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Informing an assistive living technology intervention to prevent hospitalisations for home-dwelling older persons
Get PDFThis thesis describes the process of planning an assistive living technology intervention for home-dwelling older persons receiving community care. The use of such technologies in the community care setting is heralded as one answer to address the challenges facing the health care system, as well as a mean for the health and care services to improve, simplify and enhance the efficiency of their activities.
Although the implementation of assistive living technologies is complex, the implementation is informed basically in two ways—directly, based on empirical reports, or indirectly, through systematic or meta-analytic reviews. The main objective of this thesis is to provide a theory and evidence-based rationale for applying an assistive living technology intervention in community care to prevent hospitalisations for older persons.
By using hospital admissions which may be prevented as a case, exploring health care personnel’s and managers’ perspectives, and furthermore using existing theories and research concerning implementation, we have applied both an empirical and theoretical approach to inform a future assistive living technology intervention in the defined context.
A socio-technical perspective has been applied; the different stakeholders involved on different organisational levels and the framework conditions constitute the socio technical system in the study, implying that a multi-level approach is appropriate to help identify potential barriers and incentives for the implementation of assistive living technologies in community care. Furthermore, has the Model for Understanding Success in Quality (MUSIQ) provided guidance to identify contextual factors likely to influence a future implementation process
Hjemmeboende eldres erfaringer med appetitt og evne til å påvirke middagsleveringstjenesten
No full textAbstract
Objective: To explore the home living elderly’s experience with appetite and perceived ability to influence their Meals on wheels service. Design: Exploratory qualitative study using semi-structured qualitative interviews. Setting: A meals on wheels service in a municipality situated in South-western Norway. Participants: A total of three home living elderly receiving a meals-on-wheels service aged 80-90 years, one male and two females. Results: Systematic text condensation revealed three categories that represents the experience of the home living elderly relating to appetite and influence on their meals-on-wheels service: 1) Aspects of the meals challenging the informant’s appetite 2) Compensating and complementary strategies developed to ensure appetite in relation to their received meals 3) User involvement; the informants perceived ability to exert influence on the meals Conclusion: Findings from this study indicate a need for MOW products that considers the elderly’s sensory capabilities and preferences, as to maintain and increase the elderly’s appetite. In addition, the importance of user involvement as a factor to counteract the feeling of being dependent whilst receiving MOW service has been highlighted in this study, and should be further investigated.
Key words: Appetite, Meals-on-Wheels, experiences, Home-living, elderl
Meals on Wheels - Home Living Elderly’s Experiences of Appetite and Influence on the Service
Get PDFMaster's thesis in Health and social sciencesAbstract
Objective: To explore the home living elderly’s experience with appetite and perceived ability to influence their Meals on wheels service. Design: Exploratory qualitative study using semi-structured qualitative interviews. Setting: A meals on wheels service in a municipality situated in South-western Norway. Participants: A total of three home living elderly receiving a meals-on-wheels service aged 80-90 years, one male and two females. Results: Systematic text condensation revealed three categories that represents the experience of the home living elderly relating to appetite and influence on their meals-on-wheels service: 1) Aspects of the meals challenging the informant’s appetite 2) Compensating and complementary strategies developed to ensure appetite in relation to their received meals 3) User involvement; the informants perceived ability to exert influence on the meals Conclusion: Findings from this study indicate a need for MOW products that considers the elderly’s sensory capabilities and preferences, as to maintain and increase the elderly’s appetite. In addition, the importance of user involvement as a factor to counteract the feeling of being dependent whilst receiving MOW service has been highlighted in this study, and should be further investigated.
