Forskningsartikler

Objectives: This research project investigated how family carers in Norway experienced delivering iCST, their need for supervision and the potential for co-occupation.

Methods: Reflexive thematic analysis was used to understand the experiences of 11 carers using iCST for 8 wk. Three semi-structured interviews were conducted with each participant, including a pre-assessment of caregiver burden and a rating of dementia severity.

Results: Most carers described the manual as self-instructive. Some felt overwhelmed when starting iCST. It was important to plan and individualise the sessions to the specific needs of the person with dementia. After delivering iCST the carers described new insights into the person with dementia’s resources and challenges. Obstacles to doing iCST were related to the context, the manual or to specific challenges linked to the person with dementia or to the carer. Most participants described positive experiences, in which shared interaction, engagement and mastery were common.

Conclusion: When the carer understands the iCST programme as a tool and adapts it to the specific needs of the person with dementia then co-occupation and positive interactions happen. However, some carers would benefit from supervision and the iCST programme did not address all persons with dementia.

Kristine G. Madsø, Rita Weum & Torhild Holthe

Bcakground and purpose
The aims were to compare the novel regional brain volumetric measures derived by the automatic software NeuroQuant (NQ) with clinically used visual rating scales of medial temporal lobe atrophy (MTA), global cortical atrophy-frontal (GCA-f), and posterior atrophy (PA) brain regions, assessing their diagnostic validity, and to explore if combining automatic and visual methods would increase diagnostic prediction accuracy.

Methods
Brain magnetic resonance imaging (MRI) examinations from 86 patients with subjective and mild cognitive impairment (i.e., non-dementia, n = 41) and dementia (n = 45) from the Memory Clinic at Oslo University Hospital were assessed using NQ volumetry and with visual rating scales. Correlations, receiver operating characteristic analyses calculating area under the curves (AUCs) for diagnostic accuracy, and logistic regression analyses were performed.

Results
The correlations between NQ volumetrics and visual ratings of corresponding regions were generally high between NQ hippocampi/temporal volumes and MTA (r = −0.72/−0.65) and between NQ frontal volume and GCA-f (r = −0.62) but lower between NQ parietal/occipital volumes and PA (r = −0.49/−0.37). AUCs of each region, separating non-dementia from dementia, were generally comparable between the two methods, except that NQ hippocampi volume did substantially better than visual MTA (AUC = 0.80 vs. 0.69). Combining both MRI methods increased only the explained variance of the diagnostic prediction substantially regarding the posterior brain region.

Conclusions
The findings of this study encourage the use of regional automatic volumetry in locations lacking neuroradiologists with experience in the rating of atrophy typical of neurodegenerative diseases, and in primary care settings.

Karin Persson, Maria L. Barca, Trine Holt Edwin, Lena Cavallin-Eklund, Gro Gujord Tangen, Hanneke F. M. Rhodius-Meester, Geir Selbæk, Anne-Brita Knapskog og Knut Engedal

Abstract

Objective
Although knowledge about the experience of being diagnosed with dementia is limited, with the expected rise in dementia’s prevalence in the coming decades, such knowledge is pivotal for the people diagnosed, their families, and healthcare planners. Thus, the aim of our study was to explore the experience of living with cognitive impairment and dementia and the impact of being diagnosed with dementia.

Method
A qualitative design was applied. Participants were recruited based on age-adjusted values below ​​threshold values on the Montreal Cognitive Assessment Scale (i.e. 70–79 years, < 22; 80–89 years, < 21; 90 + years, < 20), and the sample ultimately included 15 participants: six with and nine without a documented dementia diagnosis. Qualitative content analysis was performed on the transcribed interviews in four steps to identify codes, categories, and the overall theme.

Results
Three major categories emerged from the interviews: (1) experiences with changes, (2) experiences with being diagnosed with dementia, and (3) existential experience. All participants with and most participants without a dementia diagnosis experienced changes in cognition.

Conclusion
Our findings imply that being diagnosed with dementia is a relief because it explains observed cognitive and functional decreases and reduces confusion, shame and stigma. However, it also raises concerns about an unknown future. Most participants not diagnosed with dementia reported having little or no difficulty with everyday living and leading a fulfilling life. Those findings emphasise the significance of timely versus early diagnosis.

Inger Molvik, Grete Kjelvik, Geir Selbæk & Anne Marie Mork Rokstad

Background
The mouth is a central organ for communication and fluid intake, also for dying nursing home patients. This study describes the prevalence and severity of oral symptoms from nursing home admission until the day of perceived dying and the day of death.

Methods
A prospective, longitudinal cohort study including 696 patients who were admitted to 47 Norwegian nursing homes in 35 municipalities. During the first year of their stay, 189 died (27%), of whom 82 participants were assessed on the day they were perceived as dying and 134 on the day of death. Mouth care, nutrition, and bedsores were assessed with the Residents’ Assessment Instrument for nursing homes (RAI-NH) and palliative care (RAI-PC). Pain intensity was assessed with the Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale (MOBID-2).

