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  • 1.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Development and initial validation of the staff perception of residential care environments (SPORE) instrument2024Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 19, nr 1, artikel-id e12596Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

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  • 2.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Saade, Sandra
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Digital homecare twin expectations among Swedish social service professionals – a qualitative study2024Konferensbidrag (Refereegranskat)
    Abstract [en]

    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. 

  • 3.
    Saade, Sandra
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Nordin, Susanna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Digital twin of homecare services in Sweden- views of older adults2024Konferensbidrag (Refereegranskat)
    Abstract [en]

    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. 

  • 4.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin J
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Older Adults' Experiences, Worries and Preventive Measures Regarding Home Hazards: A Survey on Home Safety in Sweden2023Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, nr 2, artikel-id 1458Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 5.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Rosberg Petersson, Johanna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Giedraitis, Vilmantas
    Högskolan Dalarna, Institutionen för hälsa och välfärd. Uppsala University.
    McKee, Kevin J
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Rosendahl, Erik
    Umeå University.
    Halvorsen, Kjartan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Tecnologico de Monterrey, Campus Estado de Mexico, Mexico.
    Berglund, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study2023Ingår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, nr 1, artikel-id 535Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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

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  • 6.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Rosberg Petersson, Johanna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Giedraitis, Vilmantas
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Rosendahl, Erik
    Umeå University.
    Berglund, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Prediction of conversion to dementia disorders based on Timed Up and Go dual-task test verbal outcomes: A longitudinal prospective memory-clinic-based study2023Konferensbidrag (Refereegranskat)
  • 7.
    Rosberg Petersson, Johanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Berglund, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Giedraitis, Vilmantas
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Halvorsen, Kjartan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Rosendahl, Erik
    Umeå University.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Åberg, Anna Cristina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Step length during Timed Up and Go performance: preliminary results of a cross-sectional cohort study2023Konferensbidrag (Refereegranskat)
  • 8.
    Dahlberg, Lena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet and Stockholm University.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Lennartsson, Carin
    Rehnberg, Johan
    A social exclusion perspective on loneliness in older adults in the Nordic countries2022Ingår i: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 19, nr 2, s. 175-188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the associations between social exclusion indicators and loneliness in older adults (60+ years) in four Nordic countries. Data from four waves of the European Social Survey were pooled, providing a total of 7755 respondents (Denmark n = 1647; Finland n = 2501, Norway n = 1540; Sweden n = 2067). Measures of loneliness, demographic characteristics, health, and eight indicators of social exclusion were selected from the survey for analysis. Country-specific and total sample hierarchical logistic regression models of loneliness were developed. Significant model improvement occurred for all models after social exclusion indicators were added to models containing only demographic and health variables. Country models explained between 15.1 (Finland) and 21.5% (Sweden) of the variance in loneliness. Lower frequency of social contacts and living alone compared to in a two-person household was associated with a higher probability of loneliness in all countries, while other indicators were associated with loneliness in specific countries: lower neighbourhood safety (Sweden and Denmark); income concern (Sweden and Finland); and no emotional support (Denmark, Finland, and Sweden). A robust relationship was apparent between indicators of social exclusion and loneliness with the direction of associations being highly consistent across countries, even if their strength and statistical significance varied. Social exclusion has considerable potential for understanding and addressing risk factors for loneliness.

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  • 9.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Exploring the design of physical environments for older adults – a qualitative study on staff perceptions of outdoor areas2022Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Although the importance of the design of physical care environments for older adults and healthcare staff of residential care facilities (RCFs) is well recognized, few studies have taken the staff perspective regarding how environmental factors influence its users. This study considers healthcare staff perceptions of older adults’ RCFs with a focus on outdoor areas. 

    Methods: Twenty RCFs in Sweden were purposively sampled to obtain facilities with varying building design, type of ownership, year of construction, building size and geographic location. Ten healthcare staff from each facility were randomly selected and recruited by the care home managers. Healthcare staff completed the Staff Perception of Older People’s Residential Care Environments (SPORE) questionnaire. In this study, only written responses to open-ended questions on the physical care environment were analysed, using qualitative content analysis. 

    Results: The importance of outdoor areas for the well-being of older adults was emphasised, and several requirements and deficiencies in the physical features of such areas were identified. Concerns were expressed about the lack of accessibility to outdoor areas. Physical features that can provide support for older adults when using outdoor areas, such as ramps and stable surfaces, were limited, as was their maintenance. 

    Conclusions: This study shows the importance of taking the users’ needs into account when planning and designing RCFs for older adults. There is potential for improving the design of outdoor areas in order to provide safe and supportive physical care environments and to facilitate care delivery.

  • 10.
    Naseer, Mahwish
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Schön, Pär
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 2, artikel-id e055484Artikel i tidskrift (Refereegranskat)
    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.

