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Aim: This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people's homes. Materials and Method: Open-ended group interviews with personnel were carried out, three of the group interviews preimplementations of the model, and three of the group interviews post -implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis. Results: The quality of the integrated care model was based on care -chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person -centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants' experiences of the post -implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting. Conclusion: Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question. Plain language summary: The intention of the present study was to follow the process of working with a ne

PURPOSE: To offer guidance for future welfare technology research, this review provides an overview of current knowledge gaps and research needs as reported in primary scientific studies addressing the implementation of welfare technology for older people, people with disabilities and informal caregivers. MATERIALS AND METHODS: This paper conducted a state-of-the-art review based on systematic searches in 11 databases followed by a descriptive qualitative analysis of 21 selected articles. RESULTS: Knowledge gaps and research needs were identified concerning two categories: research designs and populations and focus of research. The articles reported needs for comparative studies, longitudinal studies, and demonstration trials as well as the development of co-design processes involving technology users. They also called for studies applying a social system theory approach, involving healthy and frail older adults, representative samples of users within and across countries, informal and formal caregivers, inter-and multidisciplinary teams, and care organizations. Moreover, there are reported needs for studies of acquirement, adoption and acceptance of welfare technology, attitudes, beliefs, and context related to welfare technology, caregiver perspectives on welfare technology, services to provide welfare technology and welfare technology itself. CONCLUSIONS: There are considerable knowledge gaps and research needs concerning the implementation of welfare technology. They relate not only to the research focus but also to research designs, a social system theory approach and study populations. IMPLICATIONS FOR REHABILITATION When planning for the implementation of welfare technology for older people and persons with disabilities, it is important to be aware that necessary evidence and guidance may not always be available in peer-reviewed scientific literature but considerable knowledge gaps and research needs remain. Actors implementing welfare technology are encourag

PURPOSE: To offer guidance for future welfare technology research, this review provides an overview of current knowledge gaps and research needs as reported in primary scientific studies addressing the implementation of welfare technology for older people, people with disabilities and informal caregivers. MATERIALS AND METHODS: This paper conducted a state-of-the-art review based on systematic searches in 11 databases followed by a descriptive qualitative analysis of 21 selected articles. RESULTS: Knowledge gaps and research needs were identified concerning two categories: research designs and populations and focus of research. The articles reported needs for comparative studies, longitudinal studies, and demonstration trials as well as the development of co-design processes involving technology users. They also called for studies applying a social system theory approach, involving healthy and frail older adults, representative samples of users within and across countries, informal and formal caregivers, inter-and multidisciplinary teams, and care organizations. Moreover, there are reported needs for studies of acquirement, adoption and acceptance of welfare technology, attitudes, beliefs, and context related to welfare technology, caregiver perspectives on welfare technology, services to provide welfare technology and welfare technology itself. CONCLUSIONS: There are considerable knowledge gaps and research needs concerning the implementation of welfare technology. They relate not only to the research focus but also to research designs, a social system theory approach and study populations. IMPLICATIONS FOR REHABILITATION When planning for the implementation of welfare technology for older people and persons with disabilities, it is important to be aware that necessary evidence and guidance may not always be available in peer-reviewed scientific literature but considerable knowledge gaps and research needs remain. Actors implementing welfare technology are encourag

The growing older population will increase the demands on the health and welfare systems, including elder care services. One way of meeting these growing service needs is to shift from traditional care services to technologically oriented services. Robotic innovations are gradually being introduced to elder care services. The aim was to explore attitudes toward the use of care robots in elder care services - specifically focusing on situations and interaction, influence, and emotions in interaction with care robots. Data were obtained from visitors at a welfare technology fair (n = 124). The results show that the most negative attitudes concerned if the care robots were humanized and had emotions. The attitudes toward interacting with care robots in general were predominately positive. In conclusion, concrete usage scenarios in elder care services need to be detected, based both on users' needs, digital literacy and on the maturity of the technology itself.

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The number of older people (aged 65+) will more than double by 2050 in Sweden. The ageing population is an increasing concern due to rising health-care costs and a shortage of health professionals. Older people generally prefer ageing in place, as long as they feel confident and comfortable. However, preventive and supportive measures are needed to maintain older people’s independence and active participation in society. The aim of this study is to explore the prerequisites for a healthy and independent life among older people in Sweden. A Delphi study was conducted in three rounds. In round 1, seven focus group interviews were performed with older persons aged 65–79, older persons aged ⩾80, next of kin of older persons, health professionals in primary and home health care, assistant nurses in home care, care managers and local politicians. The data were analysed using thematic analysis, resulting in 35 statements of the prerequisites needed for a healthy and independent life. These statements were sent to the participants from round 1, who were asked to evaluate the degree to which they agreed with each statement in round 2, and again in round 3. There was an agreement of at least 80 per cent for 31 of the 35 statements. When asked to identify the three prerequisites of most importance for a healthy and independent life, most participants stated: to have a social life, to have freedom of choice and power over one’s own situation, and to have the possibility to choose independently one’s type of housing. There was an overall high group agreement on the prerequisites needed for a healthy and independent life among older people. The main areas of importance were to have a social life, several dimensions of feeling safe and to retain one’s personal control.

