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  • 1. Austin, CA
    et al.
    McKee, Kevin
    Dalarna University, School of Health and Social Studies, Social Work.
    Why did I fall? Older people’s perceptions of the cause of their fall predict outcomes at 6 month2009In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 38, no Suppl. 3, p. 41-Article in journal (Refereed)
  • 2. Austin, CA
    et al.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Cheung Chung, M
    Posttraumatic stress disorder in older people after a fall2009Conference paper (Refereed)
  • 3. Barnes, S
    et al.
    Torrington, J
    Darton, R
    Holder, J
    Lewis, A
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Netten, A
    Orrell, A
    Does the design of extra care housing meet the needs of the residents?: a focus group study2012In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 32, no 7, p. 1193-1214Article in journal (Refereed)
    Abstract [en]

    The study objective was to explore the views of residents and relatives concerning the physical design of extra-care housing. Five focus groups were conducted with residents in four extra-care schemes in England. One focus group was carried out with relatives of residents from a fifth scheme. Schemes were purposively sampled to represent size, type, and resident tenure. Data were analysed thematically using NVivo 8. Two over-arching themes emerged from the data: how the building supports the lifestyle and how the building design affects usability. Provision of activities and access to amenities were more restrictive for residents with disabilities. Independent living was compromised by building elements that did not take account of reduced physical ability. Other barriers to independence included poor kitchen design and problems doing laundry. Movement around the schemes was difficult and standards of space and storage provision were inadequate. The buildings were too hot, too brightly lit and poorly ventilated. Accessible external areas enabled residents to connect with the outside world. The study concluded that, while the design of extra-care housing meets the needs of residents who are relatively fit and healthy, those with physical frailties and/or cognitive impairment can find the building restrictive resulting in marginalisation. Design across the dependency spectrum is key in meeting the needs of residents. Inclusive, flexible design is required to benefit residents who are ageing in situ and have varying care needs.

  • 4.
    Bellardini, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Mckee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    The effect of gender on strength training in older people: a Swedish population study2012In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 27, no s1, p. 155-156Article in journal (Refereed)
    Abstract [en]

    Background: Physical exercise contributes to healthy ageing, and strength training has beenshown to improve independence in older people.

    Method: Six hundred older people wererandomly selected from the Swedish population, and sent a self-completion questionnaire(57% response rate, n¼343) examining exercise history, current strength training, andperceived benefits and barriers to strength training.

    Results: Gender was associated with aperceived positive effect of strength training on quality of life (Women 42% vs. Men 27%).The most commonly reported benefits of strength training were better mobility (71%), energy(70%), and muscle strength (69%), with most benefits endorsed more commonly by womenthan men. The most commonly reported barriers to strength training were believing otherforms of exercise more suitable (49%) and cost (20%; Women 31% vs. Men 13%).

    Discussion:To better promote healthy ageing, interventions should be embedded in an understanding ofthe effect of gender on exercise behaviour.

  • 5. Bichard, J
    et al.
    van den Heuvel, E
    Gilhooly, M
    Parker, S.G.
    Long, A.
    Ratcliffe, N.
    McKee, Kevin
    Dalarna University, School of Health and Social Studies, Social Work.
    Gaydecki, P.
    Tackling ageing continence through theory, tools & technology (TACT3)2012In: International journal of aging in society, ISSN 2160-1909, Vol. 1, no 2, p. 83-98Article in journal (Refereed)
  • 6.
    Bień, Barbara
    et al.
    Medical University of Bialystok, Department of Geriatrics, Poland.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Döhner, H.
    3 University Medical Centre Hamburg-Eppendorf, Centre for Psychosocial Medicine, Department of Medical Sociology and Health Economics, Germany.
    Triantafillou, J.
    50plus Hellas Athens, Member of the Administrative Council, Greece.
    Lamura, G.
    INRCA, Department of Post-Acute and Transitional Care, Centre for Socio-Economic Research on Ageing, Ancona, Italy.
    Doroszkiewicz, H.
    Medical University of Bialystok, Department of Geriatrics, Poland.
    Krevers, B.
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Kofahl, C.
    University Medical Centre Hamburg-Eppendorf, Centre for Psychosocial Medicine, Department of Medical Sociology and Health Economics, Germany.
    Disabled older people’s use of health and social care services and their unmet care needs in six European countries2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 6, p. 1032-1038Article in journal (Refereed)
    Abstract [en]

    Background: The national health and social care systems in Europe remain poorly integrated with regard to the care needs of older persons. The present study examined the range of health and social care services used by older people and their unmet care needs, across six European countries. 

    Methods: Family carers of older people were recruited in six countries via a standard protocol. Those providing care for disabled older people (n = 2629) provided data on the older person’s service use over a 6-month period, and their current unmet care needs. An inventory of 21 services common to all six countries was developed. Analyses considered the relationship between older people’s service use and unmet care needs across countries. 

    Results: Older people in Greece, Italy and Poland used mostly health-oriented services, used fewer services overall and also demonstrated a higher level of unmet care needs when compared with the other countries. Older people in the United Kingdom, Germany and Sweden used a more balanced profile of socio-medical services. A negative relationship was found between the number of different services used and the number of different areas of unmet care needs across countries. 

    Conclusions: Unmet care needs in older people are particularly high in European countries where social service use is low, and where there is a lack of balance in the use of health and social care services. An expansion of social care services in these countries might be the most effective strategy for reducing unmet needs in disabled older people.

