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Naseer, M., Dahlberg, L., Ehrenberg, A., Schön, P. & Calderón-Larrañaga, A. (2023). The role of social connections and support in the use of emergency care among older adults. Archives of gerontology and geriatrics (Print), 111, Article ID 105010.
Open this publication in new window or tab >>The role of social connections and support in the use of emergency care among older adults
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2023 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 111, article id 105010Article in journal (Refereed) Published
Abstract [en]

Objectives: Limited and inconsistent findings have been reported on the link between social connections and support and emergency department (ED) visits in older populations. Moreover, the adequacy of informal care for older adults has rarely been considered. This study explored the associations of social connections, social support, and informal care with ED visits in younger-old (<78 years) and oldest-old (≥78 years) adults. Methods: This is a prospective cohort study based on community-living adults ≥60 years old participating in the Swedish National Study on Aging and Care in Kungsholmen (N=3066 at wave 1, 2001-2004; N=1885 at wave 3, 2007-2010; N=1208 at wave 5, 2013-2016). Standardised indexes were developed to measure social connections, social support, and informal care. The outcome variable was hospital-based ED visits within 4 years of the SNAC-K interview. Associations between exposure variables and ED visits were assessed through negative binomial regressions using generalised estimating equations. Results: Medium (IRR 0.77; 95% CI 0.59–0.99) and high (IRR 0.77; 95% CI 0.56–0.99) levels of social support were negatively associated with ED visits compared to low levels of social support, but only in oldest-old adults. No statistically significant associations were observed between social connections and ED visits. Higher ED visit rates were seen in oldest-old adults with unmet informal care needs, even if the differences did not reach statistical significance. Conclusions: ED visits were associated with social support levels among adults aged ≥78 years. Public health interventions to mitigate situations of poor social support may improve health outcomes and reduce avoidable ED visits in oldest-old adults. © 2023

Place, publisher, year, edition, pages
Elsevier Ireland Ltd, 2023
Keywords
adult, aged, aging, article, cohort analysis, community living, controlled study, emergency care, emergency ward, exposure variable, female, human, human experiment, interview, major clinical study, male, negative binomial regression, outcome assessment, outcome variable, prospective study, public health, social network, social support, statistical significance, Acute care, Emergency care use, Informal care
National Category
Nursing
Research subject
Health and Welfare, Varför söker äldre personer akutsjukvård? Orsaker, omständigheter och förklaringar
Identifiers
urn:nbn:se:du-45870 (URN)10.1016/j.archger.2023.105010 (DOI)000981084800001 ()37058774 (PubMedID)2-s2.0-85152132820 (Scopus ID)
Available from: 2023-04-20 Created: 2023-04-20 Last updated: 2023-09-22Bibliographically approved
Naseer, M., McKee, K., Ehrenberg, A., Schön, P. & Dahlberg, L. (2022). Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study. BMJ Open, 12(2), Article ID e055484.
Open this publication in new window or tab >>Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 2, article id e055484Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.

DESIGN: A register-based prospective cohort study.

SETTING: Swedish region of Dalarna.

PARTICIPANTS: Participants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period.

OUTCOME MEASURES: Dependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit.

RESULTS: Approximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED visit was significantly associated with older age, number of chronic diseases, receipt of home help, number of primary care visits, proportion of 80+ in the population and shorter distance to the ED; while an ED revisit was significantly associated with greater use of social care, number of hospital admissions and disposition (discharged; admitted to hospital) at initial ED visit.

CONCLUSION: Contextual factors explain variance in initial ED visit, additional to that explained by individual factors alone, which indicates inequitable access to ED care. These findings suggest considering local variations in contextual factors in order to improve health-related outcomes among older adults.

Keywords
accident & emergency medicine, international health services, public health
National Category
Health Sciences
Research subject
Health and Welfare, Varför söker äldre personer akutsjukvård? Orsaker, omständigheter och förklaringar
Identifiers
urn:nbn:se:du-39472 (URN)10.1136/bmjopen-2021-055484 (DOI)000754022100011 ()35140159 (PubMedID)2-s2.0-85124275853 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00440Region Dalarna
Available from: 2022-02-15 Created: 2022-02-15 Last updated: 2023-08-28
Dahlberg, L., McKee, K., Frank, A. & Naseer, M. (2021). A systematic review of longitudinal risk factors for loneliness in older adults. Aging & Mental Health, 26(2), 225-249
Open this publication in new window or tab >>A systematic review of longitudinal risk factors for loneliness in older adults
2021 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 26, no 2, p. 225-249Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To effectively reduce loneliness in older adults, interventions should be based on firm evidence regarding risk factors for loneliness in that population. This systematic review aimed to identify, appraise and synthesise longitudinal studies of risk factors for loneliness in older adults.

METHODS: Searches were performed in June 2018 in PsycINFO, Scopus, Sociology Collection and Web of Science. Inclusion criteria were: population of older adults (M = 60+ years at outcome); longitudinal design; study conducted in an OECD country; article published in English in a peer-review journal. Article relevance and quality assessments were made by at least two independent reviewers.

