Older persons with dementia have several risk factors for being exposed to domestic abuse, for example dependency on others to manage daily life. The purpose of the study was to explore how staff act and reason when suspecting domestic abuse perpetrated by informal caregivers of persons with dementia. Eight semi-structured group interviews were conducted with staff (n = 39) working with persons with dementia living in their ordinary homes. A thematic analysis generated two themes; Missing a map for guidance and Being left to one’s own inner compass for direction indicating that staff experienced a lack of guidelines and protocols to work from when suspecting abuse. This resulted in staff taking actions based on their own norms, values, and experiences when suspecting domestic abuse. Not knowing how to act risks leading to staff ending up doing nothing or being unable to identify effective interventions, accompanied by feelings of guilt and ethical stress. The results highlight the necessity of providing staff with tools for how to act when they suspect domestic abuse, such as collaboration with others, colleagues, and other organisations where different options for interventions can emerge.

Svensk titel: En svensk studie om hur personal resonerar och agerar när demisstänker våld i nära relationer som begås av anhöriga tillpersoner med demenssjukdom.

Äldre personer med demenssjukdom har flera riskfaktorer för att utsättas för våld i nära relationer, till exempel att vara beroende av andra för att klara det dagliga livet. Syftet med studien var att undersöka hur personal agerar och resonerar vid misstanke om våld i nära relationer som begås av anhöriga till personer med demenssjukdom. Åtta semistrukturerade gruppintervjuer genomfördes med personal (n = 39) som arbetar med personer med demenssjukdom som bor i ordinärt boenden. En tematisk analys genererade två teman; karta saknas för att ge guidning och vara utlämnad till en inre kompass för att finna riktning, vilket tyder på att personalen upplevde en brist på rutiner och riktlinjer att utgå ifrån vid misstanke om våld i nära relation. Detta resulterade i att personalen vidtog åtgärder utifrån sina egna normer, värderingar och erfarenheter vid misstanke om våld i nära relationer. Att inte veta hur man ska agera riskerar att leda till att personalen inte gör något eller har svårighter att hitta effektiva insatser, vilket kan leda till skuldkänslor och etisk stress. Resultatet belyser behovet av att ge personalen verktyg för hur de ska agera vid misstanke om våld i nära relationer, såsom samarbete med andra, kollegor och andra verksamheter där olika alternativ för insatser kan växa fram.

BACKGROUND: Health and social care staff play a significant role in detecting and reporting abuse among persons with dementia. However, they are often left to their own judgements which can lead to elder abuse not being detected or acted on. The aim was to explore what healthcare and social care staff consider elder abuse, and their experience of elder abuse perpetrated by family members of persons with dementia.

METHODS: This mixed-method vignette study was conducted in Sweden during the year 2021. In total 39 staff working in dementia care were included. They first answered the Caregiver Scenario Questionnaire and then participated in a group interview.

RESULTS: An inconsistency was revealed regarding whether a management strategy for behavioural difficulties included in the Caregiver Scenario Questionnaire should be considered an abusive act or not. No participants were able to identify all five abusive behaviour management strategies. Participants described witnessing 101 abusive acts including different types of abuse of a person with dementia, with emotional/psychological abuse and neglect being most common.

CONCLUSIONS: Health and social care staff who work close to older persons are able to detect abuse perpetrated by family members. However, inconsistency in defining abusive acts demonstrates the uncertainty in identifying abuse. This may lead to abuse not being identified, but it also creates feelings of inadequacy among staff.

