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Aim: The aim of this study was to analyse the effects of a full-scale implementation of a care process programme on life satisfaction among frail older people, as compared with those receiving usual care. Design: The study includes participants from a full-scale care process programme (N = 77) and participants from a historical control group (N = 66). The care process programme establishes a comprehensive continuum of care through components including case management, interprofessional teamwork and care-planning meetings in the older people's own homes. Methods: Questionnaires were used and data were collected at baseline, with follow-ups at three, six and 12 months. Results: The implementation of the full-scale care process programme had a positive effect on life satisfaction among frail older people. From 6-month–12-month follow-ups, a higher proportion of participants in the care process programme had positive life satisfaction outcomes, as compared with the historical control group.

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

This study is part of the Promoting Aging Migrants’ Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants’ everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70- 83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.

Objective: To study gender differences in older adults according to practice, knowledge and attitudes regarding food habits and meal patterns. Design: Cross-sectional study. Setting: Two urban districts of Gothenburg, Sweden. Participants: A total of 297 individuals were included, 102 men and 195 women. They were 80 years or older and living in ordinary housing without being dependent upon the municipal home help services or help from another person in Activities of Daily Life, and cognitively intact, defined as having a score of 25 or higher in the Mini Mental State Examination. Measurements: Telephone interviews regarding food habits and meal patterns were conducted. Results: Almost all participants (99%) ate their main meal at home and men preferred company at meals more often (p<0.001). Women had the sole responsibility to shop for food more often (p<0.000), and generally regarded cooking as a routine or something they just had to do. Among men, few (13%) took a great interest in cooking and 36 % of the men stated that cooking was something they were not capable of performing (p<0.000). Men had company at meals every day more often (71% vs 40%). Respondents stated that loneliness took away the enjoyment of cooking and changed their habits when becoming a widow or widower. Conclusion: Women take greater responsibility for the household than men, regardless of marital status. A large proportion of the men thought cooking was something they were not able to do. The findings in this study may indicate a possible gender difference in the need for societal support.

OBJECTIVE: Very old persons (80+) are often described as "frail", implying that they are particularly vulnerable to adverse health outcomes. Elderly Persons in the Risk Zone was designed to determine whether a preventive home visit or multiprofessional senior group meetings could postpone deterioration in frailty if the intervention is carried out when the person is not so frail. DESIGN AND SAMPLE: The study was a RCT with follow-ups at 1 and 2 years. A total of 459 persons (80+), still living at home, were included. Participants were independent in activities of daily life and cognitively intact. MEASURES: Frailty was measured in two complementary ways, with the sum of eight frailty indicators and with the Mob-T Scale measuring tiredness in daily activities. RESULTS: Both interventions showed favorable effects in postponing the progression of frailty measured as tiredness in daily activities for up to 1 year. However, neither of the two interventions was effective in postponing frailty measured with the sum of frailty indicators. CONCLUSIONS: The results in this study show the potential of health promotion to older persons. The multiprofessional approach, including a broad spectrum of information and knowledge, might have been an important factor contributing to a more positive view of aging.

Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researchercommunity partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.

Rationale, aims and objectives Improving the possibilities for ageing persons to take control over their health is an increasingly important public health issue. Health promotion has previously been visualized to succeed with this goal, but research has primarily focused on ageing persons who are native-born, leaving the generalizability to persons who are foreign-born unexplored. Therefore, as part of the development of a larger health promotion initiative for ageing persons who have experienced migration, this study aimed to assess the feasibility of an adapted protocol. The specific feasibility objectives were to assess recruitment procedure, retention rates, study questionnaire administration and variability of collected data. Method Forty persons who were ≥70 years, and who had migrated from Finland, Bosnia and Herzegovina, Croatia, Montenegro or Serbia to Sweden were randomly allocated to a health promotion programme or a control group. The programme was linguistically adapted with regard to translated information material, bilingual health professionals and evaluators, and a person-centred approach was applied to both programme development and provision. The data analysis was explorative and descriptive. Results The results visualized structural and linguistic barriers to recruitment and study questionnaire administration, and describe strategies for how to bridge them. Retention rates and data variability were satisfying. Conclusions Calling for iterative and pragmatic programme design, the findings describe how to move towards a more inclusive health care environment. Person-centred and bilingual approaches with attention to the possibilities for building authentic relationships between participants and providers are emphasized, and a structured methodology for developing study questionnaires is suggested.

