The Experience of Active Wheelchair Provision and Aspects of Importance Concerning the Wheelchair Among Experienced Users in Sweden

This qualitative study describes the experience of active ultra lightweight rigid frame wheelchairs (active wheelchairs) provision. Eleven interviews with experienced users showed that the wheelchair should support physical as well as social functioning, but that users experienced injustice and unfairness when negotiating their wheelchair needs and felt insecure within the system. Changes of attitudes and organization are suggested

Discovery and characterisation of dietary patterns in two Nordic countries. Using non-supervised and supervised multivariate statistical techniques to analyse dietary survey data

This Nordic study encompasses multivariate data analysis (MDA) of preschool Danish as well as pre- and elementary school Swedish consumers. Contrary to other counterparts the study incorporates two separate MDA varieties - Pattern discovery (PD) and predictive modelling (PM). PD, i.e. hierarchical cluster analysis (HCA) and factor analysis (using PCA), helped identifying distinct consumer aggregations and relationships across food groups, respectively, whereas PM enabled the disclosure of deeply entrenched associations. 17 clusters - here defined as dietary prototypes - were identified by means of HCA in the entire bi-national data set. These prototypes underwent further processing, which disclosed several intriguing consumption data relationships: Striking disparity between consumption patterns of Danish and Swedish preschool children was unveiled and further dissected by PM. Two prudent and mutually similar dietary prototypes appeared among each of two Swedish elementary school children data subsets. Dietary prototypes rich in sweetened soft beverages appeared among Danish and Swedish children alike. The results suggest prototype-specific risk assessment and study design

Being in want of control: Experiences of being on the road to, and making, a suicide attempt

Attempted suicide is a risk factor for future suicidal behaviour, but understanding suicidality from the perspective of people who have experienced attempted suicide is limited. The aim of the study was to explore the lived experience of being suicidal and having made a suicide attempt, in order to identify possible implications for health care professionals. Semi-structured individual interviews were held with 10 persons shortly after they attempted suicide and were analysed through qualitative content analysis. The participants’ experience of being suicidal and of having attempted suicide could be described as “Being on the road towards suicidal action”, which culminated in an experience of either chaos or turned off emotions, “Making sense of the suicide attempt”, and “Opening the door to possible life lines”. An overall theme, “Being in want of control”, captured their all-embracing lack of sense of control and was seen in relation to different aspects of oneself, overall life-situation, the immediate suicide attempt situation and in the outlook on the future. Being in want of control may be a relevant and general feature of being suicidal. People who have attempted suicide need more adequate help to break vicious circles before they reach a point of no return and enter an acute suicidal state of mind. Patients’ experience-based knowledge is highly important to listen to and use clinically as well as theoretically when constructing suicide prevention programs

Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home

Background The very old (80+) are often described as a "frail" group that is particularly exposed to diseases and functional disability. They are at great risk of losing the ability to manage their activities of daily living independently. A health-promoting intervention programme might prevent or delay dependence in activities of daily life and the development of functional decline. Studies have shown that those who benefit most from a health-promoting and disease-preventive programme are persons with no, or discrete, activity restrictions. The three-armed study "Elderly in the risk zone" is designed to evaluate if multi-dimensional and multi-professional educational senior meetings are more effective than preventive home visits, and if it is possible to prevent or delay deterioration if an intervention is made when the persons are not so frail. In this paper the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants are presented. Methods/Design The study is a randomised three-armed single-blind controlled trial with follow-ups 3 months, 1 and 2 years. The study group should comprise a representative sample of pre-frail 80-year old persons still living at home in two municipalities of Gothenburg. To allow for drop-outs, it was estimated that a total of about 450 persons would need to be included in the study. The participants should live in their ordinary housing and not be dependent on the municipal home help service or care. Further, they should be independent of help from another person in activities of daily living and be cognitively intact, having a score of 25 or higher as assessed with the Mini Mental State Examination (MMSE). Discussion We believe that the design of the study, the randomisation procedure, outcome measurements and the study protocol meetings should ensure the quality of the study. Furthermore, the multi-dimensionality of the intervention, the involvement of both the professionals and the senior citizens in the planning of the intervention should have the potential to effectively target the heterogeneous needs of the elderly. Trial registration ClinicalTrials.gov, NCT0087705

Living with persistent pain: experiences of older people receiving home care.

