Forskningsartikler

Samandrag
Hensikt: Å undersøkje fysioterapeutar sine erfaringar med å rekruttere, lære opp og rettleie frivillige instruktørar som skal ha ansvar for å leie Sterk og stødig-treningsgrupper som ein del av kommunen sitt fallførebyggande tilbod til heimebuande eldre.

Metode: Fire individuelle djupneintervju med fysioterapeutar tilsett i ulike kommunar vart analysert med systematisk tekstkondensering.

Funn: Fem tema vart funne: (1) Ei naturleg rolle som skapar variasjon i arbeidskvardagen, (2) Rekruttering – ei ny rolle, (3) Frivillige som brubyggjarar for kunnskapsformidling, (4) Kontinuerleg rettleiing for å sikre riktig dosering og (5) Sterk og stødig for målgruppa?

Studien syner at opplærings- og rettleiingsrolla i Sterk og stødig vart opplevd som naturleg, og prega av tryggheit, kompetanse og ei positiv haldning til å arbeide førebyggande med målgruppa. Frivillige instruktørar fungerte som kunnskapsformidlarar om trening og fallførebygging til gruppedeltakarane. Å rekruttere eigna frivillige instruktørar var essensielt for både treningseffekt og drift av tilbodet, men var også ressurskrevjande for fysioterapeutane. Synet på å inkludere deltakarar utanfor målgruppa varierte.

Konklusjon: Fysioterapeutane opplever at arbeidsoppgåver knytt til Sterk og stødig integrerast naturleg inn i eiga rolle. Trass krevjande rekrutteringsarbeid, vert samarbeidet med frivillige gruppeinstruktørar ein viktig ressurs i det fallførebyggande arbeidet. Å finne gode løysingar knytte til rekrutteringsarbeid er sentralt.

Ane Brekke, Bård Erik Bogen, Ingebjørg Kyrdalen & Lill Anette Juvik

Abstract

Aim
This study explores nurses’ experience and reflections on the use of advance care planning (ACP) for older adult patients in home care services.
Method
The study employs an explorative qualitative design. Five focus groups with 21 nurses in home care services were conducted and analyzed using content analysis.
Results
Three main categories were identified; 1) limited experience with the use of ACP, 2) reflections on systematic use of ACP and 3) prerequisites for successful ACP conversations. The participants revealed limited experience with ACP but recognized that such conversations could provide important clarifications for patient and family caregiver support. The use of ACP needs to be individually tailored, involving family caregivers, and being conducted in collaboration with a physician. The need for open conversations initiated by the patient or family caregivers should be addressed. For successful implementation, competence building, a planned process, and support from management are essential.
Conclusion
ACP could be beneficial in the follow-up of older, chronically ill patients living at home, but should not substitute the need for individualized spontaneous conversations.

Beth Helen Tomren Løken & Anne Marie Mork Rokstad

Abstract:

Objective: What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers?

Design: A three-round modified e-Delphi study.

Participants: Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field.

Methods: A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus.

Results: Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 51 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n = 36; 2) Assessment, n = 39; 3) Management, interventions and prevention n = 40; 4) Communication, therapeutic relationship and person-centred care, n = 17; and 5) Physiotherapists self-management and improvement, n = 5.

Conclusions: This e-Delphi study outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians.

Morag E Taylor, Karen Sverdrup, Julie Ries, Erik Rosendahl, Gro Gujord Tangen, Elisabeth Telenius, Katherine Lawler, Keith Hill, Annika Toots, Hans Hobbelen, Vanina Dal Bello-Haas, Abi Hall, Susan W Hunter, Victoria A Goodwin, Julie Whitney, Michele L Callisaya

Abstract:

Objectives: To evaluate the relationships of cognitive function and care dependency with oral health in a Norwegian older adult population.