  • 7. Bozkurt Ahman, H
    et al.
    Giedraitis, V
    Cedervall, Y
    Berglund, L
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Correlations Between Dual-Task Performance and Alzheimer’s Disease Cerebrospinal Fluid Biomarkers2018Conference paper (Refereed)
  • 8. Cedervall, Y
    et al.
    Giedraitis, V
    Berglund, L
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Kilander, L
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Timed Up-and-Go dual-task performance – a marker for dementia?2018Conference paper (Refereed)
  • 9. Cheung Chung, M
    et al.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Austin, C
    Barkby, H
    Brown, H
    Cash, S
    Ellingford, J
    Hanger, L
    Pais, T
    Posttraumatic stress disorder in older people after a fall2009In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 24, no 9, p. 955-964Article in journal (Refereed)
  • 10.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Andersson, Lars
    Linköpings universitet.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Lennartsson, Carin
    Karolinska Institutet ; Stockholms universitet.
    Predictors of loneliness among older women and men in Sweden: A national longitudinal study2014Conference paper (Other academic)
    Abstract [en]

    Objectives: To examine the extent to which older women and men (70+) report feelings of loneliness with a focus on: a) changes in reported loneliness as people age, and b) which factors predict loneliness.

    Methods: Data from the 2004 and 2011 waves of SWEOLD, a longitudinal national survey study, was used. The prediction of loneliness in 2011 by data collected in 2004 was examined in three logistic regression models for the total sample (n=587), for women and for men.

    Results: Older people moved in and out of frequent loneliness over time, but there was a general increase in loneliness as they aged. Recent widowhood and depression increment were associated with loneliness in both women and men. Loneliness, widowhood, depression and mobility problems measured in 2004 predicted loneliness uniquely in women in 2011; whereas low level of education and social contact reduction predicted loneliness uniquely in men.

    Discussion: Loneliness is not always a stable condition, demonstrating the importance of longitudinal research. Gender differences in incidence and predictors make it important to look at women and men separately both when researching loneliness and when targeting interventions to prevent or reduce loneliness in older people.

  • 11.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work. Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Andersson, Lars
    National Institute for the Study of Ageing and Later Life, Linköping University, Norrköping, Sweden.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Lennartsson, Carin
    Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Predictors of loneliness among older women and men in Sweden: A national longitudinal study2015In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 19, no 5, p. 409-417Article in journal (Refereed)
    Abstract [en]

    Objectives: Longitudinal research on loneliness in old age has rarely considered loneliness separately for men and women, despite gender differences in life experiences. The objective of this study was to examine the extent to which older women and men (70C) report feelings of loneliness with a focus on: (a) changes in reported loneliness as people age, and (b) which factors predict loneliness.

    Method: Data from the 2004 and 2011 waves of SWEOLD, a longitudinal national survey, was used (n D 587). The prediction of loneliness in 2011 by variables measured in 2004 and 20042011 variable change scores was examined in three logistic regression models: total sample, women and men. Variables in the models included: gender, age, education, mobility problems, depression, widowhood and social contacts.

    Results: Older people moved into and out of frequent loneliness over time, although there was a general increase in loneliness with age. Loneliness at baseline, depression increment and recent widowhood were significant predictors of loneliness in all three multivariable models. Widowhood, depression, mobility problems and mobility reduction predicted loneliness uniquely in the model for women; while low level of social contacts and social contact reduction predicted loneliness uniquely in the model for men.

    Conclusion: This study challenges the notion that feelings of loneliness in old age are stable. It also identifies important gender differences in prevalence and predictors of loneliness. Knowledge about such differences is crucial for the development of effective policy and interventions to combat loneliness in later life.

  • 12.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Bruhn, Åsa
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Marusarz, Marika
    Ersta Sköndal Högskola.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Turunen, Päivi
    Linköpings universitet.
    Socialt deltagande och tillgång till service: Upplevda hinder och hur de kan reduceras2012Report (Other academic)
  • 13.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Correlates of social and emotional loneliness in older people: evidence from an English community study2014In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 18, no 4, p. 504-514Article in journal (Refereed)
    Abstract [en]

    Objectives: Loneliness is an important influence on quality of life in old age, and has been conceptualised as consisting of two dimensions, social and emotional. This paper describes analyses that sought to produce models of social and emotional loneliness in older people, using demographic, psychological and health, and social variables.

    Method: Older people (aged 65+, N=1255) from the Barnsley metropolitan area of the United Kingdom were recruited randomly from within a stratified sampling frame, and received a questionnaire-based interview (response rate: 68.1%). The questionnaire contained items and scales on demographic, psychological and health and social characteristics, and a validated measure of loneliness that assesses both social and emotional loneliness.

    Results: Of the respondents, 7.7% were found to be severely or very severely lonely, while another 38.3% were moderately lonely. Social and Emotional Loneliness shared 19.36% variance. Being male, being widowed, low well-being, low self-esteem, low income comfort, low contact with family, low contact with friends, low Activity, low Perceived Community Integration, and receipt of community care were significant predictors of Social Loneliness (R=.50, R2=.25, F(18, 979)=18.17, p<.001). Being widowed, low well-being, low self-esteem, high activity restriction, low income comfort, and non-receipt of informal care were significant predictors of Emotional Loneliness (R=.55, R2=.30, F(18, 973)=23.00, p<.001).

    Conclusion:  This study provides further empirical support for the conceptual separation of emotional and social loneliness. Consequently, policy on loneliness in older people should be directed to developing a range of divergent intervention strategies if both emotional and social loneliness are to be reduced.

