COVID-19 related visiting ban in nursing homes as a source of concern for residents’ family members: a cross sectional study

Abstract Background: Visiting a close relative who resides in a nursing home is an opportunity for family members to extend their caring roles and to find reassurance that the older person’s life is continuing as well as possible. At the same time, visits allow family members to observe the quality of formal care in the facility. In Finland, the COVID-19 pandemic led to the imposition of visiting bans in nursing homes in March 2020, thereby preventing customary interaction between residents and their family members. The aim of this study is to investigate family members’ experiences of the visiting ban and its effects on the concern they experienced over the wellbeing of close relatives living in a nursing home. Methods: A cross-sectional study was carried out to explore self-reported concerns of family members and factors associated with the concerns. In this unpredictable pandemic situation this was considered to be an appropriate approach, for information in the very beginning of the visiting ban was looked for, and interest was not in causal relations. The data consist of a quantitative survey (n=366) conducted among family members in May-June 2020. Binary logistic regression analyses were carried out to explore the association of the independent variables with reported concern. Results: The results showed that increased concern was very common (79%). The factors associated with the notable increase were sufficiency of contact and information, noticing changes in wellbeing of the close one, and questioning whether the visiting restriction was the right solution. Conclusions: In light of the findings, care providers should improve their information delivery to residents’ family members, and to find new ways of allowing visits in nursing homes in the future, at all circumstances.Peer reviewe

Foot-related diabetes complications : care pathways, patient profiles and costs

Publisher Copyright: © 2022, The Author(s).Background: Foot-related diabetes complications reduce individual well-being, increase mortality and results in increased healthcare costs. Despite their notable stress on health services, studies examining the foot complication care pathways, especially from the viewpoint of health services, are limited. We aimed to identify the most typical care pathways following an initial foot-related diabetes complication, to characterize the patients on each pathway and calculate the related healthcare costs. Methods: The identification of pathways was based on population-wide register-based data including all persons diagnosed with diabetes in Finland from 1964 to 2017. For each patient, initial foot-related complication from 2011–2016 was identified using the ICD-10 codes and related healthcare episodes were followed for two years until the end of 2017 or death. A sequence analysis was conducted on care episodes resulting in groups of typical care pathways, as well as their patient profiles. The costs of pathways resulting from the care episodes were calculated based on the data and the reported national unit costs and analyzed using linear models. Results: We identified six groups of typical pathways each comprising mainly single type of care episodes. Three of the groups comprised over 10 000 patients while the remaining groups ranged from a few hundred to a few thousand. Majority of pathways consisted only single care episode. However, among the rest of the care pathways variability in length of care pathways was observed between and within group of pathways. On average, the patients were over 65 years of age and were diagnosed with diabetes for over a decade. The pathways resulted in an annual cost of EUR 13 million. The mean costs were nearly 20-fold higher in the group with the highest costs (EUR 11 917) compared to the group with the lowest costs (EUR 609). Conclusions: We identified groups of typical care pathways for diabetic foot and discovered notable heterogeneity in the resource use within the groups. This information is valuable in guiding the development of diabetes care to meet the growing need. Nevertheless, reasons underlying the observed heterogeneity requires further examination. Since foot complications are largely preventable, substantial savings could be achieved using cost-effective technologies and more efficient organization of care.Peer reviewe

COVID-19 related visiting ban in nursing homes as a source of concern for residents' family members : a cross sectional study

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Ikääntyneiden kuolinpaikat Suomessa ja Norjassa

Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.Peer reviewe

Study protocol of a mixed method pragmatic quasi-experimental trial to evaluate the day activity services targeted at older home care clients in Finland