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  • 11.
    Vicente, Joana
    et al.
    Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Magnusson, Lennart
    Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden; The Swedish Family Care Competence Centre, Kalmar, Sweden.
    Johansson, Pauline
    The Swedish Family Care Competence Centre, Kalmar, Sweden; Faculty of Health and Life Sciences, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
    Ekman, Björn
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Hanson, Elizabeth
    Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden; The Swedish Family Care Competence Centre, Kalmar, Sweden.
    Informal care provision among male and female working carers: Findings from a Swedish national survey2022Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 17, nr 3, artikel-id e0263396Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Informal carers in paid employment-working carers (WKCs)-have complex support needs. However, little is known about WKCs' pattern of informal care provision, the support they receive, the impact providing care has on their employment, and how these vary between male and female WKCs. This study describes the pattern of informal care provision and received support among Swedish WKCs.

    RESEARCH METHOD/DESIGN: The study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire addressed the type and extent of informal care provided, support received and the impact of care provision on employment. Of the 30,009 people who received the questionnaire, 11,168 (37.3%) responded, providing an analytic sample of 818 (7.32% of respondents) employed or self-employed informal carers.

    FINDINGS: A typical Swedish WKC was a middle-aged female, providing weekly or daily care to a non-cohabitant parent, who experiences care as sometimes demanding and receives no formal support as a carer. Female WKCs were more likely than males to care alone and with higher intensity, to report a need for help in meeting their care-recipient's needs, and to experience care as demanding. Approximately 17% of WKCs reported their employment had been affected due to caring, 40% their ability to work, and 31% their career development opportunities. Female WKCs' ability to work was affected more than males', and they were more commonly prevented from applying for work.

    CONCLUSION: Swedish female WKCs compared to males provide more hours of informal care, across more care domains, more often alone. This places them in a challenging situation when combining paid work and care. Greater recognition of the challenges faced by WKCs is required in Sweden and other countries, as are policies to reduce gender inequalities in informal care provision in this group.

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  • 12.
    Nilsen, Charlotta
    et al.
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Institute of Gerontology, Jönköping University, Jönköping, Sweden.
    Celeste, Roger K
    Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
    Lennartsson, Carin
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Long-term risk factors for old-age social exclusion in Sweden: a 30-year longitudinal study2022Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 103, artikel-id 104760Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE OF THE RESEARCH: Social exclusion threatens quality of life in older age. However, there is a lack of research on social exclusion from life-course and gender perspectives. We investigated early- and midlife risk factors for old-age social exclusion among women and men.

    MATERIALS AND METHODS: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over a 30-year period on 1,819 people at baseline. Indicators of economic exclusion, leisure/social exclusion, and civic exclusion were assessed at early late life (M=70 years) and late life (M=81). Educational attainment, non-employment, psychological health problems and mobility problems were measured as risk factors at midlife (M=54) and late midlife (M=61). Path analysis derived a model of old-age social exclusion.

    RESULTS: Exclusion on a domain in early late life led to exclusion on the same domain in late life, except for the economic domain. Leisure/social exclusion in early late life also led to civic exclusion in late life. Midlife risk factors influenced late-life exclusion almost exclusively through early late-life exclusion. While model fit could not be significantly improved by allowing coefficients to vary freely by gender, there was a stronger effect of non-employment on exclusion in women and a stronger effect of psychological health problems on exclusion in men.

    CONCLUSIONS: This study confirms that old-age exclusion is persistent and dynamic, and influenced by risk factors experienced earlier in life. A holistic approach with integrated efforts across different policy areas is needed to efficiently reduce old-age social exclusion.

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  • 13.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet & Stockholm University.
    Summer Meranius, Martina
    Mälardalens Högskola .
    Williams, Christine L.
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalens universitet; Karolinska institutet.
    Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 3, artikel-id 1788Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    (1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.

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  • 14.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Perceptions and experiences of safety at home: a survey among older adults in Sweden2022Ingår i: 26th Nordic Congress of Gerontology. Abstracts: Change and continuity, 2022, s. 277-277Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction

    Home safety is important to prevent injuries and accidents in older adults living at home. Feeling safe at home is also essential for frail older adults’ well-being. "Ageing in place" is a term focusing on enabling older adults to stay in their ordinary homes, rather than in special housing. But when older adults continue living at home, more injuries and accidents can occur. The aim of this study was to explore older adults’ experiences, preventive measures, and feelings of safety in their home in relation to a range of potential home-based health and safety hazards.

    Methods and Materials

    The study had a cross-sectional design and was based on a national telephone survey among 400 adults over 70 years of age, living at home in ordinary housing in Sweden. Descriptive and comparative statistics were used to analyse the data.

    Results

    The participants rated the importance of feeling safe at home as high, and seldom felt unsafe. Higher age, greater frequency of feeling unsafe at home or in the neighbourhood, access to support, better health, importance of safety and living alone were associated with level of worry or for having taken preventive measures against some but not all hazards in the home.

