To Örebro University

Assistive technology (AT) is a powerful enabler of participation. The World Health Organization's Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a "state of the science" view of AT users, conceptualized as "People" within the set of GATE strategic "P"s. People are at the core of policy, products, personnel and provision. AT is an interface between the person and the life they would like to lead. People's preferences, perspectives and goals are fundamental to defining and determining the success of AT. Maximizing the impact of AT in enabling participation requires an individualized and holistic understanding of the value and meaning of AT for the individual, taking a universal model perspective, focusing on the person, in context, and then considering the condition and/or the technology. This paper aims to situate and emphasize people at the centre of AT systems: we highlight personal meanings and perspectives on AT use and consider the role of advocacy, empowerment and co-design in developing and driving AT processes.

BACKGROUND: Housing environments that hinder performance of daily activities and impede participation in social life have negative health consequences particularly for the older segment of the population. From a public health perspective accessible housing that supports active and healthy ageing is therefore crucial. The objective of the present study was to make an inventory of environmental barriers and investigate accessibility problems in the ordinary housing stock in Sweden as related to the functional capacity of senior citizens. Particular attention was paid to differences between housing types and building periods and to identify environmental barriers generating the most accessibility problems for sub-groups of senior citizens.

METHODS: Data on environmental barriers in dwellings from three databases on housing and health in old age was analysed (N = 1021). Four functional profiles representing large groups of senior citizens were used in analyses of the magnitude and severity of potential accessibility problems. Differences in terms of type of housing and building period were examined.

RESULTS: High proportions of one-family houses as well as multi-dwellings had substantial numbers of environmental barriers, with significantly lower numbers in later building periods. Accessibility problems occurred already for senior citizens with few functional limitations, but more profound for those dependent on mobility devices. The most problematic housing sections were entrances in one-family houses and kitchens of multi-dwellings.

CONCLUSIONS: Despite a high housing standard in the Swedish ordinary housing stock the results show substantial accessibility problems for senior citizens with functional limitations. To make housing accessible large-scale and systematic efforts are required.

PURPOSE: The aim was to investigate outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use regarding need for assistance when moving around, frequency of mobility-related participation, easiness/difficulty in mobility during participation, and number of participation aspects performed in everyday life.

METHOD: The study was a prospective cohort study, using an instrument focusing on mobility-related participation outcomes of mobility device interventions (NOMO 1.0), at baseline, after 4-months and 1-year use.

RESULTS: The results show that the outcomes in terms of participation frequency and easiness in mobility occur in a short time perspective, and that the effects remained stable at 1-year follow-up. The frequency of going for a walk increased most prominently (26%). Even though the majority of the participation aspects were not performed, more often they became easier to perform: 56-91% found that shopping, walking and visiting family/friends were easier. Moreover, independence outdoors and indoors increased.

CONCLUSIONS: This small study provides knowledge about the outcomes of powered wheelchairs and scooters in terms of mobility and mobility-related participation in real-life situations. The study supports results from former studies, but even so, larger studies are required in order to provide evidence for the effectiveness of powered wheelchairs and scooters. [Box: see text].

Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization's Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less well-resourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidence-informed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable. Implications for Rehabilitation The development of policy in the area of asssitive technology is important to provide an overarching vision and outline resourcing priorities. This paper identifies some of the key themes that should be addressed when developing or revising assistive technology policy. Each country should establish a National Assistive Technology policy and develop a theory of change for its implementation.

This thesis elucidates the use of powered mobility devices in a Swedish context. The overall aim was to increase and deepen the knowledge on powered mobility device use in relation to participation and accessibility in different environments and among different user groups, with a specific focus on independence and autonomy. An additional aim was to contribute to the knowledge base regarding the optimization of use of such devices. The thesis is based on four studies in which different research approaches were applied through the combination of different types of data in order to interpret the complexity of powered mobility device use. Quantitative, qualitative and mixed methods were utilized. The first study was a prospective cohort study in which data was collected using structured interviews at baseline and two follow-ups. The second study was an exploratory multiple longitudinal case study. A focusgroup methodology with a descriptive design was used in the third study. The fourth study was a cross-sectional study based on survey data collected from people with spinal cord injury. The main contribution of the studies that constitute the empirical basis of this thesis is that the purpose of providing people with powered mobility devices is mostly fulfilled in that such devices provide their users’ with greater opportunities for participation. Nevertheless, there are also problems in terms of accessibility in various environmental arenas that have an impact on mobility. An additional important contribution is that the results show that the experiences of users of powered mobility devices should be taken seriously as they convey different aspects of how the use of such devices could be optimized. In conclusion, this thesis contributes to our understanding of the use of powered mobility devices and has the potential to optimize independence in terms of mobility and participation among users of such devices. Finally, the results have practical implications for occupational therapy in the provision of powered mobility devices. Likewise, this new knowledge about the needs of powered mobility device users in terms of accessibility are of importance to politicians, professionals and other stakeholders engaged in housing provision and physical planning.