Key words: Appetite, Meals-on-Wheels, experiences, Home-living, elderl
«My home is my castle» -en kvalitativ litteraturstudie om implementering av personsentrert omsorg til enslige, hjemmeboende personer med demens
Get PDFBakgrunn: Egen interesse for dagens demensomsorg. Det er et stadig stigende antall personer med demens og mange ønsker å bo i sitt eget hjem så lenge det er mulig. Studien hadde fokus på om implementering av personsentrert omsorg hadde betydning for enslige, hjemmeboende personer med mild til moderat demens sin opplevelse av å kunne bo lengst mulig hjemme, og hva helsepersonell opplevde relatert til personsentrert omsorg for personer med demens i deres hjem. Hensikten med studien var å få en bedre forståelse av og innsikt i erfaringer som er av betydning for personer med demens og helsepersonell når pasienten bor alene i sitt hjem. Målet med undersøkelsen var å finne svar på problemstillingen med håp om nytteverdi for demensomsorgen. Metoden var en fenomenologisk, tradisjonell litteraturstudie med utgangspunkt i analyse av kvalitativ forskning. Utvalget var 10 publiserte, vitenskapelige artikler fra skandinavisk- og engelsktalende land. Funnene ble diskutert opp mot teoretisk rammeverk av Tom Kitwood’s filosofi om personsentrert omsorg, Kari Martinsens omsorgsteori og litteratur om autonomi. Resultat: Antyder verdighet, identitet, utfordringer og beslutningsprosesser som viktig for hjemmeboende personer med demens. I tillegg fant resultatene betydningen av relasjoner, samhandling, udekkede behov og kompetanse som viktig. Funnene avdekket to overgripende tema: Betydningen av medbestemmelse for å opprettholde verdighet og identitet, og betydningen av relasjoner og kompetansebygging i omsorgskulturen. Konklusjon: Personer med demens opplever beslutningsstøtte, identitet og verdighet som betydningsfullt for å bo hjemme. Implementering av personsentrert omsorg i hjemmetjenester er viktig og krever økt kompetanseutvikling
Complementary and alternative medicine in relation to the behavioural and psychological symptoms in people with dementia: A systematic review
Get PDFMaster's thesis in Health and social sciencesThe purpose of this thesis is to assess the efficacy of Complementary and Alternative Medicine in people with dementia with behavioural and psychological symptoms. A literature search was undertaken. Three databases, Medline, EMBASE, and PsycINFO were searched. Only peer-reviewed journal articles in English published in 1990s or later with clinic trials for humans were included in the current review. Randomized clinical trials or studies with control groups employing five following complementary and alternative therapies (Acupuncture/Acupressure, Aromatherapy, Massage, BLT, and TENS) for managing BPSD in people with dementia were included in our systematic review. In the review 565 related studies were identified, where 30 RCTs or studies with control group met the inclusion criteria for this systematic review. 22 studies of which 17 were RCTs, out of the total 30 studies selected and analysed in this work have demonstrated effectiveness of CAM. In conclusion, dementia as a medical problem currently can not be cured, but the symptoms of dementia and the quality of life of patients with dementia can be improved by different therapies. Although not all studies demonstrated consist statistic significant improvement, there were obviously benefited evidences or positive trend from CAM. More research, however, is needed to provide definitive evidence about the benefits of CAM
Konsistenstilpasset mat – En kilde til økt mestringsfølelse hos helsepersonell
Get PDFMaster's thesis in Health and social sciencesMål og hensikt
Hensikten var å undersøke helsepersonellets opplevelser og erfaringer ved bruk av konsistenstilpasset mat til pasienter med dysfagi. Målet med studien var å få ny kunnskap om hvordan maten fungerer som produkt og hvordan bruken kan påvirke helsepersonellets oppfatning av egengitt pleie
Problemstilling
Hvilke erfaringer har helsepersonellet på en sykehjemsavdeling med bruk av konsistenstilpasset mat til personer med dysfagi?
Metode
Studiens har en kvalitativ tilnærming, men fokusgruppeintervju som datainnsamlingsmetode. Det ble utført to intervjuer med henholdsvis 5 og 7 deltakere. Intervjuene var basert på en semistrukturert intervjuguide. Datasettene ble analysert ved bruk av systematisk tekstkondensering som forklart av Malterud.
Resultater
Analysen førte til følgene fire hovedtemaer: Behov for konsistenstilpasset mat, bruk av konsistenstilpasset mat, utfordringer ved bruk av konsistenstilpasset mat og bruk av konsistenstilpasset mat til ulike pasientgrupper. Pasienter med dysfagi hadde behov for tilpasset mat for å forebygge komplikasjoner i matsituasjonen. Helsepersonellet opplevde bruken som en kilde til trygghet, men omstendighetene kunne gjøre det utfordrende. Personer med demens spiste på en annen måte når de fikk servert maten.
