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Karlsson, S., Fagerström, C., Midlöv, P. & Hallberg, I. R. (2017). Antipsychotic medication in relation to national directives in people with dementia in Sweden. In: IAGG 2017 Abstract Book: . Paper presented at 21st IAGG World Congress of Gerontology and Geriatrics, in San Francisco, USA, July 23-27, 2017 (pp. 349-350). Washington, DC: The Gerontological Society of America
Open this publication in new window or tab >>Antipsychotic medication in relation to national directives in people with dementia in Sweden
2017 (English)In: IAGG 2017 Abstract Book, Washington, DC: The Gerontological Society of America , 2017, p. 349-350Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care as reported in the most recent empirical studies on the topic, and to relate these trends to directives and recommendations from national authorities.

The study included two scoping review studies and two empirical studies. The scoping studies reviewed published data in electronic databases as well as Swedish recommendations and directives in the field.

During the past decade, recommendations have been developed regarding antipsychotic medication in Sweden. These recommendations were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and those with moderate cognitive impairment and living in nursing homes for people with dementia. A trend towards a decrease in antipsychotic use has been seen over the last 15 years. The empirical studies showed that the medication with antipsychotics decreased from 23.4% in 2001 to 11.5% in 2007, for older people in general as well as for older people with dementia. Among older people with dementia, 10% were utilizing antipsychotic medication, with no difference between those cared for at home and those in nursing homes.

Directives from Swedish national authorities seem to have had an impact on antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while other psychotropic medication has increased. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.

Place, publisher, year, edition, pages
Washington, DC: The Gerontological Society of America, 2017
Series
Innovation in aging, E-ISSN 2399-5300 ; Suppl. 1
Keyword
Dementia, Antipsychotic medication, Drug utilization, Directive
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-36007 (URN)
Conference
21st IAGG World Congress of Gerontology and Geriatrics, in San Francisco, USA, July 23-27, 2017
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2018-01-10Bibliographically approved
Karlsson, S. (2017). Promotion of health with digital learning for older persons with dementia and their cohabitee at home. In: : . Paper presented at International Summit Forum for “Social Security Frontier Issues”, Halmstad University, Sweden, October 13-14, 2017.
Open this publication in new window or tab >>Promotion of health with digital learning for older persons with dementia and their cohabitee at home
2017 (English)Conference paper, Oral presentation only (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-36008 (URN)
Conference
International Summit Forum for “Social Security Frontier Issues”, Halmstad University, Sweden, October 13-14, 2017
Note

Keynote speak

Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2018-02-16Bibliographically approved
Lethin, C., Renom-Guiteras, A., Zwakhalen, S., Soto-Martin, M., Saks, K., Zabalegui, A., . . . Karlsson, S. (2017). Psychological well-being over time among informal caregivers caring for persons with dementia living at home. Aging & Mental Health, 21(11), 1138-1146
Open this publication in new window or tab >>Psychological well-being over time among informal caregivers caring for persons with dementia living at home
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2017 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 21, no 11, p. 1138-1146Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate informal caregivers’ psychological well-being and predicted increase in psychological well-being, when caring for persons with dementia (PwDs) living at home, related to caregiver, PwD and formal care (FC) factors.

Method: A cohort study at baseline and 3 months’ follow-up in eight European countries. Caregivers included (n = 1223) were caring for PwDs aged ≥ 65 years at home. Data on caregivers, PwDs and FC were collected using standardized instruments. Regression analysis of factors associated with caregiver psychological well-being at baseline and 3 months later was performed.

Results: Factors associated with caregiver psychological well-being at baseline were positive experience of caregiving, low caregiver burden, high quality of life (QoL) for caregivers, male gender of PwD, high QoL of PwD, few neuropsychiatric symptoms and depressive symptoms for the PwD. At follow-up, caregivers with increased psychological well-being experienced of quality of care (QoC) higher and were more often using dementia specific service. Predicting factors for caregivers’ increased psychological well-being were less caregiver burden, positive experience of caregiving, less supervision of the PwD and higher caregiver QoL, if PwD were male, had higher QoL and less neuropsychiatric symptoms. Furthermore, higher QoC predicted increased caregivers’ psychological well-being.

