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  • 1.
    Björk, Sabine
    et al.
    Umeå University, Department of Nursing.
    Juthberg, Christina
    Umeå University, Department of Nursing.
    Lindkvist, Marie
    Umeå universitet, Department of Statistics, Umeå School of Business and Economics, Umeå University.
    Wimo, Anders
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Winblad, Bengt
    Karolinska institutet, Department of Clinical Neuroscience and Family Medicine, Karolinska institute, Department of Geriatric Medicine, Umeå University, Department of Geriatric Medicine, Department of Clinical Physiology, Umeå university, Department of Neurology, Umeå university.
    Edvardsson, David
    Umeå University, Department of Nursing, Umeå university, School of Nursing and Midwifery, University of Dundee.
    Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes: a cross-sectional study2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, article id 154Article in journal (Refereed)
    Abstract [en]

    BackgroundEarlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay.MethodsCross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test.ResultsThe results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units.ConclusionsThe prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.

  • 2.
    Edvardsson, David
    et al.
    The Medical Faculty, Department of Nursing, Umeå University, .
    Sjögren, Karin
    The Medical Faculty, Department of Nursing, Umeå University, .
    Lood, Qarin
    The Medical Faculty, Department of Nursing, Umeå University, .
    Bergland, Ådel
    Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo .
    Kirkevold, Marit
    Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    A person-centred and thriving-promoting intervention in nursing homes: study protocol for the U-Age nursing home multi-centre, non-equivalent controlled group before-after trial2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 22Article in journal (Refereed)
    Abstract [en]

    Background

    The literature suggests that person-centred care can contribute to quality of life and wellbeing of nursing home residents, relatives and staff. However, there is sparse research evidence on how person-centred care can be operationalised and implemented in practice, and the extent to which it may promote wellbeing and satisfaction. Therefore, the U-Age nursing home study was initiated to deepen the understanding of how to integrate person-centred care into daily practice and to explore the effects and meanings of this.

    Methods

    The study aims to evaluate effects and meanings of a person-centred and thriving-promoting intervention in nursing homes through a multi-centre, non-equivalent controlled group before-after trial design. Three nursing homes across three international sites have been allocated to a person-centred and thriving-promoting intervention group, and three nursing homes have been allocated to an inert control group. Staff at intervention sites will participate in a 12-month interactive educational programme that operationalises thriving-promoting and person-centred care three dimensions: 1) Doing a little extra, 2) Developing a caring environment, and 3) Assessing and meeting highly prioritised psychosocial needs. A pedagogical framework will guide the intervention. The primary study endpoints are; residents’ thriving, relatives’ satisfaction with care and staff job satisfaction. Secondary endpoints are; resident, relative and staff experiences of the caring environment, relatives’ experience of visiting their relative and the nursing home, as well as staff stress of conscience and perceived person-centredness of care. Data on study endpoints will be collected pre-intervention, post-intervention, and at a six-month follow up. Interviews will be conducted with relatives and staff to explore experiences and meanings of the intervention.

    Discussion

    The study is expected to provide evidence that can inform further research, policy and practice development on if and how person-centred care may improve wellbeing, thriving and satisfaction for people who reside in, visit or work in nursing homes. The combination of quantitative and qualitative data will illuminate the operationalisation, effects and meaning of person-centred and thriving-promoting care.

  • 3.
    Hemmingsson, Eva-Stina
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Gustafsson, Maria
    Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden.
    Isaksson, Ulf
    Department of Nursing, Umeå University, Umeå, Sweden. Arctic Research Centre at Umeå University, Umeå, Sweden.
    Karlsson, Stig
    Department of Nursing, Umeå University, Umeå, Sweden.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Nursing, Umeå University, Umeå, Sweden. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lövheim, Hugo
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Prevalence of pain and pharmacological pain treatment among old people in nursing homes in 2007 and 20132018In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, no 4, p. 483-488Article in journal (Refereed)
    Abstract [en]

    Purpose

    Many elderly people living in nursing homes experience pain and take analgesic medication. The aim of this study was to analyze the prevalence of pain and pharmacological pain treatment among people living in nursing homes in Sweden, in two large, comparable, samples from 2007 to 2013.

    Methods

    Cross-sectional surveys were performed in 2007 and 2013, including all residents in nursing homes in the county of Västerbotten, Sweden. A total of 4933 residents (2814 and 2119 respectively) with a mean age of 84.6 and 85.0 years participated. Of these, 71.1 and 72.4% respectively were cognitively impaired. The survey was completed by the staff members who knew the residents best.