RESULTS: The search found 967 unique articles, of which 34 met relevance and quality criteria. The Netherlands and the United States together contributed 19 articles; 17 analysed national samples while 7 studies provided the data for 19 articles. One of two validated scales was used to measure loneliness in 24 articles, although 10 used a single item. A total of 120 unique risk factors for loneliness were examined. Risk factors with relatively consistent associations with loneliness were: not being married/partnered and partner loss; a limited social network; a low level of social activity; poor self-perceived health; and depression/depressed mood and an increase in depression.

CONCLUSION: Despite the range of factors examined in the reviewed articles, strong evidence for a longitudinal association with loneliness was found for relatively few, while there were surprising omissions from the factors investigated. Future research should explore longitudinal risk factors for emotional and social loneliness.

Keywords
Loneliness, longitudinal, older people, predictor, risk factor
National Category
Social Work
Research subject
Health and Welfare, Ensamhet och hälsa bland äldre personer i Norden; Health and Welfare, Att leva i samhällets utkant: Social exkludering bland äldre kvinnor och män i Sverige
Identifiers
urn:nbn:se:du-36187 (URN)10.1080/13607863.2021.1876638 (DOI)000616926900001 ()33563024 (PubMedID)2-s2.0-85101060469 (Scopus ID)
Available from: 2021-02-18 Created: 2021-02-18 Last updated: 2023-04-14Bibliographically approved
Baxter, R., Jemberie, W. B., Li, X., Naseer, M., Pauelsen, M., Shebehe, J., . . . Badache, A. (2021). COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden. Scandinavian Journal of Public Health, 49(1), 29-32
Open this publication in new window or tab >>COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden
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2021 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 1, p. 29-32Article in journal, Editorial material (Refereed) Published
Abstract [en]

The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.

Keywords
COVID-19, Sweden, aged, ageing, older people, public health, patient and public engagement (PPE), evidence-based policy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:du-35382 (URN)10.1177/1403494820969544 (DOI)000614539300006 ()33161880 (PubMedID)2-s2.0-85095721712 (Scopus ID)
Available from: 2020-11-10 Created: 2020-11-10 Last updated: 2023-04-14Bibliographically approved
Dahlberg, L., Frank, A., Lennartsson, C., McKee, K., Naseer, M. & Rehnberg, J. (2020). Ensamhet bland äldre personer i Norden. Copenhagen: Nordisk Ministerråd
Open this publication in new window or tab >>Ensamhet bland äldre personer i Norden
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2020 (Swedish)Report (Other academic)
Abstract [sv]

Rapporten presenterar översikter av tidigare forskning och analyser av känslan av ensamhet bland äldre personer. Överlag finns det kunskap om ensamhetens konsekvenser för ohälsa, men det behövs ytterligare forskning där starkare slutsatser kan dras om sambandens riktning, och ett tydligare fokus på ensamhet i gruppen äldre personer. En systematisk översikt visar att det finns god kunskap om en del faktorer som ökar risken för ensamhet, men mer forskning behövs om andra potentiella riskfaktorer. Analyserna visar en relativt låg och stabil förekomst av ensamhet bland äldre personer i Norden, samt att ohälsa och olika indikatorer för social exkludering (t.ex. bristande sociala relationer, otillräcklig inkomst, samt otrygghet i närområdet) har samband med ensamhet. Slutligen konstateras att forskningen om nordiska interventioner för att minska ensamhet bland äldre personer är begränsad.

Place, publisher, year, edition, pages
Copenhagen: Nordisk Ministerråd, 2020. p. 71
National Category
Social Work
Research subject
Health and Welfare, Ensamhet och hälsa bland äldre personer i Norden
Identifiers
urn:nbn:se:du-34940 (URN)10.6027/temanord2020-517 (DOI)978-92-893-6647-2 (ISBN)978-92-893-6648-9 (ISBN)
Available from: 2020-09-03 Created: 2020-09-03 Last updated: 2021-11-12
Naseer, M., Agerholm, J., Fastbom, J., Schön, P., Ehrenberg, A. & Dahlberg, L. (2020). Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study. Archives of gerontology and geriatrics (Print), 86, Article ID 103960.
Open this publication in new window or tab >>Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study
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2020 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 86, article id 103960Article in journal (Refereed) Published
Abstract [en]

Objectives

To assess the association between baseline characteristics at an index ED visit and ED revisit within 30 days among adults aged ≥ 65 years in two Swedish regions.

Methods

This was a register-based prospective cohort study. The sample included (N=16 688; N=101 017) older adults who have had an index ED visit in 2014 at hospital based EDs in the regions of Dalarna and Stockholm, Sweden. Several registers were linked to obtain information on sociodemographic factors, living conditions, social care, polypharmacy and health care use. Multivariate logistic regression was used to analyse the data.

Results

Seventeen percent of the study sample in Dalarna and 20.1% in Stockholm revisited ED within 30 days after an index ED visit. In both regions, male gender, being in the last year of life, excessive polypharmacy (≥ 10 drugs), ≥11 primary care visits and ED care utilization were positively associated with ED revisits. In Stockholm, but not in Dalarna, low level of education, polypharmacy, and institutional care was also associated with ED revisits. In contrast, home help was associated with ED revisits in Dalarna but not in Stockholm.

