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Trygghet - på vems villkor? Uppfattningar om och erfarenheter av trygghet hos äldre personer med behov av omsorg
Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Syftet med avhandlingen var att bidra till ökad förståelse av hur äldre personer med skiftande omsorgsbehov uppfattade och erfor trygghet, i ordinärt och särskilt boende.

Avhandlingens två första studier baserades på material från fokusgruppintervjuer med totalt 45 äldre personer boende i seniorboende. Intervjuerna analyserades med kvalitativ innehållsanalys (I, II). Den tredje studien bestod av en sekundäranalys av en brukarenkät till 350 äldre personer i ordinärt boende med hemtjänst och 145 äldre personer i särskilt boende. Materialet bearbetades med deskriptiv och analytisk statistik (III). I den fjärde studien följdes tre äldre personer, genom djupintervjuer och observationer under 12-16 veckor, vid flytt till särskilt boende och den första tiden på särskilt boende. Även detta material analyserades med kvalitativ innehållsanalys (IV).

Avhandlingens resultat visar bland annat att de trygghetslarm som de äldre hade erfarenhet av uppfattades som begränsande då larmets korta räckvidd gav orsak till minskad frihet, otrygghet, oro och rädsla (I). Övervakningsteknik, där den äldres person och position övervakas i större omfattning, ansågs inte som något problem att använda när omsorgsinsatserna ökade, så länge detta medförde ökad trygghet (II). Upplevd hälsa, relationstrygghet samt kunskap och kontroll var faktorer som var positivt relaterade till hur äldre personer med äldreomsorg uppfattade och erfor trygghet i vardagen, både i ordinärt och i särskilt boende (III). Flytt till särskilt boende som innebar att stegvis överlämna sitt livoch sin kontroll till omsorgspersonalen, ledde till en känsla av ökad säkerhet för de äldre personerna men inte nödvändigtvis till känsla av trygghet (IV).

Resultatet tolkades i förhållande till Antonovskys salutogena teori där de tre koncepten meningsfullhet, hanterbarhet och begriplighet, tillsammans utgör grunden för känsla av sammanhang (KASAM).

Sammanfattningsvis uppfattade och erfor äldre personer trygghet som så meningsfull att de kunde tänka sig att ge avkall på en del av sin frihet, integritet, självständighet och självbevarande för att uppnå den. De äldre personerna beskrev att resurser som personal och trygghetslarm stärkte tryggheten, men att hanterbarheten av dessa resurser kan stärkas ytterligare, i både ordinärt boende och särskilt boende. Resultaten visaratt äldre personers begriplighet av vardagen relaterar positivt till uppfattningar och erfarenheter av trygghet. Äldre personer saknar dock begriplighet avseende exempelvis trygghetslarm och nya rutiner, vilket får negativ inverkan på deras trygghet. Äldre personer bör ges större utrymme att själva beskriva trygghet utifrån sina unika villkor. För att stärka trygghet på äldre personers villkor, oavsett deras omsorgsbehov, bör således hanterbarheten, men framförallt begripligheten, stärkas.

Abstract [en]

The aim of this thesis was to increase the knowledge and understanding of how older people with varying needs of care perceive and experience sense of security in ordinary homes and in nursing homes.

This thesis comprised four studies, which are to be found at the end of this manuscript. The first two studies were based on the same data material, collected using focus group interviews with 45 elderly individuals living in senior housing with minimal care needs. The interviews were analyzed using qualitative content analysis (I, II). The third study was based on secondary analysis of a user survey of 350 older individuals in ordinary housing with some kind of elder care/service and 145 older individuals with around-the-clock care needs living in nursing homes. The material was processed using descriptive and analytical statistics (III). The fourth study followed three older individuals for 12-16 weeks, using four in-depth interviews and observations to examine the move from ordinary into nursing homes. This material was also analyzed using qualitative content analysis. The use of a personal emergency response system (PERS) was perceived as limiting the lives of elderly people, because the alarm only functions within a person’s apartment. The limited range of the PERS was perceived as reducing elders’ freedom and increasing insecurity, anxiety, and fear (I). Increased reliance on care interventions using monitoring technology, with which the individual and their position is monitored on a larger scale, was not considered a problem, as long as it led to increased security and allowed older individuals to maintain control and a sense of self (II). Perceived health, secure relationships, knowledge, and control were factors that were related to perceived sense of security in the daily lives of older individuals with care, both in ordinary homes and in nursing homes (III).

