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De som träffar barn, unga och deras vårdnadshavare i sin yrkesverksamhet har en anmälningsplikt som syftar till att skydda barn som far illa, eller misstänks fara illa. Denna länk mellan socialtjänsten och utsatta barn är mycket viktigt för ett fungerande skyddsnät i samhället. Syftet med denna uppsats har varit att utreda de rättsliga förutsättningarna för anmälningsplikten och dess tillämpning. Frågeställningar som väglett arbetet är hur ser anmälningspliktens bakgrund ut, vad är gällande rätt och hur tillämpas anmälningsplikten, hur går en orosanmälan till och vad händer när den är gjord, samt hur förhåller sig anmälningsplikten till regler om sekretess. För att besvara frågorna har den rättsdogmatiska metoden använts. Av resultatet framgår att anmälningsplikten inte alltid följs och att det kan bero på att anmälningspliktiga har för lite kunskap om vad misshandel av barn innefattar, eller att det finns en rädsla för hur vårdnadshavarna kommer reagera, eller att socialtjänsten inte ingriper. Det krävs tydliga rutiner för hur anmälningsplikten ska hanteras i verksamheter som har att göra med barn, unga och dess vårdnadshavare, samt utveckling och kompetensutveckling för att veta när man är skyldig att anmäla.

This study examines the impact of hip fractures on trajectories of home care, care home residence, and mortality among individuals aged 65 and older and explores the impact of living arrangement, cohabitation, frailty, and socioeconomic position on these trajectories. Based on a linkage of nationwide Swedish population registers, our study included 20,573 individuals with first hip fracture in 2014-2015. Care trajectories during two years following the fracture were visualized and compared to two hip fracture-free control groups drawn from the general population; age-and-sex-matched controls and health-matched controls identified through propensity score matching. Multistate modeling was employed to identify sociodemographic and health-related factors associated with care trajectories among hip fracture patients. Already before their fracture, hip fracture patients had worse health than the general population. However, when controlling for pre-fracture health, hip fractures still had a considerable impact on care use and mortality. Comparisons to the health-matched controls suggest that hip fractures have an immediate, yet short-term, impact on care trajectories. Long-term care needs are largely attributable to poorer health profiles independent of the fracture itself. This emphasizes the importance of adequate comparison groups when examining the consequences of diseases which are often accompanied by other underlying health problems.

Background and Purpose: The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in community-living older men and women, who may be targets for primary preventive interventions. The FIF tool consists of 3 self-reported questions and 1 physical test (1-leg standing balance). The purpose of this study was to examine the predictive ability of the FIF tool and a modified FIF tool (in which 1-leg standing is replaced by self-reported balance) for first-time injurious falls. Methods: A cohort of 1194 community-living people 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden, was followed longitudinally for 5 years. Data on injurious falls were collected from registered data and were defined as receipt of care after a fall. The predictive ability of the FIF tool and the m-FIF tool was explored using Harrell's C statistic, stratified by sex. Results and Discussion: The injurious fall rate per 1000 person-years was 54.9 (95% CI: 47.22-63.78) for women and 36.3 (95% CI: 28.84-45.78) for men. The predictive ability for women and men according to Harrell's C statistic was 0.70 and 0.71 for the FIF tool and the m-FIF tool. The predictive ability was 0.70 and 0.69 for 1-leg standing, and 0.65 and 0.60 for self-reported balance problems. Conclusions: The m-FIF tool presented similar predictive ability as the FIF tool regarding first-time injurious falls. This finding could extend the usefulness of the tool to other settings, such as to electronic health (eHealth). A quickly and easily administered screening tool can help physical therapists to identify people with a high risk of falling who may need to undergo a more comprehensive fall risk assessment.

In this study, we examined the impact of hip fractures on trajectories of home care, nursing home residence, and mortality among individuals aged 65 years or more and explored the impacts of living arrangements, cohabitation, frailty, and socioeconomic position on these trajectories. Based on a linkage of nationwide Swedish population registers, our study included 20,573 individuals with first hip fracture in 2014–2015. Care trajectories during the 2 years following the fracture were visualized and compared with those of 2 hip-fracture–free control groups drawn from the general population: age- and sex-matched controls and health-matched controls identified through propensity score matching. Multistate modeling was employed to identify sociodemographic and health-related factors associated with care trajectories among hip fracture patients. We found that hip fracture patients already had worse health than the general population before their fracture. However, when controlling for prefracture health, hip fractures still had a considerable impact on use of elder-care services and mortality. Comparisons with the health-matched controls suggest that hip fractures have an immediate, yet short-term, impact on care trajectories. Long-term care needs are largely attributable to poorer health profiles independent of the fracture itself. This emphasizes the importance of adequate comparison groups when examining the consequences of diseases which are often accompanied by other underlying health problems.

