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  • 1.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Analysis of multimorbidity in individual elderly nursing home residents: development of a multimorbidity matrix2009In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, no 3, p. 413-419Article in journal (Refereed)
    Abstract [en]

    The chronic multimorbidity in individual elderly people is rarely documented in its entirety in present medical records, neither as cross-sectional overview nor as longitudinal time-course of various health problems. This obviously hampers an integrated clinical analysis. This work was aimed at evaluating the chronic multimorbidity in individual elderly patients and developing a method to map, quantify and grade the prevalence of the multimorbidity. An explorative study in 70 nursing home residents (55 women), mean age 85 was performed. Information on health problems was obtained through history, clinical examination and medical records. A 19-item multimorbidity matrix that maps, quantifies and grades the chronic morbidity in individual patients is presented. The 70 residents exhibited 275 different health problems; the top 3 items being neuropsychiatric, cardiovascular and gastrointestinal ones. The residents had a mean of 17 different chronic health problems and were prescribed a mean of 6.6 continuous medications per day. There was a significant correlation between the number of continuous drug prescriptions and both quantitative and graded multimorbidity-scores. The presented multimorbidity matrix provides a useful taxonomic overview over the health situation in individual multimorbid elderly and constitutes the basis for ongoing work to develop and renew the electronic health record into an "interactive health analysis system".

  • 2.
    Asplund, R.
    et al.
    Family Medicine Stockholm, Karolinska Institute, Huddinge, Sweden; Research and Development Unit, Jämtland County Council, Östersund, Sweden.
    Lindblad, Birgitta Ejdervik
    Department of Ophthalmology, Sundsvall Hospital, Sundsvall, Sweden.
    Sleep and sleepiness 1 and 9 months after cataract surgery2004In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 38, no 1, p. 69-75Article in journal (Refereed)
    Abstract [en]

    This study was undertaken to analyze sleep development in a group of patients during the first 9 months after cataract extraction. Men and women (n=407) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during two periods in 2000-2002 were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 and 9 months after the operation. The response rate was 90.8%. The mean ages of the participating men and women were 74.5 and 75.6 years, respectively. One week after cataract extraction the visual acuity in the treated eye was 0.67 (+/-0.31) in men and 0.69 (+/-0.28) in women (NS), and showed an inverse relationship to age in both men (P<0.01) and women (P<0.0001). One month after cataract extraction 28.3% of the men and 37.5% of the women experienced poor sleep, and after 9 months the figures were 15.8 and 31.4%, respectively. Frequent awakenings and difficulty in falling asleep after nocturnal awakenings improved correspondingly. Being well rested in the morning increased and daytime sleepiness decreased. The results indicate that in elderly persons with cataract sleep is improved 1 month after cataract extraction and further improvement during the first 9 months may be experienced.

  • 3.
    Asplund, R.
    et al.
    Family Medicine Stockholm, Karolinska Institute, Huddinge, Sweden; Research and Development Unit (Forsknings- och utvecklingsenheten), Jämtland County Council, Östersund, Sweden.
    Lindblad, Birgitta Ejdervik
    Department of Ophthalmology, Sundsvall Hospital, Sundsvall, Sweden.
    The development of sleep in persons undergoing cataract surgery2002In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 35, no 2, p. 179-187Article in journal (Refereed)
    Abstract [en]

    This study was undertaken in order to analyse sleep in a group of patients who were operated on for cataract. All patients (n=328) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during a 4-month period were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 month after the operation. Twelve persons were unable or declined to participate. The response rate was 97.2%. The mean ages of the participating men and women were 74.5 and 76.3 years, respectively. Pre-operative visual acuity in the operated eye was 0.16 in men and 0.18 in women. After cataract extraction sleep was improved in 12.0% of the men and in 26.3% of the women. Nevertheless poor sleep 1 month post-operatively was reported by 29.3% of the men and 42.6% of the women (P<0.05). There was no age-related increase in sleep complaints. The results indicate that in elderly persons with cataract sleep is impaired, and that 1 month after cataract extraction improved sleep may be experienced.

  • 4.
    Josefsson, Karin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ryhammar, Lars
    Örebro University, School of Humanities, Education and Social Sciences.
    Threats and violence in Swedish community elderly care2010In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 50, no 1, p. 110-113Article in journal (Refereed)
    Abstract [en]

    Violence in elderly care has been reported on a global scale. The aim of this study was to describe nurses' perceptions of threats and violence, directed at themselves and other staff in community elderly care. Another aim was to describe nurses' access to prevention measures for handling threats and violence. A questionnaire was answered by registered nurses (RNs) (n = 213) in community elderly care. Data was analyzed by SPSS. The results showed that nurses had experienced high-degree indirect threats (48%). direct threats of violent acts (40%) and violent acts (40%). Forty-five percent of the nurses had witnessed violence and threats toward other staff. Twenty percent of the nurses stated to have access to education in managing threats and violence. The conclusions were that violence occurred frequently in community elderly care, as perceived by nurses, as well as that community authority should increase staff education for handling violence. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

  • 5.
    Olsson, Lovisa A.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Hagnelius, Nils-Olof
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Olsson, Henny
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Torbjörn K
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Subjective well-being in Swedish active seniors or seniors with cognitive complaints and its relation to commonly available biomarkers2013In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 56, no 2, p. 303-308Article in journal (Refereed)
    Abstract [en]

