Mat og måltider

Leve hele livet beskrives som en reform for større matglede, og målet for myndighetene er å skape gode måltidsopplevelser og redusere underernæring blant eldre (Helse- og omsorgsdepartementet, 2018). For alle personer – både eldre og yngre – er kosthold, mat og måltider viktig. Mat og måltider har innvirkning på helse og trivsel og er en sentral del av hverdagen, og mange eldre synes det er en av dagens viktigste begivenheter. Mat og måltider har også en sentral plass i mange kulturelle aktiviteter og i et sosialt fellesskap. Et usunt kosthold er på sin side en av de viktigste risikofaktorene for sykdom og for tidlig død (Departementene, 2017; Helse- og omsorgsdepartementet, 2018). I kunnskapsoppsummeringen som ble gjort i forbindelse med utarbeiding av Leve hele livet-reformen slår forfatterne fast at mat og ernæring blant eldre i høyeste grad er satt på dagsordenen i Norge. Forfatterne refererer til et stort antall stortingsmeldinger, handlingsplaner, kostholdsanbefalinger, retningslinjer, veiledere og tiltakspakker som har blitt utarbeidet. Likevel viser det seg å være et stort gap mellom anbefalt praksis og utøvet praksis (Bøhn, Medbøen, Langballe, & Totland, 2017), og det er grunn til å tro at ikke alle eldre får ivaretatt sine grunnleggende behov for mat, ernæring og gode måltidsopplevelser (Helse- og omsorgsdepartementet, 2018)

Supporting Older People to Live Safely at Home – Findings from Thirteen Case Studies on Integrated Care Across Europe

Introduction: While many different factors can undermine older people’s ability to live safely at home, safety as an explicit aspect of integrated care for older people living at home is an underexplored topic in research. In the context of a European project on integrated care, this study aims to improve our understanding of how safety is addressed in integrated care practices across Europe. Methods: This multiple case study included thirteen integrated care sites from seven European countries. The Framework Method guided content analyses of the case study reports. Activities were clustered into activities aimed at identifying and managing risks, or activities addressing specific risks related to older people’s functioning, behaviour, social environment, physical environment and health and social care receipt. Results: Case studies included a broad range of activities addressing older people’s safety. Although care providers felt they sufficiently addressed safety issues, older people were often concerned and insecure about their safety. Attention to the practical and social aspects of safety was often insufficient. Conclusions and discussion: Integrated care services across Europe address older people’s safety in many ways. Further integration of health and social care solutions is necessary to enhance older people’s perceptions of safety

A Cross-European Study of Informal Carers’ Needs in the Context of Caring for Older People, and their Experiences with Professionals Working in Integrated Care Settings

Introduction: Informal carers are increasingly relied on for support by older people and the health and social care systems that serve them. It is therefore important that health and social care professionals are knowledgeable about and responsive to informal carers’ needs. This study explores informal carers’ own needs within the context of caregiving; and examines, from the informal carers’ perspective, the extent to which professionals assess, understand and are responsive to informal carers’ needs

The SUSTAIN project: a European study on improving integrated care for older people living at home

Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans , evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home

Remittances and risk of major depressive episode and sadness among new legal immigrants to the United States

<b>Background</b>: The impact of remittances on health problems like depression among immigrants is understudied. Yet immigrants may be particularly emotionally vulnerable to the strains and benefits of providing remittances. <b>Objective</b>: This study examines the association between sending remittances and major depressive episode (MDE) and sadness among legal immigrants in the United States. <b>Methods</b>: Cross-sectional data (N=8,236 adults) come from the New Immigrant Survey (2003-2004), a representative sample of new U.S. permanent residents. <b>Results</b>: In logistic regression models, immigrants who remitted had a higher risk of MDE and sadness compared to those who did not, net of sociodemographic and health factors. For remitters (N=1,470), the amount of money was not significantly linked to MDE but was associated with a higher risk of sadness among refugees/asylees compared to employment migrants. <b>Conclusions</b>: Among socioeconomically vulnerable migrants such as refugees/asylees, sending remittances may threaten mental health by creating financial hardship. Initiatives that encourage economic stability for migrants may protect against depression

Effects of introducing a fee for “inpatient overstays” on the rate of death and readmissions across municipalities in Norway

The Norwegian healthcare coordination reform (Samhandlingsreformen) was implemented from January 1, 2012. In addition to providing municipalities with funding to strengthen their health infrastructure, it required municipalities to pay hospitals a daily fee for patients who, having been declared ready for discharge and in need of municipal health services, were not received by the municipalities on time. This study examines the effects of the reform on the rate of death and readmissions occurring within 60 days of hospitalization. We use aggregated municipal data for years 2009, 2010, 2012-2014 (N=1646) for Norwegian patients (age 18+) hospitalized in the same years for COPD/asthma, heart failure, hip fracture, and stroke. We stratify our analyses of the municipal data by these patient groups. Our linear regression models test for moderated (interaction) effects whereby associations between the reform and the rate of death and readmissions vary by whether or not patients were classified as ready for discharge and in need of follow-up care in the municipality. The models adjust for municipal sociodemographic and health characteristics. We found no statistically significant moderated effects of the reform across the patient groups, except for patients with stroke (b=.027, SE=.109, p<.05). Specifically, compared to the pre-reform period (2009 2010), the post-reform period (2012-2014) was associated with a higher rate of readmissions at high predicted values of needing follow-up care. Although our analyses of municipal data suggest that patients with stroke are vulnerable to the reform and its incentive scheme, there is no strong evidence overall to suggest that the Norwegian healthcare coordination reform is functioning in a manner that exacerbates the risk of death and readmissions

