Denna studie har haft som syfte att undersöka varför eller varför inte biståndshandläggare frågar äldre klienter om våldsutsatthet och vad som de anser behövs för att fråga rutinmässigt. Semistrukturerade intervjuer med kvalitativ ansats har utförts för att fånga upplevelser hos åtta biståndshandläggare i olika kommuner i Mellansverige. En tematisk analys genomfördes för att sammanställa teman och subteman. Resultatet visar att det som hindrar biståndshandläggare från att fråga om våld är brist på rutiner och kunskap, hög arbetsbörda, brist på förtroende, att potentiella våldsutövaren är med, att frågan är känslig, föreställningar om att äldre inte är utsatta för våld, samt en nedprioritering av frågan på organisatorisk nivå. Vad som möjliggör för biståndshandläggare att fråga är att gå två professionella på hembesök för att få till enskildhet, råd och stöd från arbetsgruppen och andra professionella, samt utbildning. Att ha som rutin inom organisationen att fråga rutinmässigt är också en viktig möjliggörare. / The aim of this study was to explore why or why not social workers who work with older people ask if they have been subjected to abuse and what barriers and facilitators there are to screening for abuse. Qualitative, semi-structured interviews were conducted to gather the experience of eight social workers in Mid Sweden. A thematic analysis was used to create themes and subthemes. The result shows that barriers for asking include lack of routines and knowledge, lack of trust, a high workload, that it is a sensitive question, the potential perpetrator being in the room, the idea of older people not being victims of violence, and a lack of priority at organizational level. The facilitators include separating the potential perpetrator and client by being two professionals, support from colleagues and other professionals and more training. Routines such as screening all older people could be an important facilitator for screening.

