The overall aim of this thesis was to develop, test and use a simple, clinically useful instrument for the nutritional screening of older patients. Four studies were performed, with a quantitative approach, in a geriatric rehabilitation ward in western Sweden. The number of patients who par-ticipated was: 56 (I), 114 (II), 147 (III) and 144 (IV) older patients. A nutritional screening instrument, the Nutritional Form For the Elderly (NUFFE), was constructed (I) and tested regarding reliability and validity (I, II). NUFFE was used in a screening, and the screening results were related to the patients’ perceived health and compared to the nurses’ nutritional notes in the nursing documentation (III). The screened patients’ self-care ability and sense of coherence (SOC) were investigated and the patients’ perceived health was related to selfcare ability and SOC (IV). The collection of data was done through interviews with the instruments NUFFE (I-IV), the Selfcare Ability Scale for the Elderly (SASE) (IV), Antonovsky’s SOC scale (IV), a question about perceived health, healthrelated ques-tions (III, IV) and background variables (I-IV). Weight and height were measured (I-III). The nurses’ nutritional notes in the nursing documentation were collected (III). The screening instrument contains 15 threepoint items on ordinal level. The total score ranges between zero and 30 and a higher score indicates higher risk for undernutrition. Evidence of reliability and validity was shown (I, II). The determined cut-off points of NUFFE for identification of patients at low, medium and high risk for undernutrition were set to scores of <6, ≥6 and ≥13 (III). The screening results showed that 31% of the patients were identified to be at low risk for undernutrition, 55% at medium risk and 14% at high risk. When the screening results were compared to nurses’ nutritional notes in the nursing documentation, it was shown that important nutritional issues were absent in many patient records (III). The patients at high risk were more likely to perceive ill health than were those at low risk for undernutrition (p=0.03) (III). Those at medium or high risk were more likely to perceive ill health (p=0.014) and to have lower self-care ability (p<0.001) and weaker SOC (p=0.007) than were those at low risk for undernutrition. To perceive good health was associated with higher self-care ability (p<0.001) and stronger SOC (p<0.001). Lower self-care ability, being single and having been admitted from another hospital ward were three obtained predictors for being at medium or high risk for undernutrition (IV). In conclusion, NUFFE is a simple, useful screening instrument for identification of older nutritional at-risk patients. The instrument has sufficient evidence of reliability and validity. Using NUFFE in a screening of older patients, the prevalence of patients at medium or high risk for undernutrition was found to be high. Nurses’ nutritional notes showed deficiencies, indicating that all medium or high risk patients were not identified. Using NUFFE, associations were found between older patients’ nutritional risk and their perceived health, and their self-care ability and SOC, respectively. These associations indicate that being at low risk for undernutrition is concomitant with perceived good health, higher self-care ability and stronger SOC. Conversely, being at medium or high risk for undernutrition is concomitant with perceived ill health, lower self-care ability and weaker SOC.

Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death. Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined. The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems. / <p>S. 1-48: sammanfattning, s. 49-114: 5 uppsatser</p> / digitalisering@umu

Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population. Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke. The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation. Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years. / <p>Härtill 5 uppsatser</p> / digitalisering@umu

Bakgrund: Antalet personer med hjärtsvikt beräknas till 23 miljoner i världen och ungefär 250 000 i Sverige. Hjärtsvikt är en av de vanligaste orsakerna till sjukhusinläggningar hos personer över 65 år. I framtiden kommer antalet äldre i samhället öka och det finns tendenser att även antalet yngre med hjärtsvikt ökar. Symtom som följer med hjärtsvikt påverkar den drabbade så det kan bli svårt att få vardagen att fungera. Genom egenvård kan personen lindra symtom, få en enklare vardag och minska sjukhusvården. Med rätt kunskap kan sjuksköterskor främja egenvårdsförmågan hos personer med hjärtsvikt.   Syfte: Syftet var att beskriva effekter av omvårdnadsåtgärder för att främja egenvårdsförmågan hos personer med hjärtsvikt.   Metod: En litteraturöversikt där 11 kvantitativa artiklar har analyserats.   Resultat: Olika inriktningar identifierades för hur egenvårdsförmågan kunde främjas: Utbildning med individuell inriktning- hjälpmedel, individuell inriktning- kognitivt beteende och inriktning individuell och anhörig. Alla inriktningar, utom individuell inriktning- kognitivt beteende visade sig leda till förbättrad egenvård.     Slutsats: Genom personcentrerad utbildning kan sjuksköterskan motivera personer med hjärtsvikt och deras anhöriga utifrån de resurser och familjefunktioner som är aktuella hos just den personen. Att kontakten med sjuksköterska är kontinuerlig och att personen lätt kan följa symtom med något slags hjälpmedel ökar följsamheten av egenvård och ger personen empowerment. / Background: In the world 23 million people, of which 250 000 live in Sweden, suffer with heart failure. It is one of the most common causes of hospitalization in the population 65 years and older. In the future the number of elderly people will increase and there are signs of an increasing number of younger people suffering with heart failure as well. The symptoms of heart failure affect the person’s ability to perform the chores of daily living. By performing self-care the person diagnosed with heart failure can alleviate symptoms so the chores of daily living can be performed easier. With the right knowledge can nurses promote self-care in persons diagnosed with heart failure.   Aim: Effects of nursing actions to promote self-care in persons diagnosed with heart failure.   Method: Eleven quantitative studies have been analyzed and presented in a result.   Result: The result is presented in four different categories; Individual education with aid to follow up symptoms, individual education with cognitive behavior programs, education for the person diagnosed with heart failure and his/her relatives. The result was positive in all categories except from the category individual education with cognitive behavior programs.   Conclusion: The nurse can through personcentered care motivate people diagnosed with heart failure to perform self-care. The motivation can be based on resources and family functions that are relevant to that particular person. It strengthens the adherence to self-care and empowers the patient if the contact with the nurse is continuous and if the person diagnosed with heart failure has some kind of aid to follow up symptoms.