INTRODUÇÃO A mobilidade é um componente importante da funcionalidade, necessária para realização das atividades de vida diária. O questionário The University of Alabama at Birminghan Study of Aging Life-Space Assessment (LSA) avalia a mobilidade através dos espaços que o idoso ocupa, a frequência e independência com que se desloca. O LSA é um dos poucos instrumentos que avalia a mobilidade sob o aspecto da participação e é composto por cinco questões simples e de fácil aplicação. Além disso, a avaliação pode ser realizada presencialmente ou à distância, como por exemplo, através de contato telefônico. Já existem versões do LSA validadas para utilização em outros países e, na ausência de uma versão validada em português brasileiro do LSA, faz-se necessária a adaptação transcultural e análise das propriedades de medida desta versão, para incrementar as opções de avaliação da mobilidade de idosos. O objetivo deste trabalho foi adaptar transculturalmente para o português brasileiro o instrumento LSA e testar as propriedades de medida desta versão. MÉTODOS Este estudo de adaptação transcultural e clinimetria foi realizado em duas fases. Fase I - adaptação transcultural e validade de conteúdo: foi realizada a adaptação transcultural do questionário e suas instruções de aplicação. O pré-teste das instruções e do questionário foi realizado com 10 profissionais, e o pré-teste do questionário foi realizado com 30 idosos da comunidade. Fase II - análise das propriedades de medida (reprodutibilidade, validade de construto e interpretabilidade): foram incluídos 80 idosos da comunidade. Inicialmente foi aplicado o LSA em português brasileiro e foi colocado um acelerômetro na cintura do participante. Após sete dias, o acelerômetro foi retirado e o questionário foi reaplicado. A reprodutibilidade foi analisada através do teste alpha de Cronbach (consistência interna), Coeficientes de Correlação Intraclasse (CCI) e intervalo de confiança de 95% (IC95%) (confiabilidade), e erro padrão da medida (erro de medida). A validade de construto foi analisada através da correlação de Pearson entre os escores do LSA e acelerometria (tempo em atividades sedentárias e tempo em atividades moderadas e vigorosas). A interpretabilidade foi analisada através de histograma, cálculo da diferença mínima detectável (DMD) e determinação de efeitos piso e teto. RESULTADOS Foi obtida a versão em português brasileiro do questionário LSA e suas instruções de aplicação. Essa versão atendeu aos critérios adotados neste trabalho para validade de conteúdo. A consistência interna apresentou alpha de Cronbach de 0,92 e confiabilidade com CCI de 0,97 (IC95% 0,95 a 0,98). O erro padrão da medida foi calculado em 4,12 pontos (3%). O escore do LSA apresentou correlação negativa com o tempo em atividades sedentárias (R = -0,63; p < 0,001) e correlação positiva com o tempo em atividades moderadas e vigorosas (R = 0,49; p < 0,001), a DMD foi de 0,36 pontos, e não houve efeitos piso e teto. CONCLUSÃO A versão em português brasileiro do LSA reproduz a versão original com reprodutibilidade, validade e interpretabilidade adequadas. Recomendamos, portanto, a utilização desta versão para avaliação da mobilidade dos espaços de vida dos idosos brasileiros / BACKGROUND Mobility is an important component of functionality, necessary for performance of activities of daily living. The questionnaire The University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA) evaluates mobility from the spaces that older adults go, the frequency and independence that the person moves through these spaces. The LSA is one among only few instruments that evaluate mobility in the context of participation, and it consists of five simple and quick questions. In addition, the questionnaire may be applied in person or by telephone. There are already validated versions of the LSA for use in other countries and, in the absence of a validated version of the LSA in Brazilian Portuguese, it is necessary to adapt cross-culturally and to analyze the measurement properties of the adapted version, in order to increase the options for mobility evaluation of older adults. The purpose of this study was to adapt cross-culturally the LSA into Brazilian Portuguese, and to analyze its measurement properties. METHODS This cross-cultural adaptation and clinimetric study was conducted in two phases. Phase I - cross-cultural adaptation and analysis of content validity: we performed a cross-cultural adaption of the questionnaire and its instructions for application. The adapted version was pretested with 10 professionals and 30 community-dwelling older adults. Phase II - analysis of measurement properties (reliability, construct validity and interpretability): we included 80 community-dwelling older adults. Initially, the adapted LSA was applied; and