336. Dahlin-Ivanoff S, Haak M, Fange A, Iwarsson S. The multiple meaning of home as experienced by very old Swedish people. Scand J Occup Ther 2007;14(1):25-32.
Abstract: The aim of this study was to explore aspects of the meaning of home as experienced by very old single-living people in Sweden. A grounded theory approach was used, and interviews were con-ducted with 40 men and women aged 80-89. The findings indicate that home has a central place in the lives of very old people because it is where they live and spend so much time. The significance of the home is based on the fact that it means so many different things to the participants. The theme comprises two key categories: home means security and home means freedom. Each of these has three sub-categories. In home means security, these are: living in a familiar neighborhood, everything functions, and having memories to live on. Home means freedom comprises a place for reflection, a social meeting-point, and leaving your own mark. Home is part of the environment and influences the meaning and se-lection of activities that very old people decide to engage in. When occupational therapists prescribe as-sistive devices or recommend changes in the home environment, they must be very well aware of and re-flect on what home means to their clients and base their measures on that
337. Dale B, Saevareid HI, Kirkevold M, Soderhamn O. Formal and informal care in relation to activities of daily living and self-perceived health among older care-dependent individuals in Norway. International Journal of Older People Nursing 2008;3(3):194-203.
Abstract: Background: Research about formal care of older home-dwelling people in the Nordic coun-tries is comprehensive, while research on informal care has been less inclusive. Aim: To describe self-reported activities of daily living and perceived health, and to relate them to amount and types of formal and informal care received by a group of care-dependent, home-dwelling older individuals in Norway. De-sign and methods: A sample consisting of 242 persons aged 75+ years receiving home nursing services.
Data were collected by means of structured interviews with questions about activities of daily living (ADL), amount and types of formal and informal care and demographic variables. Descriptive statistics, chi-square test, Mann-Whitney U-test and multiple stepwise regression were used in the analyses. Results:
ADL dependency was the only predictor for explaining quantity of home nursing received. Those who re-ceived a generous amount of formal care also rere-ceived a lot of care and support from informal networks.
The type of care from the two sources differed. The home nurses performed PADL tasks. While the in-formal caregivers offered help with IADL tasks. Conclusion: This study of receiving help in this group of older people in Norway shows that formal and informal care resources complement one another.
338. Gierveld JDJ, Hagestad GO. Perspectives on the integration of older men and women. Res Aging 2006;28(6):627-37.
Abstract: This introduction to the special issue "Social Integration in Later Life" addresses the back-ground ideas and concepts of the articles encompassing research into the extent and quality of older adults' integration in organizations, family, and personal networks. A rough conceptual framework is pro-vided, distinguishing between types of integration and different units of analysis. The macro level of soci-ety and its social institutions as well as smaller groups and the social locations of individuals are ad-dressed. On a macro level, integration and segregation are juxtaposed, building on classic discussions of integration, as well as recent ideas about social resources, welfare states, and rekindled considerations of age segregation. At the individual level, the concepts of integration and isolation and the subjective as-sessments of embeddedness and loneliness are contrasted.
339. Haak M, Fange A, Iwarsson S, Ivanoff SD. Home as a signification of independence and autonomy: ex-periences among very old Swedish people. Scand J Occup Ther 2007;14(1):16-24.
Abstract: The aim of this study was to explore independence in the home as experienced by very old single-living people in Sweden. A grounded theory approach was used and interviews were conducted with 40 men and women aged 80-89. Data analysis revealed the core category "Home as a signification of independence" with two main categories: "Struggle for independence" and "Governing daily life". The findings showed that home is strongly linked to independence, and being independent is extremely val-ued. Explicit descriptions of the ageing process as an individual process of changing living conditions within the home emerged from the findings. Hence, the ageing process influences the participants' per-ception of themselves as independent persons. Along the ageing process the participants' view of inde-pendence changed from being independent in activity performance without help from others to experienc-ing independence in beexperienc-ing able to make autonomous decisions concernexperienc-ing daily life at home. Conse-quently, there is a need to develop strategies to support very old people in staying as active and inde-pendent as possible in their own homes. In addition, since the findings highlight that independence is a complex construct, there is a need for conceptual differentiation between independence and a construct often used synonymously, namely autonomy
340. Johannesen A, Petersen J, Avlund K. Satisfaction in everyday life for frail 85-year-old adults: A Danish population study. Scand J Occup Ther 2004;11(1):3-11.
