The quality of the physical environment and its association with activities and well-being among older people in residential care facilities

The physical environment can influence older people’s health and well-being, and is often mentioned as being an important factor for person-centred care. Due to high levels of frail health, many older people spend a majority of their time within care facilities and depend on the physical environment for support in their daily life. However, the quality of the physical environment is rarely evaluated, and knowledge is sparse in terms of how well the environment meets the needs of older people. This is partly due to the lack of valid and reliable instruments that could provide important information on environmental quality. Aim: The aim of this thesis was to study the quality of the physical environment in Swedish care facilities for older people, and how it relates to residents’ activities and well-being. Methods: The thesis comprises four papers where both qualitative and quantitative methods were used. Study I involved the translation and adaptation of the Sheffield Care Environment Assessment Matrix (SCEAM) into a Swedish version (S-SCEAM). Several methods were used including forward and backward translation, test of validity via expert consultation and reliability tests. In Study II, S-SCEAM was used to assess the quality of the environment, and descriptive data were collected from 20 purposively sampled residential care facilities (RCFs). Study III was a comparative case study conducted at two RCFs using observations, interviews and S-SCEAM to examine how the physical environment relates to older people’s activities and interactions. In study IV, multilevel modeling was used to determine the association between the quality of the physical environment and the psychological and social well-being of older people living in RCFs. The data in the thesis were analysed using qualitative content analysis, and descriptive, bivariate and multilevel statistics. Results: A specific result was the production of the Swedish version of SCEAM. The instrument contains 210 items structured into eight domains reflecting the needs of older people. When using S-SCEAM, the results showed a substantial variation in the quality of the physical environment between and within RCFs. In general, private apartments and dining areas had high quality, whereas overall building layout and outdoor areas had lower quality. Also, older people’s safety was supported in the majority of facilities, whereas cognitive support and privacy had lower quality. Further, the results showed that environmental quality in terms of cognitive support was associated with residents’ social well-being. Specific environmental features, such as building design and space size, were also noted, through observation, as influencing residents’ activities, and several barriers were found that seemed to restrict residents’ full use of the environment. Conclusions: This thesis contributes to the growing evidence-based design field. The S-SCEAM can be used in future research on the association between the environment and people’s health and well-being. The instrument could also serve as a guide in the planning and design process of new RCFs

Evaluating physical environments for older people-Validation of the Swedish version of the Sheffield Care Environment Assessment Matrix for use in Finnish long-term care

Aim: To validate a Finnish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM) instrument for assessing the physical environment of long-term care settings and to describe the current status of the environmental quality of long-term care settings for older people in Finland.Background: The importance of providing a well-designed physical environment for older people is supported by the research literature. There is limited research of the physical environments of long-term care settings from the perspective of nursing science and nor is there much research into the instruments for assessing them.Design: A descriptive, correlational and observational study.Methods: Forward and back translation process was used followed by structured observations with S-SCEAM-Fin in 20 long-term care units in intensive residential care facilities for older people with 24-h nursing assistance and with extensive support for daily activities. Spearman's rho correlation, Cohen's kappa, percentage of agreement and Kuder-Richardson formula coefficients were calculated to assess psychometric properties of the translated S-SCEAM-Fin. S-SCEAM-Fin standardised scores were calculated to describe the current status of the environmental quality.Results: Inter-scale (domain) correlations showed low to moderate correlations between the domains. Consistency was acceptable in four of the domains. Cohen's kappa values indicated good (0.796 and 0.648) intra-rater and inter-rater (0.910 and 0.553) reliability. The overall mean of the standardised scores was 57.00, but there was variation between domains. Small units received the highest scores in the six domains.Conclusions: S-SCEAM-Fin was useful in assessing environmental quality. Assessment of the environmental quality disclosed deficiencies in ensuring settings adequate for older people.Implications for practice: The increasing numbers of older people with health conditions are residing in long-term care settings. It is essential to create supportive physical environments. The instrument can be useful when planning new facilities or proposing new recommendations for institutional living environments

ARCH 14 - International Conference on Research on Health Care Architecture - November 19-21, 2014, Espoo, Finland - Conference Proceedings

Healthcare Architecture has grown rapidly in recent years. However, there are still many questions remaining. The commission, therefore, is to share the existing research knowledge and latest results and to carry out research projects focusing more specifically on the health care situation in a variety of contexts. The ARCH14 conference was the third conference in the series of ARCH conferences on Research on Health Care Architecture initiated by Chalmers University. It was realized in collaboration with the Nordic Research Network for Healthcare Architecture .It was a joint event between Aalto University, Finnish Institute of Occupational Health (FIOH) and National Institute of Health and Welfare (THL International).The conference gathered together more than 70 researchers and practitioners from across disciplines and countries to discuss the current themes

GWAS for systemic sclerosis identifies multiple risk loci and highlights fibrotic and vasculopathy pathways

Systemic sclerosis (SSc) is an autoimmune disease that shows one of the highest mortality rates among rheumatic diseases. We perform a large genome-wide association study (GWAS), and meta-analysis with previous GWASs, in 26,679 individuals and identify 27 independent genome-wide associated signals, including 13 new risk loci. The novel associations nearly double the number of genome-wide hits reported for SSc thus far. We define 95% credible sets of less than 5 likely causal variants in 12 loci. Additionally, we identify specific SSc subtype-associated signals. Functional analysis of high-priority variants shows the potential function of SSc signals, with the identification of 43 robust target genes through HiChIP. Our results point towards molecular pathways potentially involved in vasculopathy and fibrosis, two main hallmarks in SSc, and highlight the spectrum of critical cell types for the disease. This work supports a better understanding of the genetic basis of SSc and provides directions for future functional experiments

