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Nursing Ethics

The Meaning of Dignity for Older Adults: A Meta-Synthesis

Abstract

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.

Forfattere

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

Journal of geriatric psychiatry and neurology, 2020

Young- and Late-Onset Dementia: A Comparative Study of Quality of Life, Burden, and Depressive Symptoms in Caregivers

Abstract

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.

Forfattere

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

Journal of multidiciplinary healthcare, 2020

Community Health Care Workers’ Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia

Abstract

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.

Forfattere

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

BJPsych Open, 2020

Elderly patients with no previous psychiatric history: suicidality and other factors relating to psychiatric acute admissions

Abstract

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.

Forfattere

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

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The journals of gerontology, 2020

The effects of tau, amyloid and white matter lesions on mobility, dual tasking and balance in older people

Abstract

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.

Forfattere

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

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Journal of occupational science, 2020

A critical occupational perspective on user engagement of older adults in an assisted living facility in technology research over three years

Abstract

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.

Forfattere

Torhild Holthe, Liv Halvorsrud, Anne Lund

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Nordic Journal of psychiatry, 2020

Milieu therapy for hospitalized patients with late-life anxiety and depression: a qualitative study

Abstract

Background: Milieu therapy (MT) is an important interprofessional part of therapy for persons with late-life anxiety and depression in psychogeriatric inpatient units. Research on how this is conducted is scarce.

Aim: To explore nurses’ and nurse assistants’ experience regarding MT interventions for persons with late-life anxiety and depression and how this is applied and conducted in the everyday life in a psychogeriatric inpatient unit.

Method: Four focus group interviews with nurses and nurse assistants were conducted. Systematic text condensation was used for analyzing and interpreting the data.

Results: MT was described as a dynamic and active process. Conscious individualized cooperation and communication day and night emerged as overarching theme, with following categories: 1. Collecting clues about the patient’s history, challenges and coping strategies. 2. Active use of these clues. 3. Active use of the ward setting as arena for staff to learn from each other, for patients to learn from other patients and as frame for MT in general. Strategies from both psychiatric and dementia care were used in MT interventions.

Conclusion: Results from this study describe content and complexity of MT strategies that can be supportive in everyday practice in psychogeriatric inpatient units and nursing homes, and have the potential to facilitate teaching, supervision and counseling of health professionals, caregivers and patients

Forfattere

Marit Nåvik, Solveig Hauge, Ulrike Sagen

Tidsskriftet den norske legeforening, 2020

Behandling, omsorg og pleie for døende sykehjemspasienter med covid-19

Abstract

Skrøpelige eldre med multisykdom har høy risiko for alvorlig sykdom og død ved smitte med koronavirus. Til forskjell fra «vanlig død» på sykehjem der det er tid til forberedelser, kan tilstanden endre seg raskt og gi organsvikt. I denne artikkelen beskriver vi lindrende ikke-invasive og invasive tiltak for skrøpelige eldre på sykehjem som er døende på grunn av covid-19.

Forfattere

Siren Eriksen, Ellen Karine Grov, Bjørn Lichtwarck, Ingunn Holmefoss, Kjell Bøhn, Christian Myrstad, Geir Selbæk, Bettina Husebø

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Scandinavian journal of primary health care, 2020

Characteristics of patients assessed for cognitive decline in primary healthcare, compared to patients assessed in specialist healthcare

Abstract

Objective: The aim of this study was to describe patients assessed for cognitive decline in primary healthcare, compared to patients assessed in specialist healthcare and to examine factors associated with depression.Design: This was an observational study.Setting: Fourteen outpatient clinics and 33 general practitioners and municipality memory teams across Norway.Subjects: A total of 226 patients assessed in primary healthcare and 1595 patients assessed in specialist healthcare outpatient clinics.Main outcome measures: Cornell scale for depression in dementia (CSDD), Mini-Mental Status Examination (MMSE), Clock drawing test, Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Instrumental Activities of Daily Living, Personal Self-Maintenance Scale, Relatives’ stress scale (RSS), and Neuropsychiatric Inventory Questionnaire (NPI-Q)Results: Patients assessed in primary healthcare were older (mean age 81.3 vs 73.0 years), less educated, had poorer cognition (MMSE median 22 vs 25), more limitations in activities of daily living (ADL), more behavioural and psychological symptoms of dementia (BPSD), more depressive symptoms (CSDD median 7 vs 5), more often lived alone (60% vs 41%) and were more often diagnosed with dementia (86% vs 47%) compared to patients diagnosed in specialist healthcare. Depression was associated with female gender, older age, more severe decline in cognitive functioning (IQCODE, OR 1.65), higher caregiver burden (RSS, OR 1.10) and with being assessed in primary healthcare (OR 1.53).Conclusion: Post-diagnostic support tailored to patients diagnosed with dementia in primary healthcare should consider their poor cognitive function and limitations in ADL and that these people often live alone, have BPSD and depression.

Forfattere

Mona Michelet, Anne Lund, Bjørn Heine Strand, Knut Engedal, Geir Selbæk, Sverre Bergh

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Frontiers in Psychology, 2018

The Effect of Blood Pressure on Cognitive Performance. An 8-Year Follow-Up of the Tromsø Study, Comprising People Aged 45–74 Years

Abstract

Background: The relationship between blood pressure (BP) and cognition is complex were age appears to be an intervening variable. High and low BP have been associated with cognitive deficits as part of the aging process, but more studies are needed, especially in more recent birth cohorts.Methods: The study sample comprised 4,465 participants, with BP measured at baseline in the Tromsø Study, Wave 6 in 2007–2008 (T0), and cognition assessed at follow-up 8 years later, in 2015–2016 in Tromsø Study 7 (T1). Age at T0 was 45–74 years, and at T1 it was 53–82 years. Cognition was assessed with three tests: The Mini Mental State Examination (MMSE), the Digit Symbol Test, and the Twelve-word Test. The associations between BP and cognition were examined specifically for age and sex using linear regression analysis adjusted for baseline BP medication use, education and body mass index (kg/m2).Results: BP was associated with cognition at the 8-year follow-up, but the association differed according to age and sex. In men, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) at a young age (45–55 years of age) was associated with poorer cognition; the association was reversed at older ages, especially for those above 65 years of age. In women, the associations were generally weaker than for men, and sometimes in the opposite direction: For women, a higher SBP was associated with better cognition at a younger age and higher SBP poorer cognition at older ages – perhaps due to an age delay in women compared to men. Digit Symbol Test results correlated best with BP in a three-way interaction: BP by age by sex was significant for both SBP (p = 0.005) and DBP (p = 0.005).Conclusion: Increased SBP and DBP at the younger age was clearly associated with poorer cognitive function in men 8 years later; in women the associations were weaker and sometimes in the opposite direction. Our findings clearly indicate that interactions between age and sex related to BP can predict cognitive performance over time. Men and women have different age trajectories regarding the influence of BP on cognition.

Forfattere

Knut Hestad, Knut Engedal, Henrik Schirmer, Bjørn Heine Strand

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