Abstract: The purpose of this study was to investigate whether social relations, continuity,
self-determination, and use of own resources are associated with everyday life satisfaction among 85-year-old
adults with physical disabilities. The population includes 187 frail men and women from the longitudinal study of the 1914 population in Glostrup, Copenhagen. Participants were all interviewed in their homes by an occupational therapist. Findings provide evidence that frail older adults more frequently express satis-faction with their daily lives when they (1) are occupied as usual; (2) have friends; (3) feel able to manage their own lives; (4) do not live alone; and (5) have not lately lost close friends. Lack of everyday life satis-faction is associated with (1) using home-care services and (2) living in an institution. The findings stress the importance of helping old persons stay active and independent of help, and able to continue living in their own homes.
341. Kjolseth I, Ekeberg O, Steihaug S. "Why do they become vulnerable when faced with the challenges of old age?": Elderly people who committed suicide, described by those who knew them. Int Psychogeriatr 2009;21(5):903-12.
Abstract: Background: Suicidal behavior among the elderly is a research field in which qualitative and quantitative methods can and should supplement each other. The objective of this qualitative study is to investigate whether the descriptions of elderly people who committed suicide, given by those who knew them, can provide common features that create recognizable patterns, and if so whether these patterns can help to shed light on the suicidal process. Method: This is a psychological autopsy study based on qualitative interviews with 63 informants concerning 23 suicides committed by persons aged over 65 in Norway. The informants were relatives, their family doctors, and home-based care nurses. In general, the analysis of the interviews follows the systematic text condensation method. Results: The descriptions have three main topics: life histories, personality traits and relationships. "Life histories" includes the sub-topics ability to survive and action-oriented achievers. They describe people who came through difficult circumstances when growing up and who were action-oriented in life in general and in crises. "Personality traits" includes the sub-topics obstinacy and controlling others. The informants saw the elderly people as strong-willed, obstinate and possessing a considerable ability to control themselves and those around them. "Relationships" includes the sub-topics I didn't know him and He showed no ability to meet us half-way, and describes the informants' experience of emotionally closed persons who kept a distance in their relationships. Conclusions: On the basis of the descriptions of the elderly people given in this study, we argue that these individuals will find difficulty in accepting and adapting to age-related loss of function since their self-esteem is so strongly associated with being productive and in control. Loss of control re-veals their vulnerability--and this they cannot tolerate.
342. Kjolseth I, Ekeberg O, Steihaug S. Why suicide? Elderly people who committed suicide and their experi-ence of life in the period before their death. Int Psychogeriatr 2010;22(2):209-18.
Abstract: BACKGROUND: The objective of this study is to acquire an understanding of the suicides among a group of elderly people by studying how they experienced their existence towards the end of life.
METHODS: This is a psychological autopsy study based on qualitative interviews with 63 informants in relation to 23 suicides committed by persons aged over 65 in Norway. Informants who knew the de-ceased persons well describe what the elderly person communicated to them about their experience of life in the period before the suicide and how they as informants saw and understood this. The informants comprise relatives, family doctors and home-based care nurses. The analysis of the interviews follows the systematic text condensation method. RESULTS: The descriptions are divided into three main elements:
the elderly persons' experiences of life, their perception of themselves, and their conceptions of death.
