Synneve Dahlin-Ivanoff

Background: The purpose of this study is to exploratively evaluate the geriatric team’s views on the implementation of the Comprehensive Geriatric Assessment (CGA) and Clinical Frailty Scale (CFS) on frail older people with acute orthopaedic disorders who are cared for in two geriatric care wards in the southwest of Sweden. Methods: A qualitative design with focus groups was applied, based on a social constructivist research tradition. This approach differs from other qualitative methods, such as interviews, in that it encourages interaction between research participants and contributes to shedding light on a collective understanding of the world. This means that the analysis is based on the group’s collective input, not individual statements. The study group consisted of 21 professionals participating in four focus groups, with five to six participants per group. The participants in each group represented different professions within the geriatric team, including nurses, nursing assistants, physicians, occupational therapists, and physiotherapists. Results: The results underscore the importance of the CFS as the basis for CGA, emphasizing the effectiveness of the scale as a shared instrument promoting collaboration in healthcare. Our study uniquely points out the lack of research exploring the team-based use of tools for conducting a frailty assessment using the CFS. The study also highlights the importance of effective teamwork and a person-centred approach. The balance between person-centred care and what is feasible within the organization is crucial to providing the best possible care for patients. Conclusions: In Sweden, as in other places, how healthcare staff experience their work is key to the quality of care. The study concludes that positive staff experiences with new approaches drive healthcare improvement, benefiting patients and society. This highlights the potential for further improvements in healthcare delivery through continued innovation and collaboration. Trial registration: Clinical trial number: not applicable.

Background: Integrating art in residential care settings aims to create meaningful experiences and enhance the facility’s aesthetic as a home. However, the literature shows a gap, as the voices of older persons are largely absent. This study aimed to explore the views of older persons in residential care facilities specialised in dementia care regarding art and expressions of home. Older persons with cognitive impairments are frequently depicted as lacking meaningful contributions, limiting their opportunities to voice their opinions and influence their environment. Methods: This study used a qualitative explorative design with focus group method, allowing older persons with dementia to discuss their views of art in relation to expressions of home. Eleven older persons participated in four focus groups. This method encourages interaction between participants, shedding light on a collective understanding. Results: The study found that the residential care facility was perceived as a home by the participants, based on their descriptions of how both private and shared collective spaces in the facility fostered a dynamic sense of belonging. Art owned by the older persons often held personal value and they valued art for its intrinsic qualities, such as beauty, meaning, and expression. The perception of art differed between the private and collective spaces, and the discussions centered on aligning the artistic design with the participants’ notions of home to foster a socially engaging environment. Conclusion: Clearly defined private and collective spaces seem to be crucial for fostering self-determination and a sense of belonging for older persons living in residential care facilities specialised in dementia care. A balance between private and collective spaces boosted social engagement, with art playing a key role in reflecting older persons’ previous lives, shared interests and experiences, with co-creation of artistic design ensuring a dynamic environment.

Background: Society is placing increasing demands on collaboration with actors outside the academia to be involved in the research process, and the responsibility for turning this into reality lies with the researchers. As research collaboration is a way to increase the societal relevance of research and since older people have the right to be actively involved in research that concerns them, this study is addressed to researchers who work with and for older people. The purpose of this article is to explore researchers’ experiences of research collaboration with the heterogeneous group of older people, from healthy to frail. Methods: The focus group method was applied based on a qualitative approach that is based on a social constructivist research tradition. It differs from other qualitative methods, such as interviews, in that it encourages interaction between research participants and contributes to shedding light on a collective understanding of the world. A total of 14 researchers participated in four focus groups (three to five participants/group). Results: The results provided support for the overall theme: “Good scientific quality and ethics are balanced against the needs and abilities of older people”. This means a balance between the researcher and the older people collaborating with them to receive the best possible scientific quality. This is highlighted in the core category “Positioning for research collaboration” with the subcategories “Involvement or not”, “Traditional or innovative thinking” and “Selectivity or representativeness”, and the core category “Research collaboration – an ethical issue of power” with the subcategories “Research collaboration a risk for freedom of research”, “Research collaboration a risk of abuse of power” and “Discriminatory academic power structures create ethical issues”. Conclusions: Addressing the balancing act of collaborating with older people in research, the findings contribute with an understanding of the importance of researchers’ awareness of social and academic structures to minimise the risk of epistemic injustices in research on ageing and health. We want to highlight the researchers’ voice and clarify the role that researchers have in terms of the opportunities for older people to become part of the collective understanding of ageing and health and make their voices heard.

