Forskningsartikler

People with dementia have different needs, and it is important to have variation in the services that

are offered for this population. Farm-based day care aims to meet this diversity in need, but research

on such services is lacking. The present study provides knowledge about how people with dementia

experience attending farm-based day care services in Norway. Ten semi-structured interviews were

conducted for five different services, while the participants were at the farm. The interviews were

analysed in accordance with the content analysis of Graneheim, U., & Lundman, B. (2004) [Nurse

Education Today, 24(2), 105-112] and revealed three main categories that included (1) social relations,

(2) being occupied at the farm, and (3) individually tailored service. The findings were summarised in

the overall theme that attending day care at a farm makes me feel like a real participant. Our findings

indicate that the farm-based day cares in the present study provide person-centred care. The farm

setting facilitates services that are tailored to the individual, where the participants get to use their

remaining resources and spend time outdoors. Further, farm-based day care was described as being

suitable for people with or without farm experience and must be seen as an important supplement to

regular day care for those who could benefit from a more active service.

Tanja Ibsen, Siren Eriksen

Objectives: This exploratory study aimed at investigating profiles of care needs in people with mild to moderate dementia and examined variables associated with these profiles.

Design: A longitudinal international cohort study.

Setting and participants: The baseline data of 447 community-dwelling dyads of people with dementia and their caregivers from the Access to Timely Formal Care (Actifcare) Study were included for analysis.

Methods: A latent class analysis was applied to identify profiles of needs, measured with the Camberwell Assessment of Need for the Elderly as rated by the caregiver. We examined sociodemographic (eg, relative stress scale) and clinical characteristics (eg, neuropsychiatric inventory) associated with these profiles.

Results: Four distinct need profiles were identified through latent class analysis. These comprised a “no need” profile (41% of the sample), a “met psychological needs” profile (25%), a “met social needs” profile (19%), and an “unmet social needs” profile (15%). A larger impact of caregiving on the caregiver’s life as indicated by a higher relative stress scale score was associated with the “unmet social needs” profile.

Conclusions and implications: In this large European sample, there was a subgroup of persons with dementia with high “unmet social needs” whose caregivers simultaneously perceived high stress in their caregiving tasks. Identification of these profiles may help provision of appropriate support for these people.

Niels Janssen , Ron L Handels , Sebastian Köhler , Manuel Gonçalves-Pereira , Maria J Marques , Kate Irving , Louise Hopper , Anja Bieber , Martin Orrell , Geir Selbæk, Mona Michelet , Anders Wimo , Orazio Zanetti , Daniel M Portolani , Bob Woods , Hannah Jelley , Silvia M A A Evers , Frans R J Verhey , Actifcare Consortium.

Introduction: The aim of this study was to examine if quantitative electroencephalography (qEEG) using the statistical pattern recognition (SPR) method could predict conversion to dementia in patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI).Methods: From 5 Nordic memory clinics, we included 47 SCD patients, 99 MCI patients, and 67 healthy controls. EEGs analyzed with the SPR method together with clinical data recorded at baseline were evaluated. The patients were followed up for a mean of 62.5 (SD 17.6) months and reexamined.Results: Of 200 participants with valid clinical information, 70 had converted to dementia, and 52 had developed Alzheimer’s disease. Receiver-operating characteristic analysis of the EEG results as defined by a dementia index (DI) ranging from 0 to 100 revealed that the area under the curve was 0.78 (95% CI 0.70-0.85), corresponding to a sensitivity of 71%, specificity of 69%, and accuracy of 69%. A logistic regression analysis showed that by adding results of a cognitive test at baseline to the EEG DI, accuracy could improve. Conclusion: We conclude that applying qEEG using the automated SPR method can be helpful in identifying patients with SCD and MCI that have a high risk of converting to dementia over a 5-year period. As the discriminant power of the method is of moderate degree, it should be used in addition to routine diagnostic methods.

Knut Engedal, Maria Lage Barca, Peter Høgh, Birgitte Bo Andersen, Nanna Winther Dombernowsky, Mala Naik, Thorkell Eli Gudmundsson, Anne-Rita Øksengaard, Lars-Olof Wahlund, Jon Snaedal.

