Bakgrund Åldrande genererar försämrad hälsa, därav behöver resurser spenderas på förebyggande åtgärder. Vid ofrivillig ensamhet är det svårt att uppleva god hälsa eftersom smärtproblematik, kronisk lågintensiv stress samt depression genereras. Sjuksköterskans ansvarsområde är att främja hälsa. Jean Watson nämner omgivningens inverkan och att mänskliga behov bemöts därefter. Syfte Att beskriva åtgärder inom vården som kan förebygga ensamhet bland äldre personer. Metod I sökandet av artiklar användes CINAHL, PubMed samt PsycINFO. Det teoretiska ramverket PEO användes för att hitta sökord och skapa sökblock. I urvalet av artiklar togs hänsyn till inklusions- och exklusionskriterier samt kvaliteten utöver hur väl de svarade på syftet. Det utfördes sedan en integrerad analys enligt Fribergs metod. Två huvudkategorier och fem underkategorier framträdde. Resultat Åtgärder inom vården kan stödja äldre i dess vardag och personal kan göra äldre delaktiga i beslutsfattande. Inställningen till arbetet och bemötande var inverkande faktorer. Åtgärder som elektronik kan användas, det möjliggör distraktion från sjukdom och det vardagliga livet. Ytterligare kan levande- och digitala djur användas. Aktiviteter i grupp bidrog till gemenskap och fysisk aktivitet genererade mindre social isolering. Slutsats Det går att minska äldres känsla av ofrivillig ensamhet genom åtgärder inom vården. Det kan vidtas direkta- såväl som indirekta åtgärder. / Background Aging brings impaired health, hence resources have to be spent on preventive measures. Affected by involuntary loneliness it is difficult to experience good health because pain problems, chronic low intensity stress and depression are generated. Nurses’ responsibility is to promote health. Jean Watson mentions the surroundings influence and that needs are treated accordingly. Aim To describe nursing measures that can prevent loneliness among older adults. Method During research, CINAHL, PubMed and PsycINFO were used. The theoretical framework PEO was used to find keywords and create phrases. Selecting articles, inclusion- andexclusion criteria, quality and how well they answered the aim was considered. An integrated analysis was performed according to Friberg’s method. Two main categories and five subcategories appeared. Results Nursing measures can support older adults in their everyday life and staff can involve older adults in decision making. The attitude towards work and behaviour were influencing factors. Measures like electronics can be used, it enables distracion from sickness and everyday life. Furthermore, living- as well as digital animals can be used. Group activities contributed to solidarity and physical activity brought reduced social isolation. Conclusion It is possible to ease in voluntary loneliness among older adults through nursing measures.It can be direct- as well as indirect measures.

Background: Fear of falling has significant adverse physical and psychological effects for the community-dwelling older adult. Objective: The purpose of this study was to assess fear of falling in community-dwelling older adults and explore participant perceptions of fear of falling assessments and interventions. Methods: A mixed methods case study was utilized to gain an in-depth understanding of older adults' perceptions. It consisted of quantitative data collection by objective measures and qualitative data collection by four individual in-depth interviews. A sample of four community-dwelling adults aged 65 years and older and living in Orlando, Florida, completed the study in their home environment. To combine quantitative and qualitative data for each participant, a case-specific analysis was used, resulting in narratives with a storytelling approach aiming to explore each participant independently. This was followed by a cross-case analysis to gain a more comprehensive understanding of the participants in relation to one another. Results: Four themes emerged: 1) Feedback from an objective measure is valuable; 2) Family experiences with fear of falling drive personal interventions; 3) Fundamental assessments for fear of falling are missing, and 4) Fluctuating definitions of "fear" contribute to difficulty in assessments and interventions. Conclusion: Clear perceptual themes developed to provide a comprehensive understanding of community-dwelling older adults' perceptions of fear of falling assessments and interventions. Future research is needed to determine how to best combine feedback-oriented assessments with established interventions, such as exercise. Standardization of a subjective measure for fear of falling to use in combination with objective measures is also needed. Keywords: assessment, intervention, fear of falling, older adults, community-dwelling, mixed methods

