Older People In Sweden Research Articles

Meaning of home and health dynamics among younger older people in Sweden

Research has shown that positive evaluations of home are important for very old people’s health, well-being and independence in daily life. The rationale for the present study derives from our survey study findings, confirming such associations also in a younger cohort (N = 371). The purpose of this study was to further increase the understanding of the dynamics of meaning of home and health among community-living healthy younger older people, in the present and in a projected future. Data were collected through semi-structured interviews with 13 persons aged 67–70 years living in ordinary housing in Sweden, followed by a qualitative content analysis. Findings suggest that the home becomes progressively important after retirement. Not only the immediate home environment but also local neighbourhoods influence perceptions about home. Home brings emotional and social benefits but also worries about how to cope with complex home ambivalence when reflecting upon future housing arrangements. The findings suggest that it is important to consider the role of perceived aspects of home for health and well-being in early phases of the ageing process. The findings could be used to raise awareness among policymakers, housing authorities and professionals involved in housing-related counselling.

PREVALENCE OF SUBJECTIVE COGNITIVE DECLINE (SCD) AND THE ASSOCIATION OF MOVING TO SHELTERED HOUSING

Background A new form of housing has emerged for older people in Sweden, sheltered housing, providing social possibilities for older people feeling anxious, or lonely but otherwise capable of independent living. It is expected that sheltered housing will increase the wellbeing of residents by enhancing social interaction and reducing anxiety. Currently, there are no studies of sheltered housing in Sweden or on the prevalence of subjective cognitive decline among residents in this new form of housing. Aim To examine prevalence of subjective cognitive decline and the association of moving to sheltered housing in Sweden. Methods A cross sectional survey study with cases and controls (n=3805) matched on age, gender and municipality. Results Initial analyses show lower self-rated health and lower functional status in those living in sheltered housing compared to aging in place. A higher proportion of people in sheltered housing report subjective cognitive decline, however there is no strong association of moving to sheltered housing. Conclusion Subjective cognitive decline is more prevalent in sheltered housing compared to ageing in place. This difference indicates a need for longitudinal follow up on trajectories of cognitive decline, resource use and functional capacity of people living in sheltered housing.

Changes in oral health-related quality of life (OHRQoL) related to long-term utilization of dental care among older people

Objective: To examine whether long-term utilization of dental care, treatment with fillings and crowns and persistent tooth loss between age 50 and 65 years associate with subsequent changes in OHRQoL from age 65 to 70 years.Method: In 1992, a census of 50-year-olds received invitation to participate in a questionnaire survey. Of 6346 respondents, 3585 completed follow-ups in 1997, 2002, 2007 and 2012. OHRQoL was measured using the Oral Impacts on Daily Performances (OIDP) inventory.Results: Around 70.4%, 11.2% and 18.4% confirmed respectively, no change, worsening, and improvement in OIDP scores between age 65 and 70 years. Compared to those being permanent non-routine dental attenders, ORs of improving and worsening of OIDP were respectively, 0.4 and 0.6 if being a permanent routine dental attender. ORs for improving OIDP was 1.6 if reporting persistent specialist attendance and 2.5 if having received crowns and fillings. Participants with permanent tooth loss were most likely to both worsen and improve OIDP.Conclusion: Long-term routine dental attendance and permanent tooth loss occurred as predictors simultaneously for improvement and worsening of OIDP. Accumulation of advantages and disadvantages throughout the life-course increases and decreases the probability of improvement and worsening in OIDP among older people in Sweden.

Older people in Sweden without means: on the importance of age at immigration for being ‘twice poor’

ABSTRACTThis paper examines immigrant poverty at an older age in Sweden with an emphasis on late-in-life immigrants. We analyse tax data for the entire Swedish-born and non-Swedish-born population. The poverty status of a household is assessed using two criteria. First, the disposable income of the household in which the person lived in 2007 must be below 60 per cent of the median equivalent income in Sweden as a whole. Second, to be classified as ‘twice poor’ a household's net assets must be below SEK 10,000. The results indicate that three out of four Swedish-born older persons were not classified as poor by either of the criteria, and only 1 per cent by both criteria. In contrast, among older persons born in low-income countries almost three out of four were classified as poor according to one of the criteria and not fewer than one in three according to both. Results of estimating logistic models indicate that the risk of being considered poor according to both criteria is strongly positively related to one's age at immigration. Our results indicate that it is crucial that migrants, particularly those who arrive after age 40, be better integrated into the Swedish labour market. To alleviate poverty among those migrants who are already of older age, increased transfers are probably the only possible alternative.

