BACKGROUND: Declines in functional dependence among older adults were observed before the 1990s, but there is uncertainty about subsequent trends. Our study aimed to verify the temporal trends in disability during 1991-2010 in an older Swedish population and to estimate the associated changes in survival.

METHODS: Functional status in octogenarians and nonagenarians was assessed at seven occasions with intervals of 2-3 years. Sample size varied at each assessment with an average of 646 (range 212-1096). Disability was defined as difficulty in one or more of personal activities of daily living. We compared prevalence and incidence, as well as mortality, and survival associated with disability over the 20-year period.

RESULTS: Sex-standardized prevalence of disability remained steady over time with a tendency toward a gradual decline, and a statistically significant decrease was present among nonagenarians. Sex-standardized cumulative incidence also remained steady. The proportion of people with prevalent disability who died <3 years remained stable, as did the survival time of people with incident disability. In contrast, among nondisabled persons, 3-year mortality decreased significantly, and for octogenarians median survival time was 1.3 years longer at the more recent assessment than a decade earlier.

CONCLUSIONS: Both prevalence and incidence of disability remained stable over the last two decades in this urban Swedish population, with a trend toward a slow decline. Mortality remained steady among disabled persons but decreased among persons without disability, suggesting that increased life expectancy during the last two decades may be essentially driven by longer lives of functionally independent people.

OBJECTIVE: To describe health issues and living conditions in a cohort of adults living with Spina bifida.

MATERIAL AND METHODS: A cross-sectional study was conducted by a multidisciplinary team. Adults with spina bifida (n = 219) were invited to participate. One-hundred-and-ninety-six persons (104 women and 92 men; 18-73 years, median age 33 years) were included. Structured interviews, questionnaires, and clinical assessments for medical, social, physical, and cognitive functions were used.

RESULTS: There was large variation among participants as regards the consequences of their spina bifida. Individuals < 46 years seemed to have more secondary conditions such as hydrocephalus, Chiari II malformation, tethered cord symptoms, and latex allergy. A higher proportion of the individuals >46 years and older was able to walk, and they had performed better in primary school and on tests of psychomotor speed and executive function.

CONCLUSIONS: This study demonstrates that adults with spina bifida have a complex set of physical, cognitive, and social needs that need to be addressed in order to improve their health issues and living conditions. The high prevalence of urinary and fecal incontinence, pain, and overweight underline that these issues need much attention during follow-up. The future generations of older adults may need more attention in many ways, since they at a younger age do have more complex medical conditions, lower physical and cognitive functions, and lower prerequisites for independent living and participation in society than those > 46 years today. This elucidates that adults with spina bifida need systematic follow-up services and social support throughout life.

AIMS AND OBJECTIVES:

To describe district nurses' perspectives on detecting mental health problems and promoting mental health among homebound older people with multimorbidity.

BACKGROUND:

Mental health problems among older people with multiple chronic conditions, that is, multimorbidity, are challenging issues. These patients' homes often serve as arenas in which district nurses can promote health. Mental health promotion must be studied in greater depth within primary care because older people with multimorbidity are particularly prone to developing poor mental health, which can go undetected and untreated.

DESIGN:

A descriptive, qualitative study using semi-structured interviews and content analysis.

METHODS:

Twenty-five district nurses completed individual or focus group interviews. Data were analysed using qualitative content analysis.

RESULTS:

Most district nurses stated that detecting mental health problems and promoting mental health were important tasks but that they typically focused on more practical home health care tasks. The findings revealed that district nurses focused on assessment, collaboration and social support as means of detecting mental health problems and promoting mental health.

CONCLUSIONS:

The district nurses described various factors and actions that appeared to be important prerequisites for their involvement in primary mental health care. Nevertheless, there were no established goals for mental health promotion, and district nurses often seemed to depend on their collaboration with other actors. Our findings indicated that district nurses cannot bear the primary responsibility for the early detection of mental health problems and early interventions to promote mental health within this population.

RELEVANCE TO CLINICAL PRACTICE:

The findings of this study indicated that workforce training and collaboration between different care providers are important elements in the future development of this field. Early detection and early treatment of mental health-related issues should also be stated as explicit objectives in the provision of care to community-dwelling older people with multimorbidity.

Introduction: Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients’ mental health status.

Aim: To describe HCAs’ perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity.

Methods: We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs.

Results: Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors’ own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health. Conclusion: The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers’ decisions to support the needed care, to schedule assignments related to the detection of mental health problems, and to promote mental health.

Background: Chronic obstructive pulmonary disease (COPD) is a public health issue and the third leading cause of death worldwide. COPD affects the airways and lungs and leads to restriction of air flow in and out of the lungs. The main cause of the disease is smoking. The disease affects the patients’ well-being negatively and leads to suffering. 

Aim: The aim was to describe the patients' experiences of living with chronic obstructive pulmonary disease (COPD).

Method: A literature review with ten scientific articles and qualitative content analysis.

Result: Three categories and eight subcategories were identified. The three categories were physical impact, psychological impact, and experiences of care in hospital and at home. Subcategories were fatigue and shortness of breath, adjusting to everything, meal experience, fear, anxiety-provoking emotions, isolation, patient experiences of hospitalization and patient experiences of receiving care from their relatives. 

