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Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital: a qualitative study of health professionals' experiences
- Authors:
- DAHL Unni, et al
- Journal article citation:
- International Journal of Integrated Care, 14(2), 2014, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: This is a study of an intermediate care hospital established in Central Norway to improve discharge from a general hospital to primary health care. The aim of the study was to investigate how professionals across health care levels experience the discharge of elderly patients, who are in need of continued care, from a general hospital via an intermediate care hospital compared to a direct discharge to primary health care in a municipality without intermediate care. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels. (Edited publisher abstract)
The dark side of Norwegian nursing homes: factors influencing inadequate care
- Authors:
- MALMEDAL Wenche, HAMMERVOLD Randi, SAVERMAN Britt-Inger
- Journal article citation:
- Journal of Adult Protection, 16(3), 2014, pp.133-151.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to investigate factors that influence the probability that staff will commit acts of inadequate care, abuse, and neglect. Design/methodology/approach: A cross-sectional survey study was carried out in one county in the middle of Norway (Sør-Trøndelag). Random sampling, stratified by size of nursing homes, and location (rural or urban areas), was used to select a variety of nursing homes from a total population of 55 nursing homes. All staff working in 16 nursing homes working were asked to participate in the study. A response rate of 79 per cent was achieved (n=616). Findings: Findings reveal that location and size of the nursing home, age of the staff, education level, job satisfaction, resident aggression, and conflicts between residents and staff predict inadequate care, abuse, and neglect. The most consistent findings are that resident aggression increases the risk for all three types of inadequate care, and that conflicts predict different types of inadequate care depending on whether the conflicts are related to direct care-giving activities or not. Practical implications: Nursing home care is an important part of care for the elderly, and should be characterized by good-quality services. The relation between inadequate care and resident aggression, conflicts, and other factors shown in this study points to the relevance of further improvements in nursing home practices to minimize the occurrence of episodes of inadequate care, abuse, and neglect. Originality/value: This study investigated the relationships between 11 specific factors and different types of inadequate care in a nursing home context. (Publisher abstract)
Informal caregivers' participation when older adults in Norway are discharged from the hospital
- Authors:
- BRAGSTAD Line Kildal, et al
- Journal article citation:
- Health and Social Care in the Community, 22(2), 2014, pp.155-168.
- Publisher:
- Wiley
This paper describes the participation of informal caregivers in the discharge process when patients aged 80 and over who were admitted from home to different hospitals in Norway were discharged to long-term community care. Data for this cross-sectional survey were collected through telephone interviews with a consecutive sample of 262 caregivers recruited between October 2007 and May 2009. The Discharge of Elderly Questionnaire was developed by the research team and was designed to elicit data concerning informal caregivers' self-reported perceptions on participation in the discharge process. A descriptive and comparative analysis of Thompson's levels of participation reported by the older generation (spouses and siblings) and the younger generation (adult children and children-in-law, nieces and grandchildren) was undertaken using bivariate cross-tabulations and chi-square tests for association and trend. Analyses showed that the younger generation of caregivers received and provided information to hospital staff to a greater degree than the older generation. Overall, 52% of the informal caregivers reported co-operating with the staff to a high or to some degree. A multivariate logistic regression analysis was used to analyse factors predicting the likelihood of informal caregivers reporting co-operation with hospital staff. The odds of younger generation caregivers reporting co-operation were more than twice as high as the odds of the older generation. Caregivers of patients with a hearing impairment had higher odds of reporting co-operation than caregivers of patients with no such impairment. The length of hospital stay, the caregiver's and patient's gender and education level were not significantly associated with caregiver's co-operation. The informal caregivers' experiences with information practices and user participation in hospitals highlight important challenges that must be taken seriously to ensure co-operation between families and hospitals when elderly patients are discharged back to the community. (Edited publisher abstract)
Loneliness among men and women: a five-year follow-up study
- Authors:
- NICOLAISEN Magnhild, THORSEN Kirsten
- Journal article citation:
- Aging and Mental Health, 18(2), 2014, pp.194-206.
- Publisher:
- Taylor and Francis
Applying a life-course and gender perspective, this study investigates statuses and transitions that influence self-reported loneliness among men and women in middle age (age 40–59) and when older (age 60–80). The panel data are from two waves of the Norwegian study of the life course, ageing and generations. The sample was 3750 people aged 40–80 at baseline who were surveyed in 2002–2003 (T1) and 2007–2008 (T2). Multivariate analyses were used to investigate personal characteristics and life events associated with loneliness at baseline and life events predicting the incidence of loneliness during the five-year period. Adverse childhood events were associated with loneliness by both men and women. In the older group, men's loneliness was related to having been bullied, and conflicts between parents. Women's loneliness was related to economic problems in their childhood family. Becoming lonely between T1 and T2 – among those aged 40–59, divorce predicted women becoming lonely, but not men. Among those aged 60–80, the partner's death was a stronger predictor of the incidence of loneliness among men than among women. The results demonstrate that loneliness is influenced by events and experiences from early childhood to later life, and that some events and experiences influence loneliness in men and women differently. (Edited publisher abstract)
Exploring the meaning of a new assistive technology device for older individuals
- Authors:
- GRAMSTAD Astrid, STORLI Sissel Lisa, HAMRAN Torunn
- Journal article citation:
- Disability and Rehabilitation: Assistive Technology, 9(6), 2014, pp.493-498.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Researching the outcomes of assistive technology devices (ATDs) for older clients is important to facilitate clinical decision-making. However, to understand the outcomes associated with ATDs, one must investigate the users’ experiences and acknowledge the user as an active participant in diverse social contexts. Purpose: To enhance understanding of the users’ perspective regarding ATDs, this study aimed to investigate the meaning of the ATD for older individuals still living in their home environment. Methods: To provide descriptions of ATD experiences, older individuals who received a new ATD to compensate for their challenges in moving around, assist in self-care or both were recruited for the study. Participants were interviewed twice, with a few months between interviews, about their experience in using their new ATD. The interview transcripts were analysed in a hermeneutical–phenomenological research approach. Results: The analysis revealed three recurring themes associated with the description of ATD experiences: “enabling performance and choice”, “transformation from requiring assistance to assisting others”, and “preparing for the future”. Conclusion: The results show that ATDs are used to enhance competence, mastery, control, self-worth, hope, and preparedness. The ATD service delivery should be client-centredd and the client should be acknowledged as an active participant in producing change. Implications for Rehabilitation: researching outcomes of assistive technology devices are complicated and should involve the user experience; assistive technology devices does not have to be used in concrete actions to involve meaning for the user; health care professionals should be sensitive towards the meaning dimensions of the assistive technology devices as experienced by the user throughout the service delivery process. (Edited publisher abstract)