O6.2 Long-term care
Chair: Jørgen Wagle
O6.2.1 Few planned home deaths in Norway. A population-based cross-sectional study
Camilla Kjellstadli1, Bettina Husebo1,2, Hogne Sandvik3, Elisabeth Flo1, Steinar Hunskaar1
1University of Bergen, Norway, 2Bergen Municipality, Norway, 3 Uni Research Health, Norway
Background: There is little research on number of planned home deaths. We need information about factors associated with home deaths, but also differences between planned and unplanned home deaths to improve end-of-life-care at home and make home deaths a feasible alternative. Our aim was to investigate factors associated with home deaths, estimate number of potentially planned home deaths and differences in individual characteristics between people with and without a potentially planned home death.
Method: Cross-sectional study using data from the Norwegian Cause of Death Registry and IPLOS (municipal health and care services), including all deaths in Norway in 2012-2013. We defined planned home death by an indirect algorithm-based method using domiciliary care and diagnosis.
Results: Among 80,908 deaths, 12,156 (15.0%) were home deaths. A home death was most frequent in circulatory diseases and cancer, and associated with male sex, younger age, receiving domiciliary care, not having a nursing home stay and living alone. Only 2.3% of home deaths were from dementia. In total, 41.9% of home deaths and 6.3% of all deaths were potentially planned home deaths. Potentially planned home deaths were associated with higher age, but declined in ages above 80 years for people who had municipal care. Living together with someone was associated with more potentially planned home deaths for people with municipal care. A third of home deaths were from circulatory disease, half unplanned.
Conclusion: There are few home deaths in Norway. Our estimations indicate that even fewer people than anticipated have a potentially planned home death.
O6.2.2 Patient records in long-term care: An invaluable source of information?
Maren Sogstad1, Marianne
Sundlisæter Skinner1, Ragnhild Hellesø2
1 Centre for Care Research, NTNU, Gjøvik, Norway, 2 University of Oslo, Norway
The Norwegian care service landscape is characterized by a high level of specialization. As a result, there is a need for coordination and information flow between different municipal services, to ensure continuity of care. The patient record system may be an important source of information, but there is limited knowledge on its role as an information source when older patients move between services.
An electronic questionnaire containing various items related to coordination was distributed to nurses in the municipal healthcare services. 3021 nurses answered the questionnaire, of which 1022 stated that they were involved when patients were moved between municipal services. We include answers from these 1022 nurses about patient records as an information source in our analysis.
The answers indicate that the patient record system is an important source of information. The quality of patient records varies between settings. Some nurses report that they seldom or never find the information they need, while a few report that they always find necessary information. Information regarding patients’ functions, medical conditions, current treatment and medications are usually present in the patient record. However, information about the patient's action plan, psychosocial needs and information on further follow-up are only occasionally present.
There is still need for improvement to ensure all necessary information to be available when older patients move from one service to another.
O6.2.3 Mobility and associations with dementia diagnosis in nursing home residents
Karen Sverdrup1, Sverre Bergh2, Geir Selbæk1, Pernille Thingstad3, Gro Gujord Tangen1,
1 Norwegian National Advisory Unit on Ageing and Health, Oslo University Hospital, Norway, 2 Centre for Old Age Psychiatric Research, Norway, 3 NTNU, Norway
Mobility impairments are common in nursing home (NH) residents and in people with dementia, but patterns of impairment may vary across different dementia diagnosis. The aim of this study was to explore how mobility differs between residents with different dementia diagnosis at admission to the NH.
Residents with an expected stay of more than four weeks were recruited at admission to the NH. The Short Physical Performance Battery and the Nursing Home Life Space Diameter was used as outcome measurements of mobility. Dementia diagnosis was set by two experienced old age psychiatrists. Differences in mobility between the different dementia diagnosis were analysed using both bivariate analyses and multiple regression analyses where we controlled for age, sex and degree of dementia.
Of the 696 participants, 540 (76%) had a specific dementia diagnosis; Alzheimer’s dementia (n 414), Vascular dementia (n 57), Frontotemporal dementia (n 47) and Lewy Body- or Parkinson dementia (LBD) (n22). Mean age was 84 years (SD 7.6), and there were more men in the group of residents with LBD. We found no significant difference in mobility between groups of different dementia diagnosis in neither bivariate analyses, nor in analyses controlled for age, sex and degree of dementia.
We did not observe any differences in mobility between participants with different subtypes of dementia at admission to NH. This underline the importance of individually tailored activities to preserve mobility.