Complement component C4 structural variation and quantitative traits contribute to sex-biased vulnerability in systemic sclerosis

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER), "A way of making Europe".Copy number (CN) polymorphisms of complement C4 play distinct roles in many conditions, including immune-mediated diseases. We investigated the association of C4 CN with systemic sclerosis (SSc) risk. Imputed total C4, C4A, C4B, and HERV-K CN were analyzed in 26,633 individuals and validated in an independent cohort. Our results showed that higher C4 CN confers protection to SSc, and deviations from CN parity of C4A and C4B augmented risk. The protection contributed per copy of C4A and C4B differed by sex. Stronger protection was afforded by C4A in men and by C4B in women. C4 CN correlated well with its gene expression and serum protein levels, and less C4 was detected for both in SSc patients. Conditioned analysis suggests that C4 genetics strongly contributes to the SSc association within the major histocompatibility complex locus and highlights classical alleles and amino acid variants of HLA-DRB1 and HLA-DPB1 as C4-independent signals

Genetic correlation between amyotrophic lateral sclerosis and schizophrenia

A. Palotie on työryhmän Schizophrenia Working Grp Psychiat jäsen.We have previously shown higher-than-expected rates of schizophrenia in relatives of patients with amyotrophic lateral sclerosis (ALS), suggesting an aetiological relationship between the diseases. Here, we investigate the genetic relationship between ALS and schizophrenia using genome-wide association study data from over 100,000 unique individuals. Using linkage disequilibrium score regression, we estimate the genetic correlation between ALS and schizophrenia to be 14.3% (7.05-21.6; P = 1 x 10(-4)) with schizophrenia polygenic risk scores explaining up to 0.12% of the variance in ALS (P = 8.4 x 10(-7)). A modest increase in comorbidity of ALS and schizophrenia is expected given these findings (odds ratio 1.08-1.26) but this would require very large studies to observe epidemiologically. We identify five potential novel ALS-associated loci using conditional false discovery rate analysis. It is likely that shared neurobiological mechanisms between these two disorders will engender novel hypotheses in future preclinical and clinical studies.Peer reviewe

The Role of Information and Communication Technology (ICT) for Older Adults’ Decision-Making Related to Health, and Health and Social Care Services in Daily Life—A Scoping Review

Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults’ decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults’ decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults’ use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives

Bröstcancerpatienters psykosociala och existentiella behov samt betydelsen av komplementär och alternativ medicinEn systematisk litteraturstudie

Syftet med denna systematiska litteraturstudie var att beskriva de psykosociala och existentiella behov som kan uppstå hos kvinnor med bröstcancer samt i hur stor utsträckning bröstcancerpatienter upplever att dessa behov tillgodoses i vården. Dessutom var syftet att få en uppfattning om betydelsen av komplementär och alternativ medicin för bröstcancerdrabbade kvinnor. De vetenskapliga artiklar (n=25) som ingick i studien söktes datoriserat samt manuellt och en kvalitetsgranskning gjordes av litteraturen utifrån olika bedömningsformulär. Resultaten visar att de behov som uppstod hos kvinnorna med bröstcancer var behov av stöd, behov av information samt behov av kontinuitet i sjukvården. Majoriteten av kvinnorna upplevde att det psykosociala och existentiella stödet i sjukvården samt den information de fick hade stora brister. Detta ansågs i stor utsträckning bero på en bristfällig kontinuitet. De komplementär- och alternativmedicinska behandlingarna visade sig vara mycket betydelsefulla då de i stor utsträckning tillgodosåg de psykosociala och existentiella behoven hos bröstcancerpatienterna. Behandlingarna minskade psykiska symtom som oro, ångest och depression avsevärt hos kvinnorna samt hjälpte dem att hantera och bearbeta känslor förknippade med cancerdiagnosen och nå ett accepterande av sin sjukdom. Kontinuiteten upplevdes dock ibland som bristfällig även inom den komplementär- och alternativmedicinska vården

Vårdmiljöns betydelse för hälsa och välbefinnande

Medvetenheten om vårdmiljöns betydelse för patientens hälsa ökar världen över. Det syns tydligt då vårdprogram, nationella riktlinjer och standarder inom vård och omsorg i ökad grad beaktar aspekter av den fysiska miljöns betydelse för god vård. Även ett stort antal forskningsartiklar har presenterats genom åren som illustrerar betydelsen av arkitektur och design. Exempel på nya rön är vikten av en tillgänglig vårdmiljö som är lätt att tolka och förstå, vikten av en vårdmiljö där det finns möjlighet till privathet, samt inte minst en estetiskt tilltalande miljö som visar respekt och värdighet för besökaren. För att nya forskningsrön ska komma patienter och vårdare till gagn krävs att dessa implementeras i praktiken. En viktig utgångspunkt är dialogen mellan företrädare för vård, arkitektur, design och kultur och att deras kunskapsbidrag samspelar utifrån en gemensam övertygelse om att detta främjar patientens hälsa och välbefinnande. I denna artikel diskuteras hur olika delar och innehåll i miljön påverkar varandra och måste ses i sitt sammanhang