The risk of having a disability increases with advancing age and as the life expectancy is growing worldwide, the number of people living with disability is expected to increase, as well as the number of years lived with disability. Low back pain and sarcopenia are health problems that present a higher prevalence with aging. While low back pain is a symptom, sarcopenia is considered a geriatric syndrome. However, both issues constitute a significant health burden in older adults. Although there are many research studies investigating low back pain, the participation of older adults is often missing from these studies, preventing the generalization of the findings to this population, and leaving some questions unanswered. On the other hand, sarcopenia is a new research field with gaps to fill and flaws to correct. Questions related to low back pain management in older adults, the inclusion of this population in clinical trials, the presence of association between sarcopenia and low back pain and questions pertaining the diagnosis and measurement of sarcopenia have yet to be fully addressed by researchers. The broad aim of this thesis therefore was to contribute to a better understanding concerning low back pain and sarcopenia in older adults by performing studies in these key research areas. Different interventions are presented in clinical practice guidelines for the treatment of low back pain. However, these recommendations are based on clinical trials investigating young and middle-aged adults and as a result, the recommendations do not encompass older adults. Therefore, a systematic review was performed with the objective of assessing the effectiveness of interventions for low back pain in older adults ≥ 60 years (Chapter 3). Eligible studies were identified via searches in Medline, EMBASE, CINAHL, LILACS, PEDro, and Cochrane CENTRAL. A total of 18 randomized controlled trials fulfilled the eligibility criteria and the results from eight trials were pooled in a meta-analysis to test the effectiveness of complementary health approaches (i.e., manual therapy, acupuncture, mindfulness, yoga). Evidence about interventions to manage non-specific low back pain in older adults was found to be weak. Very low to moderate quality evidence showed that complementary health approaches, percutaneous electrical nerve stimulation, education, exercise, or pharmacological agents did not produce a clinically significant reduction in pain and disability at short and intermediate terms compared to sham, usual care, or minimal intervention. Interventions were often not well described and the risk of bias was moderate (average of 6.4 on the 10-point PEDro Scale (SD = 1.44)). Evidence about interventions for non-specific low back pain in older adults is limited and new studies are highly likely to change these results. Participation of older adults in clinical trials pertaining to the management of low back pain has been limited. Usually, the exclusion of older adults from clinical trials is based solely on an arbitrary age limit. Therefore, an investigation concerning the potential increased inclusion of older adults in upcoming clinical trials was conducted (Chapter 4). Chapter four presents an analysis of the International Clinical Trial Registry Platform database from the World Health Organization performed to verify the participation of older adults in registered clinical trials. A total of 167 clinical trial protocols for low back pain with registration dates from January 2015 through November 2018 were planning to recruit participants older than 65 years. However, only five registered trials (2.99%; pooled sample = 169 participants) were designed to target this population specifically. The exclusion of older participants was not formally justified and imposed through an arbitrary upper-age limit in 93.6% of the protocols. Most studies planning to include older adults were interested in pharmacologic interventions, devices/technology, and physical rehabilitation, and were to be carried out in developed regions. However, older adults with low back pain will continue to be under-investigated in clinical trials for low back pain in the near future. Although a slight increase in the participation of older adults in clinical trials was observed, the improvement is small and some questions still need an answer. Therefore, a survey investigating whether researchers recognize the exclusion of older adults from clinical trials, its impact, and justifications to support this exclusion was realized (Chapter 5). All attendees of the 2017 International Back Forum were invited by email to answer an electronic survey about their opinions regarding participation of older adults in clinical trials for low back pain. Approximately 90% of those who answered the questionnaire were engaged with back research, with more than a half having done or doing a clinical trial for low back pain. Most of the respondents believed that older people are excluded from clinical trials for low back pain and that exclusion based solely on age is not justifiable. About two thirds of the respondents reported that the exclusion of older people from clinical trials can impose a barrier in offering evidence-based interventions to this population. More researchers are planning to include older adults in their current/future trials compared to their previous work. An increase in the investigation of older adults in clinical trials is expected in the future which may optimize the development of evidence-based interventions for this population. As early evidence suggests an association between sarcopenic markers and low back pain, the association between the diagnosis of sarcopenia and low back pain still needs to be investigated (Chapter 6). Therefore, a study investigating the association between sarcopenia using different diagnosis criteria and low back pain in older adults was performed. Data from 12,646 older adults (50.1% men, 49.9% women) ≥ 65 years of age that participated in the Canadian Longitudinal Study on Aging (CLSA) were analyzed. The prevalence of low back pain in the past 12 months as well the prevalence of sarcopenia assessed through different definitions, and the number of comorbidities and depressive symptoms were included in the analysis. Associations between sarcopenia, comorbidities and lifestyle factors with low back pain were examined using multivariate logistic regressions. Prevalence of low back pain was 16.3% and the prevalence of sarcopenia varied among sarcopenia definitions and the presence of low back pain. Participants with low back pain had higher prevalence of pre-sarcopenia and sarcopenia compared to those without low back pain based on the International Working Group on Sarcopenia (x2 = 20.25, p < 0.001) and the Foundation National Institute of Health definitions (x2 = 13.83, p < 0.001). The odds of having low back pain was higher among those with sarcopenia based on the Foundation National Institute of Health criterion (OR 1.28, 95%CI 1.0-1.64). These results suggest that sarcopenia may influence low back pain in older adults and future studies should consider to test whether the association between sarcopenia and low back pain is causal. Current clinical practice guidelines recommend to divide patients with low back pain in specific subgroups to provide a targeted intervention. However, despite older adults presenting specific age-related characteristics that could classify them as a subgroup, this population has been neglected. Sarcopenia is a muscle disease affecting older adults and is diagnosed with the presence of a reduction in muscle strength and muscle quantity/quality. Although low back pain has been shown to be associated with muscle dysfunction, the role of sarcopenia in relation to low back pain is unknown. An experiment comparing sarcopenic markers (grip strength and gait speed), muscle activity and elasticity between older adults with and without chronic low back pain was conducted (Chapter 7). The anticipatory activity of transversus abdominis muscle during the rapid arm abduction test, transversus abdominis muscle elasticity, grip strength and gait speed were collected from a group of older adults (≥ 60 years) with chronic low back pain (≥ 3 months) and the results compared with a control group of matched older adults without low back pain. Participants with chronic low back pain presented with a reduction in the sarcopenic markers compared with the controls: grip strength (mean difference (MD) = 5.3Kg, 95%CI = 1.5-9.0, p = 0.006), gait speed (MD = 0.21m/s, 95%CI = 0.10-0.31, p<0.001), as well as a delay in activation of transversus abdominis (p = 0.002). A delay in transversus abdominis muscle activation, and a reduction in muscle strength and gait speed were observed in older adults with chronic low back pain compared to subjects without back complaints. These findings show an association between muscle dysfunction and chronic low back pain in older adults. Although the definition of sarcopenia was recently updated establishing muscle strength as the key criteria surpassing the role of muscle mass, there remains confusion regarding its diagnosis and the comparison of estimates is problematic. Therefore, a systematic review assessing how sarcopenia is measured and defined in population-based studies was performed. Chapters 8 and 9 describe the protocol of a systematic review and the full systematic review respectively. The databases Medline, EMBASE, CINAHL, Web of Science (Core Collection), and Google Scholar were searched for observational population-based studies reporting prevalence of sarcopenia in community dwelling older adults. Descriptive statistics were used to present data pertaining to sarcopenia definition and measurement tools, and the quality-effects model for meta-analysis of pooled prevalence. Results found seven different operational definitions of sarcopenia and a variety of measurement tools applied to assess the sarcopenic markers: muscle mass, muscle strength and physical performance. The prevalence of sarcopenia varied between the definitions, with general estimates ranging from 5% based on the European Working Group on Sarcopenia in Older People (EWGSOP1) criterion to 17% with the International Working Group on Sarcopenia criterion. The use of different measurement tools to assess muscle mass, strength and physical performance resulted in variations within definitions ranging from 1 to 7%, 1 to 12% and 0 to 22%, respectively. The criteria used to define sarcopenia, as well as the measurement tools used to assess sarcopenic markers has an influence in the prevalence of sarcopenia. The establishment of a unique definition for sarcopenia, the use of methods that guarantee an accurate evaluation of muscle mass, and the standardization of measurement tools are necessary to allow a proper diagnosis and comparison of sarcopenia prevalence among populations.