Conclusion: The patient experience of COPD must be taken into account in order to develop knowledge about the disease for this patient group. Mental and physical effects such as dyspnea, anxiety, fear of suffocation and limitations related to fatigue and breathing difficulties are the common experiences described by patients with COPD. That the nurse has sufficient knowledge about the disease is important because it creates confidence in the treatment and gives security to the patient.

Informal care given by family caregivers is an important part of the total care provided to older adults with multimorbidity. The current study aimed to describe how older adults with multimorbidity experienced care from family caregivers. Interviews were conducted with 24 participants (mean age = 86 years). Older adults with multimorbidity felt gratitude toward family caregivers for their willingness to help with everyday life and for representing their interests in contacts with health care providers. Family caregivers also had a significant impact on older adults' psychological well-being. However, the results also showed that older adults often felt they were a burden to their family caregivers and that their independence might be reduced. Older adults with multimorbidity should have the opportunity to be more involved in and have more influence over their health care so that they do not have to depend on representation by family caregivers.

Objective: Among social determinants of health, culture and ethnicity play a key role in defining the needs of different population groups. The aim of this study was to consider and compare the social and leisure time activities of the three .elderly groups: Iranian residing in Iran, Iranian residing in Sweden and Swedish residing in Sweden Methods and Materials: Via the cross-sectional design, 825 Iranian elderly who were living in Tehran compared with 305 Swedish elderly and 101 Iranian elderly living in Stockholm on social relations, group activities and leisure time activities. Only, elderly who could communicate properly entered the study. A structured questionnaire designed by the Iranian and Swedish Research Group on the” Assessment of Social Health Status and Needs” implemented for .the subjects. Estimation method and logistic regression used to analyze the gathered data Results: Subjects of all 3 groups were in the age range of 60-77 years old and mostly were married. Results showed despite very common characteristics, there are, also, many differences which can be explained by cultural and environmental factors. Rapid urbanization, limited resources and unawareness of or disregard for healthy life style resulted in lower levels of satisfaction with social and leisure life in the Iranian elderly. On the other hand, level of activities related to the spiritual dimension of health were more in Iranians than Swedish and the difference was significant (p=0.000), whereas the reverse was true for the group activities (p=0.000). Poor attitude toward physicalactivity and exercise in Iranian elderly, especially women, with consequent hazards for health, needs special consid.eration on behalf of the health planners and providers Conclusions: Needs assessment with trance- cultural approach, especially on social determinants of the health of elderly is a necessity. Using valid and reliable instruments, designed to overcome the cultural barriers would help.planners to apply the experience of the aged societies more reasonably, properly and creatively.

Background: Health-related infections (VRI) have a negative impact on public health and cause suffering for the patient and costs to society. Problematization: VRI is a patient safety problem and risks affecting both patient and nurse. Aim: The aim of the study was to describe nurses' experiences of preventive work against healthcare-associated infections. Method: A literature review based on 11 articles based on a qualitative method was analyzed through thematization. Results: The results showed that the nurses had varied attitudes to hygiene and prevention of infections. Some experienced the need for training to better prevent infections, while others showed different considerations for maintaining hygiene in the workplace, depending on previous experience and the opportunities offered by the nursing environment. The nurses experienced a challenging work environment with a high workload and a lack of work motivation. They wanted their nursing environment to be upgraded to increase the chances of infection prevention. Conclusion: One conclusion and implication were that nurses need to take more consideration to each patient's individual need in the prevention work against infections. Continued research can examine patients 'experiences of nurses' work towards VRI.

OBJECTIVES: To describe differences in morbidity and functional status according to living area.

DESIGN: Community-based survey.

SETTING: A community-based prospective cohort, the Kungsholmen-Nordanstig Project.

PARTICIPANTS: Adults aged 75 and older living in an urban area of central Stockholm (n=1,222) and in the rural community of Nordanstig in northern Sweden (n=919).

MEASUREMENTS: Physicians clinically examined all participants using the same standardized protocols in both living areas; trained nurses directly assessed disability.

RESULTS: Cardiovascular disease was the most common disorder in both living areas (39.9% in the urban area and 45.2% in the rural area). There were great area differences in the prevalence of stroke (7.4% and 14.0%), diabetes mellitus 6.3% and 16.1%), and Parkinson's disease (1.0% and 3.7%). It was more common to have two or more diseases than no diseases in the rural area than in the urban area (odds ratio=1.9, 95% confidence interval=1.4–2.4). Significant living area differences (urban vs rural) in population attributable risk (PAR) was found for disability due to stroke (5.6 vs 32.2), diabetes mellitus (1.2 vs 6.1), fractures (1.4 vs 10.7), and hearing impairment (8.7 vs 22.0).

CONCLUSION: Differences were found in disability, morbidity, and disease patterns according to living area. The rural elderly population was more disabled and had more diseases than the urban elderly population, despite being slightly younger than the urban cohort. There were significant area differences in the PAR of how specific chronic conditions influenced the risk of disability.

The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.