Introduction: Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions. Objectives: The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk. Methods: A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included. Results: Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff’s least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations. Conclusions: This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, w

This paper reports a study conducted to illuminate older adults’ perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults’ reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver–patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area

This is a follow-up study of intensive home-based rehabilitation from older people’s perspectives. The aim was to explore older adults’ descriptions of interactional needs related to autonomy in life. The purpose was also to explore the importance of significant others in the reablement process. Method: The sample consisted of 23 women aged 72–92 who were included consecutively in the first project year. Data were collected through face-to-face semi-structured interviews that were recorded, transcribed, and analyzed using qualitative latent content analysis. Results: Regaining autonomy through reablement was achieved by the interviewees although not always to the same extent as before. Three themes related to interactional needs were identified: (1) Transitional relations, referring to encounters with staff in time-limited relations. (2) More stable relations with significant others without limitation of time. (3) The acceptance of growing older and of death as a “natural departure”. Transitional relations with professionals, and more stable relations with significant others, are important parts of the reablement process according to older adults. In conclusion: Professionals within gerontology need to recognize the social and historical context including the symbolic meanings each older person gives to life’s necessaries. Older adults appreciate reablement which includes rehabilitation goals related to the person’s stable relationships and larger life context.

Purpose: To conduct a systematic review of existing methods to evaluate the individual aspects of welfare technology from the perspectives of independence, safety, activity, and participation. Furthermore, the study aimed to describe outcomes that have been the focus of previous research to evaluate individual aspects of welfare technology in older persons living in ordinary housing. Materials and methods: A systematic literature review in PubMed, CINAHL Plus, PsycINFO, Scopus, and Web of Science. Studies selected were those that explored the use of assistive and welfare technology devices from older persons’ perspectives, and which considered the concepts of independence, safety, activity and participation, and quality of life. Results: A broad spectrum of instruments was applied in the studies. For independence, three questionnaires were used in the identified studies. For safety, one instrument was used in two versions. To study activity and participation as well as quality of life, several scales were used. Additionally, several studies included qualitative approaches for evaluation, such as interviews, or posed one or more questions regarding the effects of welfare technology. Conclusions: The integration of digital assistive and welfare technology should be based on the needs of older persons, and those needs must be assessed using reliable and relevant instruments. The heterogeneity of the target group, i.e., older persons, together with the fact that assessments must give consideration to identifying goals, obstacles, and risks as well as users’ preferences, implies a person-centred approach., Hjälpmedel och välfärdsteknik i tre dimensioner - HV3D

The increased number of older adults who experience longevity requires increased investment in healthcare services. Short-term goal-directed reablement is expected to strengthen the functional capacity and quality of life of older adults, while homecare hours, and thus municipal expenditures, decrease. Facilitation of successful interprofessional collaboration includes not only enhancing coordination structurally, but also establishing a commitment regarding culture that overcomes professionally differentiated attitudes. Nurses have an obvious role in these multi-professional teams and the study explores some aspects' of working in this type of collaboration. The aim was to illuminate the meaning of working with short-term goal-directed reablement of older adults as experienced by an interprofessional team. Data were collected after an intervention with goal-directed time-limited reablement of older people. Written narratives from an interprofessional team were analyzed using a phenomenological-hermeneutic approach. Findings identified four major thematic structures that characterized the meaning: 1) Reliable relationship; including the aspects ‘Confidence between the older adult and staff’, ‘A sense of security’ and ‘Continuity’, 2) Empowered participation, including the following aspects: ‘Listen to the older adult’s desires’ and ‘Put the person in control’, 3) Team with a negotiated approach, including the aspects: ‘Closeness’, ‘Same direction and overarching goal’, ‘Learning from interprofessional dialogue’, 4) Time for growth with the aspects ‘Creating harmony’ and ‘Building the older adult’s self-confidence’. The process of reablement seemed strengthened by the collaborative approach of different professions and their combined efforts. The present study argues that teamwork gives confidence both in terms of general knowledge of reablement but also specific confidence in one’s profession.

