Forskningsartikler

Purpose: Farm-based daycare (FDC) is a type of daycare service for people with dementia. The aim of the present study was to explore the next of kin’s experiences with FDC and how the service may affect their daily life.

Methods: The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis.

Results: We identified three main categories: (1) I am fine when you are fine, (2) Significant aspects of the service at the farm, and (3) FDC as a part of the dementia trajectory. The findings were summarized in one overarching, latent theme: “Being sheltered from a demanding everyday life”.

Conclusions: The findings indicate that next of kin’s experience of respite is closely connected to the well-being of their relatives at the FDC and the quality of the service. FDC provides significant support through a part of the trajectory of dementia. Despite experiencing respite and support, next of kin continue to struggle with ethical and moral decisions about the futures of their relatives with dementia.

Liv Bjerknes Taranrød, Ingeborg Pedersen, Øyvind Kirkevold, Siren Eriksen

Objectives: We aimed to describe pain, use of analgesics and quality of life (QoL) in people with dementia admitted to a Norwegian nursing home (NH), and to explore if and how pain was associated with their QoL when adjusting for sociodemographic characteristics, other health conditions and use of analgesics.

Method: A total of 953 Norwegian NH residents with dementia (mean age 84.0, SD 7.5 years, 35.8% men) were included at admission to the NH. Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the use of psychotropic drugs and analgesics were assessed.

Results: In total, 36% of the participants had clinically relevant pain intensity (MOBID-2 ≥ 3) and 52% received analgesics. Paracetamol was most frequently prescribed (45%). In an adjusted linear mixed model, more severe pain was associated with higher QUALID total scores, indicating poorer QoL (regression coefficient 0.52, 95% CI 0.36-0.69).

Conclusion: Pain prevalence at NH admission was high in residents with dementia; half used analgesics, particularly paracetamol. More severe pain was associated with poorer QoL when adjusting for sociodemographic characteristics, other health conditions, and use of analgesics. The routine assessment of pain at NH admission can uncover undiagnosed and untreated pain and allow for adequate non-pharmacological and pharmacological pain management and likely increased QoL.

Anne-Sofie Helvik, Sverre Bergh, Jūratė Šaltytė Benth, Geir Selbæk, Bettina S Husebø, Kjerstin Tevik

Background: Alcohol consumption among older people is expected to increase in the years ahead. Health professionals’ experiences of, and reflections on, alcohol consumption and its relation to well-being are thus important to the provision of adequate and high-quality treatment and care.

Aim: To investigate health professionals’ experiences and reflections about alcohol consumption among older people and how it is related to their health and well-being.

Methods: A case study design approach was adopted, incorporating three qualitative studies involving Norwegian health professionals. The health professionals interviewed included workers in nursing homes, home care professionals and general practitioners.

Results: The study revealed a diversity of views and reflections on alcohol consumption, its facilitation, and the impact on the health and well-being of older patients and care recipients. Six themes were revealed by the three studies: (i) the facilitation of alcohol consumption to promote and normalize life in nursing homes, (ii) the restriction of unhealthy alcohol consumption, (iii) attempts to discuss alcohol consumption with care recipients, (iv) the initiation of collaboration with informal caregivers in restricting alcohol consumption, (v) minimalizing the dialogue regarding alcohol consumption to guard patient privacy and (vi) a desire for joint action and a national political strategy.

Conclusion: Health professionals working in NHs, in-home and GPs find it difficult to discuss the use and elevated use of alcohol with older people for whom they have care and treatment responsibilities. In general, they are concerned that such conversations infringe on the principles governing an individual’s autonomy. However, because they are aware that elevated alcohol intake may have a negative impact on health and well-being, they also express a need for guidelines how they in a better and open minded way can discuss the use and elevated use of alcohol with the patients they care for.

Aud Johannessen, Kjerstin Tevik, Knut Engedal, Gro Gade Haanes, Anne-Sofie Helvik

Background: Interventions to reduce and prevent overweight, obesity and T2D has been advocated worldwide. In Norway, Healthy Life Centres have been established to help individuals to reduce and prevent diseases, offering physical activity and dietary advice to establish healthy habits. Previous life experiences, social support and help from health personnel could play a role in the process of establishing healthy habits. The aim of this study was to explore how two groups of Healthy Life Centre participants described their previous life experiences, social relations and wish for support from Healthy Life Centre personnel.

Methods: A qualitative design was used, including 49 individual semi-structured interviews. The interviews for this study were performed in two different samples, one sample of participants applying for HLC participation in 2013 (n = 23) and one sample of participants invited to HLC participation in 2015 (n = 26). The data was analyzed using systematic text condensation.

Results: Three main themes in a chronological (past, present and future) order were identified: 1. Previous life experiences stamping life situation (past time). 2. Social relations being a support or a burden in everyday life (present time) and 3. Expressing wishes for HLC support (future).

Conclusions: In the process of establishing healthy habits, the need for help from personnel may be differentiated based on previous life experiences and present social relations.

