Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

Multifactorial analysis of changes in body mass index across the adult life course: a study with 65 years of follow-up

Background: Although the negative consequences on health of being obese are well known, most adults gain weight across the lifespan. The general increase in body mass index (BMI) is mainly considered to originate from behavioral and environmental changes; however, few studies have evaluated the influence of these factors on change in BMI in the presence of genetic risk. We aimed to study the influence of multifactorial causes of change in BMI, over 65 years. Methods and Findings: Totally, 6130 participants from TwinGene, who had up to five assessments, and 536 from the Swedish Adoption/Twin Study of Aging, who had up to 12 assessments, ranging over 65 years were included. The influence of lifestyle factors, birth cohort, cardiometabolic diseases and an individual obesity genetic risk score (OGRS) based on 32 single nucleotide polymorphisms on change in BMI was evaluated with a growth model. For both sexes, BMI increased from early adulthood to age of 65 years, after which the increase leveled off; BMI declined after age of 80 years. A higher OGRS, birth after 1925 and cardiometabolic diseases were associated with higher average BMI and a steeper increase in BMI prior to 65 years of age. Among men, few factors were identified that influence BMI trajectories in late life, whereas for women type 2 diabetes mellitus and dementia were associated with a steeper decrease in BMI after the age of 65 years. Conclusions: There are two turning points in BMI in late adulthood, one at the age of 65 years and one at the age 80 years. Factors associated with an increase in BMI in midlife were not associated with an increase in BMI after the age of 65 years. These findings indicate that the causes and consequences of change in BMI differ across the lifespan. Current health recommendations need to be adjusted accordingly.

Reflexiones sobre los cuidados de larga duración en Suecia [Reflections on Long-term care in Sweden]

La provisión de cuidados de larga duración que se ofrecen en Suecia y en el conjunto de los países nórdicos provienen de un recorrido histórico basado en la construcción territorial a través de parroquias y en las redes de solidaridad creadas a partir de la relación entre familias y amigos, por un lado, y estos con el Estado, por otro.

Arbetstidsförkortning och pykisk hälsa : En kvalitativ studie om implementering av kortare arbetsdag

Det rapporteras flitigt i media om att sjukskrivningar pga. av utbrändhet fortsätter att öka under 2000-talet, att människor i Sverige har svårt att få ihop sin tillvaro på ett långsiktigt hållbart sätt. Målet med denna uppsats är att genom en fallstudie undersöka om en reduktion av arbetstiden påverkat arbetstagarens psykiska hälsa positivt. Studien bygger på en enkätundersökning och två uppföljande djupintervjuer riktade mot ett enda företag. Efter att ha sammanställt materialet har uppsatsens författare kunnat dra vissa slutsatser om kopplingen mellan arbetstidsförkortning och förbättrat psykiskt mående.   Resultatet visade att alla respondenter i studien upplevt en betydande positiv förbättring av sin psykiska hälsa och sitt välbefinnande.

Levnadsvanor och självskattad hälsa hos 40-åringar

Självskattad hälsa beskriver personens subjektiva uppfattning av sin hälsa. En lågt självskattad hälsa har samband med ökad framtida dödlighet. Ett starkt välbefinnande är enligt Katie Erikssons dimensioner av hälsa, förutsättningen för att hälsan ska skattas som bra. Syftet med denna studie var att beskriva eventuella skillnader i självskattad hälsa sett till olika levnadsvanor hos 40-åriga kvinnor och män. Metod: Enkätsvar från totalt 1144 40-åriga kvinnor och män har använts. Enkäterna genomfördes under 2014 på 55 vårdcentraler i två regioner i södra Sverige. Levnadsvanor som valdes till denna studie var fysisk aktivitet, grönsaks- och frukostvanor, alkoholintag, rökning, sysselsättning, sömn och stress. Självskattad hälsa kategoriserades som bra (”mycket bra” och ”bra”) och dålig (”någorlunda”, ”dålig” och ”mycket dålig”). För att studera skillnader användes Student T-test på parametrisk data och Chi-två på icke parametrisk data. Resultat: De levnadsvanor som var vanligare förekommande hos de med bra självskattad hälsa var ansträngande/hård motion, låg nivå av stress och att vara i arbete (p<.001). Att inte röka hos män och att äta frukost och grönsaker hos kvinnor var också vanligare förekommande hos de med bra självskattad hälsa. Lågt intag av alkohol visade inte på några skillnader.  Slutsats: För att minska risken för framtida sjuklighet är det viktigt för distriktssköterskor, samt flera andra samhällsinsatser, att försöka påverka och uppmuntra hög fysisk aktivitet och minskad stress.