Background. Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge. Aim. To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain. Methods. Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis. Findings. Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living. Conclusion. This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain

The nurse-patient encounter and the patients' state: Effects of individual care and clinical group supervision in dementia care.

The aim of thesis was to investigate the nurse-patient encounter in dementia care (n=9 patients), functional and cognitive ability, behaviours and mood of the patients as well as the reliability of the instruments used (n=75 nursing home patients). A further aim was to investigate the effects on the aspects mentioned above of a one-year controlled intervention (individually planned care and clinical group supervision) on one ward (EW) in comparison to a control ward (CW), each housing 11 patients. The nurse-patient encounter was studied by means of tape recorded interaction episodes including patients' regarded as vocally demanding. The inter-rater reliability of the Patient Mood Assessment Scale (PMAS), the General Behaviour Assessment Scale (GBAS), the Gottfries-Bråne-Steen Scale and the patients' state were investigated using nurses' assessments of the patients. The intervention effects were investigated at baseline and throughout the year, for the patients' state using PMAS, GBAS, Organic Brain Syndrome scale, Multi Dimensional Dementia Assessment Scale, Demanding Behaviour Assessment Scale and Mini Mental State Examination, and for the nurse-patient encounter using non-participant observations during morning care and analysis of notes from clinical supervision sessions. Patients actively seeking contact and nurses mediating "caring about", i.e. mutuality and confirming actions, characterised high quality encounters. Nurses' or patients' withdrawal, nurses being inattentive i.e. unilaterality and disconfirming actions, characterised poor quality encounters. The inter-rater reliability of the nurses' assessments of patients' state was acceptable for ADL and intellectual functions but low for emotional dimensions. Significant improvements were seen on the EW for nurse-patient encounters, patients' sensitivity and demanding behaviours while significant detoriations were seen on CW in nurse-patient encounters, patients' functional performance and orientation in the ward, speech performance and strength. Thus the nurse-patient encounters and the patients' state developed in opposite directions on the two wards, positively on the EW and seemingly the intervention supported the nurses in their encounters with the patients, which in turn was reflected in the patients' state

Older non-Nordic immigrants´ care from community and family in Southern Sweden. 18th World Congress of Gerontology, Rio de Janeiro

Posterpresentation

Prioritization and resource allocation in health care. The views of older people receiving continuous public care and service.

Objective To describe the views of people, 65 years and over, receiving continuous public care and service, on prioritization and resource allocation in health care, in relation to gender, age, housing, health-related quality of life (QoL) and degree of activities of daily living (ADL) dependency. Background How older people receiving continuous public care and service view prioritization and resource allocation in health care is sparsely investigated, although this group most certainly has the experience and also often is the target in discussions concerning prioritization. It is necessary, for democracy and for the development of new models of service delivery, to find out how people receiving long-term care and service view these issues. Design 146 persons, 34 men (23%) and 112 women (77%), aged 66–100 years were interviewed face to face, following a structured questionnaire. Results The respondents thought that the patients’ well-being, way of living and family situation should affect prioritization, not age per se. Resourcing of several health-care services were considered to be below what is required by a majority of the respondents. The respondents wanted doctors to decide on prioritization at an individual level and wanted higher taxes to finance increasing health-care costs. Although the respondents wanted publicly financed health care, a relatively high number were willing to pay for treatment. Conclusions Knowledge of how older people receiving care and services, view prioritization and resource allocation has not previously been available. It seems that their views are in line with the Swedish Parliamentary Priority Commission which suggested that no account should be taken of age when allocating resources within the health-care system. Respondents’ age, gender, housing, health-related QoL and degree of dependency in ADL had limited influence on their views of resource allocation