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.

Analys av NIR hårdvaruuppsättning samt metod för fotografering av individer i fordon

Abstract Purpose – To study the possibility of using a NIR hardware solution to photograph individuals in a private vehicle as well as an analysis of its images. Method – A study of existing theories around the NIR-method’s performance in selected conditions and individual tests were performed to examine if the literature statements were valid for this study. Two empirical tests have been carried out, the first was carried out at Kapsch test track and the other outside the test track in a single stationary test. An interview which formed the basis for the assessment on the quality of empirical data with a focus on computer-based detection of the number of individuals in the vehicle. Findings – The results have demonstrated the potential of the NIR method’s performance in a fully automated detection system for the number of individuals inside the vehicle. Empirical data indicates that the method can depict individuals inside vehicles of sufficiently high quality, but it is greatly affected by reflections, weather and light conditions. Implications – Result supports the assumption that the NIR method using an external light source can be used to image the interior through a varying number of weather and lightning conditions. The study originated until the results suggested that a NIR-based hardware setup can create images with high enough quality for the human eye to be able to detect the number of individuals inside the vehicle.If the overall performance into account, it suggests that the main problem with the use of the hardware set is to maintain the quality of the whole sample and that the crucial variables for the method’s performance is the influence of light and reflection conditions. Limitations – The major limitations have been that we limited ourselves to a subjective analysis of the selection and assessment on the image features for computer-based detection of the number of individuals in the vehicle. We were limited to two tests, one in tough conditions where only the driver was in the vehicle and the second stationary test, where the focus was on the number of people in vehicles and light sources impact on the result.