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  • 1.
    Baxter, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Bergland, Ådel
    Winblad, Bengt
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing & Midwifery, La Trobe University, Melbourne, Australia.
    The thriving of older people assessment scale: Psychometric evaluation and short‐form development2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 12, p. 3831-3843Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the psychometric properties and performance of the 32‐item Thriving of Older People Assessment Scale (TOPAS) and to explore reduction into a short‐form.

    Background: The 32‐item TOPAS has been used in studies of place‐related well‐being as a positive measure in long‐term care to assess nursing home resident thriving; however, item redundancy has not previously been explored.

    Design: Cross‐sectional.

    Method: Staff members completed the 32‐item TOPAS as proxy‐raters for a random sample of Swedish nursing home residents (N = 4,831) between November 2013 and September 2014. Reliability analysis, exploratory factor analysis and item response theory‐based analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing, means comparison and model fit evaluation confirmed scale equivalence.

    Results: Psychometric properties of the 32‐item TOPAS were satisfactory and several items were identified for scale reduction. The proposed short‐form TOPAS exhibited a high level of internal consistency (α=0.90) and strong correlation (r=0.98) to the original scale, while also retaining diversity among items in terms of factor structure and item difficulties.

    Conclusion: The 32‐item and short‐form TOPAS' indicated sound validity and reliability to measure resident thriving in the nursing home context.

    Impact: There is a lack of positive life‐world measures for use in nursing homes. The short‐form TOPAS indicated sound validity and reliability to measure resident thriving, providing a feasible measure with enhanced functionality for use in aged care research, assessments and care planning for health promoting purposes in nursing homes.

  • 2.
    Corneliusson, Laura
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wimo, Anders
    Winblad, Bengt
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia; Austin Health, Melbourne, Australia.
    Well‐being and Thriving in Sheltered Housing versus Ageing in Place: Results from the U‐Age Sheltered Housing Study2020In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 3, p. 856-866Article in journal (Refereed)
    Abstract [en]

    Aims: To explore to what extent type of residence (sheltered housing or ageing in place) contributes to thriving and well-being in older adults, when controlling for age, sex, living alone, being a widow and adjusting for functional status, self-rated health, and depressive mood.

    Design: A matched cohort study.Methods A self-report survey was sent out to a total population of residents in all sheltered housings in Sweden and a matched control group ageing in place (N = 3,805). The data collection took place between October 2016-January 2017.

    Results: The interaction analyses related to thriving showed that with increasing level of depressive mood and decreasing levels of self-rated health and functional status, those residing in sheltered housing generally reported higher levels of thriving, as compared with those ageing in place. Well-being was not found to be significantly associated with type of accommodation.

    Conclusion: There may be features in sheltered housing that are associated with resident thriving especially among individuals with impairments of function, health or mood, although further studies are required to identify these specific features.

    Impact: This study informs staff and policymakers about thriving and well-being in sheltered housing accommodations. These findings may be used to further the development of sheltered housing accommodations.

  • 3.
    Corneliusson, Laura
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Wimo, Anders
    Winblad, Bengt
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Heidelberg, Vic., Australia; Austin Health, Melbourne, Vic., Australia.
    Residing in sheltered housing versus ageing in place: population characteristics, health status and social participation2019In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 27, no 4, p. E313-E322Article in journal (Refereed)
    Abstract [en]

    Sheltered housing is a housing model that provides accessible apartments with elevated social possibilities for older people, which is expected to increase resident health and independence, reducing the need for care. As previous research on sheltered housing is scarce, the aim of this study was to explore the characteristics, health status and social participation of older people living in sheltered housing, compared to ageing in place. The study utilised baseline data from a matched cohort study survey on a nationally representative total population of residents in all sheltered housings in Sweden, and a matched control group (n = 3,805). The data collection took place between October 2016 and January 2017. The survey assessed functional capability using the Katz ADL and Lawton IADL scale, self-rated health using the EQ5D scale, and depressive mood using the GDS-4 scale. Descriptive statistics, frequencies, mean scores, independent t tests, p-values and effect sizes were utilised to compare the two groups. The results of the study show that older people living in sheltered housing, compared to ageing in place, had lower self-reported health (M = 64.68/70.08, p = <0.001), lower self-reported quality of life (M = 0.73/0.81, p = <0.001), lower functional status concerning activities of daily living (M = 5.19/5.40, p = <0.001), lower functional status concerning instrumental activities of daily living (M = 4.98/5.42 p = <0.001,), and higher probability of depressive mood (M = 0.80/0.58, p = <0.001). The results imply that residents in sheltered housing may have more care needs than those ageing in place. Further longitudinal comparative studies are needed to explore the impact residence in sheltered housing has on resident health and well-being.

  • 4.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    Backman, Annica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bergland, Ådel
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bölenius, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kirkevold, Marit
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lood, Qarin
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Department of Health Sciences, Luleå University of Technology, Sweden.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wimo, Anders
    Winblad, Bengt
    The Umeå Ageing and health research programme (U-age): exploring person-centred care and health promoting living conditions for an ageing population2016In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 3, p. 168-174Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to describe the Umeå ageing and health research programme that explores person-centred care and health-promoting living conditions for an ageing population in Sweden, and to place this research programme in a national and international context of available research evidence and trends in aged care policy and practice. Contemporary trends in aged care policy includes facilitating ageing in place and providing person-centred care across home and aged care settings, despite limited evidence on how person-centred care can be operationalised in home care services and sheltered housing accommodation for older people. The Umeå ageing and health research programme consists of four research projects employing controlled, cross-sectional and longitudinal designs across ageing in place, sheltered housing, and nursing homes. The research programme is expected to provide translational knowledge on the structure, content and outcomes of person-centred care and health-promoting living conditions in home care, sheltered housing models, and nursing homes for older people and people with dementia.