Objectives: We aimed to examine to what extent blood pressure (BP) components are associated with injurious falls in older adults, and whether the possible associations differ by functional status (indicated by physical and cognitive impairment at baseline). Methods: This prospective cohort study included 3055 community-living participants of the Swedish National study on Aging and Care in Kungsholmen (aged >= 60 years). At baseline (2001-2004), we measured systolic BP (SBP) and diastolic BP (DBP), mean arterial pressure, pulse pressure (PP), and orthostatic hypotension. Physical function was assessed using tests of balance, chair stands, and walking speed. Cognitive function was assessed with the Mini-Mental State Examination. Injurious falls leading to inpatient or outpatient care during 3 and 10 years of follow-up were identified via patient registers. Data were analyzed using flexible parametric survival models adjusted for potential confounders. Results: During the 10-year follow-up period in people without functional impairment, the multi-adjusted hazard ratios (HR) of injurious falls were 1.77 (95% CI 1.02-3.07) for having SBP <130 mmHg, 1.73 (95% CI 1.05-2.83) for having SBP >= 160 mmHg (vs. 130-139), and 1.46 (1.05-2.02) for having higher tertile of PP (vs. lower tertile). During the 3-year follow-up period in people with functional impairment, the multi-adjusted HR of injurious falls was 1.91 (95% CI 1.17-3.13) for having SBP <130 mmHg (vs. 130-139) and 0.74 (0.59-0.94) for having higher tertile of PP (vs. lower tertile). There was no significant association between BP components and injurious falls either in people without functional impairment during the 3-year follow-up period, or in people with functional impairment during the 10-year follow-up period. Conclusions: This large-scale Swedish study provides evidence that the associations between some specific components of BP and risk of injurious falls in older adults vary by functional statu

OBJECTIVES: To identify sex-specific associations between risk factors and injurious falls over the short (<4 years) and long (4-10 years) term. DESIGN: Longitudinal cohort study between 2001 and 2011. SETTING: Swedish National Study on Aging and Care, Kungsholmen, Sweden. PARTICIPANTS: Community-dwelling adults aged 60 and older (N = 3,112). MEASUREMENTS: An injurious fall was defined as a fall that required inpatient or outpatient care. Information was collected on participant and exposure characteristics using structured interviews, clinical examinations, and physical function tests at baseline. RESULTS: The multivariate model showed that, in the short term, living alone (hazard ratio (HR)=1.83, 95% confidence interval (CI)=1.13-2.96), dependency in instrumental activities of daily living (IADLs) (HR=2.59, 95% CI=1.73-3.87), and previous falls (HR=1.71, 95% CI=1.08-2.72) were independently associated with injurious falls in women. Low systolic blood pressure (HR=1.96, 95% CI=1.04-3.71), impaired chair stands (HR=3.00, 95% CI=1.52-5.93), and previous falls (HR=2.81, 95% CI=1.32-5.97) were associated with injurious falls in men. Long-term risk factors were underweight (HR=2.03, 95% CI=1.40-2.95), cognitive impairment (HR=1.49, 95% CI=1.08-2.06), fall-risk increasing drugs (HR=1.67, 95% CI=1.27-2.20 for >= 2 drugs), and IADL dependency (HR=1.58, 95% CI=1.32-5.97) for women and smoking (HR=1.71, 95% CI=1.03-2.84), heart disease (HR=2.20, 95% CI=1.5-3.24), impaired balance (HR=1.68, 95% CI=1.08-2.62), and a previous fall (HR=3.61, 95% CI=1.98-6.61) for men. CONCLUSION: Men and women have different fall risk profiles, and these differences should be considered when developing preventive strategies. Some risk factors were more strongly predictive of injurious falls over shorter than longer periods and vice versa, suggesting that it may be possible to identify older men and women at short-and long-term risk of injurious falls.

The field of research on falls among older adults is well studied. Despite this, there are some knowledge gaps that need to be addressed: 1) research studying injurious falls, as opposed to any falls; 2) knowledge on sex differences, and specific risk profiles for injurious falls; 3) development of an effective screening tool for community-dwelling older adults, that can detect people at risk of first-time falls, who may be targeted by preventive interventions; and 4) what factors influence the risk of losing independence, in a long-term perspective, after an injurious fall. The purpose of this thesis is to fill these gaps through the following aims: to detect risk profiles of injurious falls among older adults, to enable early detection of those at risk, and to examine the long-term consequences of fall injuries on everyday function. To reach these aims we used data from the ongoing population-based, Swedish National study on Aging and Care in Kungsholmen (SNAC-K). These are our main findings: The results from Study I indicate that risk factors for injurious falls tend to cluster within individuals, forming specific risk profiles, rather than appearing one by one. It is possible to predict elevated fall risk up to 10 years in advance and it also seems possible to distinguish groups of people at different levels of risk. In Study II we concluded that women and men share risk factors in many cases, but the levels of significance vary between the sexes. A few risk factors indeed seem to be sex specific. We also concluded that short-term (0–3 years) and longterm (4–10 years) risk factors differ, distinguishing specific acute and long-term risk profiles. We developed a screening tool for first time injurious falls in Study III, consisting of: age, cohabitation status, IADL dependency, and a balance test. Scores on the screening tool were weighted according to sex-stratified coefficients. The predictive value (measured with Harrell’s C statistics) of the scores were 0.75

