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Idag bor många äldre personer kvar i sin bostad trots omfattande hälsoproblem i form av fysiska och kognitiva funktionsnedsättningar och långvariga sjukdomstillstånd. Miljöns utformning har potential att stödja personer med skör hälsa och således krävs fungerande boendemiljöer som är anpassade till äldre personers behov och skapar förutsättningar att leva ett gott liv. Mot denna bakgrund ville vi undersöka miljömässiga aspekter av betydelse för äldre personer och deras aktiviteter i boendemiljön. För att få en heltäckande bild av äldres boendemiljöer tillämpades olika metoder. Data har använts från SWEOLD Dalarna, en databas som fångar ett brett spektrum av levnadsvillkor för äldre personer. I SWEOLD-urvalet ingick drygt 400 personer där medelåldern var 82 år. Vidare har en mindre grupp äldre personer med hemtjänst deltagit där data har insamlats med intervjuer, observationer, aktivitetsdagböcker, frågeformulär och GPS-sändare. I den gruppen ingick 20 personer där medelåldern var 87 år. För att få ett bredare perspektiv kring äldres boendemiljöer har även hemtjänstpersonal och anhöriga till personer med hemtjänst deltagit.

Några av resultaten visade att boendemiljön kunde relateras till en känsla av gemenskap, trygghet och tillhörighet. Äldre personer hade rutiner i vardagen i form av aktiviteter i och utanför bostaden och det var av central betydelse att känna sig självständig i det dagliga livet trots hälsoproblem och försämrad funktionsförmåga. Miljöhinder förekom i samtliga bostäder både utomhus, vid entréer och inomhus, något som kunde begränsa äldre personers mobilitet och delaktighet. Av resultaten framkom även könsskillnader där kvinnor i jämförelse med män uppgav sämre mobilitet, använde hjälpmedel i större utsträckning och upplevde fler tillgänglighetshinder. Sammantaget framkom att boendemiljöns utformning har stor påverkan på äldre i deras vardag, inte minst vad gäller förutsättningar för socialt umgänge där bostadens inomhusmiljö, utomhusmiljö och närliggande omgivning måste vara tillgänglig och användbar.

BACKGROUND: The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people.

OBJECTIVES: To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE).

DESIGN: An instrument development and psychometric evaluation study.

METHODS: Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level.

RESULTS: The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment.

CONCLUSION: The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care.

IMPLICATIONS FOR PRACTICE: The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.

Digital homecare twin expectations among Swedish social service professionals – a qualitative study

Background and purpose

Designing care and support interventions that are tailored to the persons’ needs is essential to high-quality care and is increasingly recognised as associated with positive effects on the health and well-being of older adults and caregivers. In line with demographic trends observed in many countries, Sweden is confronted with a double demographic challenge where the proportion of older adults is increasing while the proportion of people of working age is decreasing. This will lead to a significant shortage of personnel within the sector of health and social care services by the year 2030 with the risk of deteriorations in the quality of care. This pressing situation underscores an urgent need for novel and innovative solutions in municipal homecare. Therefore, the purpose of this study was to identify expectations of social service professionals in Sweden concerning a digital homecare twin intended to support person-centeredness and enhance the working environment in homecare. A digital twin serves as a digital representation of assets, processes, and systems, which in the context of homecare includes older adults and their homes, as well as homecare services and personnel. This study constitutes an integral part of a broader research project aimed at the co-development and evaluation of a digital twin for homecare, which is based on Industry 4.0 technology. 

Methods

The present study adopted a qualitative design with four focus groups involving thirty participants working in municipal homecare in urban and rural locations. They represented a diverse spectrum of social service roles: homecare workers, planners, IT specialists, and managers across various levels of responsibility. During the two-hour focus group sessions, the participants discussed three topics: valuable aspects of homecare; knowledge needs for effective homecare delivery; and anticipations related to a digital twin. The focus group sessions were recorded, transcribed verbatim and analysed thematically. 

Findings

The analysis will be completed by the end of 2023 and the preliminary results will be presented at ECSWR 2024.

Conclusions and implications

The present study can contribute to valuable knowledge on how a digital twin can be used in homecare, and the results are expected to support person-centered homecare and increase job satisfaction for homecare workers. The main outcomes and their implications for practice and further research will be presented at ECSWR 2024. 

Background and purpose

The older population is steadily increasing globally and in Sweden and there is a fear that dwindling human and financial resources will not be sufficient to provide high-quality person-centred homecare in the near future. To address this situation initiatives have been taken to use digital technologies as a part of the solution. To explore the potential of using artificial intelligence-supported Industry 4.0 technology in the homecare setting, a research project was initiated in Sweden. This study aimed to identify preferences and expectations of older homecare users for a digital homecare twin to facilitate ageing in place and is an integral part of the project. A digital twin in this context is a digital representation of homecare clients and their homes, as well as homecare services and personnel, which is informed by sensor data. Sensor data may include information on older adults’ daily life in real time, their movement patterns and behaviors, as well as information on deviations in health indicators. It is believed that a digital twin with this kind of data, has the potential to add value for older people. The digital twin can lead to a better understanding of the homecare system and identifying areas for improvement. The digital twin is expected to support the homecare services and lead to more personalized services, and thereby improve homecare user satisfaction.  