O6.2.4 Inequalities in home care in Denmark: mapping the landscape of care
University of Copenhagen, Denmark
Analysis of statistics concerning home help in Denmark indicate that the percentage of older people receiving home help fallen in the past 5 years. This is also the case for people 80 years of age and over, but the number of care home places has not increased. While one study has indicated that people with a spouse are having a more difficult time being allotted help, there may be other effects of this reduction. This paper –and the project it is developing – wishes to take a closer look at some of the socio-economic consequences of these cutbacks, in particular the inequality dimension of them. It first looks more closely at the disposable incomes in Danish municipalities for people 75 and over and then orders these by income. Then the project analyses developments in allocation of home care in these municipalities. Besides finding a good twofold difference in average disposable incomes between Danish municipalities for these seniors, home care allocation findings indicate some other important factors. One is that the general percentage of home care recipients in municipalities (rich and poor) is relatively similar. However there is an important difference. In the poorer municipalities, it is more difficult to receive home care for practical help only; one seems to need personal care in order to receive help with practical tasks. The paper will present these figures and a project to analyze how these practical help needs are being met in both rich and poor municipalities.
O6.2.5 Bridging between social and medical perspectives: Old people’s experience of a new healthcare model
Elisabet Cedersund, Annettte
Sverker, Anna Olaison
Linköping University, Sweden
An explicit goal in current eldercare policy in Sweden is to support older people, even those with poor functional ability, to live in their own homes as long as possible. This places demands on coordination of municipal eldercare, primary care, and home care. To contribute to such coordination, new models for healthcare are being developed. This paper presents results from a project, within which a new healthcare model is being implemented. The model aims to identify older people (75+) with great care needs living at home, so that they can receive individual, tailored care early on.
Empirical material in this sub-study was collected through interviews with 20 older people. The interviews were based on a semi-structured interview guide that gave the interviewer an opportunity to ask follow-up questions. In processing the interview material, the focus was on a collaborative perspective, and whether the older people saw a need for better coordination between stakeholders.
The findings obtained on older people’s experience of the new healthcare model were on two levels. The first level concerned the importance the older people believed the new healthcare model has for them, and whether they had an opportunity to influence the care provided. The second level concerned knowledge related to coordination between stakeholders in the care organisation.
The data obtained provide information useful for understanding the context and life situation of older people with poor functional ability, living at home, and their views on coordination between social and medical care provision.
O6.2.6 Health care quality indicators for Norwegian municipalities
Julie Kjelvik, Hanne
Norwegian Directorate of Health, Oslo, Norway
By law the Norwegian Directorate of Health is responsible for development and communication of national health care quality indicators (NHQI) (Health and Care Services Act § 12-5). The purpose is to measure the healthcare systems performance and make results available to the public, politicians, healthcare professionals and leaders. NHQIs are published on www.helsenorge.no.
The OECD conceptual framework-model for presentation of the healthcare systems performance is adopted. In short the model consists of six dimensions of quality, by which the healthcare services are measured. NHQI is developed by expert-groups.
25 of the 172 indicators covers municipal primary health care services whereof 9 are nursing home indicators. Primary care indicators measure medication reviews, nutrition status, day activities for persons with dementia, waiting times, infections in nursing homes and sickness leave for health care personnel. Results show that nutritional status is assessed for only half of the nursing home residents. 36 percent of those assessed are in risk of malnutrition and 71 percent have a nutrition plan. Nutrition risk assessment varies between municipalities. Data are missing for 25 percent of the nursing home residents.
Important quality dimensions are measured by the Norwegian NHQI system. However, there is still a way to go in measuring quality in the municipal primary health care services by using national indicators. In December 2017 a new national register for the municipal health care services is established. This register will hopefully serve as a future data source for new indicators.
O6.2.7 Enhancing dignity in older persons in Sweden- adaptation of the Dignity Care
Annika Söderman1, Ulrika
Östlund2, Carina Werkander Harstäde3, Karin Blomberg1
1 Örebro University, Sweden, 2 Linnaeus University/Uppsala University/Region Gävleborg, Sweden,
3 Linnaeus University, Sweden
In end of life, the older persons´ experiences of dignity can be affected due to serious illness and life changes, derived from physical, psychological, social and existential dimension. Loss of dignity impact the persons´ will to live. The Dignity Care Intervention (DCI) was developed and tested in Scotland and Ireland, to enhance dignity of older persons with palliative care needs, by nurses in municipality care. DCI consists a patient dignity inventory, reflective questions and examples of evidence-based care actions.
The aim was to develop and adapt the DCI to a Swedish context.
The process of developing and adapting the DCI consisted of 1) translating and adapting the patient dignity inventory including expert panel and cognitive interviews, 2) a literature review and interviews with older persons, relatives and health care professionals gathering culturally relevant dignity conserving care actions.
The patient dignity inventory was overall accepted by older persons in home care, however some changes in the wording were performed. The Swedish care actions reflected mostly earlier care actions described in the original version. However some more care actions derived in some of the categories in the Swedish DCI (DCI-SWE) e.g. “social support”, and some less care actions derived for example in the category “aftermath concerns”. In DCI-SWE general care actions like e.g. to show respect were concretized unlike the original DCI.
The DCI-SWE has prospects to enhance older persons´ dignity, and is now tested in a feasibility study by twelve nurses in home care.