BACKGROUND: High-cost healthcare users (HCUs) are patients who use disproportionate healthcare resources compared to their peers. A better understanding of their co-morbidity status, medication use, and healthcare utilization is needed to improve health interventions and policies. OBJECTIVES: We aimed to: (1) synthesize what is known about HCUs and interventions for managing them, (2) characterize how HCUs differ from non-HCUs, and (3) explore the impact of medications and whether prescribing quality contributes to differences in healthcare costs and HCU status development. METHODS: We synthesized what is known about HCUs and used the GRADE framework to evaluate the evidence for interventions designed to improve their health. We conducted retrospective population-based matched cohort and case-control studies of incident older adult HCUs using health administrative data. We examined prescribing and medication costs over the non-HCU to HCU transition period and compared them to non-HCUs. We conducted logistic regression to evaluate associations between HCU status development and the use of high-cost drugs and potentially inappropriate medications. RESULTS: HCU interventions to date have shown inconsistent effects on clinical outcomes and healthcare costs and the overall quality of evidence supporting their efficacy is low. Compared to non-HCUs, HCUs have higher rates of polypharmacy, hospitalization, and mortality. Medications are the highest healthcare cost category in the pre-HCU year and these costs rise nearly 1.7-fold in the HCU year. High-cost drug use increases significantly during the HCU transition period and 3.6% achieve HCU status based on drug costs alone. Use of several potentially inappropriate medications and high-cost drugs significantly increase the odds of HCU development. CONCLUSIONS: Medications can contribute to high-cost healthcare directly through drug costs alone or indirectly through adverse effects on health. Medication optimization interventions and policies to reduce inappropriate medication use and ensure cost-effective medication use are needed to manage high-cost healthcare and prevent HCU development. / Thesis / Doctor of Philosophy (PhD) / High-cost healthcare users (HCUs) are patients who use disproportionate healthcare resources compared to their peers. More research is needed to better understand HCUs to design interventions to improve their health outcomes and costs. In this thesis, we evaluated what previous studies have discovered about HCUs and we used Ontario’s health system data to explore whether the quality of prescribing and medication use in older adults influences their risk of becoming a HCU. We found that current interventions for HCUs have had inconsistent effects on improving health outcomes and costs. We also found two medication-related factors contributing to the risk of becoming an older adult HCU: (1) use of very expensive medications, and (2) use of potentially inappropriate medications where the risk of harm may outweigh potential benefits. Interventions and health policies to optimize the appropriate and cost-effective use of medications are needed to manage high-cost healthcare and prevent HCU development.

In Canada, patients who occupy hospital beds but do not require that intensity of care are called Alternate Level of Care (ALC) patients. ALC has numerous negative implications on patient health and the health care system. Early identification of patients who are at risk of becoming ALC could help decision-makers better manage the situation and alleviate this problem. This thesis evaluates the use of various ML algorithms in predicting ALC at two different time points in the patient’s trajectory. Moreover, it identifies the most important predictors of ALC in each time point and provides insights on how adding more information, at the expense of time for decision-making, would improve the predictive accuracy. / Thesis / Master of Science (MSc)

Self-reported health is typically captured as a response to the question, “In general, would you rate your health as excellent, very good, good, fair or poor?” Among community-dwelling older adults (≥65 years), self-reported health decreases as the number of chronic conditions increases. Despite this well-documented relationship, little is known about how other sociodemographic or health-related factors may shape this relationship, what may predict high self-reported health among this population, or how older adults perceive these factors as influencing their perceptions of health. Informed by the Lifecourse Model of Multimorbidity Resilience, the objective of this multimethod research study was to advance understanding of self-reported health among community-dwelling older adults. To this end, four research studies were completed: 1) scoping review of the factors associated with self-reported health, 2) cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging to understand the relationship between multimorbidity and self-reported health and the factors that predict high self-reported health; 3) qualitative case study to explore the influence of individual, social, and environmental factors on self-reported health, including multimorbidity resilience, in community-dwelling older adults, and; 4) a multimethod study that brought together all findings in a matrix analysis. From this work, two meta-inferences were generated: 1) the factors that shape self-reported health are multidimensional and complex; and 2) adaptation to health adversity, resulting from experiences acquired over the lifecourse, shape how older adults perceive their health. Findings from this work advance three implications. First, there is a need to use and apply information gained by asking about self-reported health in clinical practice to inform care planning. Second, there is a need for whole person care to guide health and social care policy for older adults. Third, future health research must further explore longitudinal understanding of self-reported health as well as additional qualitative understanding of the differences of those older adults with the well-being paradox. / Dissertation / Doctor of Philosophy (PhD)

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