Methods: This cross-sectional study included 2623 participants aged 70 and older from the fourth wave of the Trøndelag health study (HUNT4 70+) and the city of Trondheim (Trondheim 70+). Neurocognitive disorders (NCDs) were diagnosed by clinical experts according to the DSM-5 framework. Care dependency referred to nursing home residency. Oral health was assessed by using the Revised Oral Assessment Guide-Jönköping (ROAG-J). Individuals were considered as ‘having oral problem’ if the score was two or three in at least one of the nine ROAG-J items. Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results: The prevalence of having oral problems was 19% higher in participants with NCDs than those with normal cognitive function after adjusting for potential confounders (PR 1.19, 95% CI: 1.09-1.29). Further analysis showed a higher prevalence of having oral problems for home dwellers with NCDs (PR 1.23, 95% CI: 1.13-1.33) and nursing home residents (PR 1.32, 95% CI: 1.20-1.45) compared to home dwellers with normal cognitive function.

Conclusions: NCDs were associated with an increased prevalence of oral problems in this Norwegian older adult population. The study suggests the need for increasing oral care for home dwellers with NCDs and nursing home residents.

Ernest Obeng Asante, Rannveig Sakshaug Eldholm, Marit Kolberg, Håvard Kjesbu Skjellegrind, Geir Selbæk, Xiao-Mei Mai, Yue Chen, Yi-Qian Sun

Abstract

Background: Frail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services.

Methods: A qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data.

Results: Our findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication-a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant’s experience of insufficient communication and the lack of a holistic approach from the service, but also in the user’s sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis.

Conclusions: Our findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach.

Janne Myhre, Sverre Bergh, Øyvind Kirkevold and Bjørn Lichtwarck

Purpose
Information about outcomes of particular relevance to older prostate cancer survivors is limited. This study aimed to compare health, activities of daily living (ADL), and use of health care services between survivors and matched controls.

Methods
A single-centre study on men treated for prostate cancer with curative intent at the age ≥ 70 years 2 to 7 years earlier. Controls matched on age and education were drawn (1:3) from the Trøndelag Health Study (HUNT) in Norway. Self-reported general health, independence in ADL and instrumental activities of daily living (IADL), hospital admissions and emergency room visits were compared by estimating non-adjusted and adjusted (age, education, comorbidity, cohabitant status and pack years of smoking) regression models.

Results
The majority of both survivors (N = 233) and controls (N = 699) reported good (58.7% vs. 62.7%) or very good (11.2% vs. 6.8%) health and independence in ADL (95.6% vs. 96.3%) and IADL (82.7% vs. 81.9%). Hospital admission was reported by 17.3% vs. 18.2% and emergency room visit by 23.6% vs. 26.7%. Regression models showed no significant differences between survivors and controls.

Conclusions
Older prostate cancer survivors reported similar health, independence in ADL and use of emergency room and hospital admissions as matched controls.

Implications for Cancer Survivors.

This study shows that survivors after curatively intended treatment of prostate cancer have as good health as matched controls, indicating that many patients tolerate such treatment well despite being of old age and that current practice for selection of patients offered such treatment is appropriate.

Sletten, Reidun & Jordhoy, Marit & Oldervoll, Line & Skjellegrind, Håvard & Saltyte Benth, Jurate & Åstrøm, Lennart & Kirkevold, Øyvind & Bergh, Sverre & Grønberg, Bjørn & Rostoft, Siri & Bye, Asta & Mork, Paul & Christiansen, Ola

Abstract

Background
Cardiorespiratory fitness (CRF) refers to the capacity of the cardiovascular and respiratory system to process oxygen. CRF is associated with depressive symptoms and findings suggest that CRF decreased significantly in older adults during the COVID-19 pandemic. However, purchase of prescribed antidepressants before and after the pandemic lockdown by CRF level in older adults has not yet been described.

Methods
This longitudinal study included 1221 community-dwelling older adults ≥70 years old participating in the Norwegian HUNT4 Trondheim 70+ study (2018–2019). Data on estimated CRF (eCRF) were linked to the Norwegian Prescribed Drug Registry and utilized defined daily doses (DDDs) of antidepressants from January 2019 throughout December 2021. Paired t-tests were performed to assess changes in DDDs before and after the Norwegian COVID-19 lockdown in March 2020.