we put an accelerometer on the participant\'s waist. After seven days, the accelerometer was removed and the questionnaire was reapplied. Reliability was analyzed by the Cronbach\'s alpha (internal consistency), intraclass correlation coefficients (ICC) and 95% confidence interval (95%CI) (reproducibility), and standard error of measurement (measurement error). The construct validity was analyzed by Pearson\'s correlation between the scores of LSA and accelerometry data (time in sedentary activities and time in moderate and vigorous activities). Interpretability was analyzed by histograms, minimal detectable change (MDC), and determination of floor and ceiling effects. RESULTS We obtained a Brazilian Portuguese version of the LSA and its instructions for application. This version met the criteria for content validity adopted in this study. Internal consistency (Cronbach\'s alpha) was 0.92 and reproducibility (ICC) was 0.97 (95%CI 0.95 to 0.98). The standard error of measurement was calculated in 4.12 points (3%). The LSA score showed negative correlation with sedentary activities (R = -0.63; p < 0.001), and positive correlation with moderate to vigorous activities (R = 0.49; p < 0.001), the MDC was 0.36 points, and we observed no floor or ceiling effects. CONCLUSION The Brazilian Portuguese version of the LSA reproduces the original version with adequate reliability, validity and interpretability. We therefore recommend the use of this version to evaluate life-space mobility of Brazilian older adults

Ottosson, B. & Skog, S. Åtgärder för att symtomlindra depression eller nedstämdhet hos äldre - en litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö universitet: Fakulteten för hälsa och samhälle, institutionen för vårdvetenskap, 2020.Bakgrund: Många äldre lider av nedstämdhet, vilket kan vara ett tecken på depression. Det anses ofta inte som något att söka vård för då det till stor del räknas som en naturlig del av åldrandet. De symtom på nedstämdhet som ignoreras då är: ökad oro, känsla av hopplöshet, sömnsvårigheter, minskad aptit och viktminskning.Metod: En litteraturstudie med 10 kvantitativa artiklar, artiklarna delades in i fyra kategorier som de sedan presenterades genom. Nivån av symtom mättes med Geriatric depression scale (GDS).Syfte: Målet med den här litteraturstudien var att undersöka och beskriva åtgärder som kan användas för att lindra depressionssymtom eller nedstämdhet hos äldre.Resultat: Alla studier hade inte signifikanta sänkningar av GDS i slutet av studien men alla hade det under tiden studien pågick. Den minsta sänkningen av GDS var 4,34 % med minnesterapi (Wang 2005) och den högsta sänkningen var efter interventionen med konst då GDS minskade med 66 % (Ching-Teng M.fl. 2019).Konklusion: Det sammanfattade resultatet visade att alla interventioner gav bra resultat under tiden studien varade. Enligt de procentuella beräkningarna så var det konst (66 %), mindfulness (50,7 %) och Qi-Gong (41,3 %) som gav bäst resultat enligt GDS skalan.Nyckelbegrepp: Depressionssymtom, geriatrik, nedstämdhet, sjuksköterska, symtomlindring. / Ottosson, B. & Skog, S. Strategies to ease depression symptoms or blues in the elderly - a literature review. Degree project in nursing 15 Credits. Malmö University: Faculty of Health and Society, Department of Care Science), 2020.En litteraturstudie med 10 kvantitativa artiklar, artiklarna delades in i fyra kategorier som de sedan presenterades genom.Background: Many elderly people suffer from the blues, which can be a sign of depression. It is not often considered something to seek care for as it is largely regarded as a natural part of aging. The symptoms of depression that are then ignored are: increased anxiety, feelings of hopelessness, insomnia, decreased appetite and weight loss.Method: A literature review of 10 quantitative articles, the articles were selected into 4 different categories and then presented through these. Symptoms were measured with the geriatric depression scale (GDS).Aim: The main purpose of this literature study was to investigate and describe what measures that can be used to prevent or alleviate depression symptoms or the blues in the elderly.Results: All the studies did not have significant reductions of GDS at the end of the study but they all had it during the study. The smallest reduction of GDS was 4.34 % with reminiscence therapy (Wang 2005) and the highest decrease was after the intervention with art when GDS decreased by 66 % (Ching-Teng M.fl. 2019).Conclusion: The summarized results showed that all interventions produced good results during the study. According to the percentage calculations, art (66 %), mindfulness (50.7 %) and Qi-Gong (41.3 %) gave the best results according to the GDS scale.Keywords: Blues, depression symptom, geriatric, nurse, symptom relief.