Konklusjon
Funnene kan tyde på at konsistenstilpasset mat er en viktig faktor for å yte god omsorg til pasientene, samt øke mestringsfølelsen hos personalet. Spesielt i forhold til personer med demens ble viktigheten av denne typen mat trukket frem. Likevel avhenger bruken av organisatoriske faktorer. Tidspress og manglende kommunikasjon med kjøkkenet kan hindre god bruk av konsistenstilpasset mat
Use of drugs with anticholinergic properties and factors affecting cognition in patients with mild dementia
Get PDFMaster's thesis in Health and social sciencesBackground: Elderly people, particularly those with dementia, are at high risk of adverse anticholinergic drug effects. Despite the well-recognized potential for cognitive decline with anticholinergic agents, their use continues even among patients with dementia. Objectives: to estimate the prevalence of drugs with anticholinergic drug effects and its impact on cognitive decline over time in home-dwelling people with dementia in Norway. Methods: Referrals to five outpatient clinics in geriatric medicine, old age psychiatry and neurology in Western Norway during 2005-2013 were included. Cognitive decline was assessed for up to 5 years using Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE). Cox regression was applied to model the cognitive decline. Results: Nearly 60% patients received at least one drug with anticholinergic property whereas almost 12% were taking drugs with well-known anticholinergic activity. However, the findings did not support the hypothesis that use of drugs with anticholinergic properties increases the risk of worsening cognitive decline among home-dwelling people with dementia. Moreover, the study showed that patients with Lewy body dementia and lower cognition at baseline predicted faster cognitive decline.
The thesis is part of the Master Study in Health Sciences at University of Stavanger, Norway. The thesis is divided into two parts; the first part is supported by theoretical framework, and the second part is an article, which is to be sent for publication
Patient participation in transitional care of older patients
Get PDFPhD thesis in Health, medicine and welfareBackground: Older patients often have several health challenges, with multiple medications, which leads to a need of treatment and care from diverse healthcare services. These patients are often in need of transitions from different levels of care, specifically during hospital admission and discharge. Patient participation is highlighted and stated in patients’ rights and healthcare directives, with patients being informed and involved in all treatment and care processes. Nevertheless, literature reveals a lack of patient participation, with minimal information in transitional care.
Aims: The overall aims of this thesis were 1) to give an overview of the research literature on older patients’ participation in transitional care, 2) to explore older patients’ perspectives on participation during hospital admission and discharge, 3) to explore healthcare professionals’ perspectives on patient participation and identify factors influencing older patients’ participation during hospital admission, and 4) to conduct and describe interprofessional simulation to improve competencies about patient participation in transitional care.
Methods: The study comprises several qualitative methods, applied in four partial studies. First, a literature review was written involving 30 studies, 15 exploring older patients’ participation in transitional care and 15 studies on experiences with tools to support patient participation. In 2012, 41 older patients were included in participant observations, 21 in hospital admission and 20 in hospital discharge. Further, 27 personal interviews with different healthcare professionals (ambulance workers, nurses, doctors) were conducted. In November 2013, interprofessional simulation was carried out.
Results: Paper 1 reveals variable information and patient participation among older patients during hospital discharge in the literature review. Results show that older patients often were excluded and not participating in discussions about discharge. When present, they often felt they were not being seen or heard by healthcare professionals, and a paternalistic approach was revealed. Several tools to support patient participation in transitional care have been implemented, with variable results. Most successful were family meetings, checklists and education programs.
Paper 2 identifies variable degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision- making were observed and experienced by the patients. Next of kin appeared to be important advocates for the patients in admission and provided practical support both during hospital admission and discharge. Data suggests that patient participation in admission and discharge is influenced by time constraints and heavy workloads of healthcare professionals. Patients’ health conditions also influenced participation.
Paper 3 shows the interviews with healthcare professionals, wherein it was found that patient participation in hospital admissions was influenced by five main factors: routine treatment and care during hospital admission, particularly procedures like medical examinations; the frail and thankful older patients, with the compound picture of their medical needs; hospital resources, such as available staff and beds; healthcare professionals’ attitude towards patients’ experiences; and the presence of a supportive and demanding next of kin, acting as an advocate for the patient.