  • 14.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Living on the edge: Social exclusion and the receipt of informal care in older people2016In: Journal of Aging Research, ISSN 2090-2204, E-ISSN 2090-2212, p. 1-10, article id 6373101Article in journal (Refereed)
    Abstract [en]

    Older people have been identified as being at risk of social exclusion. However, despite the fact that care is commonly required in later life and the majority of that care provided by informal carers, a connection between social exclusion and informal care-receipt has rarely been considered. The aim of this study was to examine how informal care-receipt is related to social exclusion.

    A face-to-face questionnaire survey on social exclusion and informal care-receipt was carried out among older people (n=1255) living in Barnsley, United Kingdom. Multivariable analyses examined the association between social exclusion and categories of informal care-receipt: care receiver; assurance receiver; non-receiver with no need; non-receiver with need.

    Compared to being a non-receiver with no need participants were more likely to be a care receiver or assurance receiver if they had higher levels of social exclusion. The highest level of social exclusion, however, was found in non-receivers with need. Despite a lack of informal care and support, formal practical support and personal care was also low in this latter group. Findings are discussed in relation to the conceptualisation of care-receipt and how contact with medical services could be an opportunity for identification and appropriate referral of non-receivers with need.

  • 15.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Psychological, health and social predictors of emotional and social loneliness in older people2013In: Proceedings of the 20th IAGG World Congress of Gerontology and Geriatrics, Seoul, Korea, 2013Conference paper (Refereed)
    Abstract [en]

    Background: Loneliness in old age has been shown to have negative outcomes such as mortality, physical and mental health problems, and reduced activity levels. To reduce loneliness in older people, factors associated with loneliness and open to intervention must be identified.

    Methods: Older people (aged 65+, N=1255) from the United Kingdom received a questionnaire-based interview (response rate: 66.0%). The questionnaire covered items on demographic, psychological, health and social characteristics. It also contained the de Jong-Gierveld Loneliness Scale (de Jong-Gierveld & Kamphuis, 1985), measuring Emotional and Social Loneliness.

    Findings: Eight percent of the respondents were found to be severely or very severely lonely, while another 38% were moderately lonely. Being female, widowed, low well-being, low self-esteem, high activity restriction, and high concern about personal finances were significant predictors of Emotional Loneliness (F(17, 976)=25.59, R2=.31, p<.001).  Being female, widowed, low well-being, low self-esteem, high concern about personal finances, low contact with family, low contact with friends, low engagement, and low perceived community integration were significant predictors of Social Loneliness (F(17, 982)=19.63, R2=.25, p<.001).

    Discussion:  This study provides empirical evidence for conceptual separation of emotional and social loneliness. Consequently, different targets for intervention are required in order to reduce emotional and social loneliness respectively, although psychological intervention has the potential to reduce both. 

    Background: Loneliness in old age has been shown to have negative outcomes such as mortality, physical and mental health problems, and reduced activity levels. To reduce loneliness in older people, factors associated with loneliness and open to intervention must be identified.

    Methods: Older people (aged 65+, N=1255) from the United Kingdom received a questionnaire-based interview (response rate: 66.0%). The questionnaire covered items on demographic, psychological, health and social characteristics. It also contained the de Jong-Gierveld Loneliness Scale (de Jong-Gierveld & Kamphuis, 1985), measuring Emotional and Social Loneliness.

    Findings: Eight percent of the respondents were found to be severely or very severely lonely, while another 38% were moderately lonely. Being female, widowed, low well-being, low self-esteem, high activity restriction, and high concern about personal finances were significant predictors of Emotional Loneliness (F(17, 976)=25.59, R2=.31, p<.001).  Being female, widowed, low well-being, low self-esteem, high concern about personal finances, low contact with family, low contact with friends, low engagement, and low perceived community integration were significant predictors of Social Loneliness (F(17, 982)=19.63, R2=.25, p<.001).

    Discussion:  This study provides empirical evidence for conceptual separation of emotional and social loneliness. Consequently, different targets for intervention are required in order to reduce emotional and social loneliness respectively, although psychological intervention has the potential to reduce both. 

  • 16.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Social exclusion and well-being among older adults in rural and urban areas2018In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 79, p. 176-184Article in journal (Refereed)
    Abstract [en]

    Background: Social exclusion (SE) is a process that limits participation in society across life domains, and is associated with poor quality of life. Neighbourhood exclusion has been identified as particularly important for older adults. This paper examines the association between SE and well-being in older adults from urban and rural areas, focusing on neighbourhood exclusion.

    Methods: Using a cross-sectional survey design with a stratified sampling frame, participants (aged 65+) from rural (n=628) and urban (n=627) areas of Barnsley, United Kingdom, completed a questionnaire containing indicators of five SE domains: civic activity, material resources, social relationships, services and neighbourhood. Sequential linear regression models were developed for 1) total sample; 2) rural areas; and 3) urban areas, with well-being regressed on SE indicators after controlling for self-reported health.

    Results: SE indicators explained 13.4% of the variance in well-being in the total sample (of which neighbourhood exclusion explained 1.2%); corresponding figures for the rural model were 13.8% (3.8%) and for the urban model 18.0% (1.7%); the addition of neighbourhood exclusion significantly improved all three models.  Five SE indicators were significant in the rural model, compared with seven in the urban model, with four common to both.