    Conclusions

    Taking preventive measures is not always is not always associated with experiences or level of worry. Age, feelings of safety, access to support, health and living alone or not, are all factors that can influence level of worry or for taking preventive measures or not against specific hazards in the home.

  • 15.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Preventing accidents and injuries: older adults' experiences, worries, and preventive measures regarding home hazards2022Ingår i: 36th Annual Conference of the European Health Psychology Society. Abstracts: Charting new territories in health psychology, 2022, s. 707-707Konferensbidrag (Refereegranskat)
  • 16.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sturge, Jodi
    Ayoub, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Jones, Allyson
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet & Stockholm University.
    Meijering, Louise
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The Role of Information and Communication Technology (ICT) for Older Adults’ Decision-Making Related to Health, and Health and Social Care Services in Daily Life—A Scoping Review2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 1, artikel-id 151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults’ decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults’ decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults’ use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives. 

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  • 17.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Karolinska Institutet; Stockholm University.
    Williams, Christine L.
    Summer Meranius, Martina
    Hanson, Elizabeth
    Magnusson, Lennart
    Ekman, Björn
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalen University, Västerås; Karolinska Institutet, Huddinge.
    A comparison of spouse and non-spouse carers of people with dementia: a descriptive analysis of Swedish national survey data2021Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, artikel-id 338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Being an informal carer of a person with dementia (PwD) can have a negative effect on the carer’s health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care.

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  • 18.
    Dahlberg, Lena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Karolinska Institutet; Stockholm University.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Frank, Amanda
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Naseer, Mahwish
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Karolinska Institutet; Stockholm University.
    A systematic review of longitudinal risk factors for loneliness in older adults2021Ingår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 26, nr 2, s. 225-249Artikel i tidskrift (Refereegranskat)
    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.

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  • 19.
    Marmstål Hammar, Lena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Insitute, Mälardalen University.
    Williams, Christine L
    Florida Atlantic University, USA.
    Meranius, Martina Summer
    Mälardalen University.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Being 'alone' striving for belonging and adaption in a new reality: The experiences of spouse carers of persons with dementia2021Ingår i: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 20, nr 1, s. 273-290, artikel-id 1471301219879343Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aim: Spouse carers of a person with dementia report feeling lonely and trapped in their role, lacking support and having no time to take care of their own health. In Sweden, the support available for family carers is not specialised to meet the needs of spouse carers of people with dementia. The aim of the study described in this paper was to explore spouse carers’ experiences of caring for a partner with dementia, their everyday life as a couple and their support needs.

    Methods: Nine spouse carers of a partner with dementia living at home were recruited through a memory clinic and a dementia organisation. Semi-structured interviews were conducted with the participants, focusing on their experiences of providing care, their support needs in relation to their caring situation, their personal well-being and their marital relationship. The interviews were transcribed and underwent qualitative content analysis.

    Results: The analysis resulted in one overall theme Being   ‘alone’   striving   for   belonging   and adaption  in  a  new  reality, synthesized from four sub-themes: (1) Being  in  an  unknown  country; (2) Longing  for a  place  for  me  and  us; (3) Being  a  carer  first  and  a  person  second; and (4) Being  alone  in  a relationship.

    Conclusions: The training of care professionals regarding the unique needs of spouse carers of people with dementia needs improvement, with education, in particular, focusing on their need to be considered as a person separate from being a carer and on the significance of the couple’s relationship for their mutual well-being.

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  • 20. Ekman, Björn
    et al.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Vicente, Joana
    Magnusson, Lennart
    Hanson, Elizabeth
    Cost analysis of informal care: estimates from a national cross-sectional survey in Sweden.2021Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 1236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Over the past decades, informal care has increased in most OECD-countries. Informal care is costly to caregivers and to society in the form of lost income and direct costs of providing care. Existing evidence suggests that providing informal care affects caregivers' overall health. However, estimates of the social costs of informal care based on national data on individuals are currently scarce.

    OBJECTIVE: This study contributes to the existing evidence on the costs of informal care by estimating the direct and indirect costs to caregivers using a purposive national household survey from Sweden.

    METHODS: Adopting a bottom-up, prevalence approach, the direct and indirect costs are estimated using the survey data and the value of working time and leisure time from existing sources.

    RESULTS: The results suggest that around 15% of the adult population of Sweden provide informal care and that such care costs around SEK 152 billion per year (around 3% of GDP; USD 16,3 billion; EUR 14,5 billion), or SEK 128000 per caregiver. Around 55% of costs are in the form of income loss to caregivers. The largest cost items are reduced work hours and direct costs of providing informal care. Replacing informal caregivers with professional care providers would be costly at around SEK 193,6 billion per year.

