and vulnerable position. There is thus a risk of staff taking command not only of the patients’ vital functions but also of their decision-making. Methods: A qualitative design was selected. Individual interviews were conducted with 11 adult patients with an intensive care episode of two days or more at six Swedish ICUs. The data were analysed using Inductive Content Analysis. Findings: Patient autonomy in intensive care was shown to be ’A trajectory towards partnership in care depending on state of health and mutual understanding’. It was experienced through acknowledged dependence, being recognised as a person, invited participation and becoming a co-partner in care. Conclusion: Patients in need of intensive care wanted to be involved in making decisions about their care as this creates a trusting and healthy care environment. Greater awareness is required about the ICU patient not only being a passive care recipient but also an active agent and where involvement in decision-making and participation in care are crucial. © 2015 Elsevier Ltd.

  • 44.
    Lindberg, Terese
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Andersson, Oscar
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Palm, Molina
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Fagerstrom, Cecilia
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    A systematic review and meta-analysis of dressings used for wound healing: the efficiency of honey compared to silver on burns2015In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535, Vol. 51, no 2-3, p. 121-134Article in journal (Refereed)
    Abstract [en]

    Background: Honey has the antibacterial effect of silver without the toxic effect of silver on the skin. Even so, silver is the dominant antibacterial dressing used in wound healing. Objectives: To evaluate the healing effects of honey dressings compared to silver dressings for acute or chronic wounds. Design: A systematic review with meta-analysis. Method: The search, conducted in seven databases, resulted in six randomised controlled trial studies from South Asia focusing on antibacterial properties and healing times of honey and silver. Result: Honey was more efficacious for wound healing than silver, as measured in the number of days needed for wounds to heal (pooled risk difference -20, 95% CI -0.29 to -0.11, p < .001). Honey turned out to have more antibacterial qualities than silver. Conclusion: All the included studies based on burns showed the unequivocal result that honey had an even more positive effect than silver on wound healing.

  • 45. M., Naseer
    et al.
    H., Forssell
    Cecilia, Fagerström
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study2016In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, no 3, p. 399-404Article in journal (Refereed)
    Abstract [en]

    Background/Objectives:This study aimed to assess the association between risk of malnutrition and 7-year mortality, controlling for functional ability, socio-demographics, lifestyle behavior and diseases, and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality.Subjects/Methods:A longitudinal study on home-living and special-housing residents aged â©Ÿ60 years was conducted. Of 2312 randomly invited participants, 1402 responded and 1203 provided information on both nutritional status and functional ability. The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure (BMI, MAC and CC) below cut-off in addition to the presence of at least one subjective measure (decreased food intake, weight loss and eating difficulty).Results:At baseline, 8.6% of subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. The risk of malnutrition was independently associated with 7-year mortality (hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.28–2.65). Additional independent predictors were dementia (HR 2.76, 95% CI 1.85–4.10), activity of daily living (ADL) dependence (HR 2.08, 95% CI 1.62–2.67), heart disease (HR 1.44, 95% CI 1.16–1.78), diabetes (HR 1.41, 95% CI 1.03–1.93) and older age (HR 1.09, 95% CI 1.07–1.10). Moreover, the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, P<0.001).Conclusions:The risk of malnutrition significantly increases the risk of mortality in older people. Moreover, risk of malnutrition and ADL dependence together explain a significantly poorer survival rate; however, the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality.European Journal of Clinical Nutrition advance online publication, 25 November 2015; doi:10.1038/ejcn.2015.196. © 2015 Macmillan Publishers Limited

  • 46.
    Marcinowicz, Ludmila
    et al.
    Medical University of Bialystok, POL.
    Jamiołkowski, Jacek
    Medical University of Bialystok, POL.
    Gugnowski, Zbigniew
    Medical Center Masuria, POL.
    Strandberg, Eva Lena
    Lund University, SWE.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Pawlikowska, Teresa
    Royal College of Surgeons in Ireland, IRL.
    Evaluation of the trust in physician scale (TIPS) of primary health care patients in north-east poland: A preliminary study2017In: Family Medicine and Primary Care Review, ISSN 1734-3402, Vol. 19, no 1, p. 39-43Article in journal (Refereed)
    Abstract [en]

    Background. Trust is a complex concept, difficult to study, but very important in a patient-family physician relationship. One of the measures used to assess interpersonal trust is a scale developed by Anderson & Dedrick entitled the Trust in Physician Scale (TI PS). Objectives. The aim of the study was to assess the TI PS properties in relation to the age, gender, and health status of primary health care patients consulting family doctors and trainees in north-east Poland. Material and methods. A cross-sectional study using the TI PS was conducted in primary health care units in north-east Poland. 120 patients (60 who came to see family doctors, and 60 who came to see trainees) were asked to participate in the survey. Results. The Trust in Physician Scale has good reliability in primary care patients in north-east Poland (Cronbach’s alpha coefficient was 0.90). Patients displayed statistically significant greater trust in family doctors than in trainees. A negative correlation was found between age and the trust scale (r = -0.30; p = 0.005); the younger the respondent, the higher trust in the physician, and conversely, a positive correlation between self-assessment of health and the trust scale (r = 0.3; p = 0.003). Conclusions. The Polish translation of the TI PS instrument performed well in terms of acceptability in the family medicine environment. It can be used to differentiate between the level of trust in family doctors and in trainees. A relation between age, sex, education level and self-assessment of health needs to be confirmed using a larger sample. © Wydawnictwo Continuo.

