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Unequal opportunities for patients with and without cognitive impairment: relatives' and significant others' views on care and rehabilitation after hip fracture
Institutionen för neurobiologi, vårdvetenskap och samhälle, Karolinska Institutet, Stockholm.ORCID iD: 0000-0001-6883-3154
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Stockholm: Karolinska institutet , 2007. , 57 p.
Keyword [en]
hip fracture, cognition disorders, caregivers
National Category
Nursing
Identifiers
URN: urn:nbn:se:rkh:diva-450Libris ID: 10351444ISBN: 978-91-7357-118-0 (print)OAI: oai:DiVA.org:rkh-450DiVA: diva2:562176
Note

 Institutionen för neurobiologi, vårdvetenskapoch samhälle, Karolinska Institutet.                    

Available from: 2014-07-04 Created: 2012-10-23 Last updated: 2014-10-21Bibliographically approved
List of papers
1. Dementia, delirium and other comorbid conditions in acute hip fracture care: Traditions, attitudes and local policies rather than actual state guide diagnose making?
Open this publication in new window or tab >>Dementia, delirium and other comorbid conditions in acute hip fracture care: Traditions, attitudes and local policies rather than actual state guide diagnose making?
2005 (English)In: Vård i Norden, ISSN 0107-4083, Vol. 25, no 4, 25-29 p.Article in journal (Refereed) Published
Abstract [en]

In the elderly, hip fracture is a common disease. Previous studies show that more than half of these patients has a co-existing dementia and/or delirium diagnose. We found a cognitive disorder diagnose code registered in only 11% of 14,993 hip fracture patients, 65 years or older, in Stockholm, Sweden during 1994–1999. Although most common in the clinical setting, acute confusional state (delirium) was hardly ever diagnose-coded (1%). Furthermore, the share of dementia/delirium registrations ranged from 6 to 17% between hospitals and within a single hospital from 1 to 20 %. The lack of pattern in diagnosis coding became even more evident in the patients who were transferred from acute care to geriatric rehabilitation – it was unusual that the diagnosis was given at both specialities. Also regarding secondary diagnoses on the whole, large differences on hospital level was found (range 0.4 – 2.2/patient). The over all impression of the findings was that recording of comorbid conditions in acute somatic care depends on other factors than the patient’s actual state such as traditions, attitudes and local policies (or the lack thereof). In conclusion, significant conditions crucial for planning, treatment and prognosis in the hip fracture population are virtually invisible in this administrative database.

Place, publisher, year, edition, pages
Oslo: Nordic Journal of Nursing Research & Clinical Studies, 2005
Keyword
comorbid conditions, cognition disorders, hip fractures, medical records, administrative database
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-447 (URN)
Available from: 2012-10-23 Created: 2012-10-23 Last updated: 2014-10-21Bibliographically approved
2. Conditions for rehabilitation of older patients with dementia and hip fracture: – the perspective of their next of kin
Open this publication in new window or tab >>Conditions for rehabilitation of older patients with dementia and hip fracture: – the perspective of their next of kin
2001 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, no 2, 151-158 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe the conditions for rehabilitation of older patients with dementia and hip fracture from the perspective of their next of kin. Twenty patients at orthopaedic wards were examined postfracture using a short cognitive test. The same number of next of kin answered four open-ended questions about rehabilitation as well as about the patient’s physical function. Qualitative content analysis was used to identify categories. The findings indicate that the conditions for rehabilitation of older patients with dementia and hip fracture are related to the patients’ competence, specific needs of support in the light of competence, environmental factors and classification of the rehabilitation activities. The study confirms that the conditions for rehabilitation are related to symptoms of dementia disease and arise from a decline in competence making the patient unable to cope with the environmental pressure and to perform rehabilitation activities. Because of difficulties in assessing competence, patients with dementia are being judged as incapable of managing rehabilitation. A supportive strategy is necessary to encourage the recovery process.