"Experience of life" has two sub-topics: this life has been lived and life as a burden. Everything that had given value to their life had been lost and life was increasingly experienced as a burden. Their "perception of themselves" concerned losing oneself. Functional decline meant that they no longer had freedom of ac-tion and self-determinaac-tion. "Concepac-tions of death" involve the following sub-topics: acknowledge-ment/acceptance and death is better than life. Life had entered into its final phase, and they seemed to accept death. For some time, many of them had expressed the wish to die. CONCLUSIONS: The results lead us to argue that their suicides should be considered as existential choices. The sum total of the dif-ferent forms of strain had made life a burden they could no longer bear. Age meant that they were in a phase of life that entailed closeness to death, which they could also see as a relief
343. Melander-Wikman A, Jansson M, Hallberg J, Mortberg C, Gard G. The Lighthouse Alarm and Locator trial - A pilot study. Technol Health Care 2007;15(3):203-12.
Abstract: An important factor for health is the possibility to be active and mobile. To make this possible various kinds of support are needed. Integrating geographical information systems technology and user experiences is important in the development of more user-friendly positioning devices. The Lighthouse Alarm and Locator trial aimed to test a new mobile alarm system with additional functionality such as posi-tioning and monitoring of vital signs which can be used regardless of location (in hospital, at home). The system was tested by elderly persons from a pensioner organisation and home care personnel answered up on the alarms. After the tests qualitative interviews were performed with the two groups. The results showed that their experiences of the new mobile alarm system could be described in three main catego-ries: to be supervised, to feel safe and to be mobile. These categories formed a theme: Positioning - an ethical dilemma. The clients' mobility was perceived to increase. The personnel did not think that position-ing was ethical but the clients (elderly) did
344. Mesteig M, Helbostad JL, Sletvold O, Rosstad T, Saltvedt I. Unwanted incidents during transition of geri-atric patients from hospital to home: a prospective observational study. BMC Health Serv Res 2010;10:1.
Abstract: ABSTRACT: BACKGROUND: Geriatric patients recently discharged from hospital experience increased chance of unplanned readmissions and admission to nursing homes. Several studies have shown that medication-related discrepancies are common. Few studies report unwanted incidents by other factors than medications. In 2002 an ambulatory team (AT) was established within the Department of Geriatrics, St. Olavs University Hospital HF, Trondheim, Norway. The AT monitored the transition of the patients from hospital to home and four weeks after discharge in order to reveal unwanted incidents.The aim of the present study was to describe unwanted incidents registered by the AT among patients dis-charged from a geriatric evaluation and management unit (GEMU) by character, frequency and stage in
the transitional process. Only unwanted incidents with a severity making contact with the primary health care (PHC) necessary were registered. METHODS: A prospective observational study with patients treated in the GEMU and followed by the AT was performed. Current practice included comprehensive geriatric assessment and management including discharge planning in the GEMU and collaboration with the primary health care on appointments on assistance to be provided after discharge from hospital. Un-wanted incidents severe enough to induce contact with the primary health care were registered during the transitional phase and after discharge. RESULTS: 118 patients (65% female), with mean age 83.2 +/- 6.4 years participated. Median Barthel Index at discharge was 18 (interquartile range 16-19) and median Mini Mental Status Examination 24 (interquartile range 21-26). A total of 146 unwanted incidents were regis-tered in 70 (59%) of the patients. Most frequent were unwanted incidents related to drug prescription re-gime (32%), exchange of information in and between the GEMU and the primary health care (25%) and service or help provided from the PHC (17%). CONCLUSIONS: Despite a seemingly well-organised sys-tem for transition of patients from the GEMU to their homes, one or more unwanted incidents occurred in most patients during discharge or four weeks post discharge. The study has revealed areas of importance for improving transitional care of geriatric patients
345. Nilsson I, Fisher A. Evaluating leisure activities in the oldest old. Scand J Occup Ther 2006;13(1):31-7.
346. Abstract: Aim. To determine whether the Modified NPS Interest Checklist (MNPS) could be developed as a tool with linear measures of four dimensions of leisure: Interest, Performance, Motivation, and Well-being. Methods. A cross-sectional descriptive study including 156 volunteers born between 1904 and 1917 and living in urban or rural northern Sweden. Each participant was individually interviewed at her/his place of residence. Subsequent data were subjected to a series of Rasch analyses using FACETS. Major findings. The items and persons demonstrated acceptable goodness-of-fit across all four dimensions in the MNPS checklist. The Rasch equivalent of Cronbach's alpha was 0.98 for items, and ranged from 0.66 to 0.75 for persons. Principal conclusion. The MNPS shows evidence for acceptable internal scale valid-ity, person response validvalid-ity, and scale reliability. This study provides initial evidence that the MNPS is a valid tool for measuring leisure among the oldest old. While this study provides the first psychometric ex-amination of an assessment designed to evaluate different dimensions of leisure, more research is needed to further assess validity and reliability of this tool with the elderly and with other groups.