About 3.9 million people live with Young Onset Dementia (YOD) worldwide. As dementia progresses, there may be a need for transition to residential care. It can be challenging for persons with YOD to access age-appropriate services, even though they might have different needs compared to persons with late-onset dementia. This scoping review aimed to present the experiences of people with YOD living in residential care facilities. Peer-reviewed research articles focusing on either the perspective of people with dementia onset before the age of 65 living in residential care or their family members were included. A literature search in MEDLINE, CINAHL, PsycINFO, Scopus, ProQuest, and Web of Science conducted in December 2023 yielded 13 qualitative studies from Europe, North America, and Australasia. Four studies included experiences of persons with YOD, three included experiences of family members, and six had a mix of participant experiences. In total, 90 (Md = 9) persons with dementia and 292 (Md = 17) family members participated. A synthesis of findings indicates that a home-like environment and age-adjusted activities based on the interests of the individual were highly valued. This review provides a first step towards understanding what person-centered care means for people with YOD in residential care. However, even though people with YOD can communicate their experiences and needs, there were few studies focusing on their perspectives. To improve care, further research needs to focus on the voices of individuals with dementia.

BACKGROUND: Approximately 3.9 million persons worldwide have young-onset dementia. Symptoms related to young-onset dementia present distinct challenges related to finances, employment, and family. To provide tailored support, it is important to gain knowledge about the formal support available for persons with young-onset dementia. Therefore, this paper aims to describe formal support for persons with young-onset dementia in Sweden and the factors influencing this support.

METHODS: This retrospective study used data on persons under 65 years of age (n = 284) from The Swedish Registry for Cognitive/Dementia Disorders (SveDem) between 2021 and 2022. SveDem was established to monitor the quality of dementia care in Sweden. Characteristics of participants were obtained, including age, sex, dementia diagnosis, MMSE, medications, accommodation, and care setting. Descriptive statistics and logistic regression were used to test for associations between participant characteristics and post-diagnostic support.

RESULTS: Information and educational support were usually offered to the person with young-onset dementia (90.1%) and their family (78.9%). Approximately half of the sample were offered contact with a dementia nurse (49.3%), counsellor (51.4%), or needs assessor (47.9%). A minority (28.5%) were offered cognitive aids. Six regression models were conducted based on participant characteristics to predict the likelihood that persons were offered support. Support was not predicted by age, sex, children at home, accommodation, or medications. Lower MMSE scores (p < .05) and home help (p < .05) were significantly associated with offer of a needs assessor. Living together was a significant predictor (p < .01) for information and educational support offered to the family. Care setting significantly predicted (p < .01) an offer of information and educational support for the person and family members, as well as contact with a counsellor.

CONCLUSION: This study indicates potential formal support shortages for persons with young-onset dementia in some areas of dementia care. Despite equal support across most characteristics, disparities based on care setting highlight the importance of specialised dementia care. Pre-diagnostic support is minimal, indicating challenges for persons with young-onset dementia to access these services before diagnosis. While our study has identified areas in need of improvement, we recommend further research to understand the changing support needs of those with young-onset dementia.

Older adults are at high risk of malnutrition, falls, pressure ulcers and poor oral health. In Sweden the quality register Senior Alert is trying to improve the preventive work among older people. This study used data from Senior Alert to understand how the preventive work process functions in different care settings. Data included 2957 persons that were assessed in Senior Alert: 864 in nursing homes, 226 in home care and 1829 in hospital. Descriptive and comparative analyses were performed to understand how many were assessed as having risk, and then the actions planned and follow-ups. The results demonstrated that people who were assessed in hospital had risks of some kind in almost half of the cases (46%), in comparison to nursing homes (29%) and home care (8%). Planned actions differed between the settings: in nursing homes, actions were more often planned to prevent poor oral health (29%) whereas hospital staff more often planned actions to prevent falls (73%), malnutrition (71%) and pressure ulcers (57%). Planned actions were significantly less in home care. Follow-ups follow the same patterns, where follow-up in home care were significantly smaller than in nursing homes and hospitals in all areas. Home care provides good opportunities to provide preventive care, as it is more continuous than, for example, hospital care. Additional analyses identified particular actions planned and performed, for a fine-grained investigation of preventive care in Sweden.

Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av att använda robotar vid läkemedelshantering bland äldre personer. Tolv sjuk­sköterskor intervjuades via telefon med hjälp av en fråge­guide. Insamlade data analyserades sedan genom en ­induktiv kvalitativ innehållsanalys.