Social Network and Support, Self-Rated Health, and Loneliness as Predictors of Risk for Depression Among pre-Frail and Frail Older People in Sweden

Social Network and Support, Self-Rated Health, and Loneliness as Predictors of Risk for Depression Among pre-Frail and Frail Older People in Sweden

Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains.

The physical housing environment is important to facilitate activities of daily living (ADL) for older people. A hindering environment may lead to ADL dependence and thus increase the need for home services, which is individually restricting and a growing societal burden. This study presents simulations of policy changes with regard to housing accessibility that estimates the potential impact specifically on instrumental activities of daily living (I-ADL), usage of home services, and related costs. The models integrate empirical data to test the hypothesis that a policy providing funding to remove the five most severe environmental barriers in the homes of older people who are at risk of developing dependence in I-ADL, can maintain independence and reduce the need for home services. In addition to official statistics from state agencies in Sweden and Germany, we utilized published results from the ENABLE-AGE and other scientific studies to generate the simulations. The simulations predicted that new policies that remove potentially hindering housing features would improve I-ADL performance among older people and reduce the need for home services. Our findings suggest that a policy change can contribute to positive effects with regard to I-ADL independence among older people and to a reduction of societal burden.

Managing complaints in multilingual care encounters

AbstractTroubles-telling and complaints are common in contexts of care for older people and need to be managed by care staff in a respectful manner. This paper examines the handling of an older person’s complaints in multilingual care encounters that involve participants who do not share a common language. The data consist of video-recordings and ethnographic fieldwork in a residential home for older people in Sweden that is characterised by a variety of languages and backgrounds. The findings are based on analyses of multi-party interactions involving an Arabic-speaking resident and caregivers with different levels of knowledge in different languages. We focus on complaint sequences when the resident expresses a negative stance (displeasure, anger, etc.) towards some difficult circumstance. Using the methodology of conversation analysis, we analyse the affect-regulating work through which the caregivers attempt to turn a pressing situation into a moment of cheerfulness and intimacy. The analyses bring to light the multilingual practices that the caregivers draw upon in pursuing this work, such as translating and giving voice to the resident’s complaining.

A part of social work and apart from social work: hospital nurses in hospital discharges of older people in Sweden

The aim of this study was to reveal how hospital nurses handle the process when older people are considering relocation to a residential home after hospitalization. The focus is of special interest as, in Sweden, hospital nurses are employed by a county council without the authority to decide on local municipal care after hospital discharge. Ten nurses from three hospital wards participated in open semi-structured interviews. The findings showed that the hospital nurses supported patients in brief talks when possible, made a mark in discreet ways and dealt with formal and informal inter-professional procedures. Examples of hospital nurses’ contributions and limitations in relation to social work and of rivalries and collaborations between hospital nurses and care managers were identified. For a better understanding and thereby implementation of practice and policy principles for older people, more research is needed on how care managers on their part perceive their positioning in hospital discharge planning. Additionally, further research is needed at an overall level on how to strengthen the social work practice with hospitalized older people.

Integration or specialization? Similarities and differences between Sweden and the United States in gerontology education and training

ABSTRACTThis article examines the similarities and differences in the education and training of gerontologists and others who work with older people in Sweden and the United States. It outlines the aging trends in both countries and assesses the level of training for those who provide care in a variety of fields. Both countries are aging, but the programs for gerontological training are quite different in the two countries, reflecting underlying cultural values. Sweden’s education is generally more oriented toward the integration of some aging education in more disciplinary fields, such as nursing and social work and thus could benefit from more specialized, aging-specific courses. The United States is highly specialized, with multiple programs in various subfields of aging (e.g., geropsychology; aging services administration) and could benefit from integrating more aging knowledge into courses in other disciplines. The authors challenge professionals to consider if there is a basic but global curriculum and/or set of competencies in gerontology that could be agreed upon. As an increasingly global village, the ability to share and learn is more easily achievable. Sweden and the United States have much to learn from each other in terms of appropriately educating and training those who support our older people.

Feeling lonely in an unfamiliar place: older people's experiences of life close to death in a nursing home.

The aim of the study was to deepen the understanding of how older persons living in a nursing home experience life close to death. A move to and a life in a nursing home while being close to death is a reality for many older people in Sweden. Being able to express thoughts and feelings about death has been described as both crucial for sustaining personhood as well as for establishing a meaningful existence at the end of life. Important are the experiences of older people living in nursing homes who are approaching death. Six older people were interviewed on one to four occasions. A total of 16 interviews were conducted with the participants. An interpretative approach was chosen. The main interpretation, Feeling lonely in an unfamiliar place, is based on three themes (i) Waiting for death, with the subthemes death as a release and thinking of oneself as dead; (ii) Subordinate oneself to values and norms of the staff, with the subthemes feeling offended and feeling trapped; and (iii) Keep the courage up. The older people's lives were characterised by feelings of aloneness in an unfamiliar place which contributed to a sense of existential loneliness. They experienced few opportunities to discuss their thoughts of life and death, including preparations for passing away. It is of importance for professionals to be able to meet older people as they are and respect them as human beings in their transitions, before, during and after the move to a nursing home. It is important to find ways to support older people's wellbeing and identity near death.

