The purpose of this study is to examine how activities are looked upon, organized and put into practice at homes designed for the elderly. To achieve this we have done a survey study, based upon the caregiver´s point of view regarding the subject activity. The result of this study has been interpreted and analyzed with help from the engagement- and disengagement theories. The result shows us that the caregiver´s find the term activity slightly abstract, and rather difficult to define. All of the caregiver´s did agree on the matter that it’s good to activate elderly people and that the elderly people are activated at a large extent. The result also shows us that it’s not always the elderly people’s own wishes and desires of activity that gets organized and put into practice at homes designed for the elderly. In conclusion we find the engagement theory to be very dominant in the thoughts and actions of caregiver´s in Swedish geriatric care, rather than the disengagement theories.

INTRODUKTION/BAKGRUND Sexualiteten är en grundläggande rättighet och central del genom livet som påverkar individens välbefinnande. Det är därav av värde att hälso- och sjukvårdspersonal inom äldrevården innehar kunskap i boendes upplevelser av sexualitet för att främja ett gott välbefinnande.  SYFTE Att studera boendes upplevelser av sexualitet inom äldrevården. METOD Litteraturöversikt med beskrivande design, baserad på tio originalartiklar med kvalitativa studier. Litteratursökning genomfördes i databaserna PubMed och CINAHL. Artiklarna kvalitetsgranskades genom SBU:s mall för Bedömning av studier med kvalitativ metodik och resultatanalyserades enligt Fribergs analysmodell. Kari Martinsens omvårdnadsteori utgjorde arbetets teoretiska referensram. RESULTAT Många boende inom äldrevården ser sin sexualitet som en viktigt del i livet, medan andra har lämnat det sexuella livet bakom sig. Äldrevårdens utformning, brister i kommunikation gällande sexualitet och negativa attityder hör till faktorer som begränsar det sexuella uttrycket. Fyra kategorier identifierades - Skilda upplevelser av sexualitet, Sexuell autonomi och integritet, Bristande kommunikation och kunskap samt Upplevelser av attityder från personal och andra boende - med totalt åtta subkategorier.  SLUTSATS Äldrevårdens sociala och fysiska miljö samt vårdpersonalens kunskapsbrist gällande sexualitet begränsar den boendes möjlighet till sexuella uttryck. En bredare förståelse och kunskap bör finnas hos hälso- och sjukvårdspersonal för att kunna identifiera och bemöta boendes sexuella behov. / INTRODUCTION/BACKGROUND Sexuality is a fundamental right and central part throughout life that affects the individual's well-being. It is therefore of value that healthcare professionals within geriatric nursing homes have knowledge of residents' experiences of sexuality in nursing homes, in order to promote good well-being. AIM To examine residents’ experiences of sexuality in geriatric nursing homes.  METHOD Literature overview with descriptive design, based on ten original articles with qualitative studies. Literature search was performed in the databases PubMed and CINAHL. The articles were quality audited through SBU’s quality assessment template for qualitative methodology and analyzed according to Friberg’s analysis model. The theoretical frame of reference for the work was Kari Martinsen’s nursing theory. RESULTS Many residents in geriatric care sees their sexuality as an important part of life, while others have left their sexual life behind. The design of the nursing home, deficiencies in communication regarding sexuality and negative attitudes are among the factors that limit the sexual expression. Four categories were identified - Different experiences of sexuality, Sexual autonomy and integrity, Lack of communication and knowledge and Experience of attitudes from staff and other residents - with a total of eight subcategories. CONCLUSION The nursing home's social and physical environment as well as the care staff's lack of knowledge regarding sexuality limits the resident's opportunity for sexual expression. A broader understanding and knowledge should be available among healthcare professionals in order to be able to identify and respond to the residents sexual needs.