Dignified care is a central issue in the nursing care of older adults. Nurses are expected to treat older adultswith dignity, and older adults wish to be treated in a dignified manner. Researchers have recommendedinvestigating the concept of dignity based on specific contexts and population groups. This meta-synthesisstudy aims to explore the understandings of dignity from the perspective of older adults in the Nordiccountries. Synthesising findings from qualitative studies on older adults’ experiences of dignity has providedimportant insight into what can be essential for dignified care in a Nordic context. The importance ofvisibility and recognition for the experience of dignity is an overarching theme in all the studies. Theparticipants’ descriptions mostly implicated an existence dominated by a lack of recognition. The olderadults do not feel valued as people or for their contribution to society and strive to tone down theirillnesses in an attempt to become more visible and acknowledged as people. Toning down their illnesses andmasking their needs can protect their independence. At the same time, becoming less visible can leave themwithout a voice. The metaphorical phrase protected and exposed by a cloak of invisibility is used to express theauthors’ overall interpretation of the findings. Lack of recognition and being socially invisible is a genuinethreat to older adults’ dignity.

Anne Clancy, Nina Simonsen, Johanne Lind, Anne Liveng, Aud Johannessen

To compare the quality of life, burden, and depressive symptoms of caregivers of individuals with young-onset dementia (YOD) and late-onset dementia (LOD).Using a cross-sectional design, a convenience sample of 110 dyads of individuals with dementia and their caregivers, all living in the community, was included. The care recipients completed assessments about cognition, quality of life, and awareness of disease. Caregivers’ quality of life, resilience, depressive and anxiety symptoms, hopelessness, and burden of care were assessed.A significant difference was found in caregivers’ burden and depressive symptoms according to the age of onset. However, there was no difference in caregivers’ quality of life between YOD and LOD groups. In both groups, a linear regression analysis indicated that caregivers’ perspective of quality of life of care recipient and caregivers’ hopelessness were associated with their quality of life. In addition, in the LOD group, caregivers’ burden was associated with their perspective of the quality of life of care recipient, type of kinship, and presence of emotional problems. In the YOD group, caregivers’ burden was associated with duration of caregiving role, cohabitating with care recipient, and their anxiety symptoms. Caregivers’ depressive symptoms were associated with anxiety symptoms in the YOD group, whereas hopelessness was associated with caregivers’ depressive symptoms in both the groups.Our findings suggest that the factors that affect quality of life, burden, and depressive symptoms of caregivers of individuals with LOD differ from those that affect the caregivers of individuals with YOD.

Nathália R S Kimura, José Pedro Simões, Raquel Luiza Santos, Maria Alice Tourinho Baptista, Maria da Glória Portugal, Aud Johannessen, Maria Lage Barca , Knut Engedal , Jerson Laks , Valeska Marinho Rodrigues , Marcia C N Dourado

Purpose: Assistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D.

Participants and Methods: Twenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke.

Results: Two main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities.Conclusion: This study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D.

Torhild Holthe, Liv Halvorsrud, Erik Thorstensen, Dag Karterud, Debbie Laliberte Rudman, Anne Lund

BackgroundThe common recommendation that adults with onset of mental illness after the age of 65 should receive specialised psychogeriatric treatment is based on limited evidence.

AimsTo compare factors related to psychiatric acute admission in older adults who have no previous psychiatric history (NPH) with that of those who have a previous psychiatric history (PPH).

MethodCross-sectional cohort study of 918 patients aged ≥65 years consecutively admitted to a general adult psychiatric acute unit from 2005 to 2014.

ResultsPatients in the NPH group (n = 526) were significantly older than those in the PPH group (n = 391) (77.6 v. 70.9 years P < 0.001), more likely to be men, married or widowed and admitted involuntarily. Diagnostic prevalence in the NPH and PPH groups were 49.0% v. 8.4% (P < 0.001) for organic mental disorders, 14.6% v. 30.4% (P < 0.001) for psychotic disorders, 30.2% v. 55.5% (P < 0.001) for affective disorders and 20.7% v. 13.3% (P = 0.003) for somatic disorders. The NPH group scored significantly higher on the Health of the Nation Outcome Scale (HoNOS) items agitated behaviour; cognitive problems; physical illness or disability and problems with activities of daily living, whereas those in the PPH group scored significantly higher on depressed mood. Although the PPH group were more likely to report suicidal ideation, those in the NPH group were more likely to have made a suicide attempt before the admission.

