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Research has highlighted that adolescent young carers (AYCs) are in a vulnerable position due to their caring responsibilitiesbeing combined with the challenges of adolescence. However, caring among adolescents does not have to be a solely negativeexperience and positive experiences of caring can co- exist. Identifying those factors that contribute to AYCs' positive or nega-tive caring experiences is important if AYCs are to be offered appropriate support. This cross-sectional survey study examinedfactors associated with AYCs' positive and negative caring experiences. Pupils aged 15–17 years from schools in 11 Swedishmunicipalities completed a questionnaire addressing demographic characteristics, care activities and the reported influence ofbeing an AYC on school results, received support, and perceived health, while caring experiences were measured by the Positiveand Negative Outcomes of Caring (PANOC-YC20) instrument. Of 3015 participants, 702 (23%) were identified as AYCs. ThePANOC-YC20 positive and negative caring experiences subscales were significantly associated with each other (r = 0.16), withthe mean score on the positive subscale (M = 10.36) significantly higher than that of the negative subscale (M = 5.18). In a mul-tinomial logistic regression model, AYCs providing higher levels of emotional care and sibling care had both stronger positiveand negative caring experiences, with a relatively greater effect on negative experiences. AYCs who had better perceived healthhad stronger positive experiences, while poorer perceived health was associated with more negative experiences. Finally, AYCswho felt their school results were negatively affected by their caring role had an increased likelihood of experiencing caring neg-atively. It is important for relevant authorities and professionals to consider that AYCs can experience caring both positively andnegatively when developing or providing support, as these experiences will likely be reflected in both their need of support, andin the forms of support that will be most effective for them.

Adolescent young carers (AYCs) face the challenges of adolescence while also having care responsibilities. Caring can negatively affect an adult carer’s health, but there is less evidence on how caring affects AYCs, of whom there is little awareness among professionals. The aim of this survey study was to describe the AYCs’ characteristics and investigate factors associated with their perceived health. School pupils aged 15–17 from 11 Swedish municipalities completed a questionnaire addressing caring activities, received support and perceived health. Of the 3,015 participants, 702 (23%) were AYCs. Female gender, having a parent with a health-related condition, mental illness in a family or non-family member, and addiction problems in a non-family member were associated with poorer perceived health, while receiving support with caring was associated with better perceived health. Identifying the factors associated with AYCs’ perceived health can lead to appropriate support, but there also needs to be better representation of AYCs in policy. © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

BACKGROUND: Identifying cognitive impairment at an early stage is important to enable preventive treatment and lifestyle changes. As gait deviations precede cognitive impairment, the aim of this study was to investigate if step parameters during different Timed Up and Go (TUG) conditions could discriminate between people with different cognitive ability.

METHODS: Participants (N = 304) were divided into the following groups: (1) controls, n = 50, mean age:73, 44% women; (2) Subjective cognitive Impairment (SCI), n = 71, mean age:67, 45% women; (3) Mild Cognitive Impairment (MCI), n = 126, mean age: 73, 42% women; and (4) dementia disorders, n = 57, mean age: 78, 51% women. Participants conducted TUG and two motor-cognitive TUG-conditions: TUG while naming animals (TUGdt-NA) and reciting months in reverse order (TUGdt-MB). Tests were video recorded for data extraction of valid spatiotemporal parameters: step length, step width, step duration, single step duration and double step duration. Step length was investigated with the step length/body height ratio (step length divided by body height). Logistic regression models (adjusted for age, sex and education) investigated associations between step parameters and dichotomous variables of groups adjacent in cognitive ability: dementia disorders vs. MCI, MCI vs. SCI, and SCI vs. controls. Results were presented as standardized odds ratios (sORs), with 95% confidence intervals (CI⁹⁵) and p-values (significance level: p < 0.05). The areas under the Receiver Operating Characteristic curves were presented for the step parameters/conditions with the highest sORs and, where relevant, optimal cutoff values were calculated.

RESULTS: Step length showed greatest overall ability to significantly discriminate between adjacent groups (sOR ≤ . 67, CI⁹⁵: .45-.99, p = ≤ . 047) during all group comparisons/conditions except three. The highest sOR for step-length was obtained when discriminating between SCI vs controls during TUGdt-MB (sOR = .51, CI⁹⁵:.29- .87, p = .014), whereby the area under the curve was calculated (c-statistics = .700). The optimal cut-off indicated a step length of less than 32.9% (CI⁹⁵ = 22.1-43.0) of body height to identify SCI compared with controls.

