Exploring access to care among older people in the last phase of life using the behavioural model of health services use: a qualitative study from the perspective of the next of kin of older persons who had died in a nursing home

Background: There is little investigation into what care older people access during the last phase of their life and what factors enable access to care in this group. Illuminating this from the perspective of the next of kin may provide valuable insights into how the health and social care system operates with reference to providing care for this vulnerable group. The behavioural model of health services use has a wide field of application but has not been tested conceptually regarding access to care from the perspective of the next of kin. The aim of this study was to explore the care accessed by older people during the last phase of their life from the perspective of the next of kin and to conceptually test the behavioural model of health services use. Methods: The data collection took place in 2011 by means of qualitative interviews with 14 next of kin of older people who had died in a nursing home. The interviews were analysed using directed content analysis. The behavioural model of health services use was used in deriving the initial coding scheme, including the categories: utilization of health services, consumer satisfaction and characteristics of the population at risk. Results: Utilization of health services in the last phase of life was described in five subcategories named after the type of care accessed i.e. admission to a nursing home, primary healthcare, hospital care, dental care and informal care. The needs were illuminated in the subcategories: general deterioration, medical conditions and acute illness and deterioration when death approaches. Factors that enabled access to care were described in three subcategories: the organisation of care, next of kin and the older person. These factors could also constitute barriers to accessing care. Next of kin’s satisfaction with care was illuminated in the subcategories: satisfaction, dissatisfaction and factors influencing satisfaction. One new category was constructed inductively: the situation of the next of kin

Hospital and outpatient clinic utilization among older people in the 3-5 years following the initiation of continuing care: a longitudinal cohort study

Background: Few studies have investigated the subsequent rate of hospital and outpatient clinic utilization in those who receive continuing care and have documented frequent usage over one year. Such knowledge may be helpful in identifying those who would benefit from preventive interventions. The aim of this study was to investigate and compare the subsequent rate of hospital and outpatient clinic utilization among older people with 0, 1, 2, 3 or more hospital stays in the first year following the initiation of continuing care. A further aim was to compare these groups regarding demographic data, health complaints, functional and cognitive ability, informal care and mortality. Methods: A total of 1079 people, aged 65 years or older, who received a decision regarding the initiation of continuing care during the years 2001, 2002 or 2003 were investigated. Four groups were created based on whether they had 0, 1, 2 or >= 3 hospital stays in the first year following the initiation of continuing care and were investigated regarding the rate of hospital and outpatient clinic utilization in the subsequent 3-5 years. Results: Fifty seven percent of the sample had no hospital stay during the first year following the initiation of continuing care, 20% had 1 stay, 10% had 2 stays and 13% had three or more hospital stays (range: 3-13). Those with >= 3 hospital stays in the first year continued to have the significantly highest rate of hospital and outpatient care utilization in the subsequent years. This group accounted for 57% of hospital stays in the first year, 27% in the second year and 18% in the third year. In this group the risk of having >= 3 hospital stays in the second year was 27% and 12% in the third year. Conclusions: There is a clear need for interventions targeted on prevention of frequent hospital and outpatient clinic utilization among those who are high users of hospital care in the first year after the initiation of continuing care. Perhaps an increased availability of medically skilled staff in the day to day care of these people in the municipalities could prevent frequent hospital and outpatient clinic utilization, especially hospital readmissions

Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

<p>Abstract</p> <p>Background</p> <p>Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people.</p> <p>Methods</p> <p>The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity.</p> <p>Results</p> <p>A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity.</p> <p>Discussion</p> <p>The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time.</p> <p>Trial registration</p> <p>ClinicalTrials.gov, <a href="http://www.clinicaltrials.gov/ct2/show/NCT01260493">NCT01260493</a>.</p

Utilization of medical healthcare among older people In relation to long-term municipal care