    CONCLUSIONS: Findings indicate that, even in a country with a relatively generous welfare system, significant resources are allocated toward providing informal care. The costing analysis suggests that effective support initiatives to ease the burden of informal caregivers may be cost-effective.

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  • 21.
    Marmstål Hammar, Lena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalens Högskola.
    Falk Johansson, Marcus
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Summer Meranius, Martina
    Mälardalens Högskola.
    Exhausted and trapped in isolation. Caring for a spouse with dementia during the Covid-19 pandemic2021Ingår i: Family Caregiving (HS Poster), 2021, s. 800-801Konferensbidrag (Refereegranskat)
    Abstract [en]

    Even before the Covid-19 pandemic, spouse carers of persons with dementia (PwDs) found their care responsibilities overwhelming and had little time to focus on their own lives. To minimize the risk of being infected with Covid-19, older persons are recommended to self-isolate in their homes, while formal support such as respite care and day care centers are withdrawn. This study involved semi-structured interviews with 24 spouse carers of community-living PwDs, with the aim of describing their situation during the pandemic. The interviews were analyzed with qualitative content analysis. Results revealed that they commonly declined help because of the perceived risk of their spouse being infected with Covid-19 and thus also possibly causing their death. They described feelings of being trapped in their situation, as they experienced having no choice than take all responsibility for the care of their partner themselves, with cost of being unable to take necessary breaks. This was described as making an already strained situation almost unbearable, which led to conflicts with their partner. However, the spouses also described positive aspects due to strategic changes in health and social care provision to prevent the spread of the virus, such as greater staff continuity in home care services, and patient transportation service. These made the PwD less stressed and influenced their everyday life positively. It could be concluded that the extent burden during the Covid-19 pandemic calls for extensive development of tailored support to better tackle the rapid changes that can occur in a society.

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  • 22.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Summer Meranius, Martina
    Mälardalens Högskola.
    Williams, Christine L.
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalen University.
    Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons With Dementia in Sweden2021Ingår i: Family Caregiving and Persons with Dementia, 2021, Vol. 5, s. 154-Konferensbidrag (Refereegranskat)
    Abstract [en]

    As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and loss of intimacy combining with stress and poor health. Research is needed to develop adequate support for spouse carers based on evidence of what influences negative and positive outcomes of care. The present study investigated psychosocial correlates of spouse carers’ (i) negative impact and (ii) positive value of caring. Data from a cross-sectional survey of 165 spouse carers community-resident in Sweden was analysed in two hierarchical regression models to predict negative impact and positive value of caring. Results found that negative impact and positive value were explained by different variables, significant predictors for negative impact included carer stress, health, and emotional loneliness, and change in intimacy with the care-recipient, while positive value was predicted by mutuality, change in closeness to the care-recipient and quality of support. Negative impact and positive value shared variance of only 17.2%. Thus, negative impact and positive value represent different aspects of the carer situation. Consequently, support needs to target several aspects in carers’ life, aiming to; facilitate for spouses to manage PwD’s impairment, increase emotional support while also strengthening the relationship between carer and PwD to reduce negative impact while increasing positive value.

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  • 23.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. The Swedish National Graduate School for Competitive Science on Ageing and Health.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Williams, Christine L.
    Florida Atlantic University Christine E Lynn College of Nursing.
    Martina, Summer Meranius
    Mälardalens Högskola.
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Spouse’s supported and unsupported care of persons with dementia: Home care and the informal caregiver’s perspective2021Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction. Caring for a person with dementia (PWD) can negatively affect the quality of life of informal carers, and research suggests spouse carers, often being older, are particularly vulnerable and requiring of support. Yet the formal support offered is rarely tailored to meet the needs of spouse carers of PWDs. The aim of the present study was to compare spouse carers to other carers of PWDs on a range of factors, as a foundation for a better understanding of their support needs. 

    Material and methods. Cross-sectional survey. In late 2018 a random stratified sample was taken of the Swedish population aged 18 and older. Of 30,009 people contacted, 11,168 completed and returned a questionnaire or completed a web-based version, a response rate of 37.3%. The questionnaire contained questions on whether the respondent was an informal carer for another person, the extent of care provided, contact with and support received from formal services, and impacts of care.

    Results. Of the respondents, 378 (3.38%) were carers of PWDs, of whom 107 (28.3%) were spouse carers. Spouse carers compared to other carers of PWD provide care more intenselyand are more informed on their right to support from local authorities. While more often being offered formal support in their carer role, they are less supported in providing care and report a higher negative impact (for all p<.05). 

    Conclusions. Formal support is offered to spouse carers in their carer role, but might not be tailored to their specific needs of support.