Paper 4 describes interprofessional simulation focusing patient participation of older patients in transitional care. Healthcare professionals from one hospital and one municipality participated in the simulation, with a film scenario, which was based on findings from the observational study. Results show that healthcare professionals did not have any common arenas to meet and discuss work issues and specific or general challenges related to transitions. The film scenario emotionally affected several participants, revealing a lack of information and lack of care, with decisions taken by healthcare professionals. Log reports show that all participants were concerned to provide sufficient information to patients and next of kin and vice versa, as well as involving the patient in treatment, care and discharge planning. Several suggestions came up and the follow-up meetings showed that some wards had continued their work to improve the quality of transitional care
Agitation and use of restraint in nursing home residents with dementia. Prevalence, correlates and the effects of care staff training
Get PDFBackground: Dementia is one of the most prevalent syndromes in the elderly population, and over half of people with dementia live in long-term care homes. 80% of residents in nursing homes have dementia, the majority with severe functional impairments and complex needs. Agitation and other behavioural changes are common, with severe consequences for their functioning and quality of life, including use of restraint and use of psychotropic drugs. To preserve the personal control, dignity and quality of life of these vulnerable individuals, as long as possible, is an important goal of our society. Few studies have explored the relationship between agitation and factors such as stress in care staff and working conditions, and there is little evidence whether education and guidance in care staff can improve agitation and reduce use of restraint and psychotropic drugs. Objective: The objective of this thesis was to study the relationship between agitation and use of restraint, carer burden, organizational and psychosocial factors and whether agitation and use of restraint could be reduced by means of a novel care staff training. Methods: Descriptive, cross-sectional surveys were conducted to analyse the prevalence of agitation in nursing home residents, and to study correlates of health and well-being in care staff. Residents and care staff from four nursing homes in Rogaland County were included. In addition, data from nursing homes in England and Austria were used. Two cluster-randomized controlled trials were conducted to study the effect of a novel care staff training program; Relation Related Care (RRC). Data on agitation and use of restraint and antipsychotics were collected immediately before and after the 6- month intervention period by a research nurse, blinded for study hypothesis. In the second study, an additional follow-up assessment was conducted 6 months after completion of the intervention. Standardized measures were used: Clinical Dementia rating Scale (CDR), Functional Assessment rating Scale (FAST) and the Global Deterioration Scale (GDS) were used to rate severity of dementia. Two rating scales were used to score agitation; Brief Agitation Rating Scale (BARS) and Cohen-Mansfield Agitation Inventory (CMAI). Frequency of use of restraint was determined by a standardized interview, where all use of restraint during the last seven days was recorded. Three scales measured health and well being in care staff: Perceived Stress Scale (PSS), Psychological Distress (HSCL-10) and Subjective health complaints (SHC). Organizational and Psychosocial factors were measured by General Nordic Questionnaire for Psychosocial and Social Factors at Work (QPSNordic). Results: We found that 75.4% of the residents with dementia exhibited at least one agitated behaviour at least weekly and 65.3% several times a week. The six most common agitated behaviours were repetitious sentences or questions, complaining, cursing, pacing, negativism and general restlessness. However, agitation in the Norwegian nursing homes was less common than in nursing homes in UK and Austria. The level of agitation differed between countries, with higher CMAI scores in the Austrian nursing home compared to UK and Norwegian nursing homes. Similarly, the use of psychotropic drugs differed significantly between the homes, with a higher proportion on antipsychotic drugs in UK and Austrian compared to Norwegian nursing homes. Organizational and psychosocial factors, in particular those related to the organizational structure of the nursing home were associated with all three measures of health and well-being in care staff. Leadership, mastery and control of work were the three organizational and psychosocial factors which significantly explained the variance in care staff health and well being. In contrast, agitation in residents was not significantly associated with any of the measures of health and well being in care staff. In the first intervention study, the proportion of restraint declined with 54% in the treatment group and increased with 18% in the control group. This difference was significant. In contrast, agitation did not differ between the groups. In the second study, the intervention led to both reduced severity of agitation and reduction in restraint, which was evident by a much smaller increase in the intervention group compared to the control group. The improvement of agitation continued 6 months after the completion of the intervention, indicating that sustained improvement of agitation can be achieved by means of staff training. The effect on restraint use however, seemed to be short-lived, suggesting that continuous supervision is needed to achieve sustained reduction of the use of restraint. Conclusion: Agitation is common in residents with dementia in Norwegian nursing homes. There is a need to explore factors contributing to agitation, in order to understand and manage it effectively and to avoid misdiagnose of symptoms, reduce inappropriate use of drugs and restraint, and thereby improving the conditions and quality of life for residents with dementia in nursing homes. Our findings from the intervention studies suggests that by lowering the care staff – resident ratio and by providing additional education, guidance and support, improved care of residents can be achieved
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