Aging Clinical and Experimental Research, 2020
Trajectories of physical performance in nursing home residents with dementia
In nursing homes (NH) the prevalence of dementia ranges from 50 to 84% and most residents have extensive physical-performance impairments. However, from time of admission, development of physical performance in NH residents with dementia remains unexplored.
To explore the overall trend in physical performance, associated characteristics, and groups following distinct trajectories from time of admission, in NH residents with dementia.
We followed newly admitted NH residents diagnosed with dementia (N = 583) from 47 NHs across Norway for 3 years. Individual assessments were conducted biannually, and main outcome measure was the Short Physical Performance Battery (SPPB). Facility-level characteristics included unit size, staff-to-resident ratio, and quality of the physical environment (Special Care Unit Environmental Quality Scale, SCUEQS).
From time of admission, NH residents with dementia showed a significant overall decline in physical performance. Further, we identified three distinct trajectory groups with significantly different baseline physical-performance status (“good,” “moderate,” and “poor”), differences between groups maintained and all declined across time. Younger age, good general medical health, less-severe dementia, and less musculoskeletal pain were associated with both an average higher overall trend and better baseline group-belonging. Additionally, less apathy and more psychosis were associated with a higher overall trend, and agitation was associated with poorer baseline group-belonging.
To prevent excessive decline in physical performance in this population, NH clinicians should focus efforts specifically on assessment of physical performance at admission and on identification and management of musculoskeletal pain and neuropsychiatric symptoms.
Dementia and Geriatric Cognitive Disorders Extra, 2020
Engagement in Everyday Activities among People Living inEngagement in Everyday Activities among People Living in Indian Nursing Homes: The Association with Person-Centredness
Introduction: It has been reported that residents living in nursing homes are often inactive and lonely and are offered a limited number of activities. However, high engagement in activities has been reported to improve residents’ quality of life and engagement in personalized activities can even reduce agitation and enhance positive mood. Information regarding occupational patterns and purpose in life is well established in Western countries. However, we know next to nothing about how people living in Indian nursing homes spend their days. Objective: To explore the participation in everyday activities among older people in Indian nursing homes and the extent to which engagement in activities is associated with person-centred care. Methods: The study was conducted in 6 nursing homes in India, comprising 147 residents. In all, 23 nursing staff took part and completed a 26-item questionnaire about resident activities based on the Multi-Dimensional Dementia Assessment Scale and the Person-Directed Care Questionnaire. Person-centredness was measured with the Person-Centred Care Assessment Tool. Results: We found low participationin everyday activities among the residents. Participation in religious activities was the most frequent, whereas the least used activities were excursions, participating in cultural activities, taking part in educational programmes, visiting a restaurant and going to the cinema. A significant positive association was foundbetween person-centred care and participation in religious activities, engagement in an activity programme and physical activity. Conclusions: The most frequently attended activity was religious activities. Person-centred care was associated with participation in religious activities, engagement in an activity programme, physical activity, spending time in the garden and playing and listening to music.
Tidsskriftet aldring og helse, 2019
Pårørendes erfaringer av kvalitet i helse- og omsorgstjenester til personer med demens og pårørende. En longitudinell narrativ studie
Bakgrunn: Det har de siste årene vært en stor satsing på å utvikle og styrke demensomsorgen i Norge. Ett av målene er at personer med demens og pårørende skal få dekket sine individuelle behov ved tjenester preget av høy kvalitet, fleksibilitet og individuell tilrettelegging.
Hensikt: Studiens hensikt var å få økt kunnskap om pårørendes opplevelser av helse- og omsorgstjenester til personer med demens og pårørende over tid.
Metode: Studien har et kvalitativt longitudinelt casestudiedesign. Data er samlet inn gjennom tre omganger over en to-års periode, med narrative dybdeintervjuer med fem pårørende; tre ektefeller og to voksne barn.
Hovedfunn: Pårørende opplevde at dagaktivitetstilbudene hadde høy kvalitet og ga god avlastning, mens avlastnings- og langtidsopphold i sykehjem hadde forbedringspotensiale knyttet til kvalitet, fleksibilitet og individuell tilrettelegging. Deltakelse på pårørendeskoler opplevdes ulikt. Hjemmesykepleie ga de voksne barna i studien trygghet og opplevelse av delt ansvar, men opplevdes som utilstrekkelig og lite individuelt tilpasset for ektefeller, særlig ved alvorlig demens.
Konklusjon: Pårørendes behov for og opplevelse av helse- og omsorgstjenester er varierende. Pårørende kan oppleve at dagaktivitetstilbudet i høy grad dekker deres behov, mens pårørendeskoler, hjemmesykepleie, avlastnings- og langtidsopphold i sykehjem kan være mindre fleksible og mindre tilpasset individuelle behov hos personen med demens og/eller pårørende.
