Utvecklingen inom äldreomsorgen har under de senaste decennierna lett till en mer marknadsanpassad äldreomsorg. Den äldre ska efter att ha fått sitt biståndsbeslut välja vilken utförare som ska tillhandahålla den beviljade insatsen. Valfrihetssystem blir allt vanligare i samhället och valfrihet i sig har länge varit ett politiskt mål. Syftet med denna uppsats var att undersöka äldre personers erfarenheter av att välja hemtjänst. Frågor som har tagits upp är hur man väljer, vad som påverkar hur man väljer, om valet anses vara lätt och om man generellt är nöjd med det system som finns. Metoden som har använts är strukturerade intervjuer där respondenternas svar har kodats i SPSS. Åtta av intervjuerna spelades in och transkriberades. Uppsatsen har ett brukarfokus och utgår från de äldres perspektiv och syftar till att lyfta fram deras åsikter och erfarenheter om valfrihetssystemet inom hemtjänsten. Materialet har analyserats med hjälp av Hirschmans teori om exit, voice och loyalty samt med en deskriptiv beslutsteori, prospektteori. Uppsatsen kommer fram till att systemet idag inte är verksamt i den mening det var tänkt. Alla äldre väljer inte hemtjänst, fysiska och psykiska hinder står i vägen och få väljer att utnyttja sin rätt att byta utförare. Generellt är de äldre nöjda med den hjälp de får och valet av hemtjänstutförare är inte det primära för de äldre. / Elin Örberg

The number of elderly people around the world is growing rapidly. This has led to an increase in the number of people who are seeking assistance and adequate service either at home or in long-term- care institutions to successfully accomplish their daily activities. Responding to these needs has been a burden to the health care system in terms of labour and associated costs and has motivated research in developing alternative services using new technologies. Various intelligent, and non-intelligent, machines and robots have been developed to meet the needs of elderly and people with upper limb disabilities or dysfunctions in gaining independence in eating, which is one of the most frequent and time-consuming everyday tasks. However, in almost all cases, the proposed systems are designed only for the personal use of one individual and little effort to design a multiple-user feeding robot has been previously made. The feeding requirements of elderly in environments such as senior homes, where many elderly residents dine together at least three times per day, have not been extensively researched before. The aim of this research was to develop a machine to feed multiple elderly people based on their characteristics and feeding needs, as determined through observations at a nursing home. Observations of the elderly during meal times have revealed that almost 40% of the population was totally dependent on nurses or caregivers to be fed. Most of those remaining, suffered from hand tremors, joint pain or lack of hand muscle strength, which made utensil manipulation and coordination very difficult and the eating process both messy and lengthy. In addition, more than 43% of the elderly were very slow in eating because of chewing and swallowing problems and most of the rest were slow in scooping and directing utensils toward their mouths. Consequently, one nurse could only respond to a maximum of two diners simultaneously. In order to manage the needs of all elderly diners, they required the assistance of additional staff members. The limited time allocated for each meal and the daily progression of the seniors’ disabilities also made mealtime very challenging. Based on the caregivers’ opinion, many of the elderly in such environments can benefit from a machine capable of feeding multiple users simultaneously. Since eating is a slow procedure, the idle state of the robot during one user’s chewing and swallowing time can be allotted for feeding another person who is sitting at the same table. The observations and studies have resulted in the design of a food tray, and selection of an appropriate robot and applicable user interface. The proposed system uses a 6-DOF serial articulated robot in the center of a four-seat table along with a specifically designed food tray to feed one to four people. It employs a vision interface for food detection and recognition. Building the dynamic equations of the robotic system and simulation of the system were used to verify its dynamic behaviour before any prototyping and real-time testing.