Conclusion: Informal caregiving for PwDs living at home is a complex task. Our study shows that caregivers’ psychological well-being was associated with, among other things, less caregiver burden and higher QoL. Professionals should be aware of PwD neuropsychiatric symptoms that might affect caregivers’ psychological well-being, and provide proper care and treatment for caregivers and PwDs. © 2016 Informa UK Limited, trading as Taylor & Francis Group

Place, publisher, year, edition, pages
Abingdon, Oxon: Routledge, 2017
Keyword
Dementia, caregivers, health professionals, home care services, adaptation, psychological
National Category
Nursing Nursing
Identifiers
urn:nbn:se:hh:diva-31595 (URN)10.1080/13607863.2016.1211621 (DOI)27463390 (PubMedID)2-s2.0-84979997852 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 242153
Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2017-09-05Bibliographically approved
Lethin, C., Renom Guiteras, A., Zwakhalen, S., Soto Martin, M., Saks, K., Zabalegui, A., . . . Karlsson, S. (2017). Psychological well-being over time among informal caregivers caring for persons with dementia living at home. In: IAGG 2017 Abstract Book: . Paper presented at 21st IAGG World Congress of Gerontology and Geriatrics, in San Francisco, USA, July 23-27, 2017 (pp. 1381-1381). Washington, DC: The Gerontological Society of America, 1
Open this publication in new window or tab >>Psychological well-being over time among informal caregivers caring for persons with dementia living at home
Show others...
2017 (English)In: IAGG 2017 Abstract Book, Washington, DC: The Gerontological Society of America , 2017, Vol. 1, p. 1381-1381Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

This study investigated informal caregivers’ psychologi- cal well-being and predicted increase in psychological well- being, when caring for persons with dementia (PwDs) living at home, related to caregiver, PwD and formal care (FC) factors. This was a cohort study, at baseline and follow-up in eight European countries. Caregivers included (n=1,223) were caring for PwDs aged ≥ 65 years living at home, in risk of being institutionalized. Data was collected using standard- ized instruments. Logistic regression analysis of factors asso- ciated with caregiver psychological well-being at baseline and 3 months later was performed. Factors associated with presence of caregiver psychological well-being at baseline were positive experience of caregiving, low caregiver burden, high quality of life (QoL) for caregivers, male gender of PwD, high QoL of PwD and few neuropsychiatric symptoms for the PwD. At follow-up, caregivers with increased psychologi- cal well-being experienced quality of care (QoC) higher and were more often using dementia speci c service. Predicting factors for caregivers’ increased psychological well-being were less caregiver burden, positive experience of caregiv- ing, less supervision of the PwD and higher caregiver QoL, if PwD were male, had higher QoL and less neuropsychiat- ric symptoms. Higher QoC predicted increased caregivers’ psychological well-being. It can be concluded that informal caregiving for PwDs living at home is a complex task. Our study showed that caregivers’ psychological well-being was associated with, among other things, less caregiver burden and higher QoL. Professionals should be aware of PwD neu- ropsychiatric symptoms that might affect caregivers’ psycho- logical well-being, and provide proper care and treatment for caregivers and PwDs.

Place, publisher, year, edition, pages
Washington, DC: The Gerontological Society of America, 2017
Series
Innovation in aging, E-ISSN 2399-5300 ; Suppl. 1
Keyword
Dementia, caregivers, health professionals, home care services, adaptation, psychological
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-36006 (URN)
Conference
21st IAGG World Congress of Gerontology and Geriatrics, in San Francisco, USA, July 23-27, 2017
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2018-01-10Bibliographically approved
Bökberg, C., Ahlström, G. & Karlsson, S. (2017). Significance of quality of care for quality of life in persons with dementia at risk of nursing home admission: a cross-sectional study. BMC Nursing, 16(1), Article ID 39.
Open this publication in new window or tab >>Significance of quality of care for quality of life in persons with dementia at risk of nursing home admission: a cross-sectional study
2017 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, no 1, article id 39Article in journal (Refereed) Published
Abstract [en]

Background

Quality of life in persons with dementia is, in large part, dependent on the quality of care they receive. Investigating both subjective and objective aspects of quality of care may reveal areas for improvement regarding their care, which information may ultimately enable persons with dementia to remain living in their own homes while maintaining quality of life. The aim of this study was to 1) describe self-reported quality of life in persons with dementia at risk of nursing home admission. 2) describe subjective and objective aspects of quality of care, 3) investigate the significance of quality of care for quality of life.