  • 24. Åhman, Hanna B
    et al.
    Berglund, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Cedervall, Ylva
    Giedraitis, Vilmantas
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Rosendahl, Erik
    Åberg, Anna Cristina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    Timed "Up & Go" Dual-Task Tests: Age- and Sex-Specific Reference Values and Test-Retest Reliability in Cognitively Healthy Controls.2021Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 101, nr 10, artikel-id pzab179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To establish reference values for the Uppsala-Dalarna Dementia and Gait (UDDGait) Timed "Up & Go" dual-task (TUGdt) test variables in cognitively healthy adults and to assess these variables' test-retest reliability.

    METHODS: For reference values, 166 participants were recruited with approximately equal numbers and proportions of women and men in the age groups 50 to 59, 60 to 69, 70 to 79, and 80+ (mean age = 70 years, age range = 50-91 years, 51% women). For reliability testing, 43 individuals (mean age = 69 years, age range = 50-89 years, 51% women) were recruited. Two dual-task tests were carried out: TUGdt naming animals and TUGdt months backward, representing 8 test variables: time scores, costs (the relative difference between single- and dual-task time scores), "number of animals", "number of months", "animals/10 s", and "months/10 s". Reference ranges for the variables were established by quantile regression in age- and sex-specific groups. For reliability, ICCs, standard error of measurement, minimal detectable change, and Bland-Altman plots were used.

    RESULTS: Reference values for the TUGdt test variables are presented for the 2.5th and 97.5th percentile. The reliability of TUGdt time scores was excellent (ICCs between 0.85 and 0.86). "Number of animals" and "animals/10 s" as well as "months/10 s" showed fair to good levels of reliability (ICCs between 0.45 and 0.58), whereas the reliability for both cost measures and "number of months" was poor (ICCs between 0.34 and 0.39).

    CONCLUSIONS: Normative reference values, potentially useful for clinical and research purposes, were presented in 4 age- and sex-specific groups from 50 years and above. Reliability for the test variables varied between poor and excellent, the lower estimates partly explained by some variables being the ratio of 2 other variables. In UDDGait, TUGdt tests are intended for diagnostic and predictive purposes, for which these tests are promising and require further investigations.

    IMPACT: We present normative reference values and test-retest reliability results for the UDDGait TUGdt test variables. These results should be useful for both clinical and research purposes.

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  • 25. Åhman, Hanna B
    et al.
    Cedervall, Ylva
    Kilander, Lena
    Giedraitis, Vilmantas
    Berglund, Lars
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Rosendahl, Erik
    Ingelsson, Martin
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala University.
    Dual-task tests discriminate between dementia, mild cognitive impairment, subjective cognitive impairment, and healthy controls: a cross-sectional cohort study2020Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, nr 1, artikel-id 258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Discrimination between early-stage dementia and other cognitive impairment diagnoses is central to enable appropriate interventions. Previous studies indicate that dual-task testing may be useful in such differentiation. The objective of this study was to investigate whether dual-task test outcomes discriminate between groups of individuals with dementia disorder, mild cognitive impairment, subjective cognitive impairment, and healthy controls.

    METHODS: A total of 464 individuals (mean age 71 years, 47% women) were included in the study, of which 298 were patients undergoing memory assessment and 166 were cognitively healthy controls. Patients were grouped according to the diagnosis received: dementia disorder, mild cognitive impairment, or subjective cognitive impairment. Data collection included participants' demographic characteristics. The patients' cognitive test results and diagnoses were collected from their medical records. Healthy controls underwent the same cognitive tests as the patients. The mobility test Timed Up-and-Go (TUG single-task) and two dual-task tests including TUG (TUGdt) were carried out: TUGdt naming animals and TUGdt months backwards. The outcomes registered were: time scores for TUG single-task and both TUGdt tests, TUGdt costs (relative time difference between TUG single-task and TUGdt), number of different animals named, number of months recited in correct order, number of animals per 10 s, and number of months per 10 s. Logistic regression models examined associations between TUG outcomes pairwise between groups.

    RESULTS: The TUGdt outcomes "animals/10 s" and "months/10 s" discriminated significantly (p < 0.001) between individuals with an early-stage dementia diagnosis, mild cognitive impairment, subjective cognitive impairment, and healthy controls. The TUGdt outcome "animals/10 s" showed an odds ratio of 3.3 (95% confidence interval 2.0-5.4) for the groups dementia disorders vs. mild cognitive impairment. TUGdt cost outcomes, however, did not discriminate between any of the groups.

    CONCLUSIONS: The novel TUGdt outcomes "words per time unit", i.e. "animals/10 s" and "months/10 s", demonstrate high levels of discrimination between all investigated groups. Thus, the TUGdt tests in the current study could be useful as complementary tools in diagnostic assessments. Future studies will be focused on the predictive value of TUGdt outcomes concerning dementia risk for individuals with mild cognitive impairment or subjective cognitive impairment.