The Common Cold, Influenza and Immunity in Post-Pandemic Times: Lay representations of Self and Other among older people in Sweden

The need for new knowledge about lay representations of contagions, immunity, vaccination, common colds, and influenza has become clear after the A(H1N1) pandemic and the resulting challenges regarding pandemic preparedness. This article analyses written responses from 67 persons, mostly women, to a semi-structured questionnaire about colds and the flu. Three themes are discussed: “Common cold and flus as ritualized experiences”, “Me, my body, and my immune defense”, and “Regulations of space, place, and behaviors.” Overall, the narratives were about trust, value, and respect in the body, in lived experiences, and in the capacity to ‘help’ and ‘nurture’ the immune system, but also about the feeling of powerlessness when perceiving inadequacies in other people’s parallel interpretations and actions. Pandemic preparedness policies need to acknowledge the multiple ‘immunity talk’ in the responses to create productive, ongoing relations with the ‘Other’, that rely on people’s trust and resilience, rather than on people´s fear.

Good personal finances or a strong social capital—on different life conditions of importance for an active life when becoming alone in old age

Becoming alone in old age can be a decisive life event that brings major changes depending on various causes as health status, financial resources, family situation, and available welfare services. This article discusses the situation of older people in Sweden who have transitioned from a two-person to single-person household in recent years and what impact this might have on their everyday lives. Through in-depth interviews with 18 older people, age 67–90, their experiences about life conditions and opportunities were examined. Findings showed large differences between the men and women. They all tried to live as they always had done and they used the same personal life strategies that they always had. But the men could live as before on their own financial merits, while the women needed assistance from children, grandchildren and the welfare system. Transportation options were central and clearly related to both private economy and social services available. Shortcomings in the welfare state's way of caring for the elderly were clearly uncovered. The gap between social policy promises of opportunities for autonomy and independence to live an active life in old age and the everyday reality for older people still seems to be wide.

The collective voice: Legitimation strategies in focus group discussions with nurses in municipal palliative care for older people in Sweden

This paper explores focus group discussions of registered nurses in municipal palliative care for older people, using data collected by researchers with an interest in health sciences. The linguistically based discourse analyis builds on a combination of Bakhtinian notions of dialogicity, the Other and addressivity, the use of quotations, and also van Leeuwen's framework for legitimation in discourse. The aim is to investigate strategies of addressing and legitimizing palliative care. Three types of narrative are discerned: the cautionary tale, fictionalization of professional experiences and the enactment of a fictive dialogue. The other professions involved (physicians, assistant nurses) are positioned as the Other as a means of legitimizing the perspectives of the registered nurses. As the patients and their next of kin are the objects of professional activities, the notion of the Third (connecting to the Other) is proposed. The objectification is a manifestation of commitment with routinized and professional distance to the patients.

Potentially inappropriate drug use in older people: a nationwide comparison of different explicit criteria for population-based estimates.

The aim was to investigate the prevalence of potentially inappropriate medication use among older people in Sweden according to five different published sets of explicit criteria from Europe and the US. This was a nationwide cross-sectional, register-based study across the whole of Sweden in 2008. All individuals aged 65 years and older were included (n = 1 346 709, both community-dwelling and institutionalized persons). We applied all drug-specific criteria included in the 2012 Beers Criteria, the Laroche's list, the PRISCUS list, the NORGEP criteria and the Swedish National Board of Health and Welfare criteria. The main outcome was the potentially inappropriate drug use according to each set of criteria, separately and combined. Multivariate logistic regression models were used to identify individual factors associated with the use of potentially inappropriate drugs. The prevalence of potentially inappropriate medication use varied between the explicit criteria from 16% (NORGEP criteria) to 24% (2012 Beers criteria). Overall, 38% of the older people were exposed to potentially inappropriate drug use by at least one of the five sets of criteria. While controlling for other possible covariates, female gender, institutionalization and polypharmacy were systematically associated with inappropriate drug use, regardless of the set of explicit criteria we considered. Although explicit criteria for inappropriate drug use among older people have been reported to be quite different in their content, they provide similar measures of the prevalence of potentially inappropriate drug use at the population level.

Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: results from a population-based study.