    Discussion: Neighbourhood exclusion explained more variance in well-being in rural than urban areas, whereas exclusion from services explained more variance in urban than rural areas. Area characteristics and the role of neighbourhood should be considered in policy initiatives to reduce SE and promote well-being.

  • 17.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Fritzell, Johan
    Lennartsson, Carin
    Trends in social exclusion among older women and men in Sweden2018Conference paper (Refereed)
    Abstract [en]

    Background: Social exclusion is a framework for understanding the complexity of disadvantage across various domains of life such as material resources, social relations, civic activities and services. Reviews have identified a lack of gender perspective in social exclusion research. This paper will introduce the framework of social exclusion, and examine trends over time in the levels of social exclusion across different life domains for older women and men in Sweden.

    Methods: Data on indicators of social exclusion were analysed from respondents aged 76+ years who participated in the 1992, 2002 and 2011 waves of the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD).

    Results: There was evidence of a gender different in exclusion from material resources and civic activities, from which women were more often excluded than men. Regardless of gender there were improvements in access to material resources, such as owning a house/apartment.  Social contacts (visiting or being visited by friends) decreased over time, while engagement in cultural activities and going to restaurants increased.

    Conclusions: Trends in social exclusion in older adults over the last 20 years are dependent on the domain considered. Over a range of indicators, older women were more vulnerable to exclusion than men, which needs to be taken into account in policy to combat exclusion.

  • 18. Di Rosa, Mirko
    et al.
    Kofahl, Christopher
    McKee, Kevin
    Dalarna University, School of Health and Social Studies, Social Work.
    Bien, Barbara
    Lamura, Giovanni
    Prouskas, Costis
    Döhner, Hanneli
    Mnich, Eva
    A typology of caregiving situations and service use in family carers of older people in six European countries: The EUROFAMCARE study2011In: GeroPsych, ISSN 1662-9647, Vol. 24, no 1, p. 5-18Article in journal (Refereed)
    Abstract [en]

    This paper presents the EUROFAMCARE study findings, examining a typology of care situations for family carers of older people, and the interplay of carers with social and health services. Despite the complexity of family caregiving situations across Europe, our analyses determined the existence of seven “caregiving situations,” varying on a range of critical indicators. Our study also describes the availability and use of different support services for carers and care receivers, and carers’ preferences for the characteristics of support services. Our findings have relevance for policy initiatives in Europe, where limited resources need to be more equitably distributed and services should be targeted to caregiving situations reflecting the greatest need, and organized to reflect the preferences of family carers.

  • 19.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Von Koch, Lena
    Wijk, Helle
    Designing for person-centered care in older people’s residential facilities2011In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 23, no Suppl. 1, p. 270-Article in journal (Refereed)
  • 20.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet; Chalmers University of Technology.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Wijk, Helle
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 12, p. 2796-2816Article in journal (Refereed)
    Abstract [en]

    AIM: To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties.

    BACKGROUND: The physical healthcare environment is regarded as a quality factor for healthcare. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment.

    DESIGN: Systematic psychometric review.

    DATA SOURCES: A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016).

    REVIEW METHOD: COSMIN guidelines were used to evaluate psychometric data reported.

    RESULTS: Twenty-three instruments were included. Most of the instruments are intended for for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated.

    CONCLUSIONS: Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators is user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required. 

  • 21.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wijk, Helle
    Göteborgs Universitet.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Development of an instrument measuring the quality of residential care facilities for older people2016In: The 23rd Nordic Congress of Gerontology, 19-22 June 2016, in Tampere, Finland, 2016Conference paper (Refereed)
    Abstract [en]

    Aims. To validate the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). The instrument’s items measure environmental elements important for supporting the needs of older people, and conceptualized within eight domains.

    Methods. Item relevance was assessed by a group of experts and measured using content validity index (CVI). Test-retest and inter-rater reliability tests were performed.  The domain structure was assessed by the inter-rater agreement of a second group of experts, and measured using Fleiss kappa.

    Results. All items attained a CVI above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ = 0.903 and 0.869) and inter-rater reliability (κ = 0.851 and 0.832). Domain structure was good,  Fleiss’ kappa was 0.63 (range 0.45 to 0.75).   

    Conclusion. The S-SCEAM of 210 items and eight domains showed good content validity and construct validity. The instrument is suggested for use in measuring of the quality of the physical environment in residential care facilities for older persons.

  • 22.
    Gilhooly, M. L.
    et al.
    Brunel Institute for Ageing Studies, Brunel University, Uxbridge, United Kingdom.
    van den Heuvel, E.
    Brunel Institute for Ageing Studies, Brunel University, Uxbridge, United Kingdom.
    Jowitt, F.
    Brunel Institute for Ageing Studies, Brunel University, Uxbridge, United Kingdom.
    Sutherland, I.
    Brunel Institute for Ageing Studies, Brunel University, Uxbridge, United Kingdom.
    Bichard, J.
    Royal College of Art, London, United Kingdom.
    Long, A.
    Bristol Urological Institute, Bristol, United Kingdom.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Vibrating underpants, smell sensors and hospital continence services: tools and technologies for improving the lives of people with incontinence2012In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 52, no s1, p. 185-185Article in journal (Refereed)
    Abstract [en]

    Social isolation, loss of self esteem and depression are often a consequence of incontinence. The overall aim of this interdisciplinary project was to reduce the impact of continence difficulties and, thus, assist older people in maintaining a positive identity and good quality of life. The TACT3 project was comprised of three research work packages:

    Assistive technology development:

    Vibrating underpants: A washable fabric underwear wetness sensor and alert mechanism has been developed to alert continence pad users of leakage. In addition, a colour change odour indicating formula has been developed to indicate the presence of the odour of urine at a just imperceptible level.

