To Örebro University

Introduction Previous research has shown that nursing home applicants had negative experiences of living and receiving care in their ordinary housing due to several factors, such as difficulties in everyday activities and being depressed. However, whether these experiences stand solely for nursing home applicants, or are common in an older population in general needs to be investigated.

Aim of this study was to compare nursing home applicants with matched older adults with respect to difficulties in everyday life, life satisfaction and depressive mood.

Methods Using a case-control design, 34 participants (17 in each group) were compared using Wilcoxon signed rank test for continuous variables and McNemar test for binary variables. The magnitude of associations was explored using conditional logistic regression.

Results Nursing home applicants experienced more difficulties in daily life and were more depressed than their matched peers, and this difference between groups was significant. To experience several difficulties in everyday life and being depressed increased the odds for a nursing home application.

Conclusions As aging in place is the societal norm, older adults with increased likelihood of nursing home applications need to be identified and catered for in an early stage, to prevent nursing home admission.

Introduction: Relatives are important when older adults return home after a hospital stay. The aim of this study was to describe close relatives' perspectives of the everyday activities of older adults who are repeatedly readmitted to hospital and discharged to home.

Methods: A semi-structured interview was performed to collect data from twenty relatives (aged 45-82 years). Data were analysed using a deductive qualitative content analysis based on the results of a previous study within this field.

Results: The overall theme 'In need of support to manage an unpredictable everyday life' shows that the older adults often needed support in everyday activities. In the two categories 'Difficulties in dealing with an unstable day' and 'Managing an unstable day' and the 10 subcategories, close relatives described that the older adults needed support in various ways from relatives or other individuals. Close contact was important for how everyday activities worked at home and in maintaining social contacts and contact with healthcare.

Conclusion: It was found that social needs, such as social contacts/activities, are just as important to assess at discharge as medical and functional needs.

BACKGROUND: Ageing in place is the social norm in Sweden, yet older adults apply for a nursing home on a daily basis which suggests that ageing in place needs further study as it is not suitable for everyone. Aim: to study descriptions of older adults' reasons for applying to a nursing home in documents of granted nursing home decisions.

MATERIALS AND METHODS: One hundred and sixty decisions were analyzed through document analysis with a deductive content analysis using the Canadian Model of Occupational Performance-Engagement (CMOP-E) as a framework.

RESULTS: Reasons for applying were represented in the three factors of the CMOP-E. In personal factors, reason for applying was e.g. connected to severe anxiety. In environmental factors, family culture had an influence in the application. In occupational factors, the ability to perform self-care and mobility greatly affected decisions to apply to nursing homes.

CONCLUSION: Descriptions of the older adults' activities in daily life were limited. If OTs were further involved in nursing home applications, adults ageing in place could be better supported and a move to a nursing home may be prevented. Significance: this study contributes to the understanding of why older adults chose to apply to a nursing home.

Introduction Societal norms and policies encourage older adults to age and receive care in their home, referred to as ageing in place. Nevertheless, Swedish older adults apply for nursing home admission. To understand how ageing in place better could be supported, the aim was to study descriptions of older adults’ reasons for applying to a nursing home in documents of granted nursing home decisions.

Methods 160 granted nursing home decisions underwent document analysis, to study if reasons occurred due to person, environmental or occupational factors according to occupational theory model Canadian Model of Occupation Performance- Engagement.

Result Several factors in different parts of life were experienced to lead to a nursing home application, e.g., multiple impairments, anxiety, loneliness, or longing to be closer to relatives or healthcare staff. Additionally, reasons could also be recommendations from healthcare staff or that a spouse didn´t want to live together with support from home-based care.

Conclusions The results highlight societal injustices that occurred for older adults who age in place, which expedited the applications. The documents described how ageing in place shrunk their opportunities for activity, social cohesion, and the possibility to proximity to staff.

Background: People with profound intellectual and multiple disabilities (PIMD) require extensive support from the healthcare system due to their multiple disabilities and other ailments. However, little is known about the quality of healthcare that is necessary to meet these individuals’ needs. Because of their communication disabilities, their experiences must be sought through their representatives. This study aims to explore the experiences and perspectives of relatives regarding healthcare services for adults with PIMD.

Method: Semi-structured telephone interviews were conducted, totalling 12 interviews with mothers (n = 7), fathers (n = 2), brothers (n = 2) and one sister. The data were analysed using qualitative content analysis.

Findings: Relatives expressed varying experiences regarding the quality of care required for adults with PIMD and the type of interaction they had with healthcare services. Three key themes emerged from the data: (1) the importance of holistic responsibility, (2) professional specialisation including coordination and complexity and (3) the need for individual-specific knowledge.

Conclusions: To enhance quality of healthcare for people with PIMD, the provision and coordination of services must be characterised by specialist knowledge about people with PIMD, which includes a holistic perspective and close collaboration with those who have person-specific knowledge about the individual.

Introduction: There is little research regarding quality of health care for people with profound intellectual and multiple disabilities (PIMD), who often are represented by their relatives, because of their limited communication. The aim of this study was to explore experiences and perspectives of relatives regarding healthcare services for adults with PIMD.

Method: Twelve semi-structured telephone interviews were conducted involving close relatives of people with PIMD: mothers (n = 7), fathers (n = 2), brothers (n = 2) and a sister (n = 1). Qualitative content analysis was used.