Methods

A cross-sectional interview study design was used, based on questionnaires about quality of life (QoL-AD) and different aspects of quality of care (CLINT and quality indicators). The sample consisted of 177 persons with dementia living in urban and rural areas in Skåne County, Sweden. Descriptive and comparative statistics (Mann-Whitney U-test) were used to analyse the data.

Results

Based upon Lawton’s conceptual framework for QoL in older people, persons with pain showed significantly lower quality of life in the dimensions behavioural competence (p = 0.026) and psychological wellbeing (p = 0.006) compared with those without pain. Satisfaction with care seemed to have a positive effect on quality of life. The overall quality of life was perceived high even though one-third of the persons with dementia had daily pain and had had a weight loss of ≥4% during the preceding year. Furthermore, 23% of the persons with dementia had fallen during the last month and 40% of them had sustained an injury when falling.

Conclusion

This study indicates need for improvements in home care and services for persons with dementia at risk for nursing home admission. Registered nurses are responsible for nursing interventions related to pain, patient safety, skin care, prevention of accidents, and malnutrition. Therefore, it is of great importance for nurses to have knowledge about areas that can be improved to be able to tailor interventions and thereby improve quality of care outcomes such as quality of life in persons with dementia living at home. © 2017 The Author(s).

Place, publisher, year, edition, pages
London: BioMed Central, 2017
Keyword
Quality of life, Quality of care, Persons with dementia, Home care
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-34831 (URN)10.1186/s12912-017-0230-6 (DOI)000405812500002 ()28725160 (PubMedID)2-s2.0-85023647327 (Scopus ID)
Projects
RightTimePlaceCare
Funder
EU, FP7, Seventh Framework Programme, 242153Swedish Research Council
Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2018-03-23Bibliographically approved
Karlsson, S., Hallberg, I. R., Midlöv, P. & Fagerström, C. (2017). The trends in treatment with antipsychotic medication in relation to national directives in people with dementia. Review in a Swedish context. In: Capacity, Creativity and Ageing in Clinical Practice: Faculty of Psychiatry of Old Age Conference 2017. Paper presented at International Psychogeriatric Association (IPA), Faculty of Psychiatry of Old Age Conference, Queenstown, New Zealand, November 8-10 (pp. 36-36).
Open this publication in new window or tab >>The trends in treatment with antipsychotic medication in relation to national directives in people with dementia. Review in a Swedish context
2017 (English)In: Capacity, Creativity and Ageing in Clinical Practice: Faculty of Psychiatry of Old Age Conference 2017, 2017, p. 36-36Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: Antipsychotic medication has been commonly used in dementia treatment despite various side effects, which differ for different drug generations. As there is no clear evidence for treatment with antipsychotic medication among older people with dementia, may a review of empirical studies and national directives be beneficial.

Objectives: The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in nursing homes as reported in the most recent empirical studies on the topic, and to relate these trends to directives from the national authorities.

Methods: The study included two scoping review studies based on searches of electronic databases as well as the Swedish directives in the field.

Findings: During the past decade, directives have been developed for antipsychotic medication in Sweden. These directives were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and in those with moderate cognitive impairment and living in nursing homes for people with dementia. A decreasing trend in antipsychotic use has been seen over the last 15 years.

Conclusions: Directives from the authorities in Sweden may have had an impact on treatment with antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while treatment with combinations of psychotropic medications is common. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.