Purpose The overall aim of this study was to describe experiences of discrimination due to inaccessibility among people using mobility devices.

Material and methods We conducted a thematic qualitative analysis of 88 complaints about wheeled mobility device use, inaccessibility, and discrimination submitted to the Swedish Equality Ombudsman (DO) during 2015 and 2016.

Results The analysis resulted in three themes: instigating change by invoking laws and regulations and highlighting lack of compliance; demanding to be recognised, understood, and listened to; and struggling for equal access and social participation. Regulations and treaties were invoked as the basis for complaints by people using mobility devices regarding their lack of access to physical environments and impediments to their enjoyment of their full right to participate in and contribute to society. The complaints described feelings of discrimination, the disadvantages and exclusion due to physical inaccessibility, and experiences of being prevented from living one’s life as others do.

Conclusions Complaints filed by people using mobility devices showed that they were denied access to a wide range of contexts, including offices, theatres, restaurants, schools, and public transportation, though they desired to live an active and social life outside their homes. Filing a complaint was a way to take action, highlight present inaccessibility, and express a hope for change.

IMPLICATIONS FOR REHABILITATION

• Difficulties experienced by people using wheeled mobility devices can reveal knowledge important for revising existing design and renovation standards for housing and public buildings.

• Documenting facilitators and barriers in different environments is important for giving voice to the needs of wheeled mobility device users and revealing standards that need to be strongly enforced or revised.

• People using wheeled mobility devices should be supported in finding solutions in inaccessible environments, both to fulfil their wishes and to enable their participation in society.

OBJECTIVE: To describe environmental barriers, accessibility problems, and powered mobility device (PMD) users' autonomy indoors and outdoors; to determine the home environmental barriers that generated the most housing accessibility problems indoors, at entrances, and in the close exterior surroundings; and to examine personal factors and environmental components and their association with indoor and outdoor autonomy.

METHOD: This cross-sectional study was based on data collected from a sample of 48 PMD users with a spinal cord injury (SCI) using the Impact of Participation and Autonomy and the Housing Enabler instruments. Descriptive statistics and logistic regression were used.

RESULTS: More years living with SCI predicted less restriction in autonomy indoors, whereas more functional limitations and accessibility problems related to entrance doors predicted more restriction in autonomy outdoors.

CONCLUSION: To enable optimized PMD use, practitioners must pay attention to the relationship between client autonomy and housing accessibility problems.

Introduction: Re-ablement services are in a period of strong development, but the terms and definitions used remain unclear, and the scientific evidence is still weak. The aim of this systematic review was to obtain an overview of the scientific literature in this evolving research area, and investigate whether there is scientific evidence for positive effects of re-ablement services for older community-living people.

Method: The systematic literature search was conducted in the databases CINAHL, PubMed and Svemed + (Swemed) and covered the years 2000-2014. Owing to the heterogeneity in the included studies, a narrative synthesis was performed.

Results: Eight original publications were found eligible and included in the systematic review. When addressed, terms and definitions varied among the papers. Effects such as less use of home care, higher likelihood to live at home, improved activities of daily living (ADL) skills, quality of life and physical health, increased physical activity and lower costs compared to conventional home care were reported.

Conclusion: More high-quality research is needed to strengthen the evidence-base regarding re-ablement services. The specific roles of various professional and staff groups are often insufficiently described, as are the interventions as such, and there is a lack of attention to person-centered aspects such as the meaningfulness of the specific activities.

OBJECTIVE: To describe how men and women experience their use of powered wheelchairs (PW) and powered scooters (PS) in everyday occupations, in the home and in society at large.

METHODS: A qualitative research approach with focus-group methodology was used. Four focus groups were created, with men and women as well as PW and PS users in different groups. Applying a descriptive approach, data were analysed according to the principles described by Krueger.