Arbetets syfte var att studera enhetschefer inom äldreomsorgens kunskapsanvändning. För att besvara syftet användes tre frågeställningar. Dessa var vilka kunskaper som enhetscheferna använder sig av, vad de anser är nödvändig kunskap och hur de fått denna samt om det finns hinder som medför att enhetscheferna begränsas i att använda viss kunskap. Arbetet har en fenomenologisk ansats. För att söka förståelse för enhetchefernas kunskapanvändning har sex enhetchefer intervjuats med olika bakgrund till det sociala arbetet inom svensk äldreomsorg. Både på särskilda boenden och inom hemtjänsten i två olika kommuner. Intervjuerna har varit semi-strukturerade. Arbetets teoretiska referensram har varit Goffmans teori om inramning samt begreppen gräsrotsbyråkrat och handlingsutrymme. Resultaten har presenterats i förankring till dessa teorier och det framkom att enhetscheferna använder sig av tre ramar för att tolka olika situationer i sitt arbete. Ledarramen, den professionella ramen samt vänskapsramen. I dessa ramar framkom många olika former av kunskap. Det framkom också att enhetscheferna fått nödvändig kunskap på många olika sätt, av tidigare utbildning, arbetslivserfarenhet, livserfarenheter men även personliga egenskaper. Enhetscheferna uttryckte begränsning i sin kunskapsanvänding i det att man hade många uppgifter i sitt arbete som tog för mycket tid från mötet med personal och brukare. Mycket av detta berodde på administrativ tid. Arbetets slutsats är att enhetschefernas gemensamma kunskapsanvändning är bred. Att det finns olika ingångsportar till att bli chef inom äldreomsorgen är viktigt att belysa, samt det faktum att äldreomsorgen är en komplex verksamhet som ses ur olika definitioner. Här belyser forskningen ofta äldreomsorg som antingen hälso-och sjukvård eller social arbete. I mitt arbete har enhetscheferna tillsammans en stor bredd, på grund av sina tidigare erfarenheter. Arbetets slutsats är därför också att enhetschefer skulle behöva möjlighet att inte enbart diskutera sin ledarroll, utan också annan kunskap som de använder sig av i sitt arbete.

Adults aged 65 years and above have grown substantially over with past decade. However, the chance of developing multiple comorbidities only increases with age. Because elderly residents of rural Appalachia often encounter barriers to healthcare, rural nurses, providers, and policy makers must overcome physical and structural barriers, but also gain a more in-depth understanding of the personal and cultural attitudes impacting the use of new and innovative forms of healthcare delivery. With a slow and variable uptake of telehealth adoption in rural Appalachia, and in the presence of well-documented medical mistrust, this study was designed to better understand the degree of medical mistrust existing in the elderly of rural Appalachia and to assess if medical mistrust may be inhibiting efforts related to telehealth acceptance. A correlational design was utilized administering the Medical Mistrust Index (MMI) and Technology Acceptance Model (TAM) questionnaire via electronic survey to those age 65 years and above living in rural Appalachia. Deemed well-established and validated, the MMI measures medical mistrust from a broader perspective, while TAM assesses telehealth acceptance in terms of perceived usefulness, perceived ease of use, and overall attitude towards telehealth as a technology. Demographics of gender, income, education, and previous telehealth experience were compared to MMI and TAM scores. The study revealed a moderate level of medical mistrust and telehealth acceptance among the elderly of rural Appalachia. A statistically significant negative relationship was found between MMI and TAM for those reporting previous telehealth experience, and among all demographics, with the strongest correlations found among females and participants of lower education. Elderly rural Appalachians have a rich social and cultural history, but past experiences and long-held beliefs have resulted in medical mistrust and slow telehealth uptake. Stakeholders have a responsibility to meet individuals where they are understanding that elderly residents of rural Appalachia may not be ready or fully prepared to incorporate telehealth into their management of care. However, quality rural nursing practice and continued research has the ability to evolve to meet the needs that exist among those of advancing age with limited healthcare resources such as those found in rural Appalachia.