    Well-being (WB) is a complex variable in its relation to physical health and other personal and social characteristics. The aim was to study subjective well-being (SWB) and its possible associations with traditional biomarkers of cardiovascular risk or dementia, in Swedish seniors. SWB was estimated by the Psychological General Well-Being (PGWB) index in two study groups. The active seniors (AS) group consisted of community-dwelling elderly Swedes leading an active life (n=389). The DGM cohort (n=300) consisted of subjects referred to the Memory Unit at the Department of Geriatrics, the cognitive problems had to be subjective, mild or moderate (MMSE≥10). There were differences in all six subdimensions of SWB or distress, and in the sum of PGWB scores, between the two study groups (p<0.001 for all), and adjustment for differences in biomarkers of somatic health (age, sex, blood pressure, BMI, HDL cholesterol, ApoB/ApoA1 ratio, creatinine, and homocysteine) did not attenuate these differences. In addition, cognition as assessed by the Clock-Drawing Test (CDT) showed independent associations with four of the PGWB subdimensions and with the PGWB sum. Among the subjects in the DGM cohort, SWB was equally low among subjects with an MCI (minor cognitive impairment) diagnosis or without a dementia diagnosis as among subjects diagnosed with dementia disorder. We conclude that the nosological grouping variable (AS vs. DGM cohort) and a cognitive factor were the main independent predictors of SWB in this sample of elderly Swedes, whereas biomarkers of somatic health played a subordinated role.

  • 6. Rydwik, Elisabeth
    et al.
    Frändin, Kerstin
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Effects of a physical training and nutritional intervention program in frail elderly people regarding habitual physical activity level and activities of daily living: a randomized controlled pilot study2010In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 51, no 3, p. 283-289Article in journal (Refereed)
    Abstract [en]

    The aim of this randomized controlled pilot study is to describe the effects of a physical training and nutritional intervention program on the physical activity level and activities of daily living (ADL) in frail elderly people. Ninety-six community-dwelling frail elderly people (58 women) above the age of 75 were included in the study. The 12-week physical and/or nutritional intervention program was followed by six months of home-based exercises for the training groups, followed up with training diaries. At baseline the subjects were screened for physical activity level, walking habits, and ADL. These measurements were repeated immediately after the intervention at 3 months, and at 2nd follow-up at 9 months. ADL data were also collected 24 months after baseline at 3rd follow-up. The intention-to-treat analyses showed an increase of the habitual physical activity level and walking duration at 1st follow-up for the two training groups compared to the other groups. These increases remained at 2nd follow-up. The nutrition intervention did not show any significant results. No significant effects on ADL were shown however, there were moderate correlations between increases in physical activity level and ADL as well as between the amounts of home-based exercises and ADL for the two training groups.

  • 7. Rydwik, Elisabeth
    et al.
    Kerstin, Frändin
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Physical training in institutionalized elderly people with multiple diagnoses: a controlled pilot study2005In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 40, no 1, p. 29-44Article in journal (Refereed)
    Abstract [en]

    Reduction in muscle mass and physical function depends on a variety of interacting factors: age, physical activity level, nutritional state and the type and impact of disease. The aim of this study was to investigate the effect of an individualized moderate intensity physical training program on muscle strength, balance, mobility, ambulation and activities of daily living (ADL) in institutionalized elderly people aged 65 and over with multiple diagnoses. Baseline assessments consisted of strength, balance, mobility/ambulation, and ADL. Twenty-one subjects were included in the intervention program. A control group (21 subjects) was first matched in pairs according to gender, age, ADL and mobility, and then by balance, ambulation and strength. The intervention program was individualized and included strength, mobility, balance and endurance training. Follow-up measures were conducted directly after the intervention and 10 weeks later. After drop-out, 20 subjects in the intervention group and 15 subjects in the control group remained for analyses. Balance and mobility improved significantly in the intervention group while declining in the control group. This pilot study indicates that a physical training program may improve functional capacity for institutionalized elderly persons with multiple diagnoses.

  • 8.
    Santini, Sara
    et al.
    Istituto Nazionale di Riposo e Cura per Anziani (INRCA), Ancona, Italy.
    Andersson, Gunnel
    Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Lamura, Giovanni
    Istituto Nazionale di Riposo e Cura per Anziani (INRCA), Ancona, Italy.
    Impact of incontinence on the quality of life of caregivers of older persons with incontinence: a qualitative study in four European Countries2016In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 63, p. 92-101Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess the impact of incontinence management on informal caregivers of older persons with incontinence. In order to investigate this phenomenon in different welfare systems via qualitative interviews and a content analysis methodology, the study was carried out in four European countries (Italy, the Netherlands, Slovak Republic and Sweden). To this purpose, 50 semi-structured interviews were conducted with spouses and children of older people receiving their help to manage the consequences of involuntary urinary and/or faecal leakage. Findings show that incontinence has a remarkably strong effect on caregivers’ quality of life, because it results in progressive social isolation, causing them financial problems as well as psychological and physical exhaustion. The lack of appropriate support and the general silence regarding the problem, which is still considered a taboo by many, aggravate thecaregivers’ situation. It is therefore crucial that caregivers can count on a strong public andprivate support network, appropriate information and suitable incontinent products, in orderto better handle incontinence and care tasks in general.

  • 9.
    Åberg, Anna Cristina
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden.
    Inpatient geriatric care in Sweden-Important factors from an inter-disciplinary team perspective.2017In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 72, p. 113-120, article id S0167-4943(17)30237-6Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care: Interactive assessment processes, A holistic care approach, and Proactive non-hierarchical interaction. Aspects of Time and Goal-Orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment - which is possibly best provided by older-friendly hospitals - appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.

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