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.

Comply-or-explain in Sweden : A study on the quality of non-compliance explanations

Purpose: The purpose of this study is to examine the effectiveness of the comply-or-explain principle in Sweden to determine if the flexible approach is functioning as in-tended. Research design: This paper scrutinizes the quality of the explanations with respect to the Swedish Corporate Governance Code. A quantitative research with a cross-sectional design has been performed and the data collection covers 241 companies listed on Nasdaq OMX Stockholm for the fiscal year of 2014. The secondary data has been gathered from corporate governance reports of the researched companies and analysed by using a tax-onomy of explanations. Findings: The report demonstrates that the comply-or-explain principle in Sweden is effective. A clear majority of the explanations, 71,8%, were deemed as informative, mean-ing that a large proportion of the Swedish firms are utilizing the flexible approach in an effective manner. However, one out of four explanations were classified as insufficient and we have thus provided recommendations in order for the code to become even more effective. Contribution: Our findings provide insights on how the comply-or-explain principle works in a country that is supposed to be a leading example of how the comply-or-explain approach should be implemented. This study should be of significance for policy makers considering that we have outlined how the principle works and provided recommenda-tions on how the Swedish Corporate Governance Code can be improved. Value: Our findings demonstrate that companies listed on Nasdaq OMX Stockholm pro-vide high quality explanations that can serve as an inspiration for companies listed in other countries. Furthermore, the results indicate that managers are likely to act within ethically desired norm. Considering the social implications, as Swedish firms are informative in terms of explanations, it minimizes the risk of firms acting dishonestly.

Inter-industry differences in local banks' effect on new firm formation : A regional study of entrepreneurship in Sweden

Formation of new firms is important, since new firms create jobs and economic growth. When entrepreneurs lack the financial resources which are needed to start a firm, they often turn to banks to borrow money. Previous research has shown that relationships between banks and new business borrowers most often are local and that the dependence on banks differs across industries. In light of this, the purpose of this paper is to investigate if local access to banks has a stronger relationship with the rate of new firm formation in some industries than in others. Based on cross-sectional data on all Swedish municipalities in 2009, a series of OLS regressions are estimated to test if variables used to describe the bank market in a municipality are related with the new firm formation rate, both in total and in different industry categories. The results show that the number of bank branches per capita is positively related with the total new firm formation rate. In regards to the inter-industry differences, the findings indicate that local access to banks is more important for new firm formation in some industries than in others. 

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.