    Challenging environmental barriers to continence: Two sets of stakeholders were involved, older people with continence difficulties and toilet providers. Focus groups, workshops, interviews and photographic diaries were conducted to identify key issues. A web based map locating toilets in London was developed which is called the Great British Toilet Map.

    Improving continence interventions and services: 140 patients and their carers were interviewed twice within a 12 month interval from a specialist continence clinic for older people and generic continence clinic. Twenty health and social care managers and 200 practitioners were also be interviewed. Care outcomes are being analysed from each clinic and a cost benefit analysis will be carried out.

    Key findings from this three year interdisciplinary project are highlighted. Prototypes of the vibrating underpants and the odour sensor will be on display. This research was funded by the UK New Dynamics of Ageing Programme.

  • 23. Kempen, GIJM
    et al.
    van Haastright, JCM
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Delbaere, K
    Zijstra, GAR
    Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling.2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 170Article in journal (Refereed)
  • 24. Lewis, Alan
    et al.
    Torrington, Judith
    Barnes, Sarah
    Darton, Robin
    Holder, Jacquetta
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Netton, Ann
    Orrell, Alison
    EVOLVE: a tool for evaluating the design of older people’s housing2010In: Housing, Care and Support, ISSN 1460-8790, Vol. 13, no 3, p. 36-41Article in journal (Refereed)
    Abstract [en]

    EVOLVE is a tool for evaluating the design of housing for older people. It is used to assess how well a building contributes to the physical support and personal well-being of older people. Developed from research into extra care housing, it can be used for a variety of building types, including sheltered housing and individual private houses. The tool can be used by architects, housing providers, commissioners, researchers and individual tenants or home owners. EVOLVE can be used as a briefing document or an aid to design. It can provide a rational basis to the selection of proposals in a competitive procurement process. The EVOLVE tool can also be used to evaluate existing housing stock, including schemes where remodelling is under consideration.

  • 25. Lüdecke, Daniel
    et al.
    Bien, Barbara
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Krevers, Barbro
    Mestheneos, Elizabeth
    Di Rosa, Mirko
    von dem Knesebeck, Olaf
    Kofahl, Christopher
    For better or worse: Factors predicting outcomes of family care of older people over a one-year period. A six-country European study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195294Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Demographic change has led to an increase of older people in need of long-term care in nearly all European countries. Informal carers primarily provide the care and support needed by dependent people. The supply and willingness of individuals to act as carers are critical to sustain informal care resources as part of the home health care provision. This paper describes a longitudinal study of informal care in six European countries and reports analyses that determine those factors predicting the outcomes of family care over a one-year period.

    METHODS: Analyses are based on data from the EUROFAMCARE project, a longitudinal survey study of family carers of older people with baseline data collection in 2004 and follow-up data collection a year later in six European countries (Germany, Greece, Italy, Poland, Sweden, and the United Kingdom), N = 3,348. Descriptive statistics of the sample characteristics are reported. Binary logistic random-intercept regressions were computed, predicting the outcome of change of the care dyad's status at follow-up.

    RESULTS: Where care is provided by a more distant family member or by a friend or neighbour, the care-recipient is significantly more likely to be cared for by someone else (OR 1.62) or to be in residential care (OR 3.37) after one year. The same holds true if the care-recipient has memory problems with a dementia diagnosis (OR 1.79/OR 1.84). Higher dependency (OR 1.22) and behavioural problems (OR 1.76) in the care-recipient also lead to a change of care dyad status. Country of residence explained a relatively small amount of variance (8%) in whether a care-recipient was cared for by someone else after one year, but explained a substantial amount of variance (52%) in whether a care-recipient was in residential care. Particularly in Sweden, care-recipients are much more likely to be cared for by another family or professional carer or to be in residential care, whereas in Greece the status of the care dyad is much less likely to change.

    DISCUSSION: The majority of family carers continued to provide care to their respective older relatives over a one-year period, despite often high levels of functional, cognitive and behavioural problems in the care-recipient. Those family carers could benefit most from appropriate support. The carer/care-recipient relationship plays an important role in whether or not a family care dyad remains intact over a one-year period. The support of health and social care services should be particularly targeted toward those care dyads where there is no partner or spouse acting as carer, or no extended family network that might absorb the caring role when required. Distant relatives, friends or acquaintances who are acting as carers might need substantial intervention if their caregiving role is to be maintained.

  • 26.
    Marmstål Hammar, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Williams, C
    Meranius, Summer
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Extended support to increase quality of life in spouse caregivers of older persons with dementia. A pilot study2018Conference paper (Refereed)
  • 27. Matlabi, H
    et al.
    Parker, S
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Tha contribution of home-based technology to older people's quality of life in extra care housing2011In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 11, article id 68Article in journal (Refereed)
    Abstract [en]

    Background: British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH). 

    Methods: A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used. 

    Results: Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19]. 

    Conclusions: The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.