Keyword
Dementia, Antipsychotic medication, Drug utilization, Directive
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-36009 (URN)
Conference
International Psychogeriatric Association (IPA), Faculty of Psychiatry of Old Age Conference, Queenstown, New Zealand, November 8-10
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2018-02-01Bibliographically approved
Karlsson, S., Rahm Hallberg, I., Midlöv, P. & Fagerström, C. (2017). Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia - a review of the Swedish context. BMC Psychiatry, 17(1), Article ID 251.
Open this publication in new window or tab >>Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia - a review of the Swedish context
2017 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, no 1, article id 251Article in journal (Refereed) Published
Abstract [en]

Background

The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in nursing homes as reported in the most recent empirical studies on the topic, and to relate these trends to directives from the national authorities.

Methods

The study included two scoping review studies based on searches of electronic databases as well as the Swedish directives in the field.

Results

During the past decade, directives have been developed for antipsychotic medication in Sweden. These directives were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and in those with moderate cognitive impairment and living in nursing homes for people with dementia. A decreasing trend in antipsychotic use has been seen over the last 15 years.

Conclusions

Directives from the authorities in Sweden may have had an impact on treatment with antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while treatment with combinations of psychotropic medications is common. National directives may possibly be even more effective, if applied in combination with systematic follow-ups. © 2017 The Author(s).

Place, publisher, year, edition, pages
London: BioMed Central, 2017
Keyword
Dementia, Antipsychotic medication, Drug utilization, Directive
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-34830 (URN)10.1186/s12888-017-1409-9 (DOI)000405824700002 ()28705243 (PubMedID)2-s2.0-85023633758 (Scopus ID)
Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2017-11-29Bibliographically approved
Bökberg, C., Ahlström, G. & Karlsson, S. (2017). Utilisation of formal and informal care and services at home among persons with dementia: a cross-sectional study. Scandinavian Journal of Caring Sciences
Open this publication in new window or tab >>Utilisation of formal and informal care and services at home among persons with dementia: a cross-sectional study
2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background

The progression of dementia disease implies increasing needs for both informal and formal care and services but also risk of institutionalisation. To better adjust care and services in the phase preceding institutionalisation it is important to find out whether utilisation of formal and informal care and services is determined by increased needs and by who meets the needs.Aim

The aim was to compare persons with dementia (65+) with different levels of cognitive impairment, regarding utilisation of formal and informal care and service at home.Methods

The participants consisted of 177 persons with dementia ≥65 years old and at risk of nursing home admission, divided into groups according to their cognitive function. Structured interviews were conducted based on questionnaires about type and amount of formal and informal care utilised, as well as questions regarding cognitive impairment, dependency in activities of daily living (ADLs) and neuropsychiatric symptoms. To analyse the data, descriptive and comparative statistics were used.Results

The findings revealed that the group with severe dementia used significantly more help with ADLs and supervision in terms of time (number of hours and days) provided by the informal caregiver, compared with the group with moderate dementia. Utilisation of formal care and services was highest in the group with the most severe cognitive impairments (Standardized Mini-Mental State Examination score of <9). The group with severe dementia were more dependent in ADLs and had more neuropsychiatric symptoms (hallucinations and motor disturbances). They were younger and more often cohabitated with the informal caregiver, compared with the group with moderate dementia.Conclusion

This study shows that in the phase preceding institutionalisation the ADL and supervision needs due to progression of dementia appear to tend to be met first and foremost by the informal caregivers. © 2017 Nordic College of Caring Science.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell Publishing Inc., 2017
Keyword
care and services at home, dementia
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-34832 (URN)10.1111/scs.12515 (DOI)28869661 (PubMedID)
Projects
RightTimePlaceCare
Funder
EU, FP7, Seventh Framework Programme, 242153Swedish Research Council
Note

The study was a part of the RightTimePlaceCare project supported by a grant from the European Commission within the 7th Framework Programme (project 242153). We would like to acknowledge the support from the Gyllenstierna Krapperup's Foundation. We would also like to acknowledge the support of the Department of Health Sciences, Lund University, Lund, Sweden. This study was accomplished while Christina Bökberg was affiliated with the Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), which is funded by the Swedish Research Council.

Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2018-03-23Bibliographically approved
Condelius, A., Jakobsson, U. & Karlsson, S. (2016). Exploring the Implementation of Individual Care Plans in Relation to Characteristics of Staff. Open Journal of Nursing, 6(8), 582-590
Open this publication in new window or tab >>Exploring the Implementation of Individual Care Plans in Relation to Characteristics of Staff
2016 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 6, no 8, p. 582-590Article in journal (Refereed) Published
Abstract [en]

The aim was to explore the implementation of individual care plans in municipal elderly care in relation to characteristics of staff. Data regarding characteristics of staff were derived through a questionnaire distributed to all staff working in the care for older people, (N = 908, n = 245) in four municipalities in Sweden. The number of care plans established during a one-year period was collected through a contact person in each municipality. In total 47 individual care plans were es-tablished during the study year. Significantly more staff in the municipality that had the most number of established individual care plans agreed that there had been sufficient education (p = 0.017), sufficient time (p = 0.002) and routines established regarding individual care plans (p = 0.014) and had a significantly better job satisfaction (p = 0.001), compared to staff in the other municipalities. Implementation leaders may need to take the working conditions and the percep-tion of available resources among staff into consideration in the on-going process of implementing individual care plans.

Place, publisher, year, edition, pages
Irvine, CA: Scientific Research Publishing, 2016
Keyword
Aged/Aged 80 and Over, Patient Care Planning, Health Plan Implementation
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-32240 (URN)10.4236/ojn.2016.68062 (DOI)
Note

Funding: The Swedish Institute for Health Sciences (Vårdalinsitutet)

Available from: 2016-10-20 Created: 2016-10-20 Last updated: 2017-11-29Bibliographically approved
Lethin, C., Hallberg, I. R., Karlsson, S. & Janlöv, A.-C. (2016). Family caregivers experiences of formal care when caring for persons with dementia through the stages of the disease. Scandinavian Journal of Caring Sciences, 30(3), 526-534
Open this publication in new window or tab >>Family caregivers experiences of formal care when caring for persons with dementia through the stages of the disease
2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 3, p. 526-534Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Family caregivers' experiences of formal care when caring for persons with dementia through the process of the disease is sparsely investigated.

AIMS: To investigate family caregivers' experiences of formal care when caring for a person with dementia, through the stages of the disease.

DESIGN: A qualitative approach with focus group interviews.

METHODS: Four focus group interviews were conducted in October 2011 with 23 spouses and adult children of persons with dementia and analysed with content analysis.

RESULTS: The participants' experiences of formal care when caring for a person with dementia were captured in the theme 'Familycaregiving requires collaboration with formal care to get support adjusted to needs specific to the stages of dementia'. This can be broken down into the categories 'The dementia diagnosis - entry into formal care as a novice family caregiver', 'Needing expanded collaboration with formal care to continue care at home' and 'Being dependent on a nursing home and trying to maintain involvement'.

CONCLUSION: Family caregiving requires collaboration with formal care to get support adjusted to the individual's needs, specific to the stages of dementia. Caregivers experience a transition process with three main turning points: the dementia diagnosis; when they realise increased need for formal care to continue caring at home; and when the person with dementia is moved into a nursing home. The interviewed caregivers experience formal care reactive to their needs and this often promoted unhealthy transitions. Formal careneeds to be proactive and deliver available care and support early on in the dementia trajectory. Interventions should focus on facilitating a healthy transition for family caregivers through the trajectory of the dementia disease to ensure their well-being. © 2015 Nordic College of Caring Science.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell, 2016
Keyword
family caregivers, experiences, formal care, dementia, Alzheimer’s disease, trajectory, nursing, qualitative research, focus groups, transition theory
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-31592 (URN)10.1111/scs.12275 (DOI)26346507 (PubMedID)2-s2.0-84941082921 (Scopus ID)
External cooperation:
Funder
EU, FP7, Seventh Framework ProgrammeEuropean Science Foundation (ESF), 09-RNP-049
Note

Funding: European Commission – the 7th framework, Greta and Johan Kochs foundation, The Swedish Institute for Health Sciences, European Science Foundation Research Network Program ‘REFLECTION' (09-RNP-049).

Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2017-11-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6624-9963

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