How to assess frailty and the need for care? Report from the Study of Health and Drugs in the Elderly (SHADES) in community dwellings in Sweden

Knowledge about the need for care of elderly individuals in community dwellings and the factors affecting their needs and support is limited. The aim of this study was to characterize the frailty of a population of elderly individuals living in community dwellings in Sweden in relation to co-morbidity, use of drugs, and risk of severe conditions such as malnutrition, pressure ulcers, and falls. In 2008, 315 elderly individuals living in community dwellings were interviewed and examined as part of the SHADES-study. The elderly demonstrated co-morbidity (a mean of three diseases) and polypharmacy (an average of seven drugs). More than half the sample was at risk for malnutrition, one third was at risk for developing pressure ulcers, and nearly all (93%) had an increased risk of falling and a great majority had cognitive problems. Age, pulse pressure, body mass index, and specific items from the modified Norton scale (MNS), the Downton fall risk index (DFRI), and the mini nutritional assessment (MNA-SF) were related to different outcomes, defining the need for care and frailty. Based on the results of this study, we suggest a single set of items useful for understanding the need for care and to improve individual based care in community dwellings. (C) 2010 Elsevier Ireland Ltd. All rights reserved

Changes in Community Mobility in Older Men and Women. A 13-Year Prospective Study

Community mobility, defined as “moving [ones] self in the community and using public or private transportation”, has a unique ability to promote older peoples’ wellbeing by enabling independence and access to activity arenas for interaction with others. Early predictors of decreased community mobility among older men and women are useful in developing health promoting strategies. However, long-term prediction is rare, especially when it comes to including both public and private transportation. The present study describes factors associated with community mobility and decreased community mobility over time among older men and women. In total, 119 men and 147 women responded to a questionnaire in 1994 and 2007. Respondents were between 82 and 96 years old at follow-up. After 13 years, 40% of men and 43% of women had decreased community mobility, but 47% of men and 45% of women still experienced some independent community mobility. Cross-sectional independent community mobility among men was associated with higher ratings of subjective health, reporting no depression and more involvement in sport activities. Among women, cross-sectional independent community mobility was associated with better subjective health and doing more instrumental activities of daily living outside the home. Lower subjective health predicted decreased community mobility for both men and women, whereas self-reported health conditions did not. Consequently, general policies and individual interventions aiming to improve community mobility should consider older persons’ subjective health

Care Trajectories in the Oldest Old

This thesis demonstrates relations among health, social network, ADL and patterns of care in the oldest old guided by a resource theoretical model. The analyzed data are based on two studies: the Nona study, a longitudinal study of 157 individuals aged 86 to 94 years, and the H70 study, a longitudinal study of 964 individuals aged 70 at baseline. Data were collected by interviews and to some extent in the H70 study, medical exams and medical records. The results demonstrate that perceived resources seem to affect patterns of care to a higher extent than the more objective resources in the sample of the oldest old. On the other hand, sociodemographic variables such as gender, marital status and SES, in addition to the more objective resources of having children nearby and the number of symptoms of illness predicted institutionalization during a subsequent 30-year period from the age of 70. The proportion of elderly persons’ institutionalization was further significantly higher than that generally found in cross-sectional studies. ADL was one of the strongest predictors for both use of formal care and institutionalization in both samples, indicating an effective targeting of the formal care system in Sweden. The care at end of life in the oldest old is challenged by the problems with progressive declines in ADL and health, which makes it hard to fit in the dying oldest old in the palliative care system. There is a need to increase the knowledge and the possibility for care staff to support and encourage social network factors and for decision-making staff to consider factors beyond ADL

The Super-Male and the Super-Female : Gender Criticism in Watchmen

This essay aims to analyze if the graphic novel Watchmen criticizes the conventions of the superhero comic genre in regards to gender. The literary theory applied is gender studies. The essay examines the visual portrayal of male and female characters, as well as the male-dominated narrative. The novel does, to some extent, satirize the genre conventions. This can be seen in the hyperbolic visual portrayals of the characters, as well as the comments made on them. However, as there is a lack of self-aware criticism, the novel could not be considered as a satire of the visual representation of genders within the genre, but rather a reinforcement of them. Furthermore, the male-dominated narrative is present in Watchmen, and Laurie could be seen as satirizing this genre convention, as she is a hyperbolic interpretation of the girlfriend archetype. However, there is little change or self-aware critique against the genre norms here as well, thus it cannot be considered satire. Laurie does, however, show criticism of the violence against women within the genre by making a number of comments on the attempted rape of her mother. This may not be satire but she does provide commentary of this trope. In conclusion, while there are instances of criticism, the novel as a whole cannot be considered satire of the superhero genre

Projekt uppsökande verksamhet avseende äldre sammanboendes behov av anhörigstöd 2014-2015.