FINDINGS: Three categories emerged and revealed that even though use of PW and PS increased independence and enabled everyday occupations, participants struggled to be independent powered mobility device (PMD) users. They experienced many accessibility problems in dwellings and in society, described similarly by users of PW and PS. Men and women experienced their use of (PMD) differently, especially in relation to the service delivery process.

CONCLUSIONS: The study contributes with new knowledge on accessibility for PW and PS users and related service delivery processes, stating that gender differences regarding provision and training must be taken into account. Occupational therapists can contribute to an enhanced understanding of PMD users' challenges in person-environment-occupation transactions in the home and society, and thereby promote occupational justice for PMD users.

OBJECTIVE: To describe powered wheelchair (PW) and powered scooter (PS) users' experiences of accessibility and housing adaptions in their homes.

METHOD: A qualitative research approach with focus group methodology was used. Four focus groups were created, with men and women as well as PW and PS users in different groups. Applying a descriptive approach, data were analysed according to the principles described by Krueger and Casey.

FINDINGS: With a specific focus on how PW and PS and housing adaptations operate together, the findings of this paper formed two categories: "Possibility of receiving housing adaptations according to individual needs" and "Importance of receiving the correct type of PW and PS in relation to individual needs".

CONCLUSION: It is vital to acknowledge the characteristics and requirements of PW and PS as well as housing adaptations in order to optimize the use of such devices in the home, as a prerequisite for independence, activity and participation. The provision of PW and PS and housing adaptations should be considered and planned simultaneously, applying an explicitly user-centred perspective. Additionally, the collaboration between the different actors involved should be improved.

Aim: To describe the use of mobility devices among people ageing with spinal cord injury (SCI), with a specific focus on use of powered mobility devices (PMD) and housing accessibility.

Method: Data on the use of walking aids (cane, crutch/es or rollator), manual wheelchair and powered wheelchair/scooter were utilized. To describe functional limitations, environmental barriers and the magnitude of accessibility problems in the home and the closest exterior surroundings for each individual, the Housing Enabler instrument was used. Descriptive statistics were used for data analysis.

Results: Mobility devices: Among participants with paraplegia, the manual wheelchair was the most frequently used mobility device indoors, and among participants with tetraplegia, it was the PMD. The PMD was the most common mobility device used outdoors among those with tetraplegia, and among participants with paraplegia. Housing accessibility: In exterior surroundings, refuse bin difficult to reach was the environmental barrier that generated the most accessibility problems, while at entrances doors that cannot be fastened in open position was identified as the most severe environmental barrier. Indoors, the environmental barrier that generated the most accessibility problems was wall-mounted cupboard and shelves placed high.

Conclusion: To enable optimal use of the PMD in the home and close neighborhoods, and support everyday activity and participation for people ageing with SCI, it is vital to take into account not only personal and environmental aspects but also the mobility device in question. Though, it could be discussed if all the environmental barriers identified in this study, actually are problems for users of a PMD, since some of them might be possible to overcome.

PURPOSE: To explore clients' experience of the housing adaptations (HAs) over time in relation to housing and health.

METHOD: A multiple longitudinal case study, employing an embedded mixed-method design was used. Four participants were included and data from semi-structured interviews were combined with data from structured survey assessments.

RESULTS: HA made it possible to maintain valuable roles and activities, to continue to live in the participants' own homes and to take part in the society. The participants strived for autonomy and control, and in order to do so they needed different kinds of support, in terms of HA and mobility devices as well as support from professionals. HA also challenged the participants' routines and habits, as well as their perception about how an appealing HA aesthetically. Thus, the decision to apply for a HA was not always straightforward. Instead, the participants were constantly engaged in negotiations with themselves, concerning benefits and drawbacks of different decisions.

CONCLUSIONS: HAs involve complex person-environment-activity (P-E-A) transactions, and enhance clients' activity and independence in spite of functional decline. The knowledge generated is important in order to improve individual HA, as well as improving the efficiency and effectiveness of the intervention.

Our aim was to explore enablers and barriers in ordinary housing for older people in care. We systematically searched Scopus, Web of Science, and Google Scholar for relevant published research and gray material. The search resulted in a final sample of eight publications, four of which focused on accessibility for older people with dementia. Thematic analysis resulted in two themes: safety and accessibility. Future studies should focus on modifications to ordinary housing to achieve safe and comfortable environments for people who want to age in place and those who provide them with care.