Background: Although falls in older adults are related to multiple risk factors, these factors have commonly been studied individually. We aimed to identify risk profiles for injurious falls in older adults by detecting clusters of established risk factors and quantifying their impact on fall risk. Methods: Participants were 2,566 people, aged 60 years and older, from the population-based Swedish National Study on Aging and Care in Kungsholmen. Injurious falls was defined as hospitalization for or receipt of outpatient care because a fall. Cluster analysis was used to identify aggregation of possible risk factors including chronic diseases, fall-risk increasing drugs (FRIDs), physical and cognitive impairments, and lifestyle-related factors. Associations between the clusters and injurious falls over 3, 5, and 10 years were estimated using flexible parametric survival models. Results: Five clusters were identified including: a healthy, a well-functioning with multimorbidity, a well-functioning, with multimorbidity and high FRID consumption, a physically and cognitively impaired, and a disabled cluster. The risk of injurious falls for all groups was significantly higher than for the first cluster of healthy individuals in the reference category. Hazard ratios (95% confidence intervals) ranged from 1.71 (1.02-2.66) for the second cluster to 12.67 (7.38-21.75) for the last cluster over 3 years of follow-up. The highest risk was observed in the last two clusters with high burden of physical and cognitive impairments. Conclusion: Risk factors for injurious fall tend to aggregate, representing different levels of risk for falls. Our findings can be useful to tailor and prioritize clinical and public health interventions.

Background: a trend towards decline in disability has been reported in older adults, but less is known about corresponding temporal trends in measured physical functions. Objective: to verify these trends during 2001-16 in an older Swedish population. Methods: functional status was assessed at three occasions: 2001-04 (n = 2,266), 2007-10 (n = 2,033) and 2013-16 (n = 1,476), using objectively measured balance, chair stands and walking speed. Point prevalence was calculated and trajectories of change in impairment/vital status were assessed and were sex-adjusted and age-stratified: 66; 72; 78; 81 and 84; 87 and 90. Results: point prevalence of impairment was significantly lower at the 2013-16 assessment than the 2001-04 in chair stand amongst age cohorts 78-90 years, and in walking speed amongst age cohorts 72-84 years (P < 0.05), but not significantly different for balance. The prevalence remained stable between 2001-04 and 2007-10, while the decrease in chair stands and walking speed primarily occurred between 2007-10 and 2013-16. Among persons unimpaired in 2007-10, the proportion of persons who remained unimpaired in 2013-16 tended to be higher, and both the proportion of persons who became impaired and the proportion of persons who died within 6 years tended to be lower, relative to corresponding proportions for persons unimpaired in 2001-04. Overall, there were no corresponding changes for those starting with impairment. Conclusions: our results suggest a trend towards less functional impairment in older adults in recent years. The improvements appear to be driven by improved prognosis amongst those without impairments rather than substantial changes in prognosis for those with impairments.

Bakgrund: En implanterbar defibrillator kallas också Implantable Cardioverter Defibrillator och förkortas ICD. ICD kan förhindra plötslig hjärtdöd. Den vanligaste indikationen för att få en ICD är en bakomliggande hjärtsjukdom med hög risk för livshotande rytmrubbningar. ICD-behandling blev 1985 godkänd för kliniskt bruk. ICD ökar patientens fysiska förmåga men kan medföra flera orosmoment. Syfte: Syftet med litteraturstudien var att beskriva patienters upplevelse av att leva med ICD samt att beskriva patienters tankar inför livets slutskede med ICD. Metod: Kvalitativ litteraturstudie baserad på tio vetenskapliga originalartiklar. Texten har analyserats i enlighet med Lundman och Graneheim-Hällgrens (2012) kvalitativa innehållsanalys. Resultat: Det innebar en förändring av livet att leva med en ICD. Många patienter levde med oro och rädsla som var direkt relaterad till ICD:n men också till obesvarade frågor som bland annat handlade om livets slutskede med ICD. Trots oro och rädsla beskrev patienter med ICD tacksamhet till att ha fått en möjlighet till ett förlängt liv. Slutsats: Livsförändringen innebar bland annat att patienter med ICD behövde mycket stöd. Flera patienter upplevde att sjukvårdens information och kommunikation gällande ICD var bristfällig på grund av att den inte var individanpassad utan mer allmän. Ytterligare forskning behövs om hur vårdpersonal kan möta den enskilde patientens behov i riktning mot hälsa.