  • 28. Matlabi, H.
    et al.
    Parker, S.G.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Experiences of extra care housing residents aged fifty-five an over with home-based technology2012In: Social behavior and personality, ISSN 0301-2212, E-ISSN 1179-6391, Vol. 40, no 2, p. 293-300Article in journal (Refereed)
    Abstract [en]

    Technological interventions could help older people live independently. In this study with 160 people aged 55 and over who were living in extra care housing in England we aimed to explore awareness of, access to, attitudes towards availability, and use of home-based technological (HBT) devices, and factors that influence the use of devices. A quantitatively designed and structured questionnaire was developed for this study. The majority of new HBT devices were not available in living units or schemes. Moreover, most basic appliances and emergency call systems were used in the living units. We found that in order to increase the use of technological devices among the elderly, their perceptions, capabilities, attitudes, and needs should be assessed in the designing, planning, and supplying process.

  • 29.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Factors associated with the willingness to care of informal carers of older people2011In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 23, no Suppl.1, p. 70-Article in journal (Refereed)
  • 30.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Frailty falls and the Body Drop2011In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 23, no Suppl. 1, p. 80-Article in journal (Refereed)
  • 31.
    McKee, Kevin
    Dalarna University, School of Health and Social Studies, Social Work.
    FUTURAGE: A road map for European ageing research2011Report (Other academic)
  • 32.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Austin, C
    Causal attributions following a fall and health outcomes at 6 months post-fall2009In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 24, no Suppl.1, p. 268-Article in journal (Refereed)
    Abstract [en]

    Background. Falls in older people decrease quality of life and increase mortality. There is littleresearch on perceptions of the cause of a fall and their influence on health outcomes. Method.A survey (N¼196) of older people hospitalised after a fall recorded attributions for the causeof the fall. A follow-up survey at 6 months measured functional limitation, anxiety anddepression. Findings. of the participants, 44.3% saw their fall as due to their character, 15.6%due to their behaviour, and 40.1% due to external factors. A hopelessness explanatory stylewas found in 21.1% of participants. Perceiving age as the cause of the fall predicted (p5.06)higher levels of depression at 6 months, while having hopelessness explanatory stylesignificantly predicted higher functional limitation (p¼.001). Discussion. Causal attributionsof fall events impact on physical and mental health outcomes, offering a route forpsychological intervention to reframe the meaning attached to a fall.

  • 33.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Bien, B
    Wojszel, B
    Kofahl, C
    Krevers, B
    Melchiorre, M G
    Mnich, E
    Prouskas, C
    The willingness of informal carers of older people to continue caring: results of the EUROFAMCARE study2010In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 25, no Suppl. 1, p. 59-59Article in journal (Other academic)
    Abstract [en]

    Objectives: The willingness to continue in the caregiving role has been shown to be one of the most significant factors in the breakdown of family care of an older person. Willingness to care was considered in the EUROFAMCARE study, which examined the characteristics of caregiving in six European countries. Methods: Nearly 6000 informal carers of older people (n = 1000 in Germany, Italy, Sweden, Greece, Poland and the UK) were recruited using a shared sampling protocol and interviewed using a standardized questionnaire. Logistic regression procedures determined the best model of willingness to care in each country. Results: Between 29% and 14% of the variance in willingness to care was explained by the models. No single variable was significant in the models across all countries, but the negative impact of care was associated with low willingness in five countries, while being a son/daughter carer was associated with high willingness in four. The category of variables that explained the most variance in willingness to care was ‘caregiving circumstances and relationships’. Conclusions: If a carer's motivation for caregiving is to be maintained, support for carers must adequately address any negative impact of their role, and use a relationship-centred approach.

  • 34.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Psychological, health and social predictors of emotional and social loneliness in older people2012In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 27, no s1, p. 89-90Article in journal (Refereed)
  • 35.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Social exclusion and well-being in older adults in rural and urban communities.2017Conference paper (Refereed)
  • 36.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    The association between receipt of informal care and health in older people2011In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 26, no Suppl. 2, p. 173-Article in journal (Refereed)
    Abstract [en]

    Background: Older people as care-receivers are under-researched. We examined the health and well-being of older people with differing levels of care need and receipt. Methods: Community resident older people (N = 1250) from a single UK metropolitan area were randomly recruited, and completed a questionnaire on social exclusion via interview. Participants were categorised into one of the four groups: receiving informal care; receiving informal support; no receipt of informal care/support despite need and no receipt of informal care/support, no need. Findings: Associations (p < 0.001) between group membership and health status (F = 75.7), functional status (F = 159.1), well-being (F = 29.5) and loneliness (F = 28.9) indicated the ‘receiving care’ and ‘no receipt of care/support despite need’ groups had the poorest health profiles. Logistic regression determined primary predictors of group membership. Discussion: A significant group of older people receives no informal care/support despite frailty. Research is needed to determine why some older people do not receive informal care appropriate to their needs.

  • 37.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    The association between social exclusion and well-being in older adults from rural and urban areas2018Conference paper (Refereed)
  • 38.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Kostela, Johan
    Dalarna University, School of Education, Health and Social Studies.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work. Stockholm University; Karolinska Institutet, Sweden.
    Five years from now: Correlates of older people’s expectation of future quality of life2014In: Age Well - Challenges for Individuals and Society: Program 22nd Nordic Congress of Gerontology Gothenburg 25-28 May, 2014Conference paper (Refereed)
    Abstract [en]