Äldre arbetssökande möter svårigheter och hinder när de söker jobb och behöver därför stöd och vägledning. Vår undersökning fyller kunskapsluckan med svaret på om stödet och vägledningen upplevs hjälpa de äldre i sin jobbsökningsprocess. Syftet med denna kvalitativa studie är att förstå hur äldre arbetssökande upplever och förhåller sig till sin ålder i jobbsökningsprocessen. Genom att undersöka och analysera betydelsen av högre ålder och de svårigheter de äldre arbetssökande beskriver på arbetsmarknaden, kan gruppen förstås bättre och därmed erbjudas bättre stöttning och vägledning.Studien genomfördes på ett omställningsföretag i en stad i västsverige som erbjuder specifik stöttning till gruppen äldre genom ett riktat seminarium. Genom metodtriangulering har material samlats in både via en observation av seminariet och djupgående intervjuer. Arbetet har växt fram induktivt och som tolkningsram för att få en förståelse för hur de äldre upplever sin situation på arbetsmarknaden användes Pierre Bourdieus teorier om fält, habitus och kapital samt olika åldersbegrepp.Resultatet bekräftar att äldre arbetssökande möter svårigheter i sin jobbsökningsprocess och dessa hinder förstås som öppen och dold åldersdiskriminering, svårigheter att förstå den nya arbetsmarknaden och det nya sättet att söka jobb, samt individens sätt att hantera sin situation.

