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Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes: a cross-sectional study
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, 154Article in journal (Refereed) Published
Abstract [en]

Background: Earlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay. Methods: Cross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test. Results: The results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units. Conclusions: The prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.

Place, publisher, year, edition, pages
BioMed Central, 2016. Vol. 16, 154
Keyword [en]
Nursing homes, Frail elderly, Dementia, Pain, Activities of daily living, Neuropsychiatric symptoms, evalence, Cross-sectional study
National Category
Geriatrics Gerontology, specializing in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-125541DOI: 10.1186/s12877-016-0328-9ISI: 000381732700001PubMedID: 27549203OAI: oai:DiVA.org:umu-125541DiVA: diva2:971344
Available from: 2016-09-16 Created: 2016-09-13 Last updated: 2017-09-06Bibliographically approved
In thesis
1. Exploring resident thriving in Swedish nursing homes: the Umeå Ageing and Health Research Programme (U-Age) Thesis I
Open this publication in new window or tab >>Exploring resident thriving in Swedish nursing homes: the Umeå Ageing and Health Research Programme (U-Age) Thesis I
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Trivsel i svenska särskilda boenden för äldre
Abstract [en]

Background

The population living in nursing homes is generally characterized by high age and female sex, as well as by physical and cognitive impairments. Also, negative symptoms such as pain and neuropsychiatric symptoms are reportedly common. Care in Swedish nursing homes is regulated by law and national guidelines implying that care is to be tailored to resident preferences and needs in order to facilitate their well-being. However, there is no national data source on the characteristics of nursing home residents or on measures of their well-being. Thriving and not merely surviving in nursing homes has been described as a subjective experience of place-related well-being resulting from interaction between residents and the nursing home environment in terms of the quality of care and caregivers, as well as from the physical and psychosocial environment. However, there is a gap in knowledge of whether and, if so, to what extent resident characteristics and factors in the nursing home environment are associated with resident thriving in nursing homes.

Aim

The overall aim of this thesis is to explore resident thriving in Swedish nursing homes, and the extent to which resident characteristics, neuropsychiatric symptoms, activities, and environmental factors are associated with resident thriving.

Methods

This thesis is based on cross-sectional baseline data from a national inventory of health and care in Swedish nursing homes collected in 2013–2014. The resident sample covered 4831 residents in 548 units from 172 nursing homes in 35 Swedish municipalities. The data were explored using descriptive statistics, as well as simple and multiple linear regression analyses and multilevel linear regression analyses. Resident characteristics and symptom prevalence as well as their associations with thriving; and engagement in everyday activities and their associations with thriving were explored in a sample comprising 4831 nursing home residents from 172 nursing homes. Associations between resident thriving and resident living conditions, nursing home facility and unit characteristics, and the psychosocial climate of units were explored in a sample comprising 4205 residents from 147 nursing homes.

Results

Engagement in everyday activities was positively associated with resident thriving, the strongest associations being found for engagement in an activity programme, dressing nicely, and spending time with someone the resident likes. 

Environmental factors associated with thriving were a positive psychosocial climate at the unit, having access to newspapers, residing in a special care unit, and residing in a facility that was unlocked during the day. Cognitive functioning was strongly associated with resident thriving. Aggressive and depressive symptoms were found to be negatively associated with resident thriving regardless of levels of cognitive functioning.

Conclusions

Engagement in everyday activities can support thriving and can be conceptualized and implemented as nursing interventions to facilitate thriving in nursing homes. Factors in the nursing home environment can support resident thriving; in particular, the psychosocial climate of units seems to have a great influence. Aggressive and depressive symptoms were associated with lower levels of thriving. Targeting these symptoms would therefore seem to be a priority in nursing homes. The population living in Swedish nursing homes has a high prevalence of neuropsychiatric symptoms and cognitive impairment. Residents with cognitive impairment also commonly resided in general units. As all data were cross-sectional, longitudinal studies would be valuable to further explore causality. As resident data were based on proxy ratings, future research exploring residents’ perspectives on thriving would be valuable. The present findings contribute to our understanding of nursing home residents’ complex care needs and identify factors that could have an impact on their well-being. These findings can provide benchmark estimates for further research, quality assessment activities, as well as further clinical development work. 