Titre : EVALUATION DE LA FRAGILITE EN ONCOLOGIE GERIATRIQUE : DEVELOPPEMENT ET VALIDATION D’UNE NOUVELLE ECHELLE DE DEPISTAGE.Mots clés : fragilité, sujet âgée, cancer, dépistage, développement, validation, analyse de survie.Résumé : Une évaluation gériatrique (EG) est recommandée pour tous les patients âgés atteints de cancer pour identifier d’éventuels problèmes de santé et ainsi optimiser la stratégie thérapeutique. Néanmoins, elle est très consommatrice de temps et de moyens. Plusieurs outils de dépistage ont été développés mais a) aucun ne dispose de propriétés diagnostiques adéquates en pratique clinique, b) ils ont le plus souvent été développés sur la base d’opinions d’experts sans développement statistique spécifique, et c) peu de données sont disponibles pour apprécier leur robustesse au changement de gold standard pour définir le concept de « fragilité ». Par conséquent, notre objectif était 1) de construire et valider un outil de dépistage performant de la fragilité et de le comparer à l’outil de dépistage G8 actuellement utilisé en oncogériatrie, 2) d’en tester la robustesse vis-à-vis de 6 définitions de référence de la fragilité et 3) d’en évaluer la valeur pronostique pour la mortalité à 1 et 3 ans. Les données étaient issues de deux cohortes prospectives de patients âgés atteints de cancer : ELCAPA (2007–2012: n=729 [développement]), et ONCODAGE (2008–2010: n=1304 [validation externe]). L’outil G8 modifié final (aire sous la courbe ROC [AUROC] : 91,6% ; Sensibilité=89% ; Spécificité=79%) comprenait 6 items indépendants : perte de poids, problèmes neuropsychologiques, statut fonctionnel, état de santé perçu, poly-prescription et existence parmi les antécédents d’une insuffisance cardiaque ou coronaropathie. Les travaux accomplis dans le cadre de cette thèse ont de plus permis de confirmer ses bonnes propriétés diagnostiques en validation externe (AUROC : 84,6% ; Sensibilité=82% ; Spécificité=69%), sa robustesse au changement de gold standard et sa valeur pronostique forte vis-à-vis de la mortalité. L’utilisation du G8 et G8 modifié devrait être encouragée en oncologie gériatrique. / Title : ASSESSMENT OF FRAILTY IN GERIATRIC ONCOLOGY: DEVELOPMENT AND VALIDATION OF A NEW SCREENING TOOL Key words: frailty, older person, cancer, screening, development, validation, survival analysis.Abstract: The comprehensive geriatric assessment (GA) is recommended in older cancer patients to inventory health problems and tailor treatment decisions accordingly. However, GA is time- and resource-consuming. Several screening tools have been developed but a) their diagnostic performance is insufficient, b) most instruments have been developed exclusively on the basis of experts’ opinions without any specific statistical psychometric development, and c) a wide variability of criteria have been used to define “frailty” as the gold standard, with no investigations of their influence on the diagnostic properties of screening instruments. Therefore, our objective was 1) to develop and validate a new screening tool for frailty that achieves high diagnostic accuracy, and to compare it to the G8 screening tool, currently used in oncogeriatrics, 2) to evaluate its robustness to modifications on the gold standard, for which 6 reference definitions were tested, and 3) to assess its prognostic value for 1- and 3-years mortality. We used two prospective cohorts of older patients with cancer: ELCAPA (2007–2012: n=729 [development]), and ONCODAGE (2008–2010: n=1304 [external validation]). The final modified-G8 (area under the ROC curve [AUROC]: 91.6%; Sensitivity=89%; Specificity=79%) included 6 independent items: weight loss, cognition/mood, performance status, self-rated health status, polypharmacy and history of heart failure or coronary heart disease. The work carried out in this thesis has also confirmed its good diagnostic properties in external validation analyses (AUROC: 84.6%; Sensitivity=82%; Specificity=69%), its robustness to modifications of the gold standard definition and its strong prognostic value for overall survival. The use of the G8 and modified-G8 should be encouraged in geriatric oncology.