Background: Outcomes are integral to psychiatry research for evaluating intervention effectiveness in randomized controlled trials (RCTs) and understanding disease progression in observational research. Carefully defined, measured, and consistently used outcomes guide clinical decision-making and enhance research applicability. Bridging methodological gaps through rigorous assessment is essential for minimizing variability and mitigating research waste. Objectives: This dissertation aims to assess: (i) outcome selection in geriatric depression RCTs, (ii) primary outcome reporting in these trials, and (iii) measurement of multimorbidity patterns in observational research on people with opioid use disorder (OUD). Methods: Three studies were conducted: (i) a systematic survey examining outcome selection heterogeneity in geriatric depression RCTs (2011-2021), (ii) an assessment of primary outcome reporting comprehensiveness in these trials, and (iii) an observational study using hierarchical cluster analysis (HCA) and K-means clustering to compare statistical techniques for measuring multimorbidity patterns among people with OUD. Results: Findings suggest variability in outcome selection, reporting, and measurement in psychiatry research. (i) The systematic survey revealed significant heterogeneity in outcomes and outcome measurement instruments (OMIs) in geriatric depression RCTs, impeding cross-study comparisons. (ii) The assessment of primary outcome reporting highlighted variability and insufficiency in reporting the rationale for outcome selection, measurement properties of OMIs, and criteria for clinically meaningful change, limiting the interpretability of trial findings. (iii) The observational study on multimorbidity patterns among people with OUD identified significant variations in chronic condition clusters using HCA and K-means clustering, indicating the need for careful consideration of statistical techniques in outcome measurement to inform clinical care accurately. Conclusion: These findings highlight the need for standardized practices in outcome selection, reporting, and measurement in psychiatry research. Addressing these issues through developing core outcome sets, improving adherence to reporting guidelines, and refining measurement methodologies will enhance research reliability and applicability, ultimately improving clinical decision-making and patient care in psychiatry. / Dissertation / Doctor of Philosophy (PhD) / When studying mental health, researchers examine outcomes to determine whether treatments are effective and how to measure co-occurring chronic conditions. These outcomes must be defined clearly, measured accurately, and used in the same way across research to help clinicians make treatment decisions and be able to use research in clinical practice. This project focussed on three main issues related to outcomes: how researchers select outcomes for studies on depression among older adults, how well they report these outcomes, and how they measure the outcome of multiple chronic diseases in people with opioid use disorder. The findings revealed significant differences in how outcomes are selected, reported, and measured, making it challenging for researchers to compare studies and for clinicians to use research results. By implementing standardized practices in outcomes and improving their selection, reporting, and measurement, research can become more useful, leading to better care for people with mental illness.

The purpose of this literature review is to determine the contributing factors of CLABSI rate increases during the COVID-19 pandemic and identify interventions which restored CLABSI rates to pre-pandemic levels to guide healthcare professionals’ actions during the next pandemic. Background: In the first two decades of the 21st century, CLABSI rates were reduced in United States hospitals by innovating safer patient care practices. However, there was a significant increase in the annual CLABSI rate in 2020 and 2021, increasing the average length of stay, mortality rate, and cost to the U.S. healthcare system. Methods: An extensive search of CINAHL and MEDLINE databases was conducted using key terms “central line-associated bloodstream infection*”, COVID, and coronavirus. After assessment of eligibility, 16 studies were selected for final review. Results: Contributing factors were staffing issues, deviation from central line care standards, patient diagnosis of COVID-19, supply chain issues, and a lack of interdisciplinary collaboration in central line care. Successful interventions were interdisciplinary involvement, nursing education, CLABSI prevention bundle auditing, a new adaptation of a CLABSI prevention toolkit, and IV access point protector cap usage. Discussion: Although the interventions studied were effective, there was a notable misalignment between some contributing factors and interventions. Staffing issues and supply chain issues were two of the most common contributing factors to CLABSI rate increases, yet there is a lack of research surrounding interventions that may alleviate these factors. Further research must be conducted to address these factors to adequately prepare healthcare professionals for a future pandemic.