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  • 26. Åhman, HB
    et al.
    Cedervall, Y
    Berglund, L
    Kilander, L
    Giedraitis, V
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Ingelsson, M
    Rosendahl, E
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Dual-Task Tests Improve Capacity of Models for Predicting Dementia Incidence - A Prospective Cohort Study2020Konferensbidrag (Refereegranskat)
  • 27. B Åhman, Hanna
    et al.
    Berglund, Lars
    Cedervall, Ylva
    Kilander, Lena
    Giedraitis, Vilmantas
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Ingelsson, Martin
    Rosendahl, Erik
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala University.
    Dual-Task Tests Predict Conversion to Dementia-A Prospective Memory-Clinic-Based Cohort Study2020Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, nr 21, artikel-id E8129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to investigate whether Timed Up-and-Go (TUG) dual-task (TUGdt) tests predict dementia incidence among patients with subjective or mild cognitive impairment (SCI; MCI). Other study objectives were to determine whether TUGdt improves dementia prediction compared to a) demographic characteristics and standard cognitive tests alone; and b) TUG and Verbal Fluency performed separately. Patients (n = 172, age range 39-91 years, 78 women) with SCI or MCI performed TUGdt tests, including 1) naming animals and 2) reciting months backwards, and clinical cognitive tests at baseline. Diagnoses were identified at follow-up after 2.5 years. Logistic regression was used to predict dementia incidence, receiver operating characteristic (ROC) curves and c-statistics for predictive capacity. Analyses were stratified by age and gender. At follow-up, 51 patients had developed dementia. The TUGdt result "animals/10 s" was associated with dementia incidence (standardized odds ratio (OR) = 4.06, 95% confidence interval (CI) 2.28-7.23, p < 0.001), more so among patients under the median age of 72 years (standardized OR = 19.4, 95% CI 3.53-106.17, p < 0.001). TUGdt "animals/10 s" improved dementia prediction compared to demographic characteristics and standard tests alone (c-statistics 0.88 to 0.94) and single-task tests (c-statistics 0.86 to 0.89), but only in the younger patient group. TUGdt has the potential to become a useful tool for dementia prediction.

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  • 28.
    Dahlberg, Lena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Frank, Amanda
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Lennartsson, Carin
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Naseer, Mahwish
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Rehnberg, Johan
    Lennartsson, Carin (Redaktör)
    Ensamhet bland äldre personer i Norden2020Rapport (Övrigt vetenskapligt)
    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.

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    FULLTEXT01
  • 29. Fagerberg, J.
    et al.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Paulsen, R.
    The unreflective practitioner: a pilot study on functional stupidity and social work2020Ingår i: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 23, nr 6, s. 992-1004Artikel i tidskrift (Refereegranskat)
    Ladda ner fulltext (pdf)
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  • 30.
    Dahlberg, Lena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete. Karolinska Institutet, Stockholm University.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Fritzell, J.
    Heap, J.
    Lennartsson, C.
    Trends and gender associations in social exclusion in older adults in Sweden over two decades2020Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 89, artikel-id 104032Artikel i tidskrift (Refereegranskat)
    Ladda ner fulltext (pdf)
    fulltext
  • 31.
    Carstensen, Gunilla
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sociologi.
    Rosberg, Birgitta
    Uppsala University Hospital.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala University.
    Before evening falls: Perspectives of a good old age and healthy ageing among oldest-old Swedish men2019Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 82, s. 35-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The late life experiences of men in the oldest-old age group have been under-researched, and their perspectives on ageing successfully neglected. This study explored the perspectives of oldest-old Swedish men on what a ‘good old age’ and ageing successfully meant to them. A purposive sample of 17 men, aged 85-90 years, was drawn from the Uppsala Longitudinal Study of Adult Men. An interview guide explored participants’ perspectives on their ageing experiences and how they viewed ageing successfully. Participants were interviewed twice, with 1–2 weeks between interviews, and both interviews were recorded and transcribed. Content analysis identified four themes: i) Adaptation, concerning the ability to adapt to growing old with increasing limitations; ii) Sustaining Independence, related to financial resources and good health as the foundation for independence; iii) Belongingness, representing close relationships, established friendships, and the significance of the spouse; and iv) Perspectives of Time, also a common thread in all themes, in which past life experiences create an existential link between the past, the present and the future, establishing continuity of the self and enhancing life satisfaction. The participants presented themselves as active agents involved in maintaining meaning and achieving life satisfaction; a process related to the ability to manage changes in life. Our findings have resonance with models of healthy or successful ageing, but also diverge in important ways, since such models do not consider the significance of an individual’s life history for their present well-being, and primarily conceptualise health as an outcome, rather than as a resource.