Despite a large prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on understanding how this population adapts to perform tasks of daily living. Past research has focused on the analysis of upper limb kinematics of young healthy individuals while performing these essential tasks (Magermans, 2004, Murray and Johnson., 2004). The purpose of this thesis was to identify kinematic and shoulder loading differences between elderly mobile individuals and elderly individuals with rotator cuff impingements during specific activities of daily living. Motion capture techniques were used in combination with the Shoulder Loading Analysis Modules (Dickerson, 2005, Dickerson et al., 2007) to estimate thoracohumeral kinematics and calculate external joint moments. Two-tailed t-tests with injury status as the factor determined that differences in active range of motion in flexion/extension and humeral rotations existed between the two populations. Results of the ADL analysis showed that the impinged population tended to have decreased plane of elevation and humeral rotations during ADLs. Task was also a main factor for most variables examined. Perineal care, hair-combing and reaching tasks were the most demanding in terms of range of motion necessary to complete the task. The reaching tasks resulted in the highest shoulder moment. K-means clustering techniques proved to be unsuccessful in identifying different motion strategies between the two study groups. This investigation showed that developing adaptations for perineal care, hair-combing and reaching tasks should be considered a priority when working with patients with rotator cuff impingements, as these tasks demanded the largest ranges of motion as well as high shoulder moments.

Abstract Objectives: This research project was undertaken to review two commonly used screening instruments for the elderly who attend at hospital emergency departments in Ontario. These instruments were then contrasted with a new potential screening instrument made up of items drawn from the Minimum Data Set-Acute Care instrument (MDS-AC Version 1_CAN). The hypothesized outcome was better specificity and sensitivity utilizing the newly prepared instrument in predicting at an earlier point if an elderly emergency department patient would become an alternate level of care (ALC) patient. The ability of the screener to predict negative outcomes (delirium, longer length of stay) was also analyzed. Methods: One dataset from a previous International Resident Assessment Instrument (interRAI) organization study in southern Ontario completed in 2000 was utilized to inform this research. Each of the commonly used screening instruments was crosswalked to the MDS-AC items, then both univariate and bivariate analyses were completed. Three research questions were then posed. By testing various logistic regression models, the research looked to establish whether the newly developed instrument would be able to perform comparably to the other two currently-used instruments, and whether it would be more effective in predicting ALC status and particular adverse patient outcomes. Results: The newly-developed instrument was found to perform more accurately. While several variables were tested, a core number were found to be more strongly predictive of future need for ALC status. Conclusions: Future research in this area is recommended.

Purpose: The primary purpose of this project was to determine the effect of aquatic exercise and aquatic exercise combined with an education group program on decreasing both psychosocial and physical fall risk factors in community-dwelling older adults with hip osteoarthritis (OA). Secondary purposes were to 1) describe fall risk, history and nature of falls and near-falls in older adults with hip OA, 2) determine the association of the timed up and go test (TUG) to history of falls and near-falls, 4) explore the relationship of both psychosocial and physical factors to history of falls and near-falls, and 5) evaluate the role of falls-efficacy in predicting balance performance. Methods: Participants were recruited from the community and screened for presence of hip osteoarthritis and fall risk. Baseline fall history and a battery of measures for balance, muscle strength, functional ability and falls-efficacy were administered. Participants were then randomly assigned to one of three groups: Aquatic Exercise, Aquatic Exercise and Education or a Control Group. The interventions were twice per week for 11 weeks. Fall risk factors were measured after 11 weeks. Study 1 described history of falls and near-falls and evaluated the association of the TUG screening test with fall and near-fall history. Study 2 summarized the relationships of physical and psychosocial fall risk factors and identified the primary predictors of fall risk, based on associations with fall history. Study 3 evaluated the randomized controlled clinical trial comparing the impact of the interventions (aquatic exercise and education) on fall risk outcomes. Results: Older adults with hip OA reported a high frequency of falls and near-falls. The TUG, using a cut-off score of 10 sec., was associated with frequent near-fall history. There was a strong association of frequent near-falls to history of actual falls, with the association increasing 7-fold if lower falls-efficacy was present. Falls-efficacy was also an independent predictor of balance impairment. Screening for history of near-falls and falls-efficacy may be important in predicting risk of future falls. The combination of Aquatic Exercise and Education improved falls-efficacy and functional mobility compared to Aquatic Exercise only or no intervention. Aquatic Exercise on its own was not effective in decreasing fall risk factors or improving falls-efficacy. Significance of Findings: The accumulation of both physical and psychosocial risk factors in older adults with hip OA increases their vulnerability to falls and injury. Fall prevention programs for this population should be designed to include both exercise and education to address falls-efficacy and physical fall risk factors.

