Among elderly persons living in nursing homes in Sweden, 42 percent have poor oral health. Poor oral health is a suffering for the elderly person and can affect the person's ability to speak, chew and smile but can also lead to poor self-esteem and depression and in worst case critical illness. Therefore, oral health is an area of nursing that must be updated and prioritized. Nurses hold a key position to be able to promote good oral health for older people and could identify oral health problems at an early stage. Therefore, nursing staff need to get knowledge about oral health related to general health. The purpose of the literature review is to shed light on how care staff can improve the oral health of people in nursing homes. The method chosen was a literature review, based on four qualitative, four quantitative and two mixed method studies. Two main categories and six subcategories were created. The two main categories were barriers to good oral health and factors for good oral health and the subcategories describe lack of knowledge among care staff, priorities and attitudes, dislike to oral care as well as interprofessional collaboration, progressive strategies and organizational support. Oral health is neglected due to barriers such as lack of time, high workload, and priorities in nursing homes. For oral health to be improved among people in nursing homes, increased knowledge and cooperation between care staff and dental staff is required.

Neisseria meningitidis infection in humans usually manifests as meningitis and septicemia with skin manifestations. Infections of the respiratory tract with N meningitidis have been documented in the past, but often this organism is not routinely considered in the differential diagnosis of pneumonia. The pathogenic role of N meningitidis in lower respiratory tract infections may be underestimated because its isolation is difficult, particularly when oropharyngeal flora are present. We profile 2 elderly patients with primary meningococcal pneumonia to show the importance of Gram stain and culture in early diagnosis. These modalities helped guide treatment and prophylactic measures.

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Background For the 1.2 million older adults residing in U.S. nursing homes, little is known about their experience with physical frailty and cognitive impairment, two critical interrelated aging conditions. Methods Minimum Data Set 3.0 was used. Physical frailty was measured by FRAIL-NH and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale. Demographic and clinical characteristics were adjusted accordingly. Aim 1 described the prevalence of physical frailty and cognitive impairment and longitudinally examined the association between two conditions with the non-proportional odds model. Aim 2 used latent class analysis to identify physical frailty subgroups and estimated their association with cognitive impairment using multinomial logistic regression. Aim 3 fitted group-based trajectory models to identify physical frailty trajectories and cognitive impairment trajectories and quantified the association between the two sets of trajectories. Main Results Around 60% of older residents were physically frail and 68% had moderate/severe cognitive impairment, with improvement and worsening observed in both conditions, particularly in the first three months. Older residents with moderate/severe cognitive impairment were consistently and increasingly more likely to be frail. Three physical frailty subgroups were identified at admission. Greater cognitive impairment was associated with higher odds to belong to “severe physical frailty”. Five physical frailty trajectories and three cognitive impairment trajectories were identified over the first six months. One in five older residents were “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Conclusion Findings emphasized the need for care management tailored to the heterogeneous presentations and progression trajectories of physical frailty and cognitive impairment.

Our aim with this study was to examine older people's experiences of loneliness. Specifically, we investigated how loneliness affects the elderly, how it is expressed, and what its sources are. The study was conducted using a qualitative method, by interviewing four caregivers at two nursing homes, and three social workers who work as care administrators for nursing homes. We found that the experience of loneliness is prevalent among the elderly who live in nursing homes. Furthermore, we identified two outstanding themes in their experiences, which we categorised as experiences of loneliness and feelings of being safe. Feelings of being safe had two subthemes; moving to a nursing home and the living situation. Feelings of being unsafe were closely related to loneliness, and this was partially a reason why the elderly wanted to move to a nursing home, as a way to get closer to other people and overcome loneliness. Experiences of loneliness varied in the following subthemes; suffering of existential loneliness, extent of social relationships, social networks, and social life, expressions of loneliness, and the meaning of loneliness. We found different forms of loneliness, including loneliness based on loss of relationships, mostly due to the passing away of one’s social group, which was expressed partially as an experience of existential loneliness. The elderly people’s network of friends and family varied; some of them had a close network with many visitors every day, and others had almost none that visited them.