Thea Ingebjørg Gjertsen, Anne-S Helvik, Ingrid S Følling

Background: how long older individuals prefer to live given hypothetical adverse changes in health and living conditions has been insufficiently studied.
Objectives: the objective of this study is to investigate the relationship between six adverse health and living conditions and preferred life expectancy (PLE) after the age of 60 years.
Design: cross-sectional face-to-face interviews.
Setting: population-based sample.
Participants: 825 community dwellers aged 60 years and older in Norway.
Methods: logistic regression models were used to analyse PLE, measured with a single question: ‘If you could choose freely, until what age would you wish to live?’ The impact on PLE of several hypothetical scenarios, such as being diagnosed with dementia, spousal death, becoming a burden, poverty, loneliness and chronic pain was analysed by age, sex, education, marital status, cognitive function, self-reported loneliness and chronic pain.
Results: average PLE was 91.4 years (95% CI 90.9, 92.0), and there was no difference between men and women, but those at older ages had higher PLE than those at younger ages. The scenarios that had the strongest negative effects on PLE were dementia, followed by chronic pain, being a burden to society, loneliness, poverty and losing one’s spouse. PLE among singles was not affected by the prospect of feeling lonely. The higher educated had lower PLE for dementia and chronic pain.
Conclusion: among Norwegians 60+, the desire to live into advanced ages is significantly reduced by hypothetical adverse life scenarios, with the strongest effect caused by dementia and chronic pain.

Vegard Skirbekk, Ellen Melby Langballe, Bjørn Heine Strand

Aims
To describe the prevalence and persistence of analgesic drug use (opioids and antipyretics [ie, paracetamol and acetylsalicylic acid]) in participants (≥70 years) with and without dementia receiving domiciliary care in the eastern part of Norway. In addition, to explore factors associated with persistent drug use and examine whether drug use has changed after admission to a nursing home.
Methods
A longitudinal study with 1001 participants (mean [SD] age 83.4 [5.7] years) receiving domiciliary care. Medical information including analgesic drug use was collected at baseline (A1) between August 2008 and December 2010, follow-up assessments after 18 (A2) and 36 months (A3). Analgesic drugs prescribed for regular use were recorded from the participants’ medical records. The participants’ cognitive and physical health was evaluated at all assessments. Level of care (domiciliary care or nursing home care) was recorded at A2 and A3. Generalized linear mixed models were used to examine the prevalence and persistence of analgesic drug use.
Results
The prevalence of prescribed use of antipyretics and opioids was 13.6% and 9.2%, respectively. Participants with dementia had more frequent use of antipyretics in all assessments and opioids in the last assessment than participants without dementia. Persistent use of both antipyretics and opioids was high between two consecutive assessments, both for participants with and without dementia. Persistent use of analgesics was associated with poorer physical functioning, but not by level of care. Overall, there was no difference between those admitted to a nursing home and those receiving domiciliary care at follow-up, with respect to change in analgesic drug use over time.
Conclusion
The prevalence and persistent use of analgesics were high in older adults receiving domiciliary care at baseline and especially in participants with dementia. A holistic approach and interdisciplinary collaboration are essential to effectively assess and treat pain in older adults.

Kjerstin Tevik, Jūratė Šaltytė Benth, Marte Aarøen, Marie Turmo Lornstad, Sverre Bergh, Anne-S. Helvik

Background
Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time.
Methods
In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time.
Results
We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period.
Conclusion
From NH admission most NH residents’ LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.

Karen Sverdrup, Sverre Bergh, Geir Selbæk, Jūratė Šaltytė Benth, Bettina Husebø, Irene Mari Røen, Pernille Thingstad, Gro Gujord Tangen

Introduction: Dementia diseases are still incurable, and in order to assist in living well with the disease, researchers are increasing their attention to the value of control beliefs. Control beliefs are associated with coping and psychological well-being; however, knowledge on how they relate to well-being outcomes in people with dementia is limited. This review aimed to synthesize knowledge about control beliefs in this group to guide future interventions and research.
Method: A systematic search of 6 databases (MEDLINE, CINAHL, PsychINFO, AgeLine, Embase, and the Cochrane Library) with broad search terms related to dementia, control, and coping was conducted. Studies that investigated people with a confirmed dementia diagnosis and that used a questionnaire to measure control beliefs quantitatively were included.
Results: Eighteen studies were identified, examining self-efficacy, personal control/mastery, or locus of control. The studies varied in aim and design, with fair to good methodological quality. However, 10 studies included <50 participants with dementia, leaving findings unreliable due to low power. Participants with dementia in the mild to moderate stages were included, with average age in the seventies. Except for one validation study, the control belief questionnaires had not been validated for people with dementia. Conclusion: There is a lack of knowledge about control beliefs among people with dementia, due to few and low-powered studies. Although we cannot conclude regarding control beliefs, our findings support the feasibility of quantitative research on control beliefs among people with dementia and we recommend that they be included in this type of research.

Ingeborg Halse, Guro Hanevold Bjørkløf, Knut Engedal, Geir Selbæk, Maria Lage Barca

Abstract:
Introduction: There is a dearth of evidence about the effects of Sonas, a multisensory stimulation on people with dementia (PWD). The main aim of this study was to examine the effects of the Sonas program on anxiety and depression in nursing home (NH) residents with dementia.

Methods: In all, 120 PWD ≥65 years of age from 6 NHs were included in a randomized control trial and were allocated to 1 of 3 groups for 24 weeks: a Sonas program group (n = 48), a reading group (n = 32), and a control group (n = 40). One hundred and five participants completed follow-up assessments. Anxiety and depression were assessed by the Rating Anxiety in Dementia (RAID) scale and the Cornell Scale for Depression in Dementia (CSDD), respectively. Generalized linear mixed models were estimated to assess trends in the proportion of participants with anxiety (a RAID score ≥11) and depression (a CSDD score ≥10).

Results: No significant reduction in anxiety from baseline to follow-up was observed in any of the groups. Participants in the Sonas group showed a significant reduction in depression from baseline to 12 weeks (p = 0.001) and from baseline to 24 weeks (p = 0.009).

Conclusion: The Sonas program had no effect on severity of anxiety but a reduction in depressive symptoms was found in PWD.

Alka R Goyal, Knut Engedal, Jūratė Šaltytė Benth, Benedicte Sørensen Strøm