We explored different professionals’ views on and experiences of comprehensive geriatric assessment (CGA) of frail older people. Forty-six professionals working in hospitals, primary care, or municipal health and social care participated in 10 focus groups. Professional groups comprised of occupational therapists, physiotherapists, nurses, physicians, and social workers. Participants shared an ideal image of how the CGA of frail elderly people should be conducted. Experience-based competence was more often used as an assessment tool than standardized tests. The ideal image contrasted with reality, listening to the needs expressed, with the person’s problems, needs, and priorities in the foreground, as described by the categories: a need that can be met; different perspectives on needs; needs can be hidden; and needs assessment is affected by the collaboration around the person, by the context, and by the dialogue. The health and social care professionals’ first priority is to make a person-centred tailor-made comprehensive geriatric assessment and not be bound to instruments. Clear guidelines need to be developed, stating which profession assesses what, when and how in order to ensure that person-centred needs are assessed including structures and procedures for how communication and collaboration within the team as well as between the organizations are achieved in order to perform a good person-centred CGA.

Health-promoting interventions tailored to support older persons to remain in their homes, so-called “ageing in place” is important for supporting or improving their health. The health-promoting programme “Elderly Persons in the Risk Zone,” (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme. Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm. In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up. Older persons living alone — as a risk of ill health — should be especially recognized and offered an opportunity to participate in health-promoting programmes such as “Elderly Persons in the Risk Zone”. Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered. The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009.

The identification of frail older persons in different health care settings is widely seen as an important step in improving the healthcare system. Screening at an emergency department (ED) should be handled in just a few minutes without the use of tests or measurements. The FRESH-screening was developed for this purpose. This study’s aim was to evaluate the FRESH-screening and its construct validity; also assessed were the sensitivity, specificity, and predictive values for frailty screening. The study had a cross-sectional design. A total of 161 elderly people who sought care at the emergency department at Mölndal Hospital were included. Inclusion criteria were ages ≥80 years or ages 65–79 with at least one chronic disease and dependence in at least one daily living activity. Sensitivity, specificity, and predictive values were calculated to describe the accuracy of the FRESH-screening in identifying those with frailty, as assessed by eight frailty indicators. Sensitivity and specificity were both set at a minimum of 80 %, and a percentage sum ≥150 of the sensitivity and positive prediction was considered a measure of excellent value. Both sensitivity and specificity were high (81 % and 80 %, respectively) when comparing the four questions of the FRESH-screening against the eight frailty indicators. The percentage sum of sensitivity and positive prediction was 173 (81 % + 92 %), thus exceeding the 150 cutoff. This study shows the FRESH-screening to be of excellent clinical value. Additionally, the clinical experience is that the instrument is simple and rapid to use, takes only a few minutes to administer, and requires minimal energy input by older persons.

There are inequities in health status associated with ethnicity, which may limit older foreign-born persons’ ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study ‘Promoting Aging Migrants’ Capabilities’ was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula. This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings (‘senior meetings’) and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated. The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context. The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853 .

The very old (80+) are often described as a "frail" group that is particularly exposed to diseases and functional disability. They are at great risk of losing the ability to manage their activities of daily living independently. A health-promoting intervention programme might prevent or delay dependence in activities of daily life and the development of functional decline. Studies have shown that those who benefit most from a health-promoting and disease-preventive programme are persons with no, or discrete, activity restrictions. The three-armed study "Elderly in the risk zone" is designed to evaluate if multi-dimensional and multi-professional educational senior meetings are more effective than preventive home visits, and if it is possible to prevent or delay deterioration if an intervention is made when the persons are not so frail. In this paper the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants are presented.