The purpose of this study was to investigate what conditions and working methods that existed among assisted nurses in geriatric homes to promote physical activity in the elderly. The method used was a qualitative approach, using a thematic analysis to interpret the results. The following two categories emerged, prerequisites and work methods. The analysis also generated six subthemes. Material resources, staff availability, time, knowledge, encouragement and motivation and the pandemics impact. The results showed that time, staff, encouragement from the assisted nurses and knowledge about the subject played a big part in enabling physical activity amongst the elderly. It is vital that assisted nurses possess reassuring prerequisites and work methods in order to promote physical activity. / Syftet var att undersöka vilka förutsättningar och arbetssätt som finns hos undersköterskor på äldreboenden för att främja fysisk aktivitet hos äldre. Metoden som användes var en kvalitativ metod och en tematisk analys användes för att tolka och analysera resultatet. Följande två kategorier uppstod, förutsättningar och arbetssätt. Analysen genererade i sex subteman. Tillgångar och förutsättningar till materiella resurser, personal, tid, kunskap samt vikten av uppmuntran och motivation och pandemins påverkan. Resultatet visade att förutsättningarna, personal och tid hade en betydande roll som saknades i främjandet av fysisk aktivitet hos de äldre. Resultatet visade att arbetssättet uppmuntran och motivation från undersköterskorna kring fysisk aktivitet spelade en betydande roll för att främja fysisk aktivitet hos äldre och hur arbetssätten och förutsättningarna under pågående Covid-19 pandemi påverkats negativt i arbetet mot fysisk aktivitet. Det är av stor vikt att undersköterskor har betryggande förutsättningar och arbetssätt för att kunna främja fysisk aktivitet.

In consideration of the demographic trends of our population, it is necessary to deal with the old age problems and problems of geriatric patients. The controversial topic of restraints, especially sensitive in association with old frail people, is closely related. The issue of restraints is defined by law. However, the ethical aspects of their application should also be considered. The theoretical part of this thesis deals with the topic of old age and serious problems of this period of life, including mental disorders. It introduces the field of geriatrics and geriatric patients. In further chapters, this thesis discusses the restraints and ethical issues related to their use. By using qualitative research methods, the empirical part of this thesis surveys the attitudes of healthcare professionals towards this issue. It discusses specific restraints and the reasons for which they are used. The results show that the most important value of healthcare professionals is health and the most respected ethical principle is the principle of beneficence. Key Words: old age, geriatric patient, health risk, restraints, ethical principle

Background: Functional Assessment (FA) in older adults is an important measure of their health status. FA using Activities of Daily Living (ADL) is a strong predictor of health outcomes, especially as we age. With the development of increasingly-connected health, we have a new opportunity for more robust and improved FA. Objective: The objective of this thesis is to collate and discuss published evidence on FA predictors and how the FA predictors can be collected using the paradigm of Connected Health (CH) architectures through an industrial case study in CHAPTER 5: INDUSTRIAL CASE STUDY. Methods: The method is to do two Systematic Literature Reviews (SLRs). The two SLRs were undertaken with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and Parsifal, an online tool for SLR. This thesis catalogs various FA and state-of-the-art Software Engineering Architectural Tactics and Styles (SEATS) used within Connected Health (CH) that focus on ADL. The results of the cataloged information were used in the industrial case study where some of the FA predictors were automated. Articles obtained from the data source during the SLRs were filtered based on the titles, abstracts, full-text provision, English language literature, including age, which must be sixty-five years and above. Another reviewer was also included in this study, while all the defined inclusion and exclusion criteria detailed in this thesis were applied. Information about FA via ADL were extracted from the articles with further extraction on the SEATS used for computer-supported FA during the industrial case study. Data Source: During the SLRs processes, database searched included PubMed, EBSCOhost, Engineering