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  • 32. Bozkurt Åhman, H
    et al.
    Cedervall, Y
    Giedraitis, V
    Berglund, L
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Combining Two Dual-Task Tests to Discriminate Between People with Dementia Disorder, Mild Cognitive Impairment, Subjective Cognitive Impairment, and Healthy Controls2019Konferensbidrag (Refereegranskat)
  • 33. Bozkurt Åhman, H
    et al.
    Giedraitis, V
    Cedervall, Y
    Berglund, L
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Correlations Between Dual-Task Performance and Alzheimer’s Disease Cerebrospinal Fluid Biomarkers2019Konferensbidrag (Refereegranskat)
  • 34. Bozkurt Åhman, H
    et al.
    Giedraitis, V
    Cedervall, Y
    Berglund, L
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Correlations between Dual-Task Performance and Alzheimer’s Disease Cerebrospinal Fluid Biomarkers2019Konferensbidrag (Refereegranskat)
  • 35.
    McKee, Kevin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Nordin, Susanna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Developmentand initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Staff perceptions of the health care environment influence the delivery of person-centred care.  Little research has examined staff perceptions of health care environments, in part because of a lack of validated instruments.  This study reports the development and initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument for use in residential care facilities for older people (RCFs).

    Items developed in a British project on the design of care environments were translated and adapted for the Swedish care context as SPORE (24 items, 5 sub-scales).  In a study of the physical environment and quality of care, 200 staff recruited from 20 RCFs sampled from across Sweden completed a questionnaire containing SPORE, the Person-centred Care Assessment Tool (PCAT), the Person-centred Climate Questionnaire – staff version (PCQ-S), and the Sheffield Care Environment Assessment Matrix –Sweden (SCEAM-S).

    All SPORE sub-scales were normally distributed with good internal consistency reliability (Cronbach αs=.85-.88). Correlations between SPORE and PCAT sub-scales ranged from .301-.503, and between SPORE and PCQ-S sub-scales from .353-.557.  RCF-level analyses (N=20) indicated that scores on SCEAM overall environment quality correlated significantly with all SPORE sub-scales (range=.496-.700).  The SCEAM Comfort sub-scale was correlated with all SPORE sub-scales (range=.509-.721), while the SCEAM Privacy sub-scale was correlated (r=.428) with the SPORE Staff Facilities sub-scale.  The SPORE Working and Caring for Residents sub-scale was correlated with SCEAM cognitive support (r=.502) and physical support (r=.566) sub-scales.

    The SPORE instrument demonstrated good psychometric properties and its sub-scales an excellent range of associations with staff perceptions of person-centred care and with objective assessments of the physical environment.  Further validation is required, but the SPORE instrument has potential for understanding how staff perceptions of the RCF environment relate to the delivery of person-centred care.

  • 36. Åhman, Hanna Bozkurt
    et al.
    Giedraitis, Vilmantas
    Cedervall, Ylva
    Lennhed, Björn
    Berglund, Lars
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Kilander, Lena
    Rosendahl, Erik
    Ingelsson, Martin
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala University.
    Dual-task performance and neurodegeneration: Correlations between timed up-and-go dual-task test outcomes and Alzheimer's disease cerebrospinal fluid biomarkers2019Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 71, nr Suppl 1, s. S75-S83Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Tools to identify individuals at preclinical stages of dementia disorders are needed to enable early interventions. Alterations in dual-task performance have been detected early in progressive neurodegenerative disorders. Hence, dual-task testing may have the potential to screen for cognitive impairment caused by neurodegeneration. Exploring correlations between dual-task performance and biomarkers of neurodegeneration is therefore of interest.

    OBJECTIVE: To investigate correlations between Timed Up-and-Go dual-task (TUGdt) outcomes and Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers amyloid-β 42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau).

    METHODS: This cross-sectional cohort study included 90 participants (age range 49-84 years) undergoing memory assessment, who were subsequently diagnosed with AD, other dementia disorders, mild cognitive impairment, or subjective cognitive impairment. TUG combined with "Naming Animals" (TUGdt NA) and "Months Backwards" (TUGdt MB), respectively, were used to assess dual-task performance. The number of correct words and time taken to complete the tests were measured. The CSF biomarkers were analysed by ELISA. Spearman's rank correlation was used for analyses between TUGdt outcomes (TUGdt NA and TUGdt MB), and CSF biomarkers, adjusted for age, gender, and educational level.

    RESULTS: The number of correct words, as well as the number of correct words/10 s during TUGdt NA correlated negatively to CSF t-tau and p-tau. No correlations were found between any time scores and CSF biomarkers.

    CONCLUSION: The correlations between TUGdt NA and t-tau and p-tau may indicate that neurodegeneration affects dual-task performance. Longitudinal studies are needed to further explore dual-task testing in screening for cognitive impairment due to neurodegeneration.