Bakgrund: Multisjuklighet är vanligt bland äldre världen över. Andelen äldre i Thailand ökar på grund av en mer avancerad sjukvård och bättre levnadsvillkor. Familjen spelar en stor roll i vårdandet av äldre. På grund av att fler kvinnor idag utbildar sig och arbetar har deras tid för att vårda den äldre minskat vilket lett till ett ökat behov av vårdboenden i Thailand. Det är idag en stor brist på vårdboenden för äldre i Thailand. Syfte: Syftet är att undersöka sjuksköterskors syn på familjens roll i vårdandet av den äldre. Metod: Metoden som användes för intervjuerna var semistrukturerade gruppintervjuerna. Till analysen av datan användes en kvalitativ innehållsmetod. Resultat: I resultatet framkom tre huvudteman som svarar på syftet; Familjens roll ur ett sjuksköterskeperspektiv i vårdandet av äldre i Thailand, Sjuksköterskan samarbetar med familjer till äldre med i Thailand samt Sjuksköterskor anser att familjen påverkar den äldre ur ett sjuksköterskeperspektiv. Till huvudtemanen framkom två underteman vilka var; Frånvaro av familj ur ett sjuksköterskeperspektiv i Thailand samt Sjuksköterskor anser att de kan stödja familjen till äldre i Thailand. Diskussion: Ensamhet och isolering påverkar multisjuklighet negativt i västvärlden. Familjen i Thailand påverkar den äldre till att känna sig trygg och bekväm. Kommunikation är en viktig komponent i vårdrelationen enligt Travelbee. Kommunikation är en förutsättning för ett bra samarbete mellan sjuksköterskan och familjen i vården av den äldre.

Syfte: Syftet är att utifrån ett omvårdnadsperspektiv undersöka hur utvecklingen av syndromet sarkopeni på ett effektivt sätt kan förebyggas.   Metod: Systematisk litteraturstudie där originalartiklar söktes i databaserna PubMed och Cinahl varav 15 originalartiklar granskades och sammanställdes.   Resultat: Omvårdnadsåtgärder som förebygger sarkopeni indelas i nutrition, styrketräning, vibrationsträning, och övrig fysisk aktivitet. Styrketräning kan med medelhög intensitet och proteinrik kost minska fettmassan, öka muskelmassan och muskelstyrkan och öka den fysiska funktionen. Fysisk aktivitet och ett stort proteinintag kan inte förhindra men bromsa utvecklingen av sarkopeni. Ett högt proteinintag i samband med träning är ett effektivt sätt att förebygga sarkopeni. Vibrationsträning kan stärka muskelgrupper och i kombination med styrketräning även öka muskelstyrka, rörlighet och muskelmassa.   Slutsats: Fysisk aktivitet och då framför allt styrketräning kan motverka sarkopeni. Träningen måste utföras regelbundet minst två gånger i veckan med en medelhög intensitet för att den ska ha effekt på kroppssammansättningen. Ett högt proteinintag är en förutsättning för muskeltillväxt och för att förebygga sarkopeni. Vidare visar denna studie att sarkopeni kan förebyggas upp i hög ålder. / Objective: From a nursing perspective, the aim is to study how the development of sarcopenia can be prevented in an efficient way.   Method: Systematic literature review where original articles where searched in PubMed and Cinahl, where the result of 15 articles where reviewed and compiled in different themes.    Result: The nursing interventions which prevent sarcopenia can be divided into nutrition resistance training, vibration training, and other physical activity. Resistance training can with medium-high intensity combined with a protein-rich diet reduce fat-mass on the body, increase muscle-mass and muscle-strength and increase physical function. Physical activity and a high protein-intake cannot prevent sarcopenia but slow the degenerative process. A high protein-intake combined with exercise is an effective way to prevent sarcopenia. Vibration, training can strengthen muscle-groups and can together with resistance training also increase muscle-strength, mobility and muscle-mass.   Conclusion: Physical activity and resistance training in particular, can prevent sarcopenia. The exercise must be performed with a medium high intensity for it to have an effect on the body composition and should be performed regularly at least twice weekly continuously. A high protein intake is a prerequisite for muscle-growth in order to prevent sarcopenia. Furthermore, this study shows that sarcopenia can be prevented even in a high age.