The aim is to evaluate the effects of intensive home rehabilitation regarding multidimensional health perceptions and other quality of life domains, physical ability and capacity among older people (65+). The design is a randomized controlled study of a reablement intervention with controls receiving traditional home care. The intervention is goal- and user oriented, home-based, time limited (3 months), and organized by an interprofessional team consisting of the professions nurse, enrolled nurses, physiotherapists, social worker, and occupational therapists. The effects of the intervention are measured by self-reported health and quality of life (EQ-5D-5L, HACT) including psychological well-being (GP-CORE), physical capacity (SPPB, hand dynamometer test), activity performance (COPM), and home care hours needed. Data are collected at inclusion (T1; applying for home care), after the three months intervention (T2), and at six months (T3). Primary outcome analyses will be performed according to intention to treat; 2 x 3 mixed design (group x time) ANCOVA with each dependent variable at T1 as covariate. Based on a medium effect size in favour of the intervention in the pilot study, and a dropout of 20%, the power calculation indicated that 240 persons should be included. The project will contribute with evidence of the effects of interprofessional home rehabilitation for reablement, and consequences for older persons’ bio-psycho-social health. The project is ongoing with more than 120 persons included. The intervention may result in reduced costs for care, but especially individual gains in relation to reduced care needs, maintained independence and good health.

Women who are forced to resettle from the Middle East have experienced the cumulative trauma of war, threats, flight and adjusting to a new life in the host country. Many of these women develop musculoskeletal pain. Considering the ongoing conflicts worldwide, the high number of forced resettled people in Sweden will persist. Primary healthcare faces new challenges in addressing the needs of patients who live with the physical and mental consequences of war and resettlement. The overall aim of this thesis was to illuminate the perceived causes of musculoskeletal pain and suggestions for rehabilitation measures to be able to support identification of needs of Middle East diaspora women. In two initial studies, women from Iraq (study I) and professionals within primary healthcare (study II) were approached with interviews and questionnaires. The goals were to explore the perceived causes and suggested measures related to chronic pain in Middle East diaspora women. The results from these two studies, together with a review of existing research, formed the basis for the development of an interview guide, which was validated by cognitive interviews and a pilot test (study III). The guide was further evaluated by healthcare professionals in an intervention study (study IV). The perception among both the women and the healthcare representatives was that the pain is complex and is related to experienced traumas and difficulties, but the women (study I), also considered the pain a physical symptom calling for a physical treatment. A physician could provide a trustworthy diagnosis and effective treatment with the main purpose of regaining a sense of control of the life situation, by controlling the consequences of pain in the body, for everyday life, and for future plans (study I). Meeting with Swedish healthcare was perceived as complicated from the perspectives of both the women (study I) and the healthcare professionals (study II). Although being able to identify the cause

Intensiv hemrehabilitering

Meeting patients from other countries constitutes a challenge for health care. The purpose of this study was to increase knowledge about tacit understandings of treatment in practice by determining the perceptions of chronic pain and rehabilitation directed to resettled women from the Middle East, from a variety of health care professionals within primary care. Based on the results, we find a need to support and increase knowledge among health care professionals to involve the patient and consider her beliefs, expectations, background, current life situation, and spirituality, and to involve family in rehabilitation.

The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.

Meeting patients from other countries constitutes a challenge forhealth care. The purpose of this study was to increase knowledgeabout tacit understandings of treatment in practice by determiningthe perceptions of chronic pain and rehabilitation directed toresettled women from the Middle East, from a variety of health careprofessionals within primary care. Based on the results, we find aneed to support and increase knowledge among health care professionalsto involve the patient and consider her beliefs, expectations,background, current life situation, and spirituality, and to involvefamily in rehabilitation.

BACKGROUND Sickness absence is very high in Sweden. The reasons for this phenomenon are not well known. The aim of this study was to investigate the association between degree of self-reported sickness absence and health. The hypothesis was that individuals with long-term sickness absence would report more symptoms and lower self-rated health. Another hypothesis was that women are more likely to self-rate psychiatric diagnoses compared to men, who are more likely to self-rate musculoskeletal diagnoses. METHODS The data was obtained with a postal survey questionnaire answered by 43,589 individuals, a Swedish random population sample of men and women aged 18-84 years. The response rate was 65%. This study included 19,826 individuals aged 18-64 years old and still at work. They were divided into four groups, based on the number of reported days of sickness absence during the past year. RESULTS Approximately 40% of the individuals at work mentioned that they had been absent due to illness sometime during the past year. Of those who had been absent 90 days or more, two thirds were women. There was a significant difference between the groups in self-rated health (p < 0.05). Every fifth woman (19.4%) and every fourth man (25.9%) in the group with a sickness absence of more than 89 days rated their health as poor or very poor, but a large proportion, 43.5% of the women and 31.6% of the men, rated their health as good. Long-term illnesses and complaints differed between the groups. The correlations between the groups and illness were mostly significant (p < 0.01). Two thirds of the subjects had both psychiatric and musculoskeletal symptoms. There was a significant difference among them, as men more often had musculoskeletal diagnoses. One third had only psychiatric or musculoskeletal symptoms and in those groups there were no significant diagnosis differences between the sexes. CONCLUSION Individuals with long-term sickness absence reported more symptoms and lower self