Jönköpings kommun har i många år arbetat aktivt med anhörigstöd och ser ständigt ett behov av utveckling. Syftet med detta projekt var att öka kunskapen hos kommunens äldre medborgare om rätten till anhörigstöd samt erbjuda ett individanpassat stöd om behov och önskemål finns. Ett delsyfte var också att undersöka om män och kvinnor upplevde olika behov av stöd. Efter en identifiering av målgruppen genomfördes 150 hembesök, och 299 intervjuer, för att ge information och för att efterfråga hur de allra äldsta klarar sin vardag och om det fanns behov av stöd och omsorg från kommunen. Projektet visade att en majoritet av de allra äldsta sammanboende klarar sin vardag självständigt, ibland genom att stötta varandra. Det fanns också en stark önskan om att fortsätta vara självständig samtidigt som informationen om anhörigstöd och kommunens äldre-omsorg var högt uppskattat. De flesta deltagarna uttryckte en ökad trygghet i att nu ha kännedom om vart de kan vända sig. Projektet har varit uppskattat och ett flertal anhöriga som stödjer en närstående har identifierats. Ett flertal av dessa anhöriga har nu en kontaktperson i anhörigstödsteamet och valt att delta i anhörigstödets verksamhet. Det stöd som deltagarna efterfrågar liknar mycket det stöd som redan finns tillgängligt i kommunen, vilket antyder att det inte krävs utveckling av nya former, utan snarare utveckling av befintliga

Mer Än en Språngbräda? : En Studie av Serier och Serieromaner som Multimodala Lärarmaterial i Engelskakurser i Gymnasie- och Högstadieskolor i Sverige

The aim of this study is to examine upper and lower secondary school teachers’ experiences of using graphic novels in the English subject in Swedish schools in order to discuss if, and how, multimodal texts can be used to increase students’ motivation to read and analyze fictional texts. This is done through qualitative semi-structured interviews with 12 participants currently working as English teachers from both upper and lower secondary schools in Sweden. The framework of this study centers around the concept of multimodality, multimodal literacy and how it can be used in the English classroom. The results of the study indicate that comics and graphic novels can and are being used for a number of purposes in English language courses in Sweden, and that they allow teachers to incorporate visual analysis into their literature modules, adding more elements for students to discuss and work with. Furthermore, the participants experience that comics and graphic novels aid in increasing students’ motivation and interest as the multimodality makes them more accessible. The results of the study also show that comics and graphic novels could be used to teach students about literary analysis, both visual and verbal. However, in order to utilize the multimodality of comics and graphic novels, teachers require an understanding for how two modalities can be used together to create meaning. Moreover, the study shows that comics and graphic novels are viewed as a lesser form of fictional texts, as they are mostly seen as motivational supplements or a stepping-stone toward other types of novels. In conclusion, there are numerous benefits to using comics or graphic novels in EFL courses, such as an increase in motivation and additional visual/multimodal aspects for students to analyze when working with fictional texts

United against the fire : An analysis of fire laws from Sweden's time of great power

The 17th century saw a time of great power for Sweden, in some cases called the Swedish empire. This period in Sweden is known as a time where Sweden’s government and state organization became more structuralized. One of the many elements that contributed to this was the process of centralization where more matters were handled by the central government and many laws were standardized throughout the nation. This essay looks at this process through some of the local fire law documents that were written during this time in order to establish a more effective fire prevention system. The aim of the essay thus becomes to analyze these documents to see whether or not they share similarities enough to showcase a centralization process. The key theoretical terms in the essay are organization, participation, central, local, private and public. The last three of these terms will be used partially to analyze how the division of responsibility worked in these laws as this time also saw development in the differentiation of what is public and private respectively. The documents were compared with each other to see whether or not they shared similarities as well as if there was any development in them between the older and newer ones. The conclusion was that the documents do prove that a certain development can be seen. The fire departments organization became much clearer in the later editions of the documents. Centralization can also be seen to a certain extent as some of the laws that came out of Stockholm started appearing in other cities documents as well. Some cities chose to have a different format but still applied some of the same laws as the capital. As a whole, however, there is no evidence to suggest a complete centralization of fire prevention in early modern Sweden. Responsibility did prove to be somewhat equally shared between the population and public officials such as the local fire department

Uppföljning av hemsjukvården i kommunerna i Jönköpings län

Inför den kommande kommunaliseringen av hemsjukvården i Jönköpings län genomfördes en bred och fördjupad baslinjemätning. År 2014 genomfördes en fördjupad uppföljning med syfte att undersöka hur vård och omsorg till de personer som är inskrivna i hemsjukvård fungerar efter kommunaliseringen av hemsjukvården i kommunerna i Region Jönköpings län. Resultaten från uppföljningen visar att hemsjukvården utför ett omfattande arbete med vård och rehabilitering i hemmet och ett arbete som är svårt att fånga med enkla indikatorer. Det bör också noteras att, även om ambitionen med uppföljningen var att göra direkta jämförelser mellan år 2012 (före skatteväxlingen) och år 2014 (efter skatteväxlingen), så visade det sig vara mycket svårt inom flera områden. Detta på grund av att de olika systemen för inhämtning av data skiljer sig väsentligt åt sedan skatteväxlingen, men också på grund av svårigheter med tolkningar och definitioner av vissa begrepp, som till exempel vem som är hemsjukvårdspatient. Sammantaget går det emellertid att urskilja vissa tydliga förändringar, såsom förbättrad samverkan mellan hemsjukvård och hemtjänst, ökad rehabilitering och aktivitetshöjande insatser, försämrad informationsöverföring och samverkan mellan hemsjukvård, vårdcentraler och slutenvård. Resultaten antyder fyra större områden med förbättringspotential: 1) Rutiner för inskrivning av hemsjukvårdspatienter; 2) Samverkan och informationsöverföring mellan hemsjukvård, vårdcentraler och slutenvård, 3) Kompetensutveckling för personal i hemsjukvården, samt 4) Patienternas delaktighet i planering av insatser av hemsjukvården. Dessa områden är också identifierade nationellt som förbättringsområden och det pågår också, nationellt och regionalt, projekt och arbete för att hitta lösningar för en bättre fungerade hemsjukvård