Mat og måltider

Leve hele livet beskrives som en reform for større matglede, og målet for myndighetene er å skape gode måltidsopplevelser og redusere underernæring blant eldre (Helse- og omsorgsdepartementet, 2018). For alle personer – både eldre og yngre – er kosthold, mat og måltider viktig. Mat og måltider har innvirkning på helse og trivsel og er en sentral del av hverdagen, og mange eldre synes det er en av dagens viktigste begivenheter. Mat og måltider har også en sentral plass i mange kulturelle aktiviteter og i et sosialt fellesskap. Et usunt kosthold er på sin side en av de viktigste risikofaktorene for sykdom og for tidlig død (Departementene, 2017; Helse- og omsorgsdepartementet, 2018). I kunnskapsoppsummeringen som ble gjort i forbindelse med utarbeiding av Leve hele livet-reformen slår forfatterne fast at mat og ernæring blant eldre i høyeste grad er satt på dagsordenen i Norge. Forfatterne refererer til et stort antall stortingsmeldinger, handlingsplaner, kostholdsanbefalinger, retningslinjer, veiledere og tiltakspakker som har blitt utarbeidet. Likevel viser det seg å være et stort gap mellom anbefalt praksis og utøvet praksis (Bøhn, Medbøen, Langballe, & Totland, 2017), og det er grunn til å tro at ikke alle eldre får ivaretatt sine grunnleggende behov for mat, ernæring og gode måltidsopplevelser (Helse- og omsorgsdepartementet, 2018)

Kartlegging av medisinskfaglig tilbud i sykehjem og heldøgns omsorgsboliger

Hvilke forhold har betydning for at legetjenesten oppleves som en integrert del av sykehjemmets drift? Spørsmålet i oppdraget har vi tolket ut ifra et premiss om at leger som er godt integrert i sykehjemmet, har økt sannsynlighet for å gi medisinskfaglige tjenester av høy kvalitet, sammenliknet med leger som har en mindre tett tilknytning til sykehjemmet. Basert på data innsamlet i kartleggingen, og supplert med innsikt fra kunnskapsoppsummeringen, synes en slik tolkning å være velberettiget: stabile, tilgjengeligelige legetjenester med høy kontinuitet er fordelaktig for både pasienter, pårørende, personale i sykehjemme og legene selv. Resultatene presentert i rapporten gir en pekepinn på hvordan en skal tilrettelegge for at det medisinskfaglige tilbudet skal bli nettopp slik

A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints

Background Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people. Methods Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2–5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. Results Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people’s functional status and needs (including for safe home environments), and to identify older people’s wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of ‘showing/doing with’ versus ‘doing for’ the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. Conclusion Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by ‘showing/doing with’ versus ‘doing for them’ when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge

Does rehabilitation setting influence risk of institutionalization? A register-based study of hip fracture patients in Oslo, Norway

Background: Reducing the economic impact of hip fractures (HF) is a global issue. Some efforts aimed at curtailing costs associated with HF include rehabilitating patients within primary care. Little, however, is known about how different rehabilitation settings within primary care influence patients’ subsequent risk of institutionalization for long-term care (LTC). This study examines the association between rehabilitation setting (outside an institution versus short-term rehabilitation stay in an institution, both during 30 days post-discharge for HF) and risk of institutionalization in a nursing home (at 6–12 months from the index admission). Methods: Data were for 612 HF incidents across 611 patients aged 50 years and older, who were hospitalized between 2008 and 2013 in Oslo, Norway, and who lived at home prior to the incidence. We used logistic regression to examine the effect of rehabilitation setting on risk of institutionalization, and adjusted for patients’ age, gender, health characteristics, functional level, use of healthcare services, and socioeconomic characteristics. The models also included fixed-effects for Oslo’s boroughs to control for supply-side and unobserved effects. Results: The sample of HF patients had a mean age of 82.4 years, and 78.9 % were women. Within 30 days after hospital discharge, 49.0 % of patients received rehabilitation outside an institution, while the remaining 51.0 % received a short-term rehabilitation stay in an institution. Receiving rehabilitation outside an institution was associated with a 58 % lower odds (OR = 0.42, 95 % CI = 0.23–0.76) of living in a nursing home at 6–12 months after the index admission. The patients who were admitted to a nursing home for LTC were older, more dependent on help with their memory, and had a substantially greater increase in the use of municipal healthcare services after the HF. Conclusions: The setting in which HF patients receive rehabilitation is associated with their likelihood of institutionalization. In the current study, patients who received rehabilitation outside of an institution were less likely to be admitted to a nursing home for LTC, compared to those who received a short-term rehabilitation stay in an institution. These results suggest that providing rehabilitation at home may be favorable in terms of reducing risk of institutionalization for HF patients