Syftet med denna studie var att undersöka hur ålder beaktades, användes och konstruerades hos yrkesverksamma socionomer. Studien hade utgångspunkt i teorierna och begreppen ålderism, ålderskodning och social identity theory. I studien intervjuades fem yrkesverksamma socionomer från olika platser i Sverige om deras föreställningar av ålder och dess betydelse samt påverkan inom det sociala arbetet. Resultatet analyserades genom ett diskursanalytiskt perspektiv med betoning på både det explicita och implicita som förmedlades under intervjuerna. Resultatet visade hur ålder kunde kodas till specifika beteenden, där det även existerade olika förväntningar av beteenden för olika åldersgrupper som primärt bestod av de gamla och de unga. Resultatet visade även att den kronologiska åldern besatt starka värdeladdningar som gav uttryck i hur respondenterna betraktade sig själva och sin omgivning, samtidigt som det existerade en problematik i att inte känna sig som sin kronologiska ålder. Olika åldersgrupper förmedlades besitta olika värden beroende på vilken kontext de sattes inom där yngre besatt en hög status i samhället men en låg status inom det sociala arbetet. Det framkom att erfarenhet värderades som en viktig resurs inom professionen som var starkt kodad till en äldre ålder. Ålder beskrevs vara ett objekt för grupptillhörighet samt utanförskap inom arbetsplatser vilket var en av flera grunder för åldersdiskriminering primärt riktad mot de yngre socionomerna. Åldersdiskriminering framgick även vara förekommande inom det sociala arbetet på ledningsnivå. En slutsats som drogs var att ålderism och ålderskodning tolkades ha en närvaro i det sociala arbetet.

Studiens syfte var att undersöka om det förekommer negativa attityder till äldre personer med alkoholmissbruk bland socialsekreterare och i så fall i vilken utsträckning, samt om det finns adekvata insatser att tillgå och om detta erbjuds till målgruppen. Studiens syfte besvarades med hjälp av en enkätstudie där intentionen var att studien skulle resultera i en totalundersökning, varpå samtliga små kommuner i mellersta Sverige (med under 15 000 invånare) tillfrågades att delta. Enkäten besvarades slutligen av totalt 12 personer varav 9 utav dessa respondenter var relevanta utifrån studiens population. Resultatet har analyserats med hjälp av det teoretiska perspektivet social konstruktionism samt teori om ålderism. Studiens huvudsakliga resultat påvisade att det inte förekommer negativa attityder bland socialsekreterarna till äldre personer med alkoholmissbruk och det är därefter inte möjligt att uttala sig om någon form av ålderism. Detta resultat skiljer sig markant från tidigare forskning på området som visar på en förekomst av negativa attityder bland denna yrkesgrupp till äldre med alkoholmissbruk. / The purpose of the study was to examine whether there are negative attitudes towards older people with alcohol abuse among social secretaries and if so to which extend, and whether there are adequate services available and if this is being offered. The purpose of the study was answered with the help of a quantitative survey and the intention was that the study would result in a total survey, whereupon all small municipalities in Sweden (with less than 15,000 inhabitants) were asked to participate. In the end the survey was answered by a total of 12 people, of which 9 of these respondents were relevant based on the purpose of the study. The result have been analyzed using the theoretical perspective of social constructionism and theory linked to ageism. The main results of the study showed no signs of negative attitudes towards older people with alcohol abuse among social secretaries and it is therefore not possible to say anything about ageism. This result differs markedly from previous research in the field that shows a prevalence of negative attitudes among this occupational group to elderly with alcohol abuse.

No description available.

Syftet med denna uppsats var att genom yrkesverksammas upplevelser undersöka hur våld i nära relationer mot äldre med demenssjukdom kan yttra sig och vilka möjliga orsaker som kan finnas. Uppsatsen hade en kvalitativ ansats med fokusgruppsintervjuer som datainsamlingsmetod. Fyra fokusgruppsintervjuer med sammanlagt tio informanter genomfördes. Resultatet analyserades tematiskt med utgångspunkt i ålderism samt våld- och maktlöshetsteori. Resultatet påvisade enighet bland informantgrupperna kring orsakerna till att våld uppstår, en orsak var utmattning hos anhöriga. Flera riskfaktorer framgick i resultatet, som att anhöriga var motvilliga till att ta emot hjälp. Demenssjukdom i sig kan ses som en riskfaktor då funktionsnedsättningen kan orsaka att personen hamnar i beroendeställning till anhöriga samt att de inte alltid förstår sin utsatthet. I resultatet framkom att informantgrupperna uppfattade psykiskt våld samt försummelse som de mest förekommande typerna av våld. En slutsats som drogs var att stöd till anhöriga och hjälp i tid var viktigt för att motverka våld. / The purpose of this essay was to, through professionals, investigate how domestic violence against elderly with dementia can manifest and possible causes for violence. The essay had a qualitative onset with focus group interviews as a data collection method, four focus group interviews with a total of ten informants was conducted. The result was analyzed thematically based on ageism and violence- and powerless-theory. The result showed that all informants perceived fatigue as a cause for violence. Several risk factors emerged from the result, for example a relative’s aversion to receive help. Dementia can be perceived as a risk factor since the disability may cause the person to become dependent on others. The informants perceived psychological abuse and neglect as the most common types of violence. A conclusion that could be drawn was that support for the relative and help in time was important to prevent and counteract violence.