Conclusion

These findings call for further in-depth examinations of variations within single countries. ED revisits among older adults are driven by need of care but also by the social and care situation.

Keywords
Emergency department, Care utilisation, Older adults, Health and social care, Primary care
National Category
Nursing
Research subject
Health and Welfare, Varför söker äldre personer akutsjukvård? Orsaker, omständigheter och förklaringar
Identifiers
urn:nbn:se:du-31108 (URN)10.1016/j.archger.2019.103960 (DOI)000496954500020 ()31704624 (PubMedID)2-s2.0-85074431752 (Scopus ID)
Available from: 2019-11-18 Created: 2019-11-18 Last updated: 2021-11-12
Naseer, M., Agerholm, J., Fastbom, J., Schön, P., Ehrenberg, A. & Dahlberg, L. (2019). Emergency department revisits among older adults: A prospective cohort study. In: : . Paper presented at International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden.
Open this publication in new window or tab >>Emergency department revisits among older adults: A prospective cohort study
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Social Work
Research subject
Health and Welfare, Varför söker äldre personer akutsjukvård? Orsaker, omständigheter och förklaringar
Identifiers
urn:nbn:se:du-31161 (URN)
Conference
International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2021-11-12Bibliographically approved
Dahlberg, L., Frank, A., Naseer, M. & McKee, K. (2019). Systematic review of longitudinal risk factors for loneliness among older adults. In: : . Paper presented at International Association of Gerontology and Geriatrics European Region Congress (IAGG-ER), 23-25 May 2019, Gothenburg.
Open this publication in new window or tab >>Systematic review of longitudinal risk factors for loneliness among older adults
2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Social Work
Research subject
Health and Welfare, Ensamhet och hälsa bland äldre personer i Norden
Identifiers
urn:nbn:se:du-30228 (URN)
Conference
International Association of Gerontology and Geriatrics European Region Congress (IAGG-ER), 23-25 May 2019, Gothenburg
Funder
Nordic Council of Ministers, 18291
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2021-11-12Bibliographically approved
Naseer, M., Dahlberg, L. & Fagerström, C. (2018). Health related quality of life and emergency department visits in adults of age ≥ 66 years: a prospective cohort study.. Health and Quality of Life Outcomes, 16(1), Article ID 144.
Open this publication in new window or tab >>Health related quality of life and emergency department visits in adults of age ≥ 66 years: a prospective cohort study.
2018 (English)In: Health and Quality of Life Outcomes, E-ISSN 1477-7525, Vol. 16, no 1, article id 144Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Age increases the risk of emergency department [ED] visits. Health related quality of life (HRQoL) is often estimated as an outcome of ED visits, but it can be a risk factor of ED visits. This study aims to assess the association of HRQoL with time to first ED visit and/or frequent ED use in older adults during four-year period and if this association differs in 66-80 and 80+ age groups.

METHODS: Data from the Swedish National Study on Aging and Care-Blekinge of wave 2007-2009 was used in combination with electronic health records on ED visits. The analytical sample included 673 participants of age 66 years and older with information on HRQoL. Cox proportional hazard model was used to assess the association between HRQoL and time to first ED visit. Logistic regression analysis was performed to estimate the association of HRQoL with frequent ED use.

RESULTS: During the study period, 55.3% of older adults visited the ED and 28.8% had a frequent ED use. Poor physical HRQoL was independently associated with first ED visit both in total sample (p < 0.001) and in 66-80 (p < 0.001) and 80+ (p = 0.038) age groups. Poor mental HRQoL had no significant association with first ED visit and frequent ED use.

CONCLUSION: Findings suggest that poor physical HRQoL is associated with time to first ED visit in older adults. Therefore, physical HRQoL should be considered while planning interventions on the reduction of ED utilisation in older adults. Explanatory factors of frequent ED use may differ in age groups. Further studies are needed to identify associated factors of frequent ED visits in 80+ group.

Keywords
Care utilisation, Emergency visit, Older adults, Quality of life, Subjective health
National Category
Social Work
Research subject
Health and Welfare, Varför söker äldre personer akutsjukvård? Orsaker, omständigheter och förklaringar
Identifiers
urn:nbn:se:du-28261 (URN)10.1186/s12955-018-0967-y (DOI)000439735900001 ()30041629 (PubMedID)2-s2.0-85050361315 (Scopus ID)
Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2024-07-04
Naseer, M., Dahlberg, L. & Fagerström, C. (2018). Poor health related quality of life: A risk factor of emergency visits among older adults. In: : . Paper presented at 24th Nordic Congress in Gerontology, Oslo, 2-4 maj 2018.
Open this publication in new window or tab >>Poor health related quality of life: A risk factor of emergency visits among older adults
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Social Work
Research subject
Health and Welfare, Varför söker äldre personer akutsjukvård? Orsaker, omständigheter och förklaringar
Identifiers
urn:nbn:se:du-28359 (URN)
Conference
24th Nordic Congress in Gerontology, Oslo, 2-4 maj 2018
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00440
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2021-11-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7231-826x

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