Village, IEEE Xplore Digital Library, and ScienceDirect. The conducted search contains both controlled terms called Medical Subject Headings(MeSH) such as activities of daily living and search strings such as functional assessment, older adults, geriatrics, seniors, elderly care, and aging. Results: From four hundred and ninety-five initial abstracts and titles, nineteen full-text journal articles were included in the final review for the SLR on FA predictors. Six full-text journal articles were obtained from the SLR on CH architectures after reading its 449 titles and abstracts. In the SLR on FA predictors, predictor metrics for FA via ADL were extracted from each of the articles. Gait speed, sleep quality, and movement activities were assessed as ADL predictor metrics for FA in older adults. Other FA predictors published involved self-reported metric scale measurement using Barthel-20 scale and performance-based scale through Timed-UP and Go test. This thesis reviewed each metric for sleep quality and movement activities. In the SLR on CH architectures, quick response of ADL and resource efficiency such as sensors were some of the major tactics related to performance in Software Engineering (SE) quality in CH, while confidentiality and integrity of FA measures related to security in SE quality in CH was another major concern. Conclusion: Having conducted the two SLRs, a wide range of measures were used for FA in older adults, including consideration on the SEATS used for computer-supported FA. Overall, these FA measures and SEATS provide inexpensive and easy-to-implement FA. The diversity of the FA measures and SEATS contributes towards the development of computer-supported FA. However, future work is needed to consider the result of this study as an open-source computer-supported FA tool, and such tool should also be evaluated and verified through direct examination with older adults. / Graduate

Verksamheter som bedriver effektivt Systematiskt Arbetsmiljöarbete (SAM) har visats ha friskare och nöjdare arbetstagare, bättre anseende, och större monetära framgångar, än verksamheter som inte gör det. Det saknas emellertid förståelse för vilka arbets- eller förhållningssätt som bidrar eller leder till att vissa verksamheter lyckas bedriva SAM effektivt. Hitintills har fallstudier fokuserat på hur SAM bedrivs i sin helhet eller på vilka brister som finns, oavsett om företaget bedriver SAM effektivt eller inte. Kort sagt saknas relevant underlag. I detta arbete studeras en verksamhet inom äldrevården (ett yrke med överlag bristande arbetsmiljö och stort behov av effektivt SAM) som bedriver effektivt SAM, i syfte att förstå hur och varför de har lyckats. Intervjuer utfördes med arbetstagare på alla nivåer för att få en insikt i vad deras yrkesroll innebär och hur det relaterar till SAM, varefter en analys av intervjumaterialet gjordes för att identifiera SAM-främjande arbetsmetoder och beteenden. Ur dessa utkristalliserades ett antal huvudkomponenter – nycklar till framgång. Nycklarna var (1) fokus på patientens välmående, (2) engagerat ledarskap, och (3) öppen kommunikation. Även om SAM ser olika ut i olika branscher och verksamheter, är nycklarna generella nog för att kunna ge arbetsgivare en ledtråd om vad de behöver arbeta med för att lyckas bättre med SAM. / Companies engaged in Systematic Work Environment Management (SWEM) have been shown to have healthier and more satisfied workers, better reputation, and greater monetary success than companies that do not. There is however a knowledge-gap about what approaches or attitudes companies with successful SWEM utilize, that lead to this success. Up to date, the focus of case studies have been how SAM as a whole is conducted in companies, or what flaws there are, regardless of the companies’ level of success. In short, there is a lack of relevant research. This work is a study of an eldercare unit (eldercare being a profession with over-all poor working environment) that conducts SWEM efficiently, the goal being to understand the reasons to their success. Employees of all levels were interviewed in order to gain insight into what type of work they do and how that relates to SWEM, after which an analysis of the interview-transcriptions was made to identify what practices and behaviours promote efficient SWEM. From these, a number of main components emerged – keys to success. The keys were (1) a focus on patient well-being, (2) keen leadership, and (3) open communication. Although work environment management may differ between different industries and companies, the keys are general enough to give employers a clue about what they need to work on in order to promote SWEM.

This dissertation explores the emerging musical relationship between myself as a music therapy intern and a geriatric client diagnosed with schizophrenia residing in a psychiatric institution at which I worked during the first six months of my clinical training. Two specific areas of focus are addressed, namely the characteristics of the developing musical relationship and the strategies employed by the music therapy intern to enable its optimal development. Three excerpts, either audio or video recordings, were selected from the clinical material for analysis. The excerpts (numbered Excerpt A, B and C) were selected based on their demonstration of the emerging musical relationship between the client and myself. Corresponding written session notes also formed part of the clinical material that had to be analysed. The clinical material was coded and categorised, resulting in emerging themes being identified for interpretation in relation to the specific areas of focus of the clinical enquiry. The findings reveal that the musical relationship developed from isolation and a high degree of non-responsiveness between the client and myself in Excerpt A towards moments of musical intersubjective relating in Excerpt C. Strategies employed by me include, inter alia, providing stability, predictability, simplicity and consistency in my musical input and progressing towards incorporating improvisations within a familiar musical structure, thus an increased flexible approach. These findings are important in light of the limited literature available regarding music therapy work conducted by interns, especially during the early stages of their clinical work. / Dissertation (MMus (Music Therapy))--University of Pretoria, 2007. / Music / MMus (Music Therapy) / Unrestricted

Institution/department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: The rational use of proton pump inhibitors among geriatric patients in the Czech Republic Supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Ivana Geletova Introduction: The dynamic process of ageing requires adequate attention at a global level, mainly in the area of providing a proper healthcare. Ageing process is specific by significant involutional changes and is often complicated by higher polymorbidity and polypharmacotherapy. Therefore, it is necessary to eliminate the negative impact of possible drug-related and nondrug-related risk factors and to ensure the rational use of medicines. Proton pump inhibitors (PPIs) are one of the most frequently prescribed classes of drugs in older adults, administered especially for the treatment of gastrointestinal tract (GIT) disorders associated with increased secretion of gastric acid and/or impairment of GIT or as a preventive treatment of potential drug-related and other gastropathies. This diploma thesis focused on evaluating the prevalence of use of PPIs among geriatric patients in acute, ambulatory and pharmacy settings of healthcare in the Czech Republic, in the EUROAGEISM H2020...

Specialistsjuksköterskors erfarenheter av läkemedelsdelegering till personal inom kommunal hemsjukvård Bakgrund: Sjuksköterskor har ett stort behov av att utfärda läkemedelsdelegeringar till hemtjänstpersonal inom kommunal hemsjukvård. Läkemedelsdelegeringar är en komplex arbetsuppgift, som kan innebära en risk för patientsäkerheten om uppgiften inte utförs i enighet med lagar och föreskrifter. Syfte: Beskriva specialistsjuksköterskors erfarenheter av läkemedelsdelegering till personal inom kommunal hemsjukvård. Metod: Datamaterialet inhämtades genom åtta semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys. Resultat: Tre kategorier och sju underkategorier framkom. ”Läkemedelsdelegering är en förutsättning för en fungerande hemsjukvård” beskriver att hemsjukvården är beroende av delegeringar och påtryckningar sker från hemtjänstchef om att utfärda delegeringar. ”Säkra delegeringar kräver kompetent hemtjänstpersonal” beskriver att kunskap, erfarenhet, ansvar och pålitlighet krävs. ”Delegeringsprocessen behöver utvecklas” beskriver behov av samordnade delegeringsutbildningar, bättre utbildningsmaterial och uppföljningen av delegeringar är bristfällig. Slutsatser: Läkemedelsdelegeringar är nödvändiga för en fungerande hemsjukvård. Lagar och föreskrifter är svåra att efterfölja på grund av otillräckliga strukturella förutsättningar. En förbättrad delegeringsprocess och kompetenshöjning hos hemtjänstpersonal behövs för säkrare delegeringar. / Specialist nurses’ experiences of medicine delegation to personnel in municipal home health care  Background: The need for nurses to delegate administration of medication to municipal home care staff is large. Delegation is a complex task, who can pose a risk to patient safety if the task is not carried out in accordance with laws and regulations. Aim: Describe specialist nurses’ experiences of medicine delegation to personnel in municipal home health care. Method: Data was collected through eight semi-structured interviews and analyzed with qualitative content analysis.  Results: Three categories emerged. “Medicine delegation is a requirement for a functional home health care” describes that municipal home health care require delegation and there is pressure from the home care manager to delegate. “Safe delegations require competent home care staff” describes that knowledge, experience, responsibility and reliability are required. “The delegation process needs to be developed” describes the need for coordinated delegations, better education materials and the follow-up of delegations are insufficient.  Conclusions: Medicine delegations are necessary for av functioning home health care. The laws and regulations are difficult to comply with due to insufficient structural conditions. An improved delegation process and increased competence of home health care staff are needed for safer delegations.