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.

Utformning av tak och möjligheter med automation av takstolstillverkning i trä

Purpose: The purpose of this work is to increase the possibilities of designing building components for specific demands to increase the building’s value, and to investigate how the possibilities can be affected by automating the production process. Method: The theoretical framework, which this study is based on, was collected using literature studies and was thereafter combined with the empirics, which were retrieved from qualitative methods as interviews and planned observations. A case study was made of the building Ormhuset in Jönköping. Findings: The objective of this work is to investigate the possibilities for designing roofs by using new automation methods for the production process of wooden roof structures. This study implies that parametric design can be used to generate new innovative shapes and designs that are optimised according to specific criteria. Furthermore, an increased use of automation in the production process of wooden roof trusses result in cheaper roof trusses, regardless of their shapes. The generated optimized designs are therefore cheaper and easier to produce using more automation in the production process. Implications: If parametric design is used, almost any kind of shapes can be generated and optimised. To ensure manufacturability of a design, an early connection between architect and manufacturer is important. Furthermore, increased use of automation can lead to easier and faster production of roof trusses and investing in more automation can be relevant for companies with large production volumes. Using digital files to control the manufacturing machines is time saving. There are alternative manufacturing methods for advanced roof structurers in wood, which are better suited for production, which cannot be rationalized as for roof trusses. Constraints for increased automation are often a high investment cost and limited space. Limitations: If the study is performed on another case than Ormhuset and with other respondents, the result might have differed but could be similar, why this study is not generally valid but only shows one possible outcome.