  • 47. Naseer, M.
    et al.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Prevalence and association of undernutrition with quality of life among Swedish people aged 60 years and above: Results of the SNAC-B study2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 10, p. 970-979Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aimed to assess the prevalence of undernutrition among elderly and to investigate the association of risk of undernutrition with health-related quality of life and life satisfaction controlling for age, gender, marital status, economic status, housing arrangement, education level, functional ability, and diseases. Design: A cross-sectional study design was used for this study. The baseline data (2001–2003) of “The Swedish National Study of Aging and Care-Blekinge (SNAC-B)” was used. Setting: This population-based study focused on both home-living and special-housing residents. Participants: The participants (n=1402) were randomly selected and included both males and females 60–96 years of age residing in a municipality of south-east Sweden. Measurements: The risk of undernutrition was estimated by the occurrence of at least one anthropometric measure (body mass index, mid-arm circumference, and calf circumference) below cut-off, in addition to the presence of at least one subjective measure (declined food intake, weight loss, and eating difficulty). The dependent variables, health-related quality of life and life satisfaction, were measured by the validated short form health survey (SF-12) and Liang’s life satisfactions index A (LSIA), respectively. Results: According to the criterion, 8.5% of the participants were at risk of undernutrition, and subjects at nutritional risk were significantly older, female, unmarried/widowed/divorced, residing in special housing, and functionally impaired. The risk of undernutrition was significantly associated with poor health-related quality of life, both in the physical (OR 2.31, 95% CI 1.18–4.52) and mental (OR 2.34, 95% CI 1.22–4.47) dimensions. However, no significant association was observed between nutritional status and life satisfaction (OR 1.30, 95% CI 0.70–2.40). Conclusion: The risk of undernutrition significantly increases the risk of poor physical and mental health-related quality of life but has negligible impact on life satisfaction. This study also highlights the importance of functional ability both for the prevention of undernutrition and promotion of quality of life. However, more studies are needed to validate the tool used here for undernutrition risk assessment before it can be used in clinical or population settings. © 2015 Serdi and Springer-Verlag France

  • 48. Rennemark, Mikael
    et al.
    Holst, Göran
    Fagerström, Cecilia
    Halling, Anders
    Factors related to frequent usage of the primary healthcare services in old age: findings from The Swedish National Study on Aging and Care2009In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 17, no 3, p. 304-311Article in journal (Refereed)
    Abstract [en]

    People aged 60 or more are the most frequent users of healthcare services. In this age range, however, both frequent and infrequent users can be found. Frequent users have high rates of illnesses. Previous research has found that the frequency may be influenced also by psychological and social factors. The aim of this study was to investigate to what degree such factors add to the explanation of differences in number of visits to a physician. A crosssectional study was conducted with a random sample consisting of 1017 individuals, aged 60 to 78 years, from the Blekinge part of the Swedish National Study on Aging and Care database. The data were collected during 2001 to 2003. Hierarchical logistic regression analyses were used with frequent (three visits or more during a year) and infrequent use as a dichotomous dependent variable. The final statistical analyses included 643 individuals (63% of the sample). Independent variables were sense of coherence (SOC), internal locus of control, education level and social anchorage. Control variables were age, gender, functional ability and comorbidity. The results showed that comorbidity was most strongly related to frequent use [adjusted odds ratio (OR) = 8.17, 95% confidence interval (CI) 5.54–12.04]. In addition, SOC and internal locus of control had small, but significant effects on the odds of being a frequent user (adjusted OR = 1.03, 95% CI 1.00–1.06 and adjusted OR = 1.14, 95% CI 1.02–1.27, espectively). The lower the SOC and the internal locus of control were, the higher were the odds of frequent use. Education level and social anchorage were unrelated to frequency of use. The results indicate that frequent healthcare services users are more ill than infrequent users. Psychological factors influence the use only marginally, and social factors as well as age and gender are not by themselves reason for frequent healthcare services use.

  • 49. Rennemark, Mikael
    et al.
    Holst, Göran
    Fagerström, Cecilia
    Halling, Anders
    What makes old people utilise the health care services?2007Conference paper (Refereed)
  • 50. Sandberg, Magnus
    et al.
    Kristensson, Jimmie
    Midlöv, Patrik
    Fagerström, Cecilia
    Blekinge Institute of Technology, School of Health Science.
    Jakobsson, Ulf
    Prevalence and predictors of healthcare utilization among older people (60+); Focusing on ADL dependency and risk of depression2012In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 54, no 3, p. 349-363Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate healthcare utilization patterns over a six-year period among older people (60+), classified as dependent/independent in Activities of Daily Living (ADL) and/or at/not at risk of depression and to identify healthcare utilization predictors. A sample (n = 1402) comprising ten age cohorts aged between 60 and 96 years was drawn from the Swedish National study on Aging and Care (SNAC). Baseline data were collected between 2001 and 2003. Number and length of hospital stays were collected for six years after baseline year. Group differences and mean changes over time were investigated. Healthcare utilization predictors were explored using multiple linear regression analysis. The results revealed that 21–24% had at least one hospital stay in the six years after baseline, 29–37% among ADL dependent subjects and 24–33% among those at risk of depression. There was a significant increase of hospital stays in all groups over time. ADL-dependent subjects and those at risk of depression had significant more hospital stays, except for those at/not at risk of depression in years 2, 4 and 5. The healthcare utilization predictors 5–6 years after baseline were mainly age, previous healthcare utilization and various symptoms and, in 1–2 and 3–4 years after baseline, age, various diagnostic groups and various physical variables. Thus healthcare utilization patterns seem to be similar for the different groups, but it is difficult to find universal predictors. This suggests that different variables should be considered, including both ADL and psychosocial variables, when trying to identify future healthcare users

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