Bakgrund: Tidigare forskning utförd inom särskilda boenden har visat att det är ett förekommande problem att äldre utsätts för vanvård och försummelse utförd av personal. Forskning om vanvård och försummelse inom ordinärt boende i svensk kontext är bristfällig. Syfte: Syftet med undersökningen var att undersöka och förstå hur omsorgspersonal och enhetschefer inom ordinärt boende resonerar kring vanvård och försummelse i komplexa omsorgssituationer av äldre personer. Metod: Undersökningen är en metodkombination med tvärsnittsdesign som genom en vinjettbaserad enkät avsåg utforska respondenternas resonemang kring komplexa omsorgssituationer. Resultat: Respondenternas resonemang visar på en tendens av bristande kunskap kring våld i form av vanvård och försummelse. Det kunde även urskiljas en ambivalens mellan att se risker och kritisera ageranden samtidigt som man rättfärdigade handlingarna. Respondenternas resonemang visade på svårigheter kring att identifiera våldshandlingar och benämna dem i termer av våld. / Background: Previous research carried out in nursing homes has shown that it is a common problem that the elderly people are exposed to neglect carried out by staff. Research on neglect within home care services in the Swedish context is lacking. Purpose: The purpose of the survey was to investigate and understand how staff and managers within home care survices reason about neglect in complex care situations of elderly people. Method: The survey is a mixed methods with a cross-sectional design that trough a vignette-based survey aimed to explore the respondents' reasoning regarding complex care situations. Results: The respondents' reasoning shows a tendency of a lack of knowledge about violence in the form of neglect. One could also discern an ambivalence between seeing risks and criticizing actions while justifying this acts. The respondents' reasoning showed difficulties in identifying acts of violence and naming them in terms of violence.

In Sweden, limited research has been carried out to examine how the combination of aging and gender affects the needs assessments for older clients in social work. This study aims to explore how conceptualizations of aging and gender is expressed by care managers in old age care, and how this affects their obligation to conduct individual needs assessments. The methods are focus group interviews with care managers and observations of staff meetings among care managers in three Swedish municipalities. The theoretical framework draws upon a combination of ageism, gender theory, the concepts of geras and elderhood, and the concepts of the third and fourth age. The results show that individual needs assessments can be affected in different ways, depending on factors such as context, the circumstances of the meeting with the client, as well as the care managers’ work conditions and the time available for reflection. In conclusion, the study highlights the need to increase care managers’ knowledge of how conceptualizations of aging and gender affect their approaches towards older clients’ needs, and to develop tools to manage these, in order to reduce the risk for biases in individual needs assessments.

Over the last decades, there has been a decline in the recognition and prevalence of communication and interaction between people of different age groups. This change can be perceived as a loss of value in societies on several different levels while this societal segregation continues to create larger divisions within societies. These divisions in generations may have different causes such as different interests, lifestyles, values, technological developments, politics and so forth.  This dissertation focuses on exploring the social dynamics, connections and interactions between older and younger generations and the project is situated in Sweden. The project adopts a user-centred design approach with several participatory design methods such as omnipresent workshops with focus groups, anecdotes and interviews with participants from different age groups. It proposes urStory, a platform that enables individuals to share life experiences, stories and memories with their voices only. The concept also discovers the accessibility and usability of such tools across generations.      Findings from the workshops and interviews indicated the awareness and the recognised value of intergenerational interactions are limited. Addressing the reacquaintance between generations and mutual respect were requirements to foster meaningful connections. Results from the testing sessions and the follow-up discussions provided valuable insights including the aspects from alternative use cases and accesibility to moderation and safety of the platform.