Associations between nurse–patient interaction and loneliness among cognitively intact nursing home residents – a questionnaire survey

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Loneliness Among Cognitively Intact Residents of Nursing Homes With and Without Cancer: A 6-Year Longitudinal Study

Limited information exists regarding the natural development of loneliness and its determinants among cognitively intact nursing home residents. We aimed to examine loneliness among nursing home residents by following up for 6 years and to determine whether sociodemographic factors, diagnosis of cancer, sense of coherence, social support, and depression symptoms influence loneliness. The study was longitudinal and prospective and included baseline assessment and 6-year follow-up. After baseline assessment of 227 cognitively intact nursing home residents (Clinical Dementia Rating score ≤0.5), 52 respondents were interviewed a second time at the 5-year follow-up and 18 respondents a third time at the 6-year follow-up. Data from the interviews were recorded using a global question of loneliness, the Social Provisions Scale, Sense of Coherence Scale, and Geriatric Depression Scale. Scores on Groll’s index (p = .02) and the Sense of Coherence Scale (p = .04) were positively correlated with loneliness and negatively correlated with geriatric depression (p = .001). Having a diagnosis of cancer, social support, and age were not correlated with loneliness 6 years from baseline. Loneliness did not change during the 6 years of follow-up, and symptoms of depression and the sense of coherence appeared to be important components of loneliness. Finally, having a diagnosis of cancer and social support were not associated with loneliness.publishedVersio

Eldre med kreft som bor hjemme

Bakgrunn: Utviklingen i Norge og andre europeiske land viser at andelen eldre øker og andelen som dør av kreft øker. Flere krefttilfeller utløser større behov for behandling og pleie. Kunnskap og kompetanse i kreftomsorg er avgjørende for hvordan eldre med kreft ivaretas. Artikkelens hensikt er å presentere utfordringer og praktiske problemstillinger når det gjelder ivaretakelsen av eldre med kreft som bor hjemme. Metode: Grounded theory var brukt for å samle og analysere data fra feltarbeid og intervju med 11 sykepleiere og 3 kreft sykepleiere i hjemmesykepleien i to mindre kommuner. Resultat: «Å skreddersy behandling og pleie til eldre med kreft» betegner prosessen sykepleierne står i når de ivaretar eldre med kreft som bor hjemme. Dette innebar samordning i tjenesten, kliniske tiltak i praksis, kroppslig og psykososial omsorg, tilrettelegging i hjemmet, ivaretakelse og opplæring av pårørende. Konklusjon: Det er av stor betydning å få til godt samarbeid med annet helsepersonell for å få til en samordning i tjenesten og å styrke arbeidet med å heve kompetansen blant ansatte. Videre forskning er nødvendig for å få kunnskap om hvordan eldre pasienter med kreft opplever sin situasjon og pårørendes erfaringer.Background: The development in Norway and other european countries show that the amount of elderly with cancer is increasing, and the amount of elderly dying of cancer is increasing. More cancer cases release more needs for treatment and care. Knowledge and competence in the cancer care is crucial for how the elderly with cancer are treated. The aim of the article is to present challenges and practical problems when it comes to taking care of elderly with cancer living at home. Method: Grounded theory was used to gather and analyze data from the fieldwork and interviews with 11 nurses and 3 cancer nurses in the home care service in two smaller municipalities. Result: «To tailor treatment and care to elderly with cancer» indicates the process the nurses are standing in when they are taking care of elderly with cancer living at home. This involved cooperation in the service, clinical measures in practice, somatic and psycho-social care, arranging in the home, caring for and teaching of the next of kin. Conclusion: It is of great meaning to manage a good cooperation with other health personell in order to acchieve cooperation within the service, and to strengthen the work by increasing the competence among the employees. Further research is necessary to get knowledge on how older patients with cancer experience their situation, and the next of kin›s experiences.publishedVersio

Health and quality of life after discharge from hospital: A prospective study on opioid treatment for acute pain after trauma or surgery

Objectives: The aim of this study was to examine opioid use, health, quality of life, and pain after discharge from hospital in opioid naïve patients receiving opioid treatment for sub acute pain after trauma or surgery. Methods: A prospective cohort with a four-week follow-up was conducted. Of the 62 patients included, 58 remained in the follow-up. The following questionnaires were assessed: Numeric Rating Scale for pain (NRS), EQ-5D-5L (health-related quality of life) and EQ-VAS (self-reported health). Paired t-test, two-sample t-test and chi square test were used in the study. Results: Every fourth participant still received opioid treatment at follow-up, and reported no significant increase in EQ-VAS. Overall, an improvement in EQ-5D-5L (0.569 (SD = 0.233) to 0.694 (SD = 0.152), p < 0.001) and EQ-VAS (55 (SD = 20) to 63 (SD = 18), p = 0.001) from baseline to follow-up was found. Pain intensity decreased in the same period (6.4 (SD = 2.2) to 3.5 (SD = 2.6), p < 0.001). An unmet need for information regarding pain management was reported by 32% of the participants. Conclusions: Our findings show that patients with acute pain, treated with opioids, reported improved pain intensity, health-related quality of life and self-reported health four weeks after discharge. There is room for improvement regarding the provision of patient information on pain management.publishedVersio

Quality of life in home-dwelling cancer patients aged 80 years and older: a systematic review