Abstract [sv]

Populationen som bor i särskilda boenden kännetecknas allmänt av hög ålder, förekomst av fysiska och kognitiva funktionsnedsättningar och majoriteten är kvinnor. Smärta och neuropsykiatriska symtom har också rapporterats vara vanliga. Vård och omsorg i svenska särskilda boenden regleras av lag och nationella riktlinjer som gör gällande att äldre personer har rätt till en aktiv och meningsfull tillvaro tillsammans med andra och det bör vara möjligt för äldre människor att leva självständigt och under trygga förhållanden. Den vård och omsorg som ges bör vara personcentrerad och därigenom anpassad till de äldre personernas behov för att underlätta deras välbefinnande. Dock saknas det nationell data om de äldre personernas fysiska och kognitiva förmåga. Det är även okänt i vilken grad personer i svenska särskilda boenden för äldre deltar i vardagliga aktiviteter. Att trivas i särskilda boenden har beskrivits som ett resultat av en optimal interaktion mellan personen själv och kvaliteter i miljön så som omsorgen och personalens kvalitet samt fysisk- och psykosocial miljö. Det finns emellertid en kunskapslucka när det gäller om, samt i vilken utsträckning personernas egen karaktäristika, deltagande i vardagliga aktiviteter och enskilda faktorer i boendemiljön är associerade med deras trivsel. Denna avhandling undersöker faktorer av betydelse för trivsel i svenska särskilda boenden för äldre med fokus på karaktäristika, deltagande i aktiviteter samt faktorer i den fysiska och psykosociala miljön.

Avhandlingens fyra delstudier baseras på tvärsnittsdata från enkätundersökningen Svensk nationell inventering av vård och hälsa inom särskilda boenden (SWENIS) som genomfördes 2013 – 2014 i 172 särskilda boenden i 35 kommuner. Insamlade data omfattar uppgifter om de äldre, personalen samt boendet. I de tre första delstudierna (I-III) användes ett urval som omfattade 4831 äldre. Proxyskattningar av de äldre personernas trivsel, karaktäristika (ålder, kön, kognitiv förmåga, ADL förmåga), samt förekomst av symtom (smärta och neuropsykiatriska symptom) och skattningar av deltagande i vardagliga aktiviteter utfördes av personalen. I delstudie IV användes ett matchat dataset innehållande proxyskattningar av de äldre personernas trivsel och karaktäristika (n=4205); personalens självskattningar av psykosociala klimatet på avdelningen (n=3509); samt karaktäristika på 147 särskilda boenden. Datat analyserades med beskrivande statistik, enkla och multipla linjära regressionsanalyser och flernivåsmodeller.

Huvudresultatet visade att ett deltagande i vardagliga aktiviteter var positivt associerat med trivsel. Deltagande i ett aktivitetsprogram, att klä sig fint samt att spendera tid med någon som personen tycker om uppvisade de starkaste associationerna med trivsel. De faktorer i boendemiljön som var positivt associerade med de äldre personernas trivsel var ett positivt psykosocialt klimat på avdelningen, tillgång till dagstidningar, att bo på demensenhet samt att bo på ett särskilt boende där entrédörren var upplåst under dagtid. Aggressiva och depressiva symptom visade sig vara negativt associerade med trivsel oavsett grad av kognitiv funktion. Vidare var den kognitiva förmågan var starkt associerad med personernas trivsel. Resultatet visade också att de som bor i svenska särskilda boenden för äldre har en hög förekomst av neuropsykiatriska symtom och kognitiv svikt. Personer med kognitiv svikt bodde också i hög utsträckning på vanliga avdelningar.

Sammantaget visar avhandlingen att deltagande i vardagliga aktiviteter kan stödja trivsel. Vardagliga aktiviteter skulle därmed kunna användas som omvårdnadsåtgärder i syfte att främja trivsel i särskilda boenden. Även faktorer i det särskilda boendets miljö kan stödja personernas trivsel, varav det psykosociala klimatet på avdelningen verkar kunna ha ett stort inflytande. Aggressiva och depressiva symtom kan indikera lägre nivåer av trivsel. Att inrikta omvårdnaden på att förebygga och lindra dessa symptom borde därmed prioriteras. Fortsatta studier, i synnerhet longitudinella kvalitativa och kvantitativa studier för att avgöra vilka faktorer som är relaterade till en förändring av trivsel skulle vara värdefulla. Intervjustudier där äldre personer med kognitiv svikt får ge sin syn på faktorer av betydelse för trivsel i särskilda boenden skulle vara värdefullt.

Resultaten i denna avhandling bidrar med en ökad förståelse för de komplexa omvårdnadsbehov som personer i särskilda boenden för äldre har, samt om faktorer som har betydelse för deras trivsel. Avhandlingen tillhandahåller även riktvärden som skulle kunna användas vid ytterligare forskning, kvalitetsbedömning samt vid kliniskt utvecklingsarbete.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1907
Keyword
Thriving, everyday activities, environment, cognitive impairment, neuropsychiatric symptoms, nursing homes, nursing, Trivsel, vardagliga aktiviteter, miljö, kognitiv svikt, neuropsykiatriska symptom, särskilda boenden, omvårdnad
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-139057 (URN)978-91-7601-752-4 (ISBN)
Public defence
2017-09-29, Vårdvetarhuset Aula, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
U-Age
Funder
Vårdal FoundationThe Kempe FoundationsForte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council
Available from: 2017-09-08 Created: 2017-09-06 Last updated: 2017-09-26Bibliographically approved

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