Rehabilitation and healthcare centers (RHCs) provide ongoing care to the elderly and chronically ill. To maximize the quality of this care, RHC staff must be properly trained to respond to patient care crises and communicate across departments. Although researchers have studied the leadership styles, strategies, and interactions of facility administrators and nursing directors, there is a substantial gap in the literature on the leadership styles and strategies employed by directors of social services (DSSs). The aim of this phenomenological study was to address this gap in the research by exploring how DSSs influenced leadership policies, prepared subordinates for crisis intervention and management, perceived that social workers influenced decision-making in patient care, and believed that communication amongst RHC staff about patient care could be improved. The conceptual framework for this study was based on 3 leadership model constructs: the multilevel leadership model construct, the situational leadership model construct, and the complex adaptive leadership model construct. Participants included a purposive sample of 10 DSSs working in large, corporate RHCs in Virginia. Data were collected via in-person, semistructured interviews consisting of open-ended questions. Data were analyzed via Hycner's phenomenological approach. Findings from this investigation helped clarify roles and responsibilities of DSSs, thereby improving the leadership they provide to subordinate social workers. Findings may be used to improve communication across professionals within RHCs and emphasize the important role that social workers should play in patient care decisions.

Bakgrund: Med en åldrande befolkning och ett ökande antal personer som lider av demenssjukdomar i samhället, blir allt fler anhöriga anhörigvårdare. Att vårda en närstående med demenssjukdom är en krävande uppgift och många familjer når en punkt där den närstående med demenssjukdom flyttar till ett vårdboende. Syfte: Syftet med denna studie var att belysa anhörigvårdares erfarenheter, i samband med att deras närstående med demenssjukdom flyttar till ett vårdboende. Metod: Litteraturstudie med induktiv design. Genom sökningar i Cinahl, PubMed, APA Psycinfo, samt Medline (EBSCO) valdes åtta kvalitativa artiklar ut för analys. Artiklarna analyserades genom innehållsanalys och Meleis transitionsteori. Totalt 121 personer deltog i studierna, 79 var kvinnor. Resultat: Utifrån analysen utformades fyra kategorier: erfarenheter av en ohållbar livssituation, erfarenheter av flytten till vårdboende, erfarenheter av livet efter flytten, och anhörigvårdares känslor och reaktioner genom flyttprocessen. Konklusion: Det behövs mer forskning kring anhörigvårdare till personer med demenssjukdom för att ge bättre stöd i övergången från anhörigvårdare till anhörig. Vårdgivare behöver vidare utbildning för att kunna ge adekvat stöd till anhörigvårdare under transitionen. Vidare studier kanske kan förbättra samhälleliga attityder kring permanent boende. / Background: With an aging population and a rising number of people suffering with dementia in society, more family members become caregivers. Caring for a family member with dementia is a demanding task, and many families reaches a point, whereupon the person with dementia moves to a nursing home. Aim: The aim of this study was to illustrate the family caregivers’ experiences, in connection to when their family member with dementia moves to a nursing home. Methods: Literary study with inductive design. Through searches of databases Cinahl, Pubmed, APA Psycinfo and Medline (EBSCO), eight qualitative studies were chosen for analysis. The studies were analysed through content-analysis and Meleis transition-theory. 121 family caregivers participated, 79 were women. Results: From the analysis, four categories were formed: experiences of an untenable life-situation, experiences of the move to a nursing home, experiences of life after the move, and family caregivers’ emotions and reactions during the moving process. Conclusion: More research about family caregivers of persons with dementia is needed to better support their transition from caregiver to family member. Professional caregivers need further education to give adequate support to family caregivers during the transition. Further studies may improve societal attitudes concerning long-term care homes.

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AbstractThis essay is about the visibility of everyday life in a nursing home. The thesis is based on the following questions: What characterizes the social life and conversation between staff and residents? What content has the social life and the conversation between these parties? What is the power relationship between the staff and residents?To answer these questions, we used the qualitative approach with open observations, along with interviews. The study is partly based on direct observation by an observer as a participant in a special housing, and on semi-structured interviews with seven respondents, three of them staff and four residents in the same nursing home. For the results and analysis section, we use the Grounded Theory as a method which constructs a parallel between data processing and analysis of the interviews, where we first encode, categorize and create themes. These we use then to tie our results to the symbolic interactionism, and role theory.