    Results

    The prescription of opioids became significantly more common while the use of tramadol decreased significantly. The staff reported that 63.4% in 2007 and 62.3% in 2013 had experienced pain. Of those in pain, 20.2% in 2007 and 16.8% in 2013 received no treatment and 73.4 and 75.0% respectively of those with pain, but no pharmacological treatment, were incorrectly described by the staff as being treated for pain.

    Conclusions

    There has been a change in the pharmacological analgesic treatment between 2007 and 2013 with less prescribing of tramadol and a greater proportion taking opioids. Nevertheless, undertreatment of pain still occurs and in many cases, staff members believed that the residents were prescribed analgesic treatment when this was not the case.

  • 4.
    Lindbo, Agnes
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafsson, Maria
    Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University.
    Isaksson, Ulf
    Department of Nursing, Umeå University.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lövheim, Hugo
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University.
    Dysphoric symptoms in relation to other behavioral and psychological symptoms of dementia, among elderly in nursing homes2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, no 1, article id 206Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Behavioral and psychological symptoms of dementia (BPSD) are common and varied in the elderly. The aim of the current study was to explore associations between BPSD and dysphoric symptoms at different levels of cognitive impairment.

    METHODS:

    Assessments of 4397 elderly individuals living in nursing homes in Sweden were performed. Data on cognitive function and BPSD were collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The relationships between dysphoria and eight BPSD factors were plotted against cognitive function to investigate how dysphoria affects BPSD throughout the dementia disease.

    RESULTS:

    Overall, dysphoric symptoms were most prevalent in persons with moderate cognitive impairment. However, moderate to severe dysphoric symptoms showed no clear variation with cognitive impairment. Furthermore, aggressive behavior, verbally disruptive/attention-seeking behavior, hallucinatory symptoms and wandering behavior were more common with concurrent dysphoria regardless of cognitive function. In contrast, passiveness was more common with concurrent dysphoria in mild cognitive impairment but not in moderate to severe cognitive impairment.

    CONCLUSIONS:

    BPSD, including aggressive behavior and hallucinations, were more common with concurrent dysphoric symptoms, providing insight into behavioral and psychological symptoms among individuals with cognitive impairment. Apathy was more commonly associated with concurrent dysphoria at early stages of cognitive decline but not at later stages, indicating that apathy and dysphoria represent separate syndromes among elderly patients with moderate to severe cognitive impairment.

  • 5.
    Patomella, Ann-Helöen
    et al.
    Division of Occupational Therapy, Department of Neurobiology, Health Sciences and Society, Karolinska Institutet.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Bergland, Ådel
    Lovisenberg Diaconal University College, Oslo.
    Edvardsson, David
    Umeå University, Department of Nursing, Umeå university, School of Nursing and Midwifery, University of Dundee, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria.
    Characteristics of residents who thrive in nursing home environments: a cross-sectional study2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 9, p. 2153-2161Article in journal (Refereed)
    Abstract [en]

    Aim: To describe what characterizes residents with higher levels compared with those with lower levels of thriving in nursing homes using the Thriving of Older People Assessment Scale. Background: Thriving is conceptualized as people's experiences of well-being in relation to the environment where they live. Thriving has the potential to emphasize health-promotion and positive experiences in nursing home residents in addition to current focus on illness and symptoms. Design: Cross-sectional design. Methods: Data from a total sample of 191 residents in a large Swedish nursing home facility were separated into two groups; rated as having high and low thriving based on a median split of thriving total score for each participating resident. The characteristics of residents with higher and lower levels of thriving were compared using bivariate analyses to investigate differences. Data were collected in 2013. Results: Residents with higher levels of thriving had shorter length of stay at the facility, higher functioning in Activities of Daily Living and less cognitive impairment, lower frequency of behavioural and psychological symptoms and higher assessed quality of life. The ability to walk and possibilities to spend time outdoors were higher among those with higher levels of thriving. Conclusion: Nursing home residents who experience thriving have a higher level of functioning in activities of daily living, a higher quality of life and are less physically and cognitively impaired

  • 6.
    Sjögren, Karin
    et al.
    Department of Nursing, Umeå University.
    Lindkvist, Marie
    Department of Statistics, Umeå School of Business and Economics, Umeå University.
    Sandman, Per-Olof
    Department of Nursing, Umeå University.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Edvardsson, David
    Department of Nursing, Umeå University.
    Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDFew studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics.METHODSA cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi2 test, Eta Squared and Phi coefficient were used to analyse data.RESULTSHighly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care.CONCLUSIONSIt is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  • 7.
    Skottheim, Andreas
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University.
    Lövheim, Hugo
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University.
    Isaksson, Ulf
    Department of Nursing, Umeå University.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Nursing, Umeå University.
    Gustafsson, Maria
    Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University.
    Insomnia symptoms among old people in nursing homes2018In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, no 1, p. 77-85Article in journal (Refereed)
    Abstract [en]