Results
The proportion of patients with ≥ 6 oral symptoms increased from 16% when perceived as dying to 20% on the day of death (P = 0.001). On the day of death, xerostomia (66%), dysphagia (59%), and mastication problems (50%) were the most frequently observed oral symptoms. Only 16% received mouth care every hour and 12% were in pain during this procedure. Compared to people without dementia, those with a diagnosis of dementia at admission (N = 112, 86%) had xerostomia and mastication problems more frequently (50% vs. 73%; 32% vs. 56% (P = 0.038), respectively) on the day of death.

Conclusions
The high extent of oral symptoms such as xerostomia, dysphagia, and mastication problems underline the need for systematic assessment and improved oral palliative care for dying nursing home patients with dementia.

Reidun K. N.M. Sandvik, Bettina S. Husebø, Geir Selbæk, Gunhild Strand, Monica Patrascu, Manal Mustafa & Sverre Bergh

Abstract:

The Norwegian health care system is built on individual rights and the principles of universal access, decentralization, and free choice of provider. Norway has universal health coverage, funded primarily by general taxes and by payroll contributions shared by employers and employees. Local authorities at the municipal level organize and finance primary health care services according to local demand and within national frameworks. Habilitation services are offered both in the primary health care and as a part of the specialist health services. They offer both inpatient and outpatient services for people with intellectual/developmental disabilities (IDD). National guidelines, known as Good health and care services for people with IDD, have recently (2021) been launched after various reports over the years of serious breaches and challenges in the health and care services provided to people with IDD.

Stine Skorpen & Erik Søndenaa

Sammendrag
Bakgrunn: Assistert død er ikke tillatt i Norge, men sykepleiere får forespørsler fra terminale pasienter og opplever det som vanskelig. Forskning viser at sykepleiere har begrenset faglig kunnskap om assistert død. Hensikten med studien er å utforske sykepleieres kompetanse og rolle i møte med pasienters forespørsel om assistert død.
Metode: Studien har et kvalitativt design med en fenomenologisk hermeneutisk tilnærming. Individuelle intervjuer av kliniske sykepleiere ble analysert med tematisk analyse.
Funn: Sykepleierne hadde begrenset teoretisk og klinisk kunnskap om temaet assistert død fra grunnutdanningen, men hadde kjennskap til temaet fra media. Sykepleiere med videreutdanning i palliativ smertelindring hadde fått opp-læring om temaet. Sykepleierne opplevde sin egen rolle som uklar i håndteringen av forespørsler om assistert død, og samtalene om døden ble ofte overlatt til andre profesjoner.
Konklusjon: Mangelfull kunnskap om assistert død blant sykepleiere krever trygge og faglige rammer, veiledning og støtte for faglig utvikling fra de mer erfarne sykepleierne og det tverrfaglige teamet. Kunnskapsutvikling om assistertdød trenger å bli belyst både i klinikken, i utdanningen og i forskningssammenheng.

Hege Hol & Anne Marie Mork Rokstad

Abstract:
Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization–Observation–Behavior–Intensity–Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = −0.15, 95% CI [−0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [−0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [−0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.

Myrenget, Martin Elstad, Rustøen, Tone, Myskja, Audun, Småstuen, Milada, Rangul, Vegar, Håpnes, Odd, Borchgrevink, Petter C., Butler, Stephen, Selbæk, Geir, Husebø, Bettina and Sandvik, Reidun

Purpose:
To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway.
Methods:
This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017–2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants’ hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16–25 dB), mild (PTA4, 26–40 dB), moderate (PTA4, 41–55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates.
Results:
The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants’ hearing status with performance on the MoCA test.
Conclusion:
While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.

Shahram Moradi, Bo Engdahl, Aud Johannessen, Geir Selbæk, Lisa Aarhus, Gro Gade Haanes

Aims. This study aimed to explore workload whether Nursing Activities Scores on one shift could predict workload for the next shift.
Method. This was a retrospective observational exploratory study of cross-sectional design carried out in a postoperative and intensive care unit at a local, nonpro3t hospital in Norway. Data were collected from the hospital’s internal database from January 1st to June 30th, 2016.
Results. A total of 2,695 patients and 5,916 Nursing Activities Scores were included. The model could predict a 55.1% to 66.9% variation in Nursing Activities Scores for the next shift. When the number of patients was added, the mode explained up to 80% of the variation.
Conclusions.
The Nursing Activities Score can be used to predict nursing workload from one shift to another and as an instrument for managers to adjust their staffing requirements.
Implications for Nursing Management.
Nursing Activities Score as asessing nursing workload for all patients in a unit can support the resource planning with accuracy for nurse staffing.

Ann-Margret Hasselgård, Siv K. Stafseth and Øyvind Kirkevold