Physical Therapy, 2020
Balance and Gait After First Minor Ischemic Stroke in People 70 Years of Age or Younger: A Prospective Observational Cohort Study
Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients < 70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group.The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institute of Health Stroke Scale (NIHSS) score ≤3). This study also explored factors predicting impaired balance after 12 months.This study was designed as an explorative longitudinal cohort study.Patients were recruited consecutively from two stroke units. Balance and gait were assessed with the Mini-BESTest, Timed Up and Go (TUG), and preferred gait speed. Predictors for impaired balance were explored using logistic regression.This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female and mean (SD) NIHSS score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and TUG improved significantly from the acute phase to 3 months, gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio =0.92, 95% CI = 0.85 – 0.95) was the only predictor of balance impairments (Mini-BESTest score ≤ 22) at 12 months post-stroke.Limitations include lack of information about pre-stroke balance and gait impairment, and post-stroke exercise. Few women limits the generalizability.This study observed improvements in both balance and gait during the follow-up, still about one third had balance or gait impairments at 12 months post-stroke. Balance in the acute phase predicted impaired balance at 12 months.
Health and Social Care in the Community, 2019
People with dementia attending farm‐based day care in Norway – Individual and farm characteristics associated with participants’ quality of life
Farm‐based day care for people with dementia is supposed to improve the participants quality of life by using activities and resources of the farm environment to promote mental and physical health. In this paper, we describe the characteristics of those attending farm‐based day care services in Norway and explore the association between individual and farm characteristics and the quality of life. A sample of 94 people with dementia who attended farm‐based day care was recruited from 25 farms between January 2017 and January 2018. The data collection was performed using standardized instruments. Information about the farms was retrieved from a former study. The association between the participants’ quality of life and their individual and/or farm characteristics was examined with a linear multilevel regression model. The participants had a mean age of 76 years, 62% were men, and 68% had additional education after primary school. Most of them had mild (54.3%) or questionable dementia (18.3%). A few participants used antipsychotics (3.7%), tranquilizers (9.9%) and painkillers (13.6%), while a higher number used antidepressants (30.9%). Quality of life was associated with the experience of having social support (p = .023), a low score on depressive symptoms (p < .001), and spending time outdoors at the farm (p < .001). The variation between the farm‐based day care services in the participants’ reported quality of life was related to time spent outdoors at the farm. In light of the present study, it seems as farm‐based day care is addressing people with dementia in an early stage, dominated by men, with quite good physical and medical condition. The strong association between quality of life and spending time outdoors underscores that facilitation for outdoor activity should be prioritized in all types of dementia care.
Journal of intellectual disability, 2019
Employment and attendance in day care centres for people with mild intellectual disabilities – do age, gender, functional level or hospital admissions matter?
Workforce inclusion is an important political goal in many countries. However, nearly 70% of Norwegians registered with mild intellectual disabilities (IDs) are not registered employed or attending in day care centres. This study investigates the association between age, gender, functional level and hospital admissions with employment or attendance in public financed, community‐based day care centres for adults with mild IDs in Norway.
This study is based on data from a linkage of the national population‐based registries from 2013 to 2015: Statistics Norway (SSB), the Norwegian Information System for the Nursing and Care Sector (IPLOS) and the Norwegian Patient Registry (NPR). The sample consisted of 2370 adults registered with a mild ID, receiving disability pension in Norway, aged 18–67 years. Binary and multinomial logistic analyses, adjusted for age, gender, functional level and hospital admissions, were performed.
In 2015, 45.7% and 19.6% of the samples aged 20–31 and 52–63 years, respectively, were registered as employed or in day care centres. Participation in day care is a public service registered in IPLOS, which requires registration of functional level, while attendance in employment support is registered in SSB, where functional level is not registered. Compared with people registered with a high functional level, the probability of being employed or in day care centres was lower for people without registration of functional level. People with hospital admissions were less likely to be employed, especially if they had both psychiatric and somatic hospital admissions. People were less likely to attend day care and open employment only if they had a combination of both types of hospital admissions. Attendance in day care centres was less likely for men than women.
Older people with mild ID, without registered functional level (meaning not receiving public community‐based services) and with a history of hospital admissions were significantly less likely to be employed or participate in day care centres. The clear association between not being employed or attending day care centres and not having one’s functional level registered implies there is a need for increased focus on how to enhance work participation among people with mild IDs who are not within the system of receiving public services.