Whilst home healthcare services for an aging population currently livingin ordinary housing are increasingly needed, physical environmentsdo not adequately meet current levels of demand for such services. Thepresent study protocol, which combines qualitative and quantitativemethods, was developed in order to explore the impact of architecturaldesign on enablers and barriers in the delivery of home healthcareservices. An interdisciplinary research team, drawn from the fields ofarchitecture, healthcare, and occupational sciences, will execute theforthcoming study. This study protocol describes the design of thatstudy, which will explore the relation between residential design and theconditions for care in ordinary housing.

The strong driving forces for ageing in place demand sustainable solutions for the housing and care of older people and the health and safety of home- and health-care staff. The aim of the study was to elucidate staff experiences of providing home- and health-care to older people living in ordinary housing. This study was part of a larger project investigating the relation between home design and conditions for care in ordinary housing. The data were gathered through focus group interviews with staff in home- and health-care. Three main themes were found according to staff experiences of particular rooms’ sizes and proportions, spatial configurations, and aspects to consider when designing new housing. This study contributes important knowledge about essential features of the physical environment for staff providing home- and health-care for older people in their own homes and to aid the development of functionally sustainable housing to minimise injuries to staff.

AIM: To estimate the effects of targeted elimination of environmental barriers (EB) in the ordinary housing stock in Sweden, and to explore the estimated effects on accessibility at a population level in relation to (a) residents with different functional profiles, (b) different housing types and (c) building periods.

METHOD: Data on dwellings from existing Swedish research databases were utilized. EB and accessibility were assessed by means of the Housing Enabler instrument. In simulations of EB removal, five items that correspond to the most common housing adaptations were selected. The simulations were applied to four functional profiles of different complexity.

RESULT: EB known to be commonly removed by housing adaptations exist in large proportions of the existing ordinary housing stock. Estimated targeted elimination of selected barriers would have the largest accessibility effects for the more complex functional profiles. The effects would be consistently larger for one-family houses, and for all types of dwellings built before 1960.

CONCLUSIONS: The elimination of the EB most commonly addressed by housing adaptations could result in a reduction of the housing accessibility problems that community-living older people are facing. For society to solve the housing situation for the ageing population well-informed and efficient upgrading of ordinary housing is imperative.

Ageing in place is a global trend with high priority on the political agenda. In Sweden, as in many other countries, a transfer from high specialty hospital care to home health care is ongoing, which calls for the need of new knowledge concerning transdisciplinary teamwork, not only between professionals but also between different levels in the health care organization. The situation that unfolds when someone’s home becomes an arena for care opens a complex context, including possible conflicts between a feeling of home and a supportive and attractive workplace. To support the process of healthy ageing, and employing staff in home- and healthcare, it is important to conduct transdisciplinary research on the interaction between researchers from different disciplines, including older people and their living environment, staff performing home- and healthcare to older people living in ordinary housing and stakeholders in society. In this chapter, we will describe in what way a transdisciplinary research approach is appropriate when planning for a study, how this can contribute to research on ageing in place, and also share lessons learnt from this process.

BACKGROUND: Social participation and the ability to build and maintain social relationships is emphasized as important for older people's health and well-being.

AIM: To explore if social participation is addressed and whether age, gender and level of functioning are associated with the composition of occupational therapy interventions within the context of reablement.

METHOD: In this cross-sectional study, invitations to participate were sent to 60 municipalities in Sweden. 318 occupational therapists participated and described the character of initiated interventions made during 3 weeks through web-based surveys.

RESULT: 1392 cases were reported in the age span of 19-103 years, 61.7% were women. A higher proportion of persons having no home care and minor functional dependency got interventions with a focus on social participation to a higher extent than persons with major functional dependency. Occupational therapists' interventions vary as related to functional limitation, age, and gender.

CONCLUSION: The results indicate that the severity of functional limitation impacts the focus of the intervention whereas age and gender do not. There is a need for social participation to be more clearly addressed within the context of reablement.

SIGNIFICANCE: To develop a person-centred intervention, one needs to consider aspects of age, gender, and functions.

BACKGROUND AND METHODS: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit.

FINDINGS: Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel.

CONCLUSIONS: There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements.

Implications for Rehabilitation

• Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community.
• Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery.
• A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO's Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide. The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications. The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog.

Implications for Rehabilitation

• Successful assistive technology product interventions are complex and include much more than the simple selection of the right product.
• Assistive technology product use is highly context sensitive in terms of an individual user's environment.
• The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well.
• As a field we have much to study and develop around assistive technology product interventions from a global perspective.