The purpose of this study was to assess the effectiveness of communication with elderly mental health clients regarding medication concordance.

The chapter titled Present state focuses on the problem of gerontology and geriatrics. Other chapters include description of the most outstanding neuropsychical and somatic changes in the old-age. Next chapters deal with functional examine and geriatric rehabilitation problem.The objective of the thesis was assessing the extent of self-reliance and psychical changes affecting all the occupants of using Crichton Geriatric Rating Scale.146 seniors were tested according to the Crichton Geriatric Rating Scale.Three hypotheses were stated. It was expected that the results of the Crichton tests would correlate with the results of MiniMental Test. Another hypothesis was that there would be better results of the test done to the people whose family care for them actively. The last hypothesis expected worse results of the people who have been in the retirement home for more than three years.The research has confirmed that the results of the Chrichton test and MiniMental test correlate. Correlation of the Crichton test with the active care and interest of the family for the senior and the length of their stay was not proved.

Digitalis in one of the most frequently prescribed drugs, especially to elderly people. The prescription of cardiac glucosides (1978) was studied by using statistics from Apoteksbolaget (the National Corpora­tion of Swedish Pharmacies). There was a threefold difference in the sales of cardiac glucosides per 1000 inhabitants in the different primary care areas. Digoxin was prescribed to 90-98 per cent of the patients, with considerable variations in the dosages. Many other factors besides the cardio-vascular morbidity were likely to cause these differences. Maintenance digitalis therapy has lately been questioned. In a retro­spective study, digitalis was discontinued in 141 geriatric patients without contraindications to digitalis withdrawal. Digoxin treatment seemed to be unnecessary in 108 patients (81 per cent), followed up two months after digoxin withdrawal. A long-term study (mean: 20,5 months) was carried out in these 108 patients. Digitalis therapy was reinstituted in 30 of 99 patients, equally distributed on the basis of clear, possible or uncertain indications. Significantly more patients (p&lt; 0,001) with atrial fibrillation compared with sinus rhythm were restarted. A prospective, randomized, double-blind placebo- controlled study in 39 out of 66 geriatric patients confirmed the results of the retrospective study. During a two-month period 32 of 37 patients (86 per cent) managed without digitalis. Eighteen out of 66 patients (27 per cent) presented contraindications to digoxin with­drawal. Those who needed digitalis were restarted mainly during the first nonth (mean: 18 days) following digoxin withdrawal. Digitalis intoxication has been studied earlier, mainly in hospitalized patients. A clinical examination and ECG of a random sample of out­patients treated with digoxin shewed that about 5 per cent were certainly intoxicated and about 2 per cent suspected of being intoxi­cated. Elderly patients are said to be more sensitive to digitalis. Eleven per cent of 66 geriatric patients were found, without doubt, to be digitalis intoxicated. The mean serum digoxin concentration was significantly higher in eight toxic patients compared with non-toxic patients, but 75 per cent of the toxic patients had serum digoxin con­centrations within or below therapeutic range. Five of these intoxi­cated patients did not need maintenance digitalis therapy. A questionnaire of 361 patients in Skellefteå and Uppsala revealed that about 45 per cent had taken digitalis for more than five years. Approximately 85 per cent took one tablet daily and stated compliance. About one fifth did not know why they were taking digoxin and about half of the patients were uncertain if they were improved, by digitalis therapy. Although digitalis intoxication is such an important clinical problem, some 55 per cent did not know about digitalis's side-effects and some 50 per cent stated that no or insufficient information had been given. Only 15 per cent were satisfied with the information they had received. A significant negative correlation between digoxin dosages and the age of the patients was found. / <p>Diss. Umeå : Umeå universitet, 1983, härtill 7 uppsatser</p> / digitalisering@umu