    Few studies have explored older people’s expected future quality of life (QoL), despite evidence that perceptions of one’s future influence healthy ageing. Research on this topic should embrace a range of potential influences, including perceptions of one’s neighbourhood and region. This study examined expected QoL in a random sample of the population of Dalarna, a Swedish region. A self-completion questionnaire assessed demographic characteristics, current neighbourhood and regional evaluations, self-evaluations, expectations for the future, and current and expected QoL.  In total, 786 people aged ≥ 65 years participated. Current QoL was favourably evaluated, and while expected QoL also received a positive assessment, the mean value for expected QoL was notably lower than that for current QoL (t(755)=24.06, p<.05). Indeed, only 3.6% (n=27) of participants rated their expected QoL higher than their current QoL. A sequential multiple regression model explained 44% of the variance in older people’s expected QoL. Nine IVs were significant (p<.05) in the final model of expected QoL: current QoL (1% unique variance explained), age (1%), education level (1%), Regional Development Beliefs (1%), Perceived Regional Status (2%), self-reported health (3%), social influence (1%), Expected Regional Opportunity (3%) and expected change in housing need (1%). Our findings establish the significance of an older person’s perception of their locality for their expected future QoL. Policies that focus only on individual and relational factors for the promotion of healthy ageing are overlooking the potential contribution of an older person’s connection to their neighbourhood and region.

  • 39.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Kostela, Johan
    Dalarna University, School of Education, Health and Social Studies.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work. Karolinska Institutet/Stockholm University.
    Five years from now: Correlates of older people’s expectation of future quality of life2015In: Research on Aging, ISSN 0164-0275, E-ISSN 1552-7573, Vol. 37, no 1, p. 18-40Article in journal (Refereed)
    Abstract [en]

    Few studies have explored older people’s expected future quality of life (QoL), despite evidence that perceptions of one’s future influence healthy ageing. Research on this topic should embrace a range of potential influences, including perceptions of one’s neighbourhood and region. This study examined expected QoL in a random sample of the population of Dalarna, a Swedish region. A self-completion questionnaire assessed demographic characteristics, current neighbourhood and regional evaluations, self-evaluations, expectations for the future, and current and expected QoL. In total, 786 people aged ≥ 65 years participated. A sequential multiple regression model explained 44% of the variance in older people’s expected QoL, with self-reported health (sr2=.03), Expected Regional Opportunity (sr2=.03), and Perceived Regional Status (sr2=.02) having the strongest associations with expected QoL. Research on the importance of one’s neighbourhood to QoL in older people should encompass people’s perceptions of their region, to better inform social policy for healthy ageing.

  • 40.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Schüz, Benjamin
    University of Tasmania.
    Psychosocial factors in healthy ageing2015In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 30, no 6, p. 607-626Article in journal (Refereed)
  • 41.
    McKee, Kevin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Spazzafumo, L
    Nolan, MR
    Wojszel, ZB
    Lamura, G
    Bien, B
    Components of the difficulties, satisfactions and management strategies of carers of older people: A principle component analysis of CADI-CASI-CAMI.2009In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 13, no 2, p. 255-264Article in journal (Refereed)
  • 42. Mocumbi, Sibone
    et al.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Munguambe, Khátia
    Chiau, Rogério
    Högberg, Ulf
    Hanson, Claudia
    Wallin, Lars
    Sevene, Esperança
    Bergström, Anna
    Ready to deliver maternal and newborn care? Health providers' perceptions of their work context in rural Mozambique2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1532631Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assessment for Community Health (COACH) tool was developed to assess modifiable aspects of the healthcare context that theoretically influence the implementation of evidence.

    OBJECTIVES: To investigate the comprehensibility and the internal reliability of COACH and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique.

    METHODS: A response process evaluation was completed with six purposively selected health providers to uncover difficulties in understanding the tool. Internal reliability was tested using Cronbach's α. Subsequently, a cross-sectional survey using COACH, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique.

    RESULTS: The content of COACH was clear and most items were understood. All dimensions were near to or exceeded the commonly accepted standard for satisfactory internal reliability (0.70). Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the Work culture, Leadership, and Informal payment dimensions. Responses to many items had low variance and were left-skewed.

    CONCLUSIONS: COACH was comprehensible and demonstrated good reliability, although biases may have influenced participants' responses. The study suggests that COACH has the potential to evaluate the healthcare context to identify shortcomings and enable the tailoring of strategies ahead of implementation. Supplementing the tool with qualitative approaches will provide an in-depth understanding of the healthcare context.

  • 43.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    von Koch, Lena
    Karolinska Institutet, Institutionen för neurobiologi, vårdvetenskap och samhälle.
    Wijk, Helle
    Sahlgrenska Akademin, Göteborgs Universitet .
    Validating a tool for evaluating nursing home environments: Integrating research and expert evidence2012In: IFA 11TH GLOBAL CONFERENCE ON AGEING, 28 May – 1 June 2012 Prague, Czech Republic, Book of Abstracts, 2012Conference paper (Refereed)
  • 44.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Sahlgrenska akademin, Göteborgs universitet.
    A person-centered design can support accessibility and equality in residential care facilities2013Conference paper (Refereed)
    Abstract [en]

    It is well known that the world foresees an ageing population for whom the physical environment plays a central role in everyday life and wellbeing. Creating a health care environment that ensures accessibility and equality, shows respect and dignity will therefore be a great challenge. With increasing levels of frailty many older persons will be more or less depending on the care environment. A modern person-centered building design considers both individual and specific needs related to old age, in order to support quality of life and care. However, many of the existing buildings do not meet modern standards and there is a need for methods to evaluate the quality of the building design. According to a recently performed review there are few validated tools measuring the physical environment, especially in terms of a person-centered approach. This study presents a translated and validated tool for evaluating design quality in nursing home facilities. The tool is based on the idea that there is a relationship between high quality caring environments and quality of life of older persons. It makes a person-centered evaluation of the building, covering aspects such as privacy, personalization, safety, choice and control. These are essential factors to assure older persons a dignified ageing as equal members of the society.