The overall aim of this thesis was to investigate utilization of medical healthcare, i.e. hospital care and outpatient care, over a period of 1 to 5 years among people aged 65 years or older. The aim was further to investigate medical healthcare utilization in relation to the predisposal factors age and sex; the enabling factors functional ability, cognitive ability, informal care, municipal long-term care and in relation to such care provided at home or in special accommodation; and the need factors multimorbidity, health complaints and mortality. Study I includes 4907 people aged 65 years or older who had one or more hospital stays during 2001. Out of these, 694 people received long- term municipal care and were included in Study II. Studies III and IV include 1079 people who received a decision concerning initiation of long-term municipal care for the first time in 2001, 2002 or 2003. The samples were identified and data collected through the Good Ageing in Skåne Study (GAS) and from the administrative registers Patient Administrative Support in Skåne (PASiS) and PrivaStat. The results from Study I show that 15% of the sample had 3 or more hospital stays during the year (range 3-15) and accounted for 35% of admissions. This group had significantly more contacts with physicians in outpatient care (median (md)=15) compared to those with 1 (md =8) or 2 admissions (md=11). The number of diagnosis groups (B=0.395) and the number of contacts with the physician in outpatient care (B=0.18) were associated with the number of hospital stays. The results from Study II show that those who were admitted to hospital and received long-term municipal care at home had a significantly larger proportion who were admitted 3 or more times (21% vs. 14%, p=0.006) and significantly more contacts with physicians in outpatient care (md=10 vs. md=7, p<0.001) than those admitted from special accommodation. Informal care was associated with care at home (OR=0.074) and with utilization of outpatient care (B=1.375). Dependency in PADL was associated with care in special accommodation (OR=1.1375) and with utilization of hospital care (B =-0.581). The results in Study III showed that that the mortality rate among those who received a decision concerning the initiation of long-term municipal care was high, 47% died within three years after the decision. Those cared for at home had significantly more hospital stays than those in special accommodation in the first year (mean 1.1 (SD 1.6) vs. 0.7 (SD 1.4), p=0.001) and in the second year (mean 0.9 (SD 1.5) vs. 0.6 (SD 1.3), p=0.003) but not in the third year (mean 0.6 (SD 1.3) vs. 0.5 (SD 1.4), p=0.4) after the initiation of long-term care. Those at home also had significantly more contacts with physicians in outpatient care in the first year (mean 11.4 (SD 9.8) vs. 8.8 (SD 8.5), p<0.001), in the second year (mean 10.4 (SD 9.9) vs. 7.6 (SD 7.1), p<0.001) and in the third year (mean 8.9 (SD 11.1) vs. 6.7 (SD 6.9), p=0.003). The results in Study IV showed that those who had 3 or more hospital stays in the first year after the initiation of long-term care remained the highest rates of hospital and outpatient care utilization in the subsequent two years and accounted for 57% of hospital admissions in the first year, 27% in the second and 18% in the third year. The risk of frequent hospital admissions in the second year was 27% in this group and 12% in the third year

Förstärkt hemtjänst - en utvärdering av projektet med fokus på brukare och personal

I Malmö stad, stadsområdesförvaltning norr, före detta stadsdelsförvaltning Centrum, pågår sedan 2011 projektet förstärkt hemtjänst. Förstärkt hemtjänst är ett alternativ till korttidsboende, vilket innebär att brukaren under en kortare tidsperiod får extra stöd och hjälp i hemmet. Det övergripande syftet med detta dokument har varit att utvärdera projektet förstärkt hemtjänst i stadsdel Centrum. Utvärderingen ska utgöra en grund till ett beslut om projektet ska bli en permanent del av verksamheten. Utvärderingen har haft särskilt fokus på brukarens tillfredsställelse med erhållen vård och omsorg, samt omsorgspersonalens arbetssituation och arbetstillfredsställelse. Brukare och personal i den ordinarie hemtjänsten i samma stadsdel har utgjort jämförelsegrupp. Data har inhämtats genom enkäter till brukare och personal i både den förstärkta hemtjänsten och i den ordinarie hemtjänsten

Exploring shared care plans for older people regarding fulfillment of policy requirements and shared decision making - A qualitative study

The aim was to explore the documentation in shared care plans regarding the fulfilment of policy requirements and shared decision-making. The sample consists of 15 shared care plans established for older people in Sweden. The analysis was performed using directed content analysis. The requirements in the Swedish law and the 15 indicators of shared decision making (SDM) in the Multifocal Approach to the Sharing in SDM inventory was used to define the main categories. The policy requirements were fulfilled to a varied extent. All the care plans were established in collaboration between the municipality and the county council, but social services were not represented in six of them. The older person and next of kin were present at 14 of the care planning meetings. The individual’s agreement to the establishment was documented in ten of the plans but how and what the person had agreed to was not specified further. The headings focused at the policy requirements and did not support a care planning process, or a documentation based on SDM. Six out of 15 indicators of SDM were reflected. The decision-making process needs to be acknowledged more in the process of establishing shared care plans for older people

Exploring Shared Care Plans for Older People Regarding their Fulfilment of Policy Requirements and Shared Decision Making