Studien identifierade tre övergripande kategorier. Skapar självständighet handlar om hur roboten bidrar till äldre personers oberoende samt ökade ansvar, engagemang och trygghet i samband med läkemedelshantering. Ökad patientsäkerhet syftar på att rätt patient får rätt läke­medel i rätt tid, vilket bidrar till färre läkemedelsavvikelser. Resurssparande tydliggör såväl miljöbesparingar, som att mindre tid och personalresurser behöver läggas på läkemedelsadministrering.

Att använda läkemedelsrobot kan således generera vinster på både individ-, grupp- och organisatorisk nivå, men det är viktigt att införande och användande anpassas till varje enskild individ.

Robot use in older people’s medication ­management – an interview study with community nurses ­in Sweden

The aim of this study was to describe nurses’ experiences of using robots in medication management among older persons. Twelve nurses were interviewed by telephone, using an interview ­guide. Collected data were analysed using an inductive qualitative content analysis.

Three main categories were identified; Creating independence regards how the medicine dispensing robot contributes to the independence and autonomy of older people as well as increased responsibility, engagement, and feelings of security. Increased patient safety means that the right patient gets the right medicine at the right time, contributing to fewer adverse drug events. Saving resources highlights savings, both regarding the environment and human resources, as staff spend less time administering medication.

The use of medicine dispensing robots can generate profits on individual, group, and organizational levels. However, it is important that implementation and use are individually adjusted.

OBJECTIVES: The International Classification of Functioning, Disability and Health (ICF) endorsed by the World Health Organization provides a conceptual framework for describing functioning and disability based on a biopsychosocial model. Although dementia is one of the leading causes of disability, yet little is known on the extent to how the ICF has been utilized in dementia research and practice. The study aimed to examine and map the current applications of the ICF with dementia from a body of earlier studies and to explore the potential use in person-centred dementia care.

METHODS: The Arksey and O'Malley framework was used to guide the searching, selecting, and synthesizing process. The scoping review was reported following The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines.

RESULTS: A total of 34 studies were included. The applications of ICF were classified into 4 themes: (1) in clinical practice and the education of health professionals (n = 20); (2) community support services and income support (n = 3); (3) population-based, census, or survey data (n = 10); (4) advocacy and empowerment purposes (n = 1).

CONCLUSION: The ICF has made a major impact on dementia in clinical settings. Findings strongly support applying the ICF to person-centered dementia care. In the future, more empirical studies are needed to expand the scope of ICF use in dementia research and practice.

Tvång och begränsningar i vård och omsorg är inte tillåtet, men används trots detta ändå ibland vid vård av personer med kognitiv nedsättning. I många fall med goda intentioner. I Jönköping kommun har olika utbildningsinsatser gjorts för att arbeta mot den nollvision som finns på nationell nivå. Ett samverkansprojekt mellan Jönköping kommun och Jönköping University startades upp för att få en tydligare bild av fortsatta utbildningsbehov. Syftet med studien var att kartlägga personals erfarenheter och uppfattningar om användandet av tvång och begränsningar inom kommunal vård och omsorg av personer med demenssjukdom. Totalt fjorton fokusgruppsintervjuer med vård- och omsorgspersonal som mötte personer med demenssjukdom inom ordinärt eller särskilt boende genomfördes och ligger till grund för studien. Materialet analyserades med tematisk analys och visa ratt användandet av tvång och begränsningar var relaterat till både relationella aspekter och det direkta mötet såväl som till strukturella och organisatoriska aspekter. Skillnader bland vård- och omsorgspersonalens kunskap och arbete med tvång och begränsningar skilde sig åt beroende på var i organisationen de arbetade. Vård- och omsorgspersonal har ofta förmåga att själva hitta alternativa lösningar och på så vis undvika tvång och begränsningar, men för att öka kunskapen ytterligare behövs ökade möjlighet att reflektera med kollegorna i det dagliga arbetet.