ConclusionsAmong psychiatric patients >65 years, the subgroup with NPH were characterised by more physical frailty, somatic comorbidity and functional and cognitive impairment as well as higher rates of preadmission suicide attempts. Admitting facilities should be appropriately suited to manage their needs.

Hallvard Lund-Heimark, Eirik Kjelby, Lars Mehlum, Rolf Gjestad , Geir Selbæk, Rune Andreas Kroken, Erik Johnsen, Ketil Joachim Oedegaard, Liv S. Mellesdal

Background

This study aimed to investigate whether white matter lesions (WML), β-amyloid- and tau pathologies are independently associated with mobility, dual tasking and dynamic balance performance in older non-demented individuals.

Methods

We included 299 older people (mean, SD, age: 71.8, 5.6 years) from the Swedish BioFINDER study, whereof 175 were cognitively unimpaired and 124 had mild cognitive impairment (MCI). In multivariable regression analyses, dependent variables included mobility (Timed Up & Go, TUG), dual tasking (TUG with a simultaneous subtraction task, i.e. TUG-Cog, as well as dual task cost), and balance (Figure-of-eight). The analyses were controlled for age, sex, education, diagnosis (i.e. MCI) and comorbidity (stroke, diabetes, and ischemic heart disease). Independent variables included WML volume, and measures of β-amyloid (abnormal CSF Aβ42/40 ratio) and tau pathology (CSF phosphorylated tau, p-tau).

Results

Multivariable regression analyses showed that an increased WML volume was independently associated with decreased mobility, i.e. TUG (standardized β=0.247; p<0.001). Tau pathology was independently associated with dual tasking both when using the raw data of TUG-Cog (β=0.224; p=0.003) and the dual task cost (β= -0.246; p=0.001). Amyloid pathology was associated with decreased balance, i.e. Figure-of-eight (β= 0.172; p=0.028). The independent effects of WML and tau pathology were mainly observed in those with MCI, which was not the case for the effects of amyloid pathology on balance.

Conclusions

Common brain pathologies have different effects where WML are independently associated with mobility, tau pathology has the strongest effect on dual tasking and amyloid pathology seems to be independently associated with balance. Although these novel findings need to be confirmed in longitudinal studies, they suggest that different brain pathologies have different effects on mobility, balance and dual tasking in older non-demented individuals.

Maria H Nilsson, Gro Gujord Tangen, Sebastian Palmqvist, Danielle van Westen, Niklas Mattsson-Carlgren, Erik Stomrud, Oskar Hansson

Digital assistive technology has potential for supporting older adults who depend upon community healthcare services. To boost the efficiency of those services, technological devices are often installed for care recipients as part of governed practice. However, the varying adoption of technology risks widening the digital divide. In response, the Assisted Living project engaged older adults in co-creating knowledge about users’ needs, to guide the development of technological solutions designed to support everyday living. This study sought to investigate how eight older adults in an assisted living facility in Norway, aged 81–92 years, evaluated user inclusion in a 3-year technology-oriented research project. Individual interviews, dialogue cafés, interventions with environmental sensors, and a final focus group discussion constituted sites for co-creation of knowledge. Participants’ answers to standardised questionnaires and statements during dialogue café meetings were collated into tables and the focus group discussion was thematically analyzed, with three themes identified: motivation for project engagement, experiencing and understanding participation in the project, and mixed feelings towards environmental sensors at home. The project revealed that older adults with impairments could nevertheless meaningfully contribute opinions about their needs. Applying a critical occupational perspective raised awareness regarding sociocultural assumptions about older adults in assisted living as frail and unable to participate, which may reinforce ageist and ableist stereotypes, as well as promote occupational injustice.

Torhild Holthe, Liv Halvorsrud, Anne Lund