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.

Introduction: Ageing in place, is in most European societies a social norm and is made possible by home-based care services and by support from relatives. Yet some older adults describe ageing in place as an unsatisfying life situation and instead apply for a nursing home. Thus, relatives supporting these older adults´ daily lives are part of that experience but the knowledge of how that unsatisfying experience is shared by the relatives is limited. Hence, the study aimed to describe experiences of being a relative to a nursing home applicant.

Method: Semi-structured interviews were conducted by phone with 15 relatives (spouse n=2, children n=13) to nursing home applicants. The data was collected in year 2020 during the covid-19 pandemic. Interviews were analyzed using a thematic analysis approach according to Braun and Clark. 

Results: Preliminary results show that the relatives have many expectations to handle, both from themselves, the nursing home applicant and healthcare. In addition, the covid-19 pandemic made it difficult to fulfill the expectations and the relatives consider both their own and the nursing home applicant’s situation as fragile. Final themes will be presented at the conference.

Conclusion: Increased understanding of what experiences that influence everyday activities when ageing in place, could facilitate occupational therapists’ work with older adults living at home. For example, relatives should be included at an early stage of the occupational therapy process in order to provide insight into which areas of daily life occupational therapists should prioritize and support. 

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.

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.

Background: Therefore, the objective of this study was to elucidate caregivers’ experiences of ordinary homes as a working environment in home care and home health care during the COVID-19 pandemic. At the beginning of the pandemic, hospital care was in focus and the care of older adults was criticized around the world.

Design and methods: Semi-structured qualitative interviews were conducted in two municipalities in Sweden between March 2020 and May 2021. One large municipality (population 155,000) with experience of care recipients with COVID-19, and a smaller municipality (population 32,000) were included; both had a focus on preventing the spread of the infection. A total of 27 participants working in home care were interviewed; these were occupational therapists, physical therapists, nurses, and assistant nurses. The interview material was analyzed using content analysis.

Results: The interviews provided a comprehensive insight into the complex work environment in municipal home care during the pandemic. The staff had to deal with constantly changing information and new guidelines. They were also given new tasks and work routines that demanded more planning and were time-consuming. The staff experienced higher workload and pressure during the pandemic and did not have enough time to recover.

Conclusions: During a pandemic situation, the information must be comprehensive and gathered in one place, and the managers must ensure sufficient staffing levels, time for reflection, and support for prioritization. The managers must also ensure the mental health of staff and meet their needs for recovery, both at and outside work.

Introduction: The importance of mobile health has increased during recent years but few studies have described the use of apps among persons with neurological disabilities.

Aim: The aim of this paper was to describe how persons ageing with a neurological disability experience barriers and facilitators in relation to using apps in everyday life.

Method: A qualitative approach was used. 16 persons with neurological disorders participated in two group discussions. Data were analyzed by content analysis.

Results: The analysis formed four categories; Impairments make apps harder to use, Use of apps is increased by learnability and sharing, Valuating the information in an app, and Apps act supportive and motivating.

Conclusion: The participants used apps in the same way as persons without disabilities. Impairments and trustworthiness were perceived as barriers, which need to be acknowledged when developing apps for this population. Use of apps was facilitated by the possibility to share data and to connect with others. Apps may have the potential to improve self-management for persons ageing with disabilities but further research is needed.

Purpose: The aim of this paper was to describe how people living with a neurological disability such as multiple sclerosis, Parkinson’s disease and stroke reason regarding using apps to facilitate self-management in everyday life.

Material and methods: A qualitative research approach with a focus group methodology was used. The sample comprised 16 participants, 11 men and 5 women, with an average age of 64 years (ranging from 51–80 years). Six participants were diagnosed with multiple sclerosis, six with Parkinson’s disease and four with stroke. Data were analyzed using thematic analysis, which is a method for identifying, analyzing and reporting patterns.

Results: The results formed two themes. The first theme “using apps to have control of my health” comprises two subthemes; “monitor and take responsibility for a healthy lifestyle” and “compensate to facilitate everyday life”. The second theme “using the app as a tool and means for communication” also comprised two subthemes; “dare to trust the app” and “feeling safe when sharing information with health care professionals”.

Conclusions: The use of apps put increased responsibility on the person and had the possibility to make them more involved in their own care. The use of an app can facilitate a healthy lifestyle and help to monitor disease-specific symptoms. In order to be able to use apps for communication with the health care sector legislation and safety issues need to be considered.