Background: 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. Methods/Design: 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. Discussion: 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 impro

Background: Limited data are available on body composition (BC) and physical function in healthy adults >80 y, potentially hampering development of reference values. We aimed to study 1) BC and physical function and 2) changes in hand-grip strength over a 4-year period in a community dwelling elderly Swedish population. Methods: Apparently healthy, community-dwelling men (n=51) and women (n=51) aged >83y were measured by Sit to Stand-test, hand grip strength, body height, body weight and BC using a Bioimpedance Spectroscopy (Impedimed). The study was approved by the Regional Ethical Review Board in Gothenburg as an addition to Elderly Persons in the Risk Zone (T176-12). Results: Mean age 86.5 y, no age difference between sexes. Men and women performed equally well at the Sit to Stand-test. Men were significantly stronger with a mean HGS of 34.1 kg compared to women of 19.5 kg. 15 % had a BMI below 22 kg/m2. According to skeletal muscle index (SMI) 64 % were assessed as having severe sarcopenia (Cruz-Jentoft et al 2010). Conclusion: In this healthy elderly population BC and physical function was well preserved compared to previous studies, although many were classified as sarcopenic according to current cut-offs. Results from this study can be used as reference values for healthy community-dwelling elderly in high age.

Purpose of the study: To investigate the effects of 2 different health-promoting interventions on physical performance, fear of falling, and physical activity at 3-month, 1-year, and 2-year follow-ups of the study Elderly Persons in the Risk Zone. Design and Methods: A randomized, three-armed, single-blind, and controlled study in which 459 independent and community-dwelling people aged 80 years or older were included. A single preventive home visit including health-promoting information and advice and 4 weekly senior group meetings focused on health strategies and peer learning, with a follow-up home visit, were compared with control. Functional balance, walking speed, fear of falling, falls efficacy, and frequency of physical activities were measured 3 months, 1 year, and 2 years after baseline. Results: There were no or limited differences between the groups at the 3-month and 1-year follow-ups. At 2 years, the odds ratio for having a total score of 48 or more on the Berg Balance scale compared with control was 1.80 (confidence interval 1.11-2.90) for a preventive home visit and 1.96 (confidence interval 1.21-3.17) for the senior meetings. A significantly larger proportion of intervention participants than controls maintained walking speed and reported higher falls efficacy. At 1 and 2 years, a significantly higher proportion of intervention participants performed regular physical activities than control. Implications: Both a preventive home visit and senior meetings reduced the deterioration in functional balance, walking speed, and falls efficacy after 2 years. The long-term effects of both interventions indicate a positive impact on postponement of physical frailty among independent older people.

Purpose: To examine independence in activities of daily living (ADL) at the 1- and 2-year followups of the health-promoting study Elderly Persons in the Risk Zone. Design and Method: A randomized, three-armed, single-blind, and controlled study. A representative sample of 459 independent and community-dwelling older adults, 80 years and older, were included. A preventive home visit was compared with four weekly multiprofessional senior group meetings including a follow-up home visit. Results: Analysis showed a significant difference in favor of the senior meetings in postponing dependence in ADL at the 1-year follow-up (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.19-3.10) and also in reducing dependence in three (OR = 0.52, 95% CI = 0.31-0.86) and four or more ADL (OR = 0.40, 95% CI = 0.22-0.72) at the 2-year follow-up. A preventive home visit reduced dependence in two (OR = 0.40, 95% CI = 0.24-0.68) and three or more ADL (OR = 0.37, 95% CI = 0.17-0.80) after 1 year. Implications: A long-term evaluation of Elderly Persons in the Risk Zone showed that both senior meetings and a preventive home visit reduced the extent of dependence in ADL after 1 year. The senior meetings were superior to a preventive home visit since additional significant effects were seen after 2 years. To further enhance the long-term effects of the senior meetings and support the process of self-change in health behavior, it is suggested that booster sessions might be a good way of reinforcing the intervention.