The aim was to explore the documentation in shared care plans regarding the fulfilment of policy requirements and shared decision-making. The sample consists of 15 shared care plans established for older people in Sweden. The analysis was performed using directed content analysis. The requirements in the Swedish law and the 15 indicators of shared decision making (SDM) in the Multifocal Approach to the Sharing in SDM inventory was used to define the main categories. The policy requirements were fulfilled to a varied extent. All the care plans were established in collaboration between the municipality and the county council, but social services were not represented in six of them. The older person and next of kin were present at 14 of the care planning meetings. The individual’s agreement to the establishment was documented in ten of the plans but how and what the person had agreed to was not specified further. The headings focused at the policy requirements and did not support a care planning process, or a documentation based on SDM. Six out of 15 indicators of SDM were reflected. The decision-making process needs to be acknowledged more in the process of establishing shared care plans for older people.El objetivo era explorarlos planes de atención compartida según elcumplimiento de los requisitos de la política y la toma de decisiones compartidas. La muestra consta de 15 planes de atención compartida establecidos para mayores en Suecia. Se utilizaron los requisitos de la ley sueca y los 15 indicadores de toma de decisiones compartidas (TDC) del inventario del Enfoque Multifocal de la TDCpara definir las categorías principales. La persona mayor y sus familiares estuvieron presentes en 14 de las reuniones de planificación de la asistencia. El acuerdo de la persona con el establecimiento estaba documentado en 10de los planes. Se reflejaron 6de los 15 indicadores de TDC, pero los títulos se centraron enlos requisitos de la política. El proceso de toma de decisiones debe ser más reconocidoen las plantillas que se utilizan en los planes de atención compartida para promover que elproceso de planificación de la atención y ladocumentación se basenen el TDC.Title in Spanish: Exploración de Planes de Atención Compartida para Mayores en Relación al Cumplimiento de los Requisitos Políticosy la Toma de Decisiones Compartidas.This work was supported by funding from the Swedish Institute for Health Sciences, Vårdalinstitutet.</p

Äldre personers rätt till omvårdnad - Behov, kompetenser, myter och evidens

År 2030 beräknas var fjärde person i Sverige vara 65 år eller äldre. Detta ställer stora krav på kunskapen om åldrandet och åldrandets sjukdomar och omvårdnad av äldre personer – i synnerhet när det gäller de allra äldsta. Äldre personer som bor på särskilda boenden är ofta multisjuka eller har nedsatt beslutsförmåga, i huvudsak till följd av demenssjukdom. De finns i dag goda kunskapsunderlag som visar att hög omvårdnadskompetens inte bara ger en kvalitativt bättre omvårdnad, det ger också en effektivare vård. Ändå förefaller varken stat, landsting eller kommuner ha en strategi för hur omvårdnadskompetensen i vården av äldre skall kunna säkras och utvecklas. Vård och omsorg av äldre skall vara personcentrerad och bygga på evidensbaserad kunskap där vetenskapliga metoder används för att förstå och bedöma den äldre personens komplexa vårdbehov. Trots det stora behovet har idag bara två procent av sjuksköterskorna en specialistutbildning inom äldrevård. Svensk sjuksköterskeförening har i mer än 100 år arbetat med att utveckla omvårdnad. Svensk sjuksköterskeförening vill gärna ha dialog med kommuner och landsting, staten, pensionärsorganisationer och alla som är intresserade av en god omvårdnad för äldre personer. Broschyren har utarbetats på uppdrag av Svensk sjuksköterskeförening av styrelseledamöterna: Anna Ehrenberg, leg sjuksköterska, professor Per Enarsson, leg sjuksköterska, doktor i omvårdnad Helle Wijk, leg sjuksköterska, docent i omvårdnad Ett varmt tack till Anna Condelius, leg sjuksköterska, doktor i medicinsk vetenskap, som författat avsnittet: Äldres överkonsumtion av vård och omsorg – en myt

The Swedish P-CAT: modification and exploration of psychometric properties of two different versions

The aim of this study was to further investigate the psychometric properties (with focus on construct validity and scale function) of the Swedish version of the Person-centred Care Assessment Tool (P-CAT) in a sample consisting of staff working in elderly care units (N = 142). The aim was also to further develop and psychometrically test a modified, noncontext-specific version of the instrument (mP-CAT) in a sample consisting of staff working in primary health care or within home care for older people (N = 182). Principal component analysis with varimax rotation initially suggested a three-factor solution for the P-CAT, explaining 55.96% of variance. Item 13 solely represented one factor wherefore this solution was rejected. A final 2-factor solution, without item 13, had a cumulative explained variance of 50.03%. All communalities were satisfactory (>0.3), and alpha values for both first factor (items 1-6, 11) and second factor (items 7-10, 12) were found to be acceptable. Principal component analysis with varimax rotation suggested a final 2-factor solution for the mP-CAT explaining 46.15% of the total variance with communalities ranging from 0.263 to 0.712. Cronbach's alpha for both factors was found to be acceptable (>0.7). This study suggests a 2-factor structure for the P-CAT and an exclusion of item 13. The results indicated that the modified noncontext-specific version, mP-CAT, seems to be a valid measure. Further psychometric testing of the mP-CAT is however needed in order to establish the instrument's validity and reliability in various contexts