    Background:: Insomnia symptoms are common among old people, and hypnotics and sedative drugs are often prescribed in spite of small benefits. The aim of this study was to estimate the prevalence of insomnia symptoms and to analyze the association between insomnia symptoms, cognitive level, and prescription of hypnotics and sedatives among old people living in nursing homes. Methods:: The study comprised 2,135 people living in nursing homes in the county of Västerbotten, Sweden. Data concerning hypnotic and sedative drugs, cognitive function, and prevalence of insomnia symptoms were collected, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). Results:: The three most common insomnia symptoms were “sleeps for long periods during the day,” “interrupted night-time sleep,” and “wakes up early in the morning” with 57.8%, 56.4%, and 48.0%, respectively, of the residents exhibiting the symptoms at least once a week. Different insomnia symptoms showed different association patterns with sex and age. Most insomnia symptoms were more common among people with cognitive impairment compared to those with no cognitive impairment and seemed to reach their peak prevalence in people with moderate to severe cognitive impairment, subsequently decreasing with further cognitive decline. Of the study population, 24.0% were prescribed hypnotics and sedatives. Prescriptions were more common among those without cognitive impairment, and among those exhibiting the symptom “difficulty initiating sleep.” Conclusions:: Insomnia symptoms and prescription of hypnotics and sedatives are common among old people living in nursing homes. Considering the risk of adverse effects, it is important to regularly re-evaluate the need for these drugs

  • 8.
    Wimo, Anders
    et al.
    Aging Research Centre, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet .
    Jönsson, Linus
    Aging Research Centre, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Fratiglioni, Laura
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge .
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gustavsson, Anders
    Aging Research Centre, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Sköldunger, Anders
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge.
    Johansson, Lennarth
    Stockholm Gerontology Research Centre.
    Erratum to: The societal costs of dementia in Sweden 2012: relevance and methodological challenges in valuing informal care2017In: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Vol. 9, no 1, article id 12Article in journal (Refereed)
    Abstract [en]

    During production of the original article [1], the line referring to “Informal Care” was omitted from Table 3. It should have been mentioned between “Total social care sector” and “Indirect costs”.

  • 9.
    Wimo, Anders
    et al.
    Aging Research Centre, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet .
    Jönsson, Linus
    Aging Research Centre, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Fratiglioni, Laura
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge .
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gustavsson, Anders
    Aging Research Centre, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Sköldunger, Anders
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge.
    Johansson, Lennarth
    Stockholm Gerontology Research Centre.
    The societal costs of dementia in Sweden 2012: relevance and methodological challenges in valuing informal care2016In: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Vol. 8, no 1, article id 59Article in journal (Refereed)
    Abstract [en]

    Background

    In this study, we sought to estimate the societal cost of illness in dementia in Sweden in 2012 using different costing approaches to highlight methodological issues.

    Methods

    We conducted a prevalence-based cost-of-illness study with a societal perspective.

    Results

    The societal costs of dementia in Sweden in 2012 were SEK 62.9 billion (approximately €7.2 billion, approximately US$9.0 billion) or SEK 398,000 per person with dementia (approximately €45,000, approximately US$57,000). By far the most important cost item is the cost of institutional care: about 60% of the costs. In the sensitivity analysis, different quantification and costing approaches for informal care resulted in a great variation in the total societal cost, ranging from SEK 60 billion (€6.8 billion, US$8.6 billion) to SEK 124 billion (€14.1 billion, US$17.8 billion).

    Conclusions

    The societal costs of dementia are very high. The cost per person with dementia has decreased somewhat, mainly because of de-institutionalisation. The majority of the costs occur in the social care sector, but the costing of informal care is crucial for the cost estimates.

  • 10.
    Zingmark, Karin
    et al.
    Department of Advanced Nursing, University of Umeå.
    Norberg, Astrid
    Department of Advanced Nursing, University of Umeå.
    Sandman, Per-Olof
    Nursing Science, Department of Advanced Nursing, University of Umeå.
    Experience of at-homeness and homesickness in patients with Alzheimer’s disease1993In: American Journal of Alzheimer's Disease and Other Dementias, ISSN 1533-3175, Vol. 8, no 3, p. 10-16Article in journal (Refereed)
    Abstract [en]

    In order to gain deeper understanding of the patient’s everyday life participant and non-participant observations were performed at a group-dwelling for Alzheimer patients, during one year and eight months. The patients’ talking and acting in various situations were noted, and the contexts were described. The phenomena, “longing for home,” “on their way home “ and “being at home “ were identified and regarded as expressions of the experience of homesickness and at homeness in the patients

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