Syfte: Syftet med denna litteraturöversikt var att beskriva hur litteraturen skildrar sjuksköterskans roll i vården av den äldre patienten i den pre- och postoperativa fasen, med fokus på nutritionens betydelse för rehabiliteringen och risken för komplikationer. Metod: Studien genomfördes som en litteraturöversikt och artiklarna söktes via CINAHL och MEDLINE.  Studiens resultat innehöll ett urval på 14 artiklar med kvantitativ ansats. Resultat: Undervisning och handledning med fokus på nutritionens betydelse för rehabiliteringen och risken för komplikationer var av vikt, även bedömningsinstrument underlättade sjuksköterskans nutritionsbedömning.  I omvårdnaden var energi- och näringstillskott, individuellt anpassade vårdplaner och måltidssituationer viktiga komponenter. Förebyggande åtgärder inom både omvårdnad och medicin hade en korrelation mellan förbättrad nutrition, rehabilitering och minskade risken för komplikationer hos äldre patienter i den pre- och postoperativa vården. Slutsats: Personer över 65 år var en utsatt patientgrupp gällande undernäring och postoperativa komplikationer. Vården bör därför vara anpassad efter den enskilda äldre individens villkor och innehålla information till patienten för att möjliggöra dennes aktiva roll i den egna vården. I det preventiva arbetet behöver sjuksköterskan fortlöpande utbildning och handledning angående hur medicinska och fysiologiska faktorer tillsammans påverkar den äldre individen samt hur sjuksköterskan i ett tidigt skede kan påvisa undernäring hos äldre.

Population aging has been an increasing in many societies during the last century, andespecially in China this issue has become one of the most urgent social phenomenonin the recent twenty years. Meanwhile, being healthy matters to the senior populationthe most. The main purpose of this paper is to investigate how to measure Chineseelderly health condition, and what the main factors are influencing their health. Thedata of this paper is from the China Health and Retirement Longitudinal Study(CHARLS). A structural equation model(SEM) was established to verify therelationship between different influencing factors and the elderly health. The latentvariables in this model were pre-studied by both exploratory factor analysis andconfirmatory factor analysis. The conclusion based on this data is elderly health canbe measured in four aspects physical condition, emotional condition, body functionand pain. The significant influencing effects of each aspects of health are time sharing,exercise, family environment and lifestyle.

Syfte: Syftet med denna litteraturstudie var att beskriva hur måltidsmiljön på särskilt boende inverkar på de äldres födointag och att beskriva de i studien ingående artiklarnas kvalité. Metod: En deskriptiv litteraturstudie genomfördes. Kvantitativa och kvalitativa vetenskapliga artiklar söktes i databaserna Medline (PubMed) och CINAHL. Tolv artiklar inkluderades i studien efter kvalitetsgranskning. Huvudresultat: Det finns många faktorer som kan påverka ätandet hos äldre människor. Det framgick att sinnesintryck i samband med måltidsmiljön var betydelsefull för aptiten hos äldre personer. Generellt visade resultatet att en trevligt inredd måltidsmiljö hade en god inverkan på de äldres aptit samt födointag. Att inreda matsalen med stark röd och blå färg på matservisen var något som ökade födo- och vätskeintaget hos äldre personer med demens. Ytterligare något som visade sig ha en god och positiv effekt på de äldres födointag var när olika musikstilar spelades under måltiden samt när olika dofter användes, vid doft ökade även hungerkänslorna hos de äldre. Slutsats: Mer forskning behövs inom detta område. Med små kostnader och enkla medel kan födointaget förbättras hos äldre människor och därmed minimera riskerna för komplikationer och lidande som de äldre kan drabbas av samt minska vårdkostnaden för samhället. / Aim: The purpose of this literature study was to describe how meal environment in different nursing home affecting the older people´s food intake and to describe the study´s articles quality. Method: A descriptive literature review was conducted. Quantitative and qualitative scientific articles were searched in the databases Medline (PubMed) and CINAHL. Twelve articles were included in the study after a quality review. Main results: There are many factors that can affect eating in elderly people. Visual impression in relation to meal environment was important for the appetite in elderly people. It also showed that a nicely decorated meal environment had a good impact on older people´s appetite and food intake. Decorating the dining room with strong red and blue color of the tableware increased food- and fluid intake in people with dementia. When different styles of music was played during the meal and using different odors also increased the food intake and hunger emotions. Conclusion: More research needs in this area. With little cost and simple means the food intake can improve in the elderly people and that minimize the risk for complications and suffering the elderly may be affected of and reduce the healthcare costs for the society.