Scandinavian Journal of Public Health, 2019
Subjective memory impairment, instrumental activities of daily living and longitudinal effect on mortality among older adults in a population-based cohort study: The HUNT Study
Background: Subjective impairment in memory and instrumental activities in daily living (IADL) are associated with future cognitive decline and poorer mental health in older adults, but their association with mortality is uncertain. Our aim was to examine the associations between subjective memory and IADL impairments and all-cause mortality, as well as the mortality risk for reporting both memory and IADL impairments. Methods: Data from the 70-year-old and older cohort in the third survey of a population-based study, the Nord-Trøndelag Health Study (HUNT3), were linked to the Norwegian Causes of Death Registry. A total of 5802 older adults had complete data from HUNT3 (70.8% of the 70+ cohort). The mean follow-up time was 8.0 years, and 1870 respondents had died. Associations between subjective memory and ADL impairments with mortality were analysed in Cox regression models adjusted for covariates with attained age as the timescale. Analyses were performed separately for two age groups – 70–79 and 80+ years – to fulfil the proportional hazards assumption. Results: Subjective impairments in short-term memory and IADL were significantly associated with mortality both separately and combined. These associations were strongest in the 70- to 79-year-old group, where reporting impairment on one short-term memory item increased the mortality risk by 51% (hazard ratio=1.51; 95% confidence interval 1.20–1.91). Long-term memory impairments were not associated with mortality in the adjusted models. Conclusions: Subjective short-term memory impairments and IADL impairments are associated with increased mortality risk. Neither of these symptoms should be regarded as benign aspects of ageing, and concerns should be properly addressed
Journal of Alzheimer´s Disease, 2019
Toward a Sequential Strategy for Diagnosing Neurocognitive Disorders: A Consensus from the «Act On Dementia» European Joint Action
Neurocognitive disorders causing progressive cognitive, functional, and behavioral impairment remain underdiagnosed. The needs for a timely diagnosis are now widely acknowledged since person-centered care helps to preserve life quality and prevent crises. One powerful barrier to detection in primary care is the lack of an easy-to-follow stepwise approach, grounded in evidence and consistent with high-quality specialty practice. To help fill this gap, the current European Joint Action proposes a graduated diagnosis strategy tailored to the patients’ needs and wills, clarifying appropriate components for primary and specialty care. This strategy considers a first evaluation in primary care that may detect a neurocognitive disorder, that would lead to a second evaluation step allowing etiological diagnosis hypotheses performed mostly by the specialist. A third evaluation stage considering some biological, electrophysiological, or neuroimaging complementary techniques would be proposed to atypical cases or patients willing to consider access to research.
International Journal of Qualitative Studies on Health and Well-being, 2019
The experiences of dealing with consequences of an avalanche – surviving soldiers’ perspectives
Purpose: The aim of the study was to explore and describe experiences of daily life after having experienced an avalanche three decades ago.Method: This paper presents a qualitative study of 12 male survivors of an avalanche during their military service, interviewed 30 years post-disaster.Findings: A comprehensive understanding of the categories led to the latent theme «Finding my own way of managing and dealing with life». Findings revealed three categories describing experiences of daily living: (i) A comfortable life; (ii) A challenging, yet accomplished life; (iii) A demanding life. The first category represents a greater degree of using adaptive coping strategies for managing everyday life compared to the other two categories. The third category represents the group having the most challenging consequences. Among the three, the latter category conveys the most maladaptive coping strategies.Conclusions:The participants had different experiences with regards to their health and how they coped with their everyday life after the avalanche disaster. Insights into coping strategies may provide a guide for appropriate interventions for survivors dealing with traumatic events.
Dementia and Geriatric Cognitive Disorders, 2018
The Validity of the Norwegian Version of the Cognitive Function instrument
Background/Aims: A timely diagnosis of dementia is important, and the Cognitive FunctionInstrument (CFI) is a newly developed instrument to screen for cognitive decline. The aim ofthis study was to evaluate the validity and internal consistency of the Norwegian version ofthe CFI.
Methods: We included 265 participants with dementia, mild cognitive impairment(MCI), subjective cognitive impairment (SCI), and a reference group without subjective or assessed cognitive decline. The participants and their relatives answered the self- and proxyratedversions of the CFI.
Results: The Norwegian CFI had power to discriminate betweenpeople with dementia and with MCI, SCI, and the reference group. The proxy version had betterpower than the self-rated version in our participants (area under the curve [AUC] proxyratedvarying from 0.79 to 0.99, AUC self-rated varying from 0.56 to 0.85). Conclusion: The Norwegian CFI was found to be a useful, valid, and robust instrument.