Methods

This study employs a qualitative strategy in which focus groups discussions are conducted in two municipalities in Sweden, involving a total of 24 older homecare users. The participants represent people of various age and gender, with diverse living and housing situations as well as homecare needs. During the two-hour focus group sessions, the participants discuss valued outcomes of homecare services, how a digital twin can help with reaching valued outcomes, and preferences and expectations for a digital homecare twin. The focus groups are recorded, transcribed and analyzed thematically. 

Findings

The analysis will be completed by the end of 2023 and the results will be presented at ECSWR 2024.

Conclusions and implications

This study explores the potential of digital twins in homecare services by capturing the voices and preferences of older adults to tailor specific solutions. Employing focus group discussions will engage older adults in expressing their needs and concerns which later can be incorporated into the development of personalized digital twins.  The main outcomes of the study and their implications for practice and further research will be added once the findings are ready. 

Informal caregivers play a crucial role in the care of individuals with dementia, and their caregiving may significantly impact their own health and well-being. This cross-sectional survey study focuses on the perceived importance of various types and characteristics of formal support in a convenience sample of caregivers aged 65 years or older (N = 175) caring for a spouse with dementia. Participants completed a questionnaire containing 17 items describing different types of support and 12 items describing different characteristics of support, rating their importance. The questionnaire also contained questions on various caregiving-related factors. Principle components analysis (PCA) was carried out on the importance ratings, separately, on the types of support items and the characteristics of support items. Each PCA produced three components. For types of support, they were Proficiency and Opportunity, Supportive Structures, Flexible Counselling. For characteristics of support, they included Respectful and Competent, Timely Support, and Accessible and Acceptable. The three characteristics of the support components all had higher mean importance ratings than the three types of support components. The content of some components indicated that while spouse caregivers rate support for their caregiving needs as important, they may not always differentiate their own needs from those of their partner with dementia. The negative impact of caregiving was the factor most strongly and consistently associated with the components' importance ratings. This study emphasizes the need for health and social care providers to address the unique needs of spouse caregivers while simultaneously ensuring the delivery of quality care for individuals with dementia.

Context: The COPE Index is a standardised instrument for use as a first assessment of negative impact, positive value, and quality of support among informal carers of older people, validated and available in several languages. However, this instrument has not been tested in a Hungarian sample. 

Objectives: The aim of the present study is to translate and adapt the COPE Index for use with Hungarian-speaking informal carers, exploring the Index’s component structure and internal consistency. 

Method: Following standard translation procedures, a Hungarian version of the Index was included in a questionnaire used in a cross-sectional online survey of carers. Principal component analysis (PCA) was used to examine the component structure of the instrument, followed by an analysis of the internal consistency reliability of the emergent components. 

Findings: PCA produced three components from the Index that largely matched those of the original instrument in the case of the full sample; however, in the case of active carers, we could not replicate the same components. Cronbach’s α was satisfactory for all subscales derived from the components. 

Conclusion: The Index is used in many European countries, and this study has produced a comparable and reliable instrument for use among Hungarian-speaking carers, considering the characteristics of the examined sample. 

Limitation: The sample is primarily drawn from Facebook, thus it may not fully represent the characteristics of family caregivers in the population. 

Implications: The Index help in examining the impacts of caregiving and the quality of support among Hungarian-speaking carers, which can contribute to developing more appropriate and effective policies to support them.

Home safety is important for preventing injuries and accidents among older adults living at home. Feeling safe at home is also essential for older adults' well-being. Thus, this study aimed to explore older adults' perceptions of safety in their homes by examining their experiences, worries and preventive measures in relation to a range of potential home-based health and safety hazards. The study was a national cross-sectional telephone survey of 400 randomly selected adults over 70 years of age living at home in ordinary housing in Sweden. Participants were asked for their experience of, worry about, and preventive measures taken regarding fifteen home hazards. Data were also collected on background variables including age, health, and cohabitation status. Falls and stab/cut injuries were the most experienced hazards and worry was highest for burglary and falls, while preventive measures were most common for fire and burglary. While older adults' experience and worry regarding home hazards were associated with preventive measures, these associations were not strong and other factors were associated with preventive behaviour. Further identification of the main determinants of older adults' preventive behaviour can contribute to policy for effectively reducing home accidents.

BACKGROUND: While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults.

METHODS: The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models.

RESULTS: During follow-up time (median (range) 3.7 (0.1-6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up.

CONCLUSIONS: TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05893524: https://www.

CLINICALTRIALS: gov/study/NCT05893524?id=NCT05893524&rank=1 .