Results
Participants had a mean (M) and standard deviation (SD) age of 76.5 (5.2) years, 53.6% were women. In the total sample, the results showed a significant rise in purchase of antidepressants from before (M = 1.25, SD = 7.17) compared to after the lockdown (M = 1.52, SD = 7.86); t (1220) = −2.47, p = 0.014). The number of participants purchasing antidepressants also increased in the total sample and within each of the eCRF groups. In the different eCRF groups, only individuals in the highest eCRF tertile showed a significant higher purchase of antidepressants after the lockdown (M = 1.44, SD = 6.65); t (413) = −2.63, p = 0.009) compared to the year before (M = 0.99, SD = 5.21).

Conclusions
Compared to before the COVID-19 pandemic lockdown, the utilization of antidepressants increased in community-dwelling older adults, with the steepest increase observed among those with the highest eCRF levels.

Maren Lerfald, Linn Marita Hagen, Ekaterina Zotcheva, Federico Palumbo, Audun Havnen, Linda Ernstsen

Abstract

Background: Frailty in older people is a rising global health concern; therefore, monitoring prevalence estimates and presenting projections of future frailty are important for healthcare planning.

Aim: To present current prevalence estimates of frailty and pre-frailty and future projections according to both dominant frailty models in a large population-based observational study including adults ≥ 70 years in Norway.

Methods: In this population-based observational study, we included 9956 participants from the HUNT4 70 + study, conducting assessments at field stations, homes, and nursing homes. Frailty was assessed using Fried criteria and a 35-item frailty index (HUNT4-FI). Inverse probability weighting and calibration using post-stratification weights and aggregated register data for Norway according to age, sex, and education ensured representativeness, and population projection models were used to estimate future prevalence.

Results: According to Fried criteria, the current prevalence rates of frailty and pre-frailty in people ≥ 70 years were 10.6% and 41.9%, respectively, and for HUNT4-FI 35.8% and 33.2%, respectively. Compared to previous European estimates we identified higher overall frailty prevalence, but lower prevalence in younger age groups. Projections suggest the number of Norwegian older adults living with frailty will close to double by 2040.

Conclusion: Frailty in older people in Norway is more prevalent than previous European estimates, emphasising the imperative for effective interventions aimed to delay and postpone frailty and ensure healthcare system sustainability in an ageing population. Future planning should consider the great heterogeneity in health and functioning within the 70 + population.

Ingebjørg Lavrantsdatter Kyrdalen, Bjørn Heine Strand, Geir Selbæk, Pernille Thingstad, Heidi Ormstad, Emiel O Hoogendijk, Håvard Kjesbu Skjellegrind, Gro Gujord Tangen

Purpose
This study aims to characterize the experiences of health professionals participating in an exploratory randomized controlled trial designed to improve hearing and vision among older adults without dementia receiving the in-home health services provided by Norwegian municipalities.

Design/methodology/approach
Semistructured individual and paired interviews were conducted by nine health professionals from five municipalities to explore health professionals’ experiences with the intervention. The data were analyzed using content analysis.

Findings
Three main categories of experiences were identified: (1) participating in the intervention, (2) emerging new knowledge and (3) developing in-home health services. The mutual collaboration between health professionals and service recipients during the screening process led to a more-thorough understanding of the service recipients’ needs and resources, enabling personalized advice and guidance.

Research limitations/implications
In-home interventions have the potential to improve the quality of life of older adults with hearing and vision impairments. Given the promising outcomes of such interventions, future research should (1) investigate their effects on changes in behaviors and attitudes, (2) integrate technological advancements and (3) explore environmental modifications to further enhance the quality of life of older adults in various settings.

Practical implications
The health professionals in this study enjoyed assisting the service recipients in receiving in-home health services by screening their hearing, vision and indoor lighting conditions. The trial enabled the health professionals to provide personalized advice, and to motivate and guide the service recipients toward actions to remedy their impairments.

Social implications
The health professionals recommended hearing, vision and indoor lighting screening to be a routine municipal service because it would safeguard independence, prevent falling and maintain the quality of life of service recipients. However, additional resources are needed to implement these recommendations.

Originality/value
In-home interventions have the potential to improve the quality of life of older adults with hearing and vision impairments.

Gro Gade Haanes, Anne-Sofie Helvik, Aud Johannessen