  • 5.
    Lood, Qarin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Backman, Annica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    The relative impact of symptoms, resident characteristics and features of nursing homes on residents’ participation in social occupations: cross-sectional findings from U-Age Swenis2017In: Journal of Occupational Science, ISSN 1442-7591, E-ISSN 2158-1576, Vol. 24, no 3, p. 327-337Article in journal (Refereed)
    Abstract [en]

    Social occupations have been described as meaningful occupations, and a determinant of health in old age. With ageing populations, and increased need for nursing home care, it is therefore important to support participation in social occupations in nursing homes. However, the limited evidence on factors that may have an impact on nursing home residents’ participation in social occupations makes it difficult to know how and when to support their participation and who to target. Therefore, the aim of this study was to explore the impact of symptoms, resident characteristics and features of nursing homes on residents’ participation in social occupations. In a sample of 4,451 nursing home residents, the average number of social occupations participated in during the week preceding data collection was 5.8. Additionally, participation in social occupations was positively influenced by fewer symptoms of cognitive impairment, female sex, shorter length of stay, and living in a dementia specific care unit. The study thereby contributes with knowledge on populations at risk for occupational deprivation, and implications for understanding who to target with interventions to promote social occupations and when. However, very little is known about how to design interventions to support nursing home residents’ occupational opportunities, and what occupations they desire and need. Further research is therefore needed to identify nursing home residents’ occupational opportunities, wishes and needs in relation to environmental barriers, individual characteristics, and individual choice.

  • 6.
    Sköldunger, Anders B.
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.  Karolinska Institutet, Division of Neurogeriatrics, Stockholm, Sweden.
    Wimo, A.
    Sandman, Per-Olov
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backman, Annica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, School of Nursing and Midwifery, Melbourne, Australia.
    Cognitive impairment and resource use in Swedish nursing homes: results from the Svenis study2016In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 56, p. 389-389Article in journal (Other academic)
  • 7.
    Sköldunger, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.
    Wimo, Anders
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backman, Annica C.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes: Results from the U-Age program (SWENIS study)2019In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 34, no 1, p. 130-136Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to investigate resource use and its association to cognitive impairment, activities of daily living, and neuropsychiatric symptoms in residents of Swedish nursing homes.

    Methods: Data were collected in 2014 from a Swedish national sample of nursing home residents (n = 4831) and were collected by staff in the facility. The sample consists of all nursing homes in 35 of 60 randomly selected Swedish municipalities. Demographic data and data on resource use, cognitive and physical function as well as neuropsychiatric symptoms were collected through proxies. Descriptive statistics and regression modeling were used to investigate this association.

    Results: We found that cognitive impairment, activities of daily living, and neuropsychiatric symptoms were associated with 23 hours per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being totally dependent increased the amount of resource use by 25 hours per week. The sex of a resident did not influence the resource use. Annual costs of resource use with no functional dependency were 359 685 SEK, and in severely cognitive impaired resident, the cost was 825 081 SEK.

    Conclusion: Being cognitively impaired as well as functionally dependent increases the resource use significantly in nursing homes. This has implications for differentiation of costs in institutional settings in health economic evaluations.

  • 8. Wilberforce, Mark
    et al.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    A Rasch analysis of the Person-Centred Climate Questionnaire - staff version2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, p. 1-9, article id 996Article in journal (Refereed)
    Abstract [en]

    Background: Person-centred care is the bedrock of modern dementia services, yet the evidence-base to support its implementation is not firmly established. Research is hindered by a need for more robust measurement instruments. The 14-item Person-Centred Climate Questionnaire - Staff version (PCQ-S) is one of the most established scales and has promising measurement properties. However, its construction under classical test theory methods leaves question marks over its rigour and the need for evaluation under more modern testing procedures. Methods: The PCQ-S was self-completed by nurses and other care staff working across nursing homes in 35 Swedish municipalities in 2013/14. A Rasch analysis was undertaken in RUMM2030 using a partial credit model suited to the Likert-type items. Three subscales of the PCQ-S were evaluated against common thresholds for overall fit to the Rasch model; ordering of category thresholds; unidimensionality; local dependency; targeting; and Differential Item Functioning. Three subscales were evaluated separately as unidimensional models and then combined as subtests into a single measure. Due to large number of respondents (n = 4381), two random sub-samples were drawn, with a satisfactory model established in the first ('evaluation') and confirmed in the second ('validation'). Final item locations and a table converting raw scores to Rasch-transformed values were created using the full sample. Results: All three subscales had disordered thresholds for some items, which were resolved by collapsing categories. The three subscales fit the assumptions of the Rasch model after the removal of two items, except for subscale 3, where there was evidence of local dependence between two items. By forming subtests, the 3 subscales were combined into a single Rasch model which had satisfactory fit statistics. The Rasch form of the instrument (PCQ-S-R) had an adequate but modest Person Separation Index (< 0.80) and some evidence of mistargeting due to a low number of `difficult-to-endorse' items. Conclusions: The PCQ-S-R has 12 items and can be used as a unidimensional scale with interval level properties, using the nomogram presented within this paper. The scale is reliable but has some inefficiencies due to too few high-end thresholds inhibiting discrimination amongst populations who already perceive that person-centred care is very good in their environment.

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