CONCLUSIONS: The results indicate that step length may be important to assess during TUG, for discrimination between groups with different cognitive ability; and that the presented cut-off has potential to aid early detection of cognitive impairment.

TRIAL REGISTRATION NUMBER: NCT05893524 (retrospectively registered 08/06/23).

Informal carers in paid work are known as working carers (WKCs). This combination of care and work is particular to them, and their support needs may differ from other informal carers. This exploratory study describes the caregiving-related factors associated with experiencing caregiving as demanding and a decreased ability to work in WKCs. The Swedish National Carer Survey was conducted in a stratified random sample (N = 30,009) of the population (>= 18 years) between October 2018 and January 2019. Of 11,168 respondents, 818 (7.32%) met the study criteria for WKCs, i.e. they provide informal care to another person on a regular basis, and they work full time. Almost half (49.3%) of WKCs report experiencing caregiving as demanding, while 40.4% indicated that their ability to work had been reduced due to providing informal care. Two ordinal logistic regression models were developed, one each for caregiving is demanding and ability to work is decreased. Psychological stress and financial problems caused by caregiving increased the odds of both experiencing caregiving as demanding and having one’s ability to work decrease, while finding caregiving satisfying decreased the odds of both. Further research is needed to establish how caregiving-related factors affect WKCs in both their care and working roles.

OBJECTIVES: Loneliness arises from a discrepancy between the relationships one desires and those one experiences. This study examines the relative importance of relationship quantity and quality for loneliness in older adults.

METHOD: The study was a cross-sectional, representative survey of 474 adults aged 77 and above living in Dalarna, Sweden. Loneliness was measured using the three-item UCLA Loneliness Scale. Four ordinal logistic regression models of loneliness were developed: one for quantity of relationships and three for quality of relationships (closeness; conflict; closeness and conflict combined). Perceived social support was included in the quality models.

RESULTS: The quality models explained the most variance in loneliness and had better model fit. Having a partner was associated with less loneliness, even when there was conflict. Having a close relationship with children was associated with less loneliness, but a lack of closeness or the presence of conflict was associated with more loneliness. Perceived social support was associated with less loneliness.

CONCLUSION: Quantity and quality of relationships are both associated with loneliness in older adults, but relationship quality appears to have greater importance. Specific types of relationships are also relevant, highlighting the need to consider relationship dynamics when designing interventions to reduce loneliness.

Purpose

The aim of this study was to investigate the effect of time-assistive products in supporting persons with mild to moderate dementia to achieve their time-related activity goals given their time processing ability.

Materials and methods

A multicentre single-blinded randomised controlled intervention study. A total of 73 persons with mild to moderate dementia aged ≥60 years were recruited through memory clinics across Sweden, of which 57 completed the three-month follow-up (intervention group n = 26, waiting list control group n = 31). The intervention group received individually prescribed time-assistive products. The primary outcome measure was the Canadian Occupational Performance Measure (COPM). Comparative analyses were done of the differences in COPM ratings at baseline and after three months within and between groups. KaTid-Senior was used to measure time processing ability.

Results

After three months, COPM ratings, adjusted for time processing ability, had significantly improved in the intervention group regarding satisfaction with performance (p = .028, 𝜂2p = 0.09) but not for performance (p = .053, 𝜂2p = 0.07). The change from the ratings at baseline to the ratings at 3 months was clinically significant in the intervention group as their improvement exceeded 2 points on a 10-point scale both for performance (mean 2.8, CI 1.8–3.7) and satisfaction with performance (mean 3.4, CI 2.3–4.6).

Conclusion

Prescription of time-assistive products can support persons with mild to moderate dementia in their daily time management in relation to individual time-related goals. However, given the weak evidence base, further research is needed on the effectiveness of time-based assistive products for persons with dementia.

Implications for rehabilitation 

• Knowledge of how to remediate problems with daily time management in dementia is limited and there is a lack of randomised controlled trials on this subject.
• This study found that time-assistive products can support time-related activities for older adults with mild to moderate dementia.
• While time processing ability decreased over the study period, satisfaction with the performance of time-related activities increased in persons who received a time-assistive product compared to the control group.
• This study contributes to the knowledge on evidence-based time-related interventions for persons with dementia.

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.