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the dataObjective: Quality of Life (QoL) in elderly cancer patients is a topic that has been little explored. This systematic review aims to identify, assess, and report the literature on QoL in home-dwelling cancer patients aged 80 years and older and what QoL instruments have been used. Methods: We systematically searched the databases of Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsykINFO, Scopus, Epistemonikos and Cinahl to identify studies of any design measuring QoL among home-dwelling cancer patients aged 80 years and older. We screened the titles and abstracts according to a predefned set of inclusion criteria. Data were systematically extracted into a predesigned data charting form, and descriptively analyzed. The included studies were assessed according to the Critical Appraisal Skills Programme (CASP) checklists, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) checklist was used to ensure rigor in conducting our investigations and reporting our fndings. This systematic review was registered in PROSPERO (CRD42021240170). Results: We included three studies that specifcally analyze QoL outcomes in the subgroup of home-dwelling cancer patients aged 80 years and older, with a total of 833 participants having various cancer diagnoses. 193 of the participants included in these three studies were aged 80 years or more. Diferent generic and cancer-specifc QoL instruments as well as diferent aims and outcomes were studied. All three studies used a diagnosis-specifc instrument, but none of them used an age-specifc instrument. Despite heterogeneity in cancer diagnoses, instruments used, and outcomes studied, QoL in home-dwelling cancer patients aged over 80 years old seems to be correlated with age, physical function, comorbidity, living alone, needing at-home care services, being in a poor fnancial situation and having a small social network. Conclusion: Our systematic review revealed only three studies exploring QoL and its determinants in the specifc subgroup of home-dwelling cancer patients aged 80 years and over. A gap in the knowledge base has been identifed. Future studies of this increasingly important and challenging patient group must be emphasized. Subgroup analyses by age must be performed, and valid age and diagnosis specifc QoL instruments must be used to generate evidence in this segment of the population.publishedVersio

In the borderland of the body: How home-dwelling older people experience frailty

Rationale The increasing number of frail home-dwelling older people has sharpened the focus on discovering and implementing suitable treatment and care in clinical practice, aiming to prevent loss of physical functioning and preserve their autonomy and well-being. People's embodied experiences may yield rich descriptions to help to understand frailty. Thoroughly understanding older people's individual perceptions is especially relevant because the numbers of home-dwelling older people are increasing, and people tend to develop more health problems and become frailer as they age. Their perspectives are important to develop knowledge and high-quality care. Aim To explore the lived experiences of frail home-dwelling older people. Methods We conducted a phenomenological study to obtain in-depth descriptions of the phenomenon. We interviewed 10 home-dwelling older adults (seven women and three men, 72–90 years old) in depth about their lived experience of frailty. We analysed the data using a hermeneutic phenomenological approach described by van Manen. Findings The lived experience of frailty is described in one essential theme: frailty as being in the borderland of the body, including three interrelated subthemes: (1) the body shuts down; (2) living on the edge; and (3) not giving up. Conclusions Our study gives insight into lived experiences with frailty among home-dwelling older people related to their own body. Older people's experience of meaningful activities strengthened their feeling of being themselves, despite their frail and deteriorating body. Healthcare providers must consider the strategies of frail older people to consider both their vulnerabilities and self-perceived strengths. The resources and deficits of frail older people present in the state of being frail need to be recognised.publishedVersio

Dimensions and predictors of disability-A baseline study of patients entering somatic rehabilitation in secondary care

Purpose: The purpose of this study was to investigate disability among patients who were accepted for admission to a Norwegian rehabilitation center and to identify predictors of disability. Materials and methods: In a cross-sectional study including 967 adult participants, the World Health Organization Disability Assessment Schedule version 2.0 36-item version was used for assessing overall and domain-specific disability as outcome variables. Patients completed the Hospital Anxiety and Depression Scale (HADS), EuroQoL EQ-5D-5L and questions about multi-morbidity, smoking and perceived physical fitness. Additionally, the main health condition, sociodemographic and environmental variables obtained from referrals and public registers were used as predictor variables. Descriptive statistics and linear regression analyses were performed. Results: The mean (standard error) overall disability score was 30.0 (0.5), domain scores ranged from 11.9 to 44.7. Neurological diseases, multi-morbidity, low education, impaired physical fitness, pain, and higher HADS depressive score increased the overall disability score. A low HADS depressive score predicted a lower disability score in all domains. Conclusions: A moderate overall disability score was found among patients accepted for admission to a rehabilitation center but “life activities” and “participation in society” had the highest domain scores. This should be taken into account when rehabilitation strategies are developed.publishedVersio

Carrying on life at home or moving to a nursing home: frail older people’s experiences of at-homeness

Aims and objectives The aim was to explore frail older people’s lived experiences of managing life at home on the verge of moving to a nursing home. Background As people age, their reserve capacity decreases, increasingthe risk of morbidity and frailty.. The experience of frailty extends beyond declining health and physical well-being and encompasses various dimensions, including familiarity with both the place and the people around. Design A phenomenological study. Methods We interviewed ten frail people aged 72–90 years in-depth in their homes. We used phenomenological hermeneutical analysis inspired by van Manen and followed the COREQ checklist. Results We identified three main themes: (1) being home with cherished people and possessions, (2) giving the nursing home a go and (3) attuning to the natural rhythms. Conclusions Our study gives insight into the lived experiences with frailty related to at-homeness. The experience of being lost in transition represents a uniquely significant experience for frail older people, foregrounding existential issues and carrying the potential of at-homeness.publishedVersio

Despite symptom severity, do nursing home residents experience joy-of-life? The associations between joy-of-life and symptom severity in Norwegian nursing home residents

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