Place, publisher, year, edition, pages
Oxford: Wiley-Blackwell, 2001
Keyword
dementia, hip fractures, rehabilitation, competence, environment
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-445 (URN)10.1046/j.1471-6712.2001.00013.x (DOI)12078628 (PubMedID)
Available from: 2012-10-23 Created: 2012-10-23 Last updated: 2014-10-21Bibliographically approved
3. Hip fracture patients’ cognitive state affects family members’ experiences: a diary study of the hip fracture recovery
Open this publication in new window or tab >>Hip fracture patients’ cognitive state affects family members’ experiences: a diary study of the hip fracture recovery
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, 451-458 p.Article in journal (Refereed) Published
Abstract [en]

Background:  Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members – spouses, daughters, sons, or even neighbours become informal carers.

Aim:  To explore how hip fracture patients’ cognitive state affect family members’ experiences during the recovery period.

Methods:  Eleven diaries written by family members’ of hip fracture patients were analysed by means of qualitative content analysis.

Findings:  The analysis generated two main categories with four categories. The first main category was; ‘Being a family member of a cognitively impaired patient’ with the categories ‘Dissatisfaction with lack of support’ and ‘Emotional distress due to the patient’s suffering’. The second main category was ‘Being a family member of a cognitively intact patient’ with the categories ‘Satisfaction with a relative’s successful recovery’ and ‘Strain due to their caring responsibilities’. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients’ suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members.

Conclusions:  The findings suggest the hip fracture patient’s cognitive state is more decisive than the hip fracture itself for the family members’ experiences.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keyword
cognitive impairment, diary, family member, hip fracture, qualitative content analysis
National Category
Nursing Health Sciences
Identifiers
urn:nbn:se:rkh:diva-443 (URN)10.1111/j.1471-6712.2010.00848.x (DOI)21175729 (PubMedID)
Note

Som manuskript i avhandling. As manuscript in dissertation.

Relatives experiences of the hip fracture recovery period of older patients with and without cognitive impairment

Available from: 2012-10-22 Created: 2012-10-22 Last updated: 2014-11-07Bibliographically approved
4. Hip fractures and cognitive state: patient outcomes and proxies’ perceptions of the rehabilitation period
Open this publication in new window or tab >>Hip fractures and cognitive state: patient outcomes and proxies’ perceptions of the rehabilitation period
2008 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 3, no 3, 178-186 p.Article in journal (Refereed) Published
Abstract [en]

Background.  Numerous studies are available on hip fracture and rehabilitation outcomes, some mention dementia but very few from a family/proxy perspective.

Aim.  To investigate whether cognitive state influences the hip fracture patients’ rehabilitation outcomes as well as the proxies’ perceptions of the 6-month rehabilitation period.

Design.  A survey with structured and unstructured questions. Statistics and content analysis.

Methods.  The questionnaire was sent to 40 proxies of hip fracture patients with and without cognitive impairment, 32 replied. Statistics and content analysis were used to analyse the data.

Results.  In the cognitively impaired group, physical function decreased (P = 0.0241) as well as locomotion (P = 0.0005) compared to pre-fracture. This group mainly participated in rehabilitation sessions in institutions (P = 0.0001) and their main support came from nursing staff. The cognitively impaired group assessed the rehabilitation period as being of a much lower quality than the cognitively intact group (P = 0.0048). In the impaired group, hindrances to rehabilitation were low level of staffing, and lack of access to rehabilitation resources such as physiotherapists.

Conclusions and relevance for clinical practice.  Hip fracture patients are a dichotomous group and cognition is decisive for physical and social outcomes as well as type of rehabilitation support.

Place, publisher, year, edition, pages
Oxford: Wiley-Blackwell, 2008
Keyword
clinical trial, cognitive impairment, hip fracture, Katz ADL, proxies, rehabilitation
National Category
Nursing Health Sciences
Identifiers
urn:nbn:se:rkh:diva-444 (URN)10.1111/j.1748-3743.2008.00131.x (DOI)20925818 (PubMedID)
Note

Som manuskript i avhandling. As manuscript in dissertation.

Available from: 2012-10-22 Created: 2012-10-22 Last updated: 2014-10-21Bibliographically approved

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Rydholm Hedman, Ann-Marie
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