  • 45.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)2015In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 3, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Background

    There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability.

    Methods

    SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics.

    Results

    Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832).

    Conclusions

    Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

  • 46.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mckee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Sahlgrenska Akademin, Göteborgs Universitet .
    Att anpassa ett engelskt instrument som mäter designkvalitet på äldreboende till svenska förhållanden: utmaningar och erfarenheter2012Conference paper (Refereed)
    Abstract [sv]

    Äldre tillbringar mycket tid i sin bostad varför kvalitet på den fysiska miljön har stor påverkan på deras livskvalitet. Det finns dock fortfarande en brist på giltiga instrument som kan utvärdera kvaliteten på byggnadsdesign. I denna artikel presenterar vi resultaten från den första fasen av ett projekt, i syfte att utveckla ett instrument för att utvärdera kvaliteten designen av den fysiska miljön. I denna fas har vi översatt och anpassat ett engelskt instrument till svenska förhållanden. Först utfördes en systematisk litteraturstudie över instrument för att utvärdera den fysiska vårdmiljön. Resultatet visade att Sheffield Care Environment Assessment Matrix (SCEAM) var ett instrument med potential för användning för särskilt boende för äldre och i svenska förhållanden. Först översattes instrumentet till svenska och därefter testades validiteten och reliabiliteten. I artikeln rapporteras utmaningar och erfarenheter av översättningsproceduren.

  • 47.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Att översätta och anpassa ett engelskt instrument för bedömning av fysisk miljö på särskilt boende till svenska förhållanden: utmaningar och erfarenheter2012Conference paper (Refereed)
  • 48.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Sahlgrenska akademin, Göteborg.
    Challenges in the cultural adaptation and validation of an instrument for evaluating residential care environments for older people2015Conference paper (Refereed)
  • 49.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Sahlgrenska Akademin, Göteborg.
    Evaluating design quality in older people's residential care facilities: Adaptation of the Sheffield Care Environment Assessment Matrix (SCEAM) for use in Sweden with focus on linguistic challenges.2014Conference paper (Refereed)
    Abstract [en]

    Background

    There is increasing interest in how the physical enviroment can support health and well-being in residential care facilities (RCF) for older people. A recent review showed a lack of instruments for evaluating design quality in RCF. The SCEAM was identified as an instrument appropriate for Swedish RCF. SCEAM is a British instrument, developed to evaluate building design of RCF. The instrument is person-centered and uses the needs of frail older people as the basis for understanding how well the residential care facility is designed.

     

    Aim

    The aim of the present study was to translate, adapt, and further develop the SCEAM instrument for use in Sweden.

     

    Method

    The study had a mixed-method design using both quantitative and qualitative methods

     

    Procedure

    The forward-backward translation method was used in five stages, broadly within two phases: translation and adaptation. The translation phase involved: 1) forward translation and 2) backward-translation. The adaptation phase involved: 3) first test of content validity of the target language instrument; 4) consultation and further adaptation; 5) final test of content validity of the revised target language instrument

     

    Results

    In this paper we focus on the linguistic challenges in translation of an instrument developed to evaluate the quality of the physical environment of RCF. A lengthy process of translation of the Sheffield Care Environments Assessment Matrix (SCEAM) has produced an instrument that fill a need of an instrument with a strong focus on the importance of the physical environment of RCF in the society. The instrument has a potential for use when planning new environments, during interventions and follow up as for quality assessment.

     

  • 50.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wijk, Helle
    Sahlgrenska akademin, Göteborgs universitet.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    von Koch, Lena
    Institutionen för neurobiologi, vårdvetenskap och samhälle, Karolinska institutet.
    Translation and cultural adaptation of an instrument evaluating design quality in residential care facilities2013In: Nordic Advances in Health Care Sciences Research, November 13-14, 2013 in Lund: Abstract book, 2013, p. 96-96Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: The population is rapidly ageing and in the near future the number of elderly will exceed the number of children. Society faces a huge challenge providing older persons high quality care and a dignified old age. With increasing levels of frailty many older people are depending on the physical environment in order to manage their everyday life, and the building design is essential in supporting quality of life and person-centered care. However, methods for evaluating design quality in residential care facilities are lacking, especially in terms of person-centeredness. A British instrument was chosen on the basis that it captures several aspects in the care environment of importance for the quality of life and care for older people.AIM: This study aims at describing the process of translating and culturally adapting a British instrument for evaluating design quality in Swedish care facilities for older people. METHOD and RESULT: The process involves seven phases; forward translation, reconciliation, back translation, harmonization, cognitive debriefing, proof-reading and pre-testing. In the first phase the items were translated from the source to the target language followed by discussions between the researchers and the translator for reconciliation. Then the items were translated from the target language back into the source language. After language harmonization the instrument was reviewed and discussed by an expert group in order to identify imprecise concepts and receive valuable comments. Finally, the items were proof-read to correct typographical errors before pre-testing the instrument. Experiences and challenges of the procedure are discussed.CONCLUSION: Cultural appropriate instruments are essential in order to validly measure the design quality in residential care facilities. This study shows the complexity of translating and adapting a British instrument for use in a Swedish care context.

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