347. Petersson I, Kottorp A, Bergstrom J, Lilja M. Longitudinal changes in everyday life after home modifica-tions for people aging with disabilities. Scand J Occup Ther 2009;16(2):78-87.
Abstract: OBJECTIVE: To investigate longitudinal impacts of home modifications on the difficulty of per-forming everyday life tasks for people aging with disabilities, and to investigate whether other factors had any additional impacts on difficulty in everyday life tasks for people receiving home modifications. METH-ODS: The sample consisted of 103 persons aging with disabilities and in need of home modifications, di-vided into an intervention group and a comparison group. The data were first subjected to Rasch analysis and a random coefficient model was used. RESULTS: Participants in the intervention group reported a significantly lower level of difficulty in everyday life tasks compared with those in the comparison group.
One confounding factor, number of months waiting for home modification, had an impact on difficulty in everyday life. CONCLUSION: Home modifications are effective in decreasing difficulty in performing eve-ryday life tasks up to six months after the installation. Furthermore, to be effective home modifications need to be installed in a timely fashion. For each consecutive month the person waited for their home modification the difficulty of performing everyday life tasks increased. Therefore, it is important that home modifications be installed as soon as possible after the need has been identified
348. Soldato M, Liperoti R, Landi F, Carpenter IG, Bernabei R, Onder G. Patient depression and caregiver atti-tudes: Results from The AgeD in HOme Care study. J Affect Disord 2008;106(1-2):107-15.
Abstract: Background: The present cross-sectional study was aimed to evaluate the association be-tween care recipient depression and caregiver attitudes. Methods: Data were from The AgeD in HOme Care project, a study enrolling subjects aged >= 65 years receiving home care in Europe. Depression was diagnosed as a score >= 3 on the MDS Depression Rating Scale. Caregiver attitudes were assessed us-ing two measures: 1) caregiver dissatisfaction (the caregiver was dissatisfied with the support received from family and friends); and 2) caregiver distress (the caregiver expressed feelings of distress, anger, or depression). Results: Mean age of 3415 participants was 82.4 years, 2503 (73.3%) were women and 430 (12.6%) were depressed. Dissatisfaction was significantly more common among caregivers of depressed, compared with those of non depressed patients (32/430, 7.4% vs. 78/2985, 2.6%; p = <0.001). After ad-justing for potential confounders, patient depression was still significantly associated with caregiver dis-satisfaction (OR: 1.84; 95% CI: 1.12-3.03). Similarly, distress was significantly more common among caregivers of depressed patients, compared with those of non depressed patients (81/430, 18.8% vs.
175/2985, 5.9%; p < 0.001). After adjusting for potential confounders, patient depression was still signifi-cantly associated with caregiver distress (OR: 2.41; 95% CI: 1.72-3.39). Limitations: The cross-sectional design of the study cannot provide the cause-effect relationship between depression and caregiver atti-tude; no data were collected on caregiver characteristics. Conclusions: Among older adults depression is associated with increased caregiver dissatisfaction and distress. Knowledge of factors influencing care-giver attitudes may be valuable to study interventions aimed to promote patient and carecare-giver well being.
349. Thygesen E, Saevareid HI, Lindstrom TC, Engedal K. Psychological distress and its correlates in older care-dependent persons living at home. Aging Ment Health 2009;13(3):319-27.
Abstract: OBJECTIVES: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological dis-tress was also examined. METHOD: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, house-hold composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints,
Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale. RESULTS: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis. CON-CLUSION: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation..