No description available.

Abstract          Background: End of life is difficult to establish in patients with dementia and many patients die due to complications related to the disease. To document that care are palliative in this group of patients is not common among nurses and physicians. This may depend on that the palliative course is extended and not similar to the palliative course common among patients with cancer. Aim: To describe how the registered staff in nursing homes document the care of persons with dementia in a late palliative phase. Method: A retrospective record study with a deductive approach. Nursing (n = 50) and medical records (n = 50) for departed patients were reviewed using a review guide based on the Liverpool Care Pathway (LCP). Data were analyzed with a manifest content analysis.  The occurrence of documentation in the records was also counted. Results: Three categories were formulated from the analysis: Initial assessment, Coherent assessment and Follow-up. According to medical records the nurses and physicians knew that patients with dementia were dying, but the position on palliative care was not always decided. Nurses and physicians knew that patients with dementia were dying but they did not take a stand that the patient needed palliative care.  Mainly physical symptoms were documented and to a lesser degree psychological, social or existential/spirituality needs. Discussion: It was difficult to form a true picture of patients’ situation from out the documentation. Partly because all caring actions were not documented and the review guide was limited as all parts provided to give a holistic care was not represented. That relative had been provided information that the patient was palliative was accurately documented. Conclusion: The holistic care that patients with dementia need in a palliative phase is not elucidated in the documentation in nursing homes in spite of nurses and physicians knowledge of that the patient are dying.

Urinary tract infection (UTI) is a common bacterial infection in women of all ages but the incidence and prevalence increase with age. Despite the high incidence of UTI, little is known about its impact on morale or subjective wellbeing and daily life in old women. UTI in older people can be a complex problem in terms of approach to diagnosis, treatment and prevention because in these patients it frequently presents with a range of atypical symptoms such as delirium, gastrointestinal signs and falls. Even if UTI has been shown to be associated with delirium it has frequently been questioned whether UTI can cause delirium or if it is only accidentally detected when people with delirium are assessed. The main purpose of this thesis was to describe the prevalence of UTI, to identify factors associated with UTI among very old women and to illuminate the impact of a UTI on old women’s health and wellbeing.  This thesis is based on two main studies, the GErontological Regional DAtabase (GERDA) a cross-sectional, population-based study carried out in the northern parts of Sweden and Finland during 2005-2007 and a qualitative interview study in western Sweden 2008-2009. Data were collected from structured interviews and assessments made during home visits, from medical records, care givers and relatives. UTI was diagnosed if the person had a documented symptomatic UTI, with either short- or long-term ongoing treatment with antibiotics, or symptoms and laboratory tests judged to indicate the presence of UTI by the responsible physician or the assessor. One hundred and seventeen out of 395 women (29.6%) were diagnosed as having suffered from at least one UTI during the preceding year and 233 of these 395 (60%) had had at least one diagnosed UTI during the preceding 5 years. These old women with UTI were more dependent in their activities of daily living, and had poorer cognition and nutrition. In these women, UTI during the preceding year was associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia. Eighty-seven of 504 women (17.3%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half (44.8%) were diagnosed as delirious or having had episodes of delirium during the past month. In all, 137 of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed as having a UTI. Delirium was associated with Alzheimer’s disease, multi-infarct dementia, depression, heart failure and UTI. Forty-six out of 319 women (14.4%) were diagnosed as having had a UTI with or without ongoing treatment and these had a significantly lower score on the Philadelphia Geriatric Center Morale Scale (PGCMS), (10.4 vs 11.9, p=0.003) than those without UTI, indicating a significant impact on morale or subjective wellbeing among very old women. The medical diagnoses significantly and independently associated with low morale were depression, UTI and constipation. The experience of suffering from repeated UTI was described in interviews conducted with 20 old women. The interviews were analysed using qualitative content analysis. The participants described living with repeated UTI as being in a state of manageable suffering and being dependent on alleviation. Being in a state of manageable suffering was described in terms of experiencing physical and psychological inconveniences, struggling to deal with the illness and being restricted regarding daily life. Being dependent on alleviation was illustrated in terms of having access to relief but also experiencing receiving inadequate care. In conclusion, UTI is very common among old and very old women and is a serious health problem. UTI seems to be associated with delirium and to have a significant impact on the morale or subjective wellbeing of old women and those affected suffer both physically and psychologically and their social life is limited. UTI was also associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might raise the suspicion that UTI can have serious medical effects on health in old women. / Embargo t o m 2011-11-11

No description available.

No description available.

Improved life expectancy is a triumph of modern medicine. However, today’s senior citizens are predicted to soon consume 75% of the available health-care resources. Identifying new strategies to promote a healthy ageing process has thus become a priority. In contribution to the research field of healthy ageing this thesis is focused on the health and gut function of older adults. Paper I explored ‘optimal functionality’; a new approach to put the older adult’s own perspectives on health in focus. According to the results a plethora of factors related to the body, the self and the external environment needs to be considered in order to create a comprehensive understanding of the health experience in old age. Paper II characterised senior orienteering athletes as a new model of healthy ageing, due to their significantly better percived health as compared to other free-living older adults; in particular they report better gut health. As the gut is important to health maintenance and immune function paper III explored inflammation and oxidative stress in senior orienteering athletes, and older adults with gut problems, generally finding low levels in both groups. Subsequently, Paper IV investigated the health status of free-living older adults in Örebro County and also reports the results from a randomised controlled trial evaluating the effect of a probiotic supplement on self-reported health and gut symptoms. Two-thirds of the included older adults reported gut problems, however, the probiotic intervention failed to show any effects. This thesis provides additional perspectives on older adults health and gut function, by concluding that 1) optimal functionality may be a useful concept to map areas of importance to the older adult’s health experience, 2) senior orienteers may be regarded as a suitable model to study healthy ageing, 3) the prevalence of gut problems among the general population of Swedish older adults is high, but was not improved by probiotic supplementation with Lactobacillus reuteri.

Jakobsbergsgeriatriken och Stockholms Läns Sjukvårdsområde betonar vikten av värdeskapande insatser och arbetssätt. Med patientperspektiv skapas resultat av betydelse för patienten. Delaktighet anges som en viktig del. Återkommande patientenkäter  visar att det finns ett gap mellan målbild och arbetssätt på kliniken. Syftet med förbättringsarbetet var att öka patienternas delaktighet under hela vårdtillfället. Syftet med studien var att identifiera vilka erfarenheter som kunde knytas till förändrade arbetssätt. Med kvalitativ metod genom interaktiv forskningsansats för förbättringsarbetet arbetade medarbetarna fram förslag på arbetssätt och metoder som bättre kunde gynna patientdelaktighet, vilka testades genom upprepade PDSA-hjul. För att besvara frågeställningarna till studien av förbättringsarbetet användes mixed method. Semistrukturerad fokusgruppsintervju, enskilda djupintervjuer, två patientenkäter låg till grund för utvärdering av upplevelser av de förändrade arbetssätten.   Förbättringsarbetet resulterade i ett flertal förändrade arbetssätt från inskrivning till utskrivning, där patientens egna förväntningar, önskemål och behov blivit tydligare.  Exempel på förändringar;  Fokus på delaktighet från inskrivningssamtalet, avstämning halvvägs in i vårdtillfället för att fånga nya frågor och ytterligare identifierande behov/ förväntningar. Studiens resultat påvisar vikten av tydlig kommunikation/information inom teamet och med patienten som partner i beslutsfattande. Insikter om teamprocesser och aktiviteter som behöver anpassas ytterligare under vårdprocessen för att skapa bättre förutsättningar för ökad patientdelaktighet. / Jakobsberg Geriatric Clinic emphasizes the importance of value creation and working methods from a patient perspective that gives results of relevance to the patient, where participation is given as an essential part. Patient surveys have shown that there is a gap between the target and working processes, which does not promote participation sufficiently.   The purpose of the improvement work was to increase patient participation throughout the hospital stay. The purpose of the study was to identify experiences that could be linked to the changing working methods, through a patient’s as well as an employee’s perspective.  The Improvement work was performed with a quality design and an interactive research approach where care-staff drafted proposals on useful methods that would better favor patient participation. These methods were then tested by repeated PDSA-wheels.  To answer the questions to the study, mixed method was used. Semi-structured focused group interviews were conducted and participation observations occurred. Individual interviews were held and patient’s surveys were filled out to evaluate the experience of the changing working method.  The improvement work resulted in a number of changes, from admission to discharge, where the patient’s own expectations, wishes and needs, became more central. Examples of changes; an increased focus on patient participation, from the enrollment, as well a reconciliation offered midway through the care episode with the purpose to catch arising issues and to identify additional needs.  The findings in the study demonstrate the importance of clear communication / information within the team and with the patient as a partner in decision-making. Insights on team processes and activities that need to be further adapted during the care process to create better conditions for increased.

Bakgrund: Psykisk ohälsa är en av Sveriges största folksjukdomar och 20 procent av befolkningen över 65 år är drabbade. Då antalet äldre kommer att öka i och med att medellivslängden ökar kommer även antalet personer med depression följa utvecklingen. Uppkomsten av depression hos äldre kan både ha biologiska och sociala faktorer. Att sätta rätt diagnos på gruppen äldre kan vara svårt då ändrad sinnesstämning ibland misstas för tecken på åldrande. Syfte: Att beskriva äldres upplevelse av att leva med depression. Metod: I litteraturöversikten användes tio vetenskapliga studier som analyserades enligt Fribergs metod. Åtta av de utvalda artiklarna var kvalitativa studier, en artikel var med metaanalys metod och en artikel var med mixad metod. Databaser som användes för sökning av vetenskapliga artiklar var CINAHL Complete och PubMed. Resultat: Resultatet har analyserats och presenterats utifrån Katie Erikssons omvårdnadsteori. Två huvudteman utformades livslidande med underteman ensamhet, hopplöshet, skam och sjukdomslidande med undertemat kroppsligt lidande. Diskussion: De två huvudfynden ensamhet och skam har diskuterats utifrån Karin Dahlbergs teori för att få djupare förståelse av resultatet. Vikten av sjuksköterskans roll lyfts fram av författarna då ett bättre bemötande och ökad kunskap leder till snabbare tillfrisknande för äldre. / Background:Mental health is one of the Swedish largest major diseases and 20 percent of the population over 65 years are suffering. As the number of elderly will increase as well life expectancy increases, the number of people with depression will also follow the developments. The arise of depression in the elderly can have both biological and social factors. Putting the right diagnosis to the elderly group can be difficult as a change of state of mind is sometimes mistaken for signs of aging. Aim: To describe elderly's experience of living with depression.  Method: In this literature review, ten scientific studies were used and analyzed and preformed according to Friberg’s method. Eight of the selected articles were qualitative studies, one article was using meta-analysis method and one article was by mixed method. Databases used for the search of scientific articles were CINAHL Complete and PubMed. Results: The result have analyzed and presented based on Katie Eriksson's nursing theory. Two main theme were designed, the first theme life suffering with subthemes loneliness, hopelessness and shame. The second main theme is suffering from illness with subthemes the physical suffering. Discussion:The main findings loneliness and shame are discussed based on Karin Dahlberg's theory of caring, to gain a deeper understanding of the result. The importance of the nurse's role is emphasize by the authors, since better treatment and increased knowledge lead to faster recovery for the elderly.

Background: 130,000 - 150,000 people in Sweden suffer from dementia and the patient group is growing all over the world. The disease affects a person's ability to communicate. The cognitive difficulties of these patients present challenges for correct pain assessment. Aim: The purpose of the study was to investigate challenges, and which methods and instruments the nurse uses to identify and relieve pain in dementia patients. Method: A literature review of ten original articles. Results were analyzed qualitatively.  Result: Two main themes with sub-themes have been identified. Challenges for correct pain assessment in patients with dementia, with sub-themes Disease symptoms that complicate pain assessment and Organizational factors and the need for more knowledge. The second main theme is Identifying pain in patients with dementia, with sub-themes Meeting and interpreting the patient's expression of pain and Pain assessment tools and pain relief. Conclusion: There are challenges for the nurse in assessing pain in people with dementia. What complicates pain assessment is the patients inability to express themselves verbally. More knowledge among staff is needed to increase quality. This also includes clearer guidelines for pain assessment, as well as resources/time. / Bakgrund: I Sverige lider 130 000 – 150 000 personer av demenssjukdom. Patientgruppen är växande både i Sverige och världen. Sjukdomen påverkar en persons förmåga att kommunicera. Denna patientgrupps kognitiva svårigheter innebär utmaningar för korrekt smärtskattning. Syfte: Syftet var att undersöka utmaningar, och vilka metoder och instrument sjuksköterskan använder, för att identifiera och lindra smärta hos patienter med demens. Metod: Litteraturöversikt med tio originalartiklar vars resultat analyserades med kvalitativ innehållsanalys. Resultat: För att besvara syftet har två huvudteman med underteman identifierats- Utmaningar för korrekt smärtbedömning hos patienter med demens, med underteman Sjukdomssymtom som försvårar smärtbedömning samt Organisatoriska faktorer och behovet av mer kunskap. Andra huvudtemat är Att identifiera smärta hos patienter med demens, med underteman Att möta och tolka patientens uttryck för smärta och Smärtbedömningsinstrument och smärtlindring. Slutsatser: Det finns stora utmaningar för sjuksköterskan att bedöma smärta hos personer med demenssjukdom, trots befintliga metoder/smärtskattningsinstrument. Det som primärt försvårar smärtbedömning hos patientgruppen är när den kognitiva försämringen påverkar patientens förmåga att uttrycka sig verbalt. För att öka kvalité inom området behövs större kunskap hos personal, tydligare riktlinjer för hur smärtskattningen ska genomföras samt resurser och tid.

Att förebygga ohälsa och att stärka det friska är centralt för att stödja ett hälsosamt åldrande. Missnöjdhet med måltidsupplevelsen är en bidragande orsak till lågt näringsintag, något som i sin tur är en riskfaktor för undernäring. För att kompensera för nedsatt aptit och matlust är det viktigt att måltidsupplevelsen upplevs bra. Syftet med studien är att undersöka hur boende inom vård- och omsorgsboende beskriver sin måltidsupplevelse. För att besvara syftet användes en litteraturstudie av kvalitativ ansats med deskriptiv design där sju studier från Australien, England, Kanada, Spanien, Sverige, USA och Wales kvalitetsgranskades och analyserades. Resultatet från studien kan sammanfattas i tre huvudteman; självbestämmande, identitet och social gemenskap. Resultatet visar att de boende själva vill vara med och utforma sin måltidssituation. De flesta boende upplever det positivt att äta och umgås med andra. Det sociala samspelet under måltiderna ger möjlighet för sociala relationer och en känsla av vardaglighet och normalitet. De tillfrågade önskade att få behålla sin individualitet och bli behandlade som enskilda personer med individuella preferenser. Ett personcentrerat arbetssätt kan förbättra både nutritionsstatus och måltidsupplevelsen samt stärka de boendes egenvårdsförmåga och självbestämmande. Det i sin tur kan leda till friskare individer med högre livskvalité. / Health promotion and disease prevention are central in supporting healthy aging. Dissatisfaction with the meal experience is a contributing factor to low nutritional intake, which in turn is a risk factor for malnutrition. To compensate for decreased appetite and promote healthy eating habits it is important with a good meal experience. The purpose of this literature study was to investigate how residents and staff in care and nursing homes over the age of 65 described the meal experience. To answer the purpose, a literature study of qualitative approach with a descriptive design was used. Seven studies from Australia, England, Canada, Spain, Sweden, USA and Wales were first quality reviewed and then analyzed. The results from the study can be summarized in three main themes: self-determination, identity and social community. The results shows that the residents want to be involved in designing their own meal situation. Most residents would like to eat and socialize with others during mealtimes. Social interactions during the meals provides the opportunity for social relationships and a feeling of normality. The residents wanted to maintain their individuality and to be treated as individuals with individual preferences. A person-centered approach can improve both nutritional status and the meal experience, as well as strengthen the residents' self-care ability and self-determination. This in turn can lead to healthier individuals with a higher quality of life.