There is limited knowledge about older people's length of stay (time until death) in institutional care and how it has changed over time. The aim of this study was to analyse changes in the length of stay for older people in institutional care between 2006 and 2012. All persons 65+ living in Kungsholmen (an urban area of Stockholm), who moved to an institution between 2006 and 2012, were included (N=1103). The data source was the care system part of a longitudinal database, the Swedish National Study on Aging and Care. The average length of stay was analysed using Laplace regression for the 10th to the 50th percentile for the years 2006-2012. The regressions showed that in 2006, it took an average of 764days before 50% of those who had moved into institutional care had died. The corresponding figure for 2012 was 595days, which amounts to a 22.1% decrease over the period studied (P=0.078). For the lower percentiles, the decrease was even more rapid, for example for the 30th percentile, the length of stay reduced from 335days in 2006 to 119days in 2012, a decrease of 64.3% (P<0.001). The most rapid increase was found in the proportion that moved to an institution and died within a short time period. In 2006, the first 10% had on average died after 85days, in 2012 after only 8days; a decrease in the length of stay of 90.5% (P=0.002). In general, there was a significant decrease in the length of stay in institutional care between 2006 and 2012. The most dramatic change over the period studied was an increase in the proportion of people who moved into an institution and died shortly afterwards.

From the state to the family or to the market? Consequences of reduced residential eldercare in Sweden

This article analyses the changing roles of the state, family and market in providing care for older people in Sweden, in relation to Scandinavian welfare ideals of universalism and de‐familisation. Since 2000 every fourth residential care bed has disappeared and the increase in homecare services has not compensated for the decline. Instead family care (defined here as help from adult children and other non‐cohabiting family or friends) has increased in all social groups: help by daughters mainly among older people with shorter education and help by sons among those highly educated. Use of privately purchased services has also increased but continues to play a marginal role. Family care remains more common among older people with less education whereas privately purchased services are more common among those with higher education. This dualisation of care challenges universalism, and working‐class daughters continue to be most affected by eldercare cutbacks.

Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden

Objectives: The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65–80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication.Method: A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65–80 years (n = 6659). Chi square tests and logistic regression analyses were conducted.Results: The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75–80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits.Conclusion: Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.

The risk of fall injury in relation to commonly prescribed medications among older people--a Swedish case-control study.

Older people not only consume more medication but they also represent a group at high risk for adverse effects such as injurious falls. This study examines the association between the medications most commonly prescribed to older people in Sweden and fall injuries. This is a population-based, matched, case-control study of 64 399 persons aged ≥ 65 years in Sweden admitted to hospital because of a fall injury between March 2006 and December 2009, and four controls per case matched by gender, date of birth and place of residence. The prevalence of the 20 most commonly prescribed medications was compiled for the 30-day period before the index date. The association between those medications and injurious falls was estimated with odds ratios and corresponding 95% confidence intervals using conditional logistic regression. Ten of the top 20 most commonly prescribed medications, and in particular the three medications affecting the central nervous system (CNS), significantly increased the risk of fall injuries (highest for opioids and antidepressants) but not the seven cardiovascular ones, who had a protective effect (lowest for angiotensin converting enzyme inhibitors and selective calcium channel blockers). The adverse effect of several commonly prescribed medications may seriously threaten their positive effects on the well-being and quality of life of older people. Their association with injurious falls is of particular concern as falls are prevalent and often leading to severe consequences. This needs to be acknowledged so physicians and patients can make informed decisions when prescribing and using them.

Locally based research and development units as knowledge brokers and change facilitators in health and social care of older people in Sweden

This article investigates the role of locally based research and development units (R&amp;Ds) focusing on health and social services. Nearly 300 local RDs are funded by the Swedish government with the intention to facilitate knowledge transfer and development of high quality and effective health and social care organisations. Based on analyses of archival data on aims, activities and outputs of R&amp;Ds focusing on care for older people the authors argue that local R&amp;Ds have potentials to act as knowledge brokers, change agents and researchers, but these overlapping roles need clarified strategies and enactment of a variety of skills.

Testing the red herring hypothesis on an aggregated level: ageing, time-to-death and care costs for older people in Sweden

In this paper we test the 'red herring' hypothesis for expenditures on long-term care (LTC). The main contribution of this paper is to assess the 'red herring' hypothesis by using the probability of dying as a measure for time-to-death (TTD). In addition, we implement models that allow for age-specific TTD effects on LTC utilization as well as sex-specific effects. We also focus on total, institutional and domiciliary LTC separately. For our analysis we use high quality administrative data from Sweden. Our analysis is based on fixed effects estimates. We use our findings to project future LTC expenditures and show that, although TTD is a relevant predictor, age itself remains the main driver of LTC expenditures.