Results: Three themes emerged from the material: (1) Holistic view and responsibility, (2) Complexity and specialisation require coordination, and (3) Specific knowledge about the individual with PIMD.

Conclusions: The relatives experienced that quality of health care should be based on a holistic view incorporating special competence and coordination. They emphasised the importance of an alliance, leveraging the relatives' person-specific knowledge alongside healthcare professionals' specialist competence.

PURPOSE: Time management skills are essential for handling daily life in a modern society. People with ADHD, Autism spectrum disorder or mental disorders may have affected time management, which for example might lead to poor occupational balance, low self-efficacy and difficulites to maintain family and working life. Let’s Get Organized’(LGO) is a manual-based group intervention to improve time management skills. The aim of this trial was to evaluate the efficiency of the Swedish version of LGO (LGO-S) compared to treatment as usual (individual occupational therapy) to improve time management for adults with impaired time management skills due to neurodevelopmental or mental disorders.

DESIGN: Multi-center two-armed open parallel randomized controlled trail (RCT). Participants (n=88) from nine out-patient psychiatric or habilitation care units were randomized into 1) Let’s Get Organized (LGO-S) and 2) individual occupational therapy (treatment as usual).

METHOD: Both groups received intervention for 10 weeks. Data was collected pre-, post- and three months post intervention. Primary outcome measure was self-assessed time management skills. Secondary outcome measures were self assessed planning and organisational skills, regulation of emotions, satisfaction with daily occupations and self-efficacy.

RESULTS: Both LGO and Individual occupational therapy showed statistically significant improvements in time management skills after intervention (p<0.001 in both groups). The results were maintained at the three month follow-up. There were no statistically significant differences between groups. Analyzes of secondary outcomes are ongoing and will be presented at the conference.

CONCLUSION: Both LGO and individual occupational therapy had a positive effect on the participants’ time management skills. Conclusions about secondary outcomes and possible correlations will be presented at the conference.

BACKGROUND: Swedish social policy enables ageing in place with support from home-based care services despite high age and/or declining health.

AIM: This study aims to describe the daily life experiences behind the decision to apply for a nursing home placement in older adults ageing in place.

MATERIALS AND METHODS: A qualitative design was chosen, and 11 semi-structured interviews were conducted and analysed using inductive qualitative content analysis.

RESULTS: The participants described a feeling of dependence in which they had to ignore their personal privacy when receiving home-based care. They reached a turning point when ageing in place was, for several reasons, no longer considered an acceptable option. This influenced their choice to apply to a nursing home where they expected that they could maintain control over their lives.

DISCUSSION AND CONCLUSION: The results indicate that when enhancing ageing in place it is important to enable older adults to receive support to maintain autonomy in daily activities and to have the opportunity to age in the right place.

BACKGROUND: Limited time management skills cause problems in daily life for people with mild intellectual disability (ID) and "Let's Get Organized" (LGO) is a promising manual-based occupational therapy group intervention aiming to support management skills.

AIMS/OBJECTIVES: To evaluate the applicability of the Swedish version of LGO-S by i) exploring enhancements in time management skills, satisfaction with daily occupations, and aspects of executive functioning in people with time-management difficulties and mild ID, and ii) describing clinical experiences of using the LGO-S for people with mild ID.

MATERIAL AND METHODS: Twenty-one adults with mild ID were included. Data were collected pre-/post-intervention and at 3- and 12-month follow-ups with: Swedish version of Assessment of Time Management Skills (ATMS-S), Satisfaction with Daily Occupation (SDO-13), and Weekly Calendar Planning Activity (WCPA-SE). There were few follow-up participants (n = 6-9).

RESULTS: Significant change in time management skills that maintained at 12-months follow-ups. Significant increase in regulation of emotions at 12-month follow-up. Results at 12-months follow-up indicated sustainability in outcomes as measured by ATMS-S. A non-significant positive trend was observed in other outcomes between pre- and post-intervention.

CONCLUSIONS AND SIGNIFICANCE: LGO-S seems applicable for improving skills in time management, organisation and planning also for people with mild ID.

Home-based care is expanding, and we need to know more about what kind of support older adults need and how such support should be designed. One way to gain more knowledge is to study the experiences that underlie a nursing home application. However, older adults in need of nursing homes are often too weak to participate in research. Thus, this study aimed to describe the experiences of close relatives of the daily life of older adults in need of a nursing home. A qualitative approach was used, where fifteen relatives of nursing home applicants in central Sweden were interviewed using a study-specific interview guide. The interviews were analysed using thematic analysis. The findings are presented in one main theme "Being the person who manages a fragile life situation" with three underlying themes: Balancing and fulfilling expectations, striving to achieve a status quo, experiencing a breaking point, a change is inevitable, and waiting and moving into a nursing home, a period of tension. The main theme describes how the participants contributed to managing the older adults' life situation and acted as a representative in contacts with health and social care. They tried to offer support in their daily life but over time experienced a breaking point when ageing in place was no longer sustainable, resulting in a nursing home application. The rationale for a nursing home application was often a combination of the older adult's own wishes and the fact that their relatives felt there was a combined need for extensive care and physical proximity to staff, which cannot be provided in ordinary housing. Sometimes the decision to apply was also based on relatives no longer having the capacity to continue managing an older adult's fragile situation.