Background: In Finland, the ‘day activity service’ is targeted at older home care clients who are unable to participate in other available activities due to poor health or functional disabilities. The aim of the day activity service is to support home care client’s ability to live at home and to enhance their wellbeing and social inclusion. This mixed method study examines the effectiveness, cost-effectiveness and process of the day activity service. Methods: The target sample size is 200 participants. The intervention group (n = 100) is composed of home care clients who begin to participate in the day activity service. The comparison group (n = 100) are home care clients who do not participate in the day activity service, and whose functioning and care needs are similar to the participants of the intervention group. The primary outcome is social inclusion (ESIS-scale). Secondary outcomes are loneliness (single item and De Jong Gierveld Loneliness Scale) and social care related quality of life (ASCOT). Baseline, three-month and six-month follow-up surveys are gathered from intervention and comparison group participants in order to compare outcomes between groups pre- and post-intervention. Costs of health and social services, based on administrative data, and the costs of the intervention are utilized in examining the cost-effectiveness of the intervention with the above-described measurements. Qualitative data are collected by interviewing the intervention participants (n = 10) and professionals working at the day activity centres and older people’s services (4 focus groups) to explore the perceived outcomes and process of the intervention to find out how and why the intervention is effective or ineffective. Discussion: The study seeks to produce a comprehensive understanding of the effectiveness, cost-effectiveness and implementation process of the day activity service. Trial registration: ISRCTN13146087, Registration date 03/04/2022

Comorbidities in dementia during the last years of life : a register study of patterns and time differences in Finland

Background Comorbidities have major implications for the care of people with dementia. Aim To investigate the patterns of comorbidities in dementia in the last five years of life and how these patterns differed between three cohorts. Methods The study included people who died at age 70 and above in 2001 (n = 13,717), 2007 (n = 34,750) and 2013 (n = 38,087) in Finland. ICD-10 morbidity data for a five-year period prior to death were extracted from national registers. Principal component analysis was employed to identify patterns for several morbidities. The associations of principal component scores with dementia were analysed using binary logistic regression. Linear regression was used to examine changes in the number of morbidities in patterns over time. Results The morbidity patterns identified in the last years of life were (1) cardiometabolic disorders, (2) neurological, (3) cerebrovascular diseases and (4) musculoskeletal, thyroid and psychiatric disorders. Among the patterns, neurological and musculoskeletal, thyroid and psychiatric disorders were associated with dementia. The number of diagnoses in the cerebrovascular pattern increased and those in the musculoskeletal, thyroid and psychiatric pattern decreased over time. Discussion Comorbidity patterns identified in this nationwide register study are largely in line with previous evidence. Time difference in these patterns provide crucial information for service planning. Conclusions Comorbidities in dementia in the last years of life occur in patterns and change over time. More systematic monitoring and updated clinical guidelines are needed for the care of comorbidities with dementia.Peer reviewe

Need and utilization of primary health care among long-term unemployed Finns

Introduction: Aim of this paper was to identify the attributes of primary health care utilization among long-term unemployed Finns, and to examine whether access to care and the choice of provider differ with respect to employment status. Methods: Data on primary health care utilization were derived from two sources; a targeted questionnaire about the use of services and quality of life among long-term unemployed individuals, and the Welfare and Services in Finland Survey, covering the general population. A two-part econometric model was applied in order to separate between the probability and level of utilization. The statistical analysis allowed predicting the monetary costs of primary care utilization. In this context, a non-parametric smearing factor was used to adjust for retransformation bias. In addition, a distinction between the level of costs and number of visits was taken to account for the effect of unit cost variation. Results: The analyses indicated that the utilization of primary health care services among the long-term unemployed varied with respect to gender, self-rated health status and economic situation, place of residence, marital status and duration of unemployment. The scope of analysis was shown to be fundamental for the interpretation of the comparative results. Taking into account the provision of occupational care services inverted the positive effect of long-term unemployment on primary care utilization. Further, while the costs of utilization were independent of employment status, long-term unemployment had a distinct reducing effect on the number of medical visits. Discussion and Conclusion: Despite of greater health care needs, the long-term unemployed sought less visits to more costly public primary care services. In order to confront unmet health care needs among the long-term unemployed, public sector interventions should be targeted accordingly, and in particular, involve gender specific social marketing measures