Background: The expression older adult refers to a person who is 65 years and older. This part of the population has increased over the past decades, and is expected to increase further, by almost 70 % over the next 90 years. Muscle mass decreases with increasing age which affects physical function and nutritional status. Age also result in increased risk of diseases that can affect the muscle mass negatively. Measurement of body composition provides information of nutritional status and indications of physical function. Reference values from healthy older adults are required as a comparison when assessing body composition, nutritional status & physical function in different groups of older adults. Objective: To study physical function in relation to body composition in an apparently healthy elderly Swedish population. Methods: One hundred community-dwelling men and women were visited. The study population was part of the project Elderly in the Risk Zone, conducted in Gothenburg with people 80 years and older within the city district Örgryte-Härlanda. Inclusion criteria in this study were those remaining after two years of follow-up, still living within the area in their own home. Exclusion criteria were pacemaker, fractures, amputation, paralysis, dementia and recent or ongoing influenza or calici. The participants answered a few questions and preformed a series of tests to determine physical function and autonomy. Height and weight were measured, as well as body composition using a bioelectrical impedance spectroscopy (BIS). The main study Elderly in the Risk Zone was approved by the Regional Ethical Review Board in Gothenburg (Dnr 650-07). This study was approved as an addition to Elderly Persons in the Risk Zone (T176-12). Results: Mean age was 86.5 years. Men and women performed equally well at the Standing-up-test and there were no difference in BMI between sexes. Men were significantly heavier, taller, stronger, and had more TBW, ECW, ICW and FFM than wom

Approximately 40 per cent of older adults living at home are at risk of malnutrition. To detect this condition, body mass index is often used as a tool. The standard way of measuring body height is in a standing position. Height decreases with age and further, many older adults are not physically capable to undergo standing height measures. As height is one of the components in BMI it can be affected by body height decrease which in turn will affect the estimated prevalence of malnutrition risk. There are many different ways to estimate height by proxy measures. The aim of this study was to investigate whether proxy measurements could prove to be useful when estimating height in Swedish community-dwelling older adults. Home visits were made to 51 men and 51 women, who had participated in the randomized, single-blinded health-promoting intervention study, Elderly in the Risk Zone, living in the urban district Örgryte-Härlanda in Gothenburg, Sweden. Body weight, standing height, recumbent height, knee-height and demi-span was measured. An interview was also conducted, retrieving information regarding e.g. height around 20 years of age. T-test and Wilcoxon rank tests were performed and to further examine the results regression analyses and Bland & Altman-plots were conducted. The result showed that between 20 years of age to present age the men had decreased, in body height, on average 3,8 cm and the women 4,9 cm. In both the regression analysis and in the Bland & Altman plots, recumbent height and youth height seem to best conform to standing measured height. In the men, a negative correlation was found between the difference standing and knee-height measure of body height compared to mean values of the two measures in the Bland & Altman plots, though it was the only measurement that did not show any group mean statistical significant difference from standing height by t-test. No negative or positive correlation was seen in the women by the Bland & Alt

Objectives To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self-rated health, and activities of daily living (ADLs) at 3-month follow-up. Design Randomized, three-armed, single-blind, controlled trial performed between November 2007 and May 2011. Setting Two urban districts of Gothenburg, Sweden. Participants Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service. Intervention A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit. Measurements Change in frailty, self-rated health, and ADLs between baseline and 3-month follow-up. Results Both interventions delayed deterioration of self-rated health (odds ratio (OR) = 1.99, 95% confidence interval (CI) = 1.12-3.54). Senior meetings were the most beneficial intervention for postponing dependence in ADLs (OR = 1.95, 95% CI = 1.14-3.33). No effect on frailty could be demonstrated. Conclusion Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term. A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit. Further research is needed to examine the outcome in the long term and in different contexts.

Purpose: To analyse the cost-effectiveness of the activity-based Health Education Programme 'Discovering New Ways' versus a standard Individual Programme. Method: Two-hundred and twenty-nine persons were randomized to either the Health Education Programme or an Individual Programme. The present study is based on 131 persons who participated in the 28-month follow-up. Costs for the low vision clinic were documented prospectively along with external costs. A cost-effectiveness analysis was done using cases with an improved level of perceived security in daily activities as the effectiveness measure. Results: The Health Education Programme led to significantly more cases with an improved level of perceived security (45 vs. 10%, CI 95%: 21-49, p value < 0.001) and the total social cost per treatment was lower (28 004 vs. 36 341 SEK). Taken separately the low vision clinic costs were slightly higher due to a higher prescription of assistive devices, but external costs were lower for the Health Education Programme compared to the Individual Programme, though neither of these differences was statistically significant. Conclusion: The results suggest that replacing the standard Individual Programme with the Health Education Programme 'Discovering New Ways' is cost-effective as more persons experience increased security to a lesser total cost. © 2005 Taylor & Francis.