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  • 37.
    McKee, Kevin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Fagerberg, Johan
    Functional stupidity and social workers: a pilot study.2019Konferensbidrag (Övrigt vetenskapligt)
  • 38.
    Dahlberg, Lena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Frank, Amanda
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Naseer, Mahwish
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Systematic review of longitudinal risk factors for loneliness among older adults2019Konferensbidrag (Refereegranskat)
  • 39.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Dahlberg, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Technology to support decision-making for older people with dementia2019Konferensbidrag (Refereegranskat)
  • 40. Cedervall, Y
    et al.
    Giedraitis, V
    Berglund, L
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Kilander, L
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Timed Up-and-Go Dual-task Performance - A Marker for Dementia?2019Konferensbidrag (Refereegranskat)
  • 41. Andersson, S
    et al.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Magnusson, L
    Erlingsson, C
    Hanson, E
    Valued and received forms of support among Swedish working carers of older people: A descriptive study with focus on ICT-mediated support.2019Ingår i: Technology and Disability, ISSN 1055-4181, E-ISSN 1878-643X, Vol. 31, nr 4, s. 189-202Artikel i tidskrift (Refereegranskat)
  • 42. Bozkurt Ahman, H
    et al.
    Giedraitis, V
    Cedervall, Y
    Berglund, L
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Correlations Between Dual-Task Performance and Alzheimer’s Disease Cerebrospinal Fluid Biomarkers2018Konferensbidrag (Refereegranskat)
  • 43. Bozkurt Åhman, H
    et al.
    Giedraitis, V
    Cedervall, Y
    Berglund, L
    Kilander, L
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Correlations Between Dual-Task Performance and Alzheimer’s Disease Cerebrospinal Fluid Biomarkers2018Konferensbidrag (Refereegranskat)
  • 44.
    Marmstål Hammar, Lena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Williams, C
    Meranius, Summer
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Extended support to increase quality of life in spouse caregivers of older persons with dementia. A pilot study2018Konferensbidrag (Refereegranskat)
  • 45. Lüdecke, Daniel
    et al.
    Bien, Barbara
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    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 study2018Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 13, nr 4, artikel-id e0195294Artikel i tidskrift (Refereegranskat)
    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.

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  • 46.
    Olsen, Marie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Dahlberg, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Boström, Anne-Marie
    Institutionen för Neurobiologi, Vårdvetenskap och Samhälle, Karolinska Institutet.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Udo, Camilla
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Older people’s views on the important values in home help provision: a Swedish study2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Little is known about the values that older people consider important in receipt of home help. Therefore, this study aimed to explore which values older people hold in relation to home help services and their experiences of how these values are reflected in the delivery of help. Interviews were conducted from November 2015 to March 2016 with 16 older persons (age ≥65 years) who received home help at the time of the study. Data were analysed using qualitative content analysis. Results identified values that older people find important in home help and suggest behaviours that should underpin home help, such as supporting the older person’s independence, building a reciprocal relationship and promoting a sense of safety and security (e.g., by providing information about what home help entails for the recipient). We conclude that it is important that care staff recognise and integrate these values into their actions on an interpersonal level in daily care, adopting a relation-oriented rather than a task-focused approach in the provision of home help for older people.

  • 47. Mocumbi, Sibone
    et al.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Munguambe, Khátia
    Chiau, Rogério
    Högberg, Ulf
    Hanson, Claudia
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Göteborgs universitet.
    Sevene, Esperança
    Bergström, Anna
    Ready to deliver maternal and newborn care? Health providers' perceptions of their work context in rural Mozambique2018Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, nr 1, artikel-id 1532631Artikel i tidskrift (Refereegranskat)
    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.

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  • 48.
    Dahlberg, Lena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Social exclusion and well-being among older adults in rural and urban areas2018Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 79, s. 176-184Artikel i tidskrift (Refereegranskat)
    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.

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  • 49.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Staff perceptions of the design of care environments for older people – a qualitative study2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Staff perceptions of the design of care environments for older people – a qualitative study

    Background: Although research has shown the important role played by the physical care environment for residents and staff of residential care facilities (RCFs) for older people, few studies have taken the care staff perspective regarding how the environment influences their ability to provide high quality care. This paper considers care staff perceptions of older people’s RCFs.

    Methods: Twenty RCFs in Sweden were purposively sampled to obtain facilities with varying building design, type of ownership, year of construction, building size and geographic location. From each RCF, ten staff were randomly selected and recruited by the care home managers. Staff completed the Staff Perception of Older People’s Residential Care Environments (SPORE) questionnaire. Written responses to open-ended questions on the care environment were analysed using qualitative content analysis.

    Results: Several needs and deficiencies in the care environment were identified. The participants described problems with limited spaces and non-functional building design, and restricted access to outside areas. They also expressed the need for physical and cognitive support in the care environment such as handrails, hoists, adequate lighting and colour coding.

    Conclusions: There is potential for improving the design of RCFs for older people to provide safe and supportive care environments for residents and to facilitate care delivery, by taking  the needs of the building users into account in future planning and design processes.

  • 50.
    McKee, Kevin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    The association between social exclusion and well-being in older adults from rural and urban areas2018Konferensbidrag (Refereegranskat)
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