Résumé: Introduction: Cette étude s’intéresse à l’expérience de soins de patients aînés de 70 ans et plus atteints de cancer entourant une visite à l’urgence. Elle repose sur plusieurs résultats d’études démontrant que ces personnes présentent des besoins spécifiques non comblés, les amenant à utiliser les services d’urgence pour y répondre. Peu d’études se sont intéressées à leur expérience de soins et encore plus rarement dans le contexte d’une visite à l’urgence. But : Mieux comprendre l’expérience de soins des patients aînés atteints de cancer entourant une visite à l’urgence. Cette étude comprend quatre objectifs soit : 1) établir le profil des patients de 70 ans et plus ayant consulté l’urgence pour un problème lié à leur cancer dans les 12 mois précédant l’étude; 2) identifier les raisons et les facteurs amenant ces patients à consulter les services d’urgence; 3) identifier les stratégies de coping utilisées avant d’aller à l’urgence et 4) décrire l’expérience de soins de ces patients à l’urgence. Méthode: Une étude à devis mixte simultané a été entreprise. Une analyse descriptive des bases de données administratives a été réalisée pour documenter le profil sociodémographique, clinique et l'utilisation des services des patients aînés atteints de cancer de 70 ans et plus qui ont visité l'urgence d'un centre hospitalier au Québec, le Canada (n = 792, Objectifs 1-2). Ensuite, des entrevues semi-structurées ont suivi (n = 11) et ont été analysées par une analyse de contenu en profondeur (Objectifs 2, 3, & 4). Résultats: Un total de 792 patients aînés atteints de cancer ont visité l'urgence pour un total de 1572 visites. Les raisons de consultation les plus fréquentes étaient de nature respiratoire (15,8%), digestive (13,4%) et les troubles cardiovasculaires (8,2%). Plus de la moitié des visites était réalisée de jour. L’anxiété, les problèmes d’accessibilité et la détérioration importante de la santé étaient des facteurs qui influençaient le recours aux services d’urgence. Les patients ont été en mesure de déployer une multitude de stratégies de coping pour faire face à leurs problèmes de santé. Par ailleurs, l’expérience de soins est un processus unique, vécu de manière très individuelle. Conclusion: Cette étude décrit l’expérience de soins de patients aînés atteints de cancer à l’urgence et souligne plusieurs domaines d’amélioration des services en périphérie de l’urgence, mais aussi au sein même du service d’urgence. / Abstract: Introduction: Older cancer patients are known to have specific unmet needs due to the complexity of their health care, leading them to use emergency services. However, it is known that emergency rooms are not well-suited to the needs of the elderly. Few studies have focused on the health care experience of older cancer patients and even less so in the context of emergency room (ER) visits. Purpose: This study aims to better understand the experience of older cancer patients in the context of ER visits for unexpected health deterioration related to cancer. We sought to: 1) establish the profile of patients aged 70 years and older who made ER visits for problems related to their cancer in the 12 months preceding the study; 2) identify the reasons and factors that motivate older patients with cancer to make ER visits; 3) identify coping strategies used by older cancer patients prior to ER visits; and 4) describe the health care experience of older cancer patients in the context of ER visits. Methods: A concurrent mixed-method design was used. Descriptive analysis of administrative databases was first conducted to document the socio-demographic, clinical, and service utilization profile of elderly cancer patients aged 70 years and older who visited the ER of a hospital in Québec, Canada (n = 792, Objectives 1-2). Semi-structured interviews were subsequently conducted (n = 11) and then analysed using in-depth content analysis (Objectives 2, 3, & 4). Results: The sample of 792 older cancer patients made a total of 1,572 ER visits. The most frequent medical reasons for ER visits were respiratory (15.8%) and digestive (13.4%) concerns, and cardiovascular conditions (8.2%). Content analysis of the qualitative data suggested that older cancer patients made most of the ER visits when experiencing high levels of anxiety, when other cancer care services were unavailable, or because of a serious life-threatening health condition. Patients were able to use a variety of coping strategies to deal with health issues. Furthermore, the care process is experienced uniquely for each individual. Conclusion: This study describes the health care experience of older cancer patients in the context of ER visits and suggests areas of improvement both outside of and within emergency services.