Moving to a nursing home and gradually transferring the control of one’s belongings and daily routines to care staff led to a feeling of greater safety for the older person, but not necessarily a sense of security (IV). In summary, older individuals value, prioritize, and perceive sense of security as very important in their life, but do not always experience a sense of security in ordinary housing and nursing homes. Security is perceived as something so important in life that older people will consider sacrificing their privacy and integrity in lieu of security. Because the sense of security is not always perceived and experienced as good, older individuals search for strategies that contribute to their sense of security through material objects and through relationships with other people. These results indicate that it is essential to support older individuals’ everyday life, regardless of care type, to promote a sense of security on their terms.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health Sciences , 2014. , p. 90
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 53
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-23852ISBN: 978-91-85835-52-2 (print)OAI: oai:DiVA.org:hj-23852DiVA, id: diva2:719116
Public defence
2014-05-23, Röda rummet, Hälsohögskolan, Jönköping, 10:00 (Swedish)
Available from: 2014-05-23 Created: 2014-05-23 Last updated: 2018-01-11Bibliographically approved
List of papers
1. Personal emergency response system (PERS) alarms may induce insecurity feelings
Open this publication in new window or tab >>Personal emergency response system (PERS) alarms may induce insecurity feelings
2011 (English)In: Gerontechnology, ISSN 1569-1101, Vol. 10, no 3, p. 140-145Article in journal (Refereed) Published
Abstract [en]

(PERS) alarms have been used in Sweden since 1974 to enable older people to age safely at home. Despite this long use, we found no studies describing independent older users’ opinions of these devices.

Aim Our aim was to describe how people living in Swedish independent senior housing perceive the alarms and to highlight their wishes for further developments and innovations.

Methods We conducted five focus group interviews with residents of senior housing who used or had used a PERS alarm and analysed the data qualitatively for latent content.

Results The data analysis revealed five themes in participants’ opinions and feelings about the PERS alarms: (i) safety, (ii) anxiety, (iii) satisfaction, (iv) being informed, and (v) older persons as active innovators.

Conclusion The 40-year-old Swedish PERS used in senior housing seems to limit rather than liberate users in their daily lives and cause feelings of insecurity rather than security. Older Swedish people require a more personalized alarm with a built-in positioning system that would allow them a greater range of movement beyond their homes.

Place, publisher, year, edition, pages
Eindhoven, Netherlands: International Society for gerontechnology, 2011
Keywords
focus groups, inclusive design, PERS, qualitative research
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-17030 (URN)10.4017/gt.2011.10.3.001.00 (DOI)
Available from: 2012-08-30 Created: 2012-01-09 Last updated: 2020-09-02Bibliographically approved
2. Older persons have ambivalent feelings about the use of monitoring technologies
Open this publication in new window or tab >>Older persons have ambivalent feelings about the use of monitoring technologies
2013 (English)In: Information Technology and Disabilities, E-ISSN 1073-5127, Vol. 25, no 2, p. 117-125Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: As they age, older persons prefer to continue to live in their own homes. Sensors in the environment and/or bodily worn systems that monitor people might contribute to an increased sense of safety and security at home, but also raise concerns about the loss of privacy by surveillance. Little is known about how older persons, living at home independently and stating good health, perceive monitoring technology in terms of personal privacy.

OBJECTIVE: to identify and describe how older persons, perceive monitoring technology in terms of personal privacy.

METHOD: A qualitative study based on five focus group interviews was used. Concepts of "freedom" and "surveillance" were used as content areas in the data analysis.

RESULTS: The results comprised three categories of ambivalence; "independence vs. security", "privacy vs. intrusion", and "in the best interest of me vs. in the best interest of others". These three categories merged into the overarching theme "maintaining a sense of self" which illustrates a desire to maintain control of one's life as long as possible.

CONCLUSIONS: Older persons generally have positive feelings and attitudes toward technology and strive to maintaining a sense of self as long as possible, by having control. They stated high value to privacy, but valued being watched over if it ensured security. To feel good and bad about monitoring technologies, rather than good or does not necessarily lead to feelings of conflict.

Keywords
Focus groups, freedom, senio housing, surveillance
National Category
Social Sciences
Identifiers
urn:nbn:se:hj:diva-22495 (URN)10.3233/TAD-130376 (DOI)
Available from: 2013-10-31 Created: 2013-10-30 Last updated: 2023-12-21Bibliographically approved
3. Promoting sense of security in old-age care
Open this publication in new window or tab >>Promoting sense of security in old-age care
2013 (English)In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 5, no 6A2, p. 56-63Article in journal (Refereed) Published
Abstract [en]

Purpose: The concept of security is related to the experience of health but has ever so often been argued from a risk perspective rather than from a promotional perspective. The experience of older persons’ sense of security in private homes and in nursing homes seems to be missing when it comes to promote aging well throughout the life span. This study aimed to describe and analyze factors related to the sense of security of older persons receiving care in nursing homes in Sweden. Design and Methods: The study was based on a questionnaire from a total of 495 persons aged ≥ 65 in private homes (n = 350) or nursing homes (n = 145) in Sweden. Results: Secure relationships, sense of control, and perceived health were significantly related to the subjects’ sense of security. No significant relationships were found between sense of security and having a personal emergency response alarm. Implications: Experience of sense of security from the older person perspective differs depending on the context. To promote the sense of security within the care of older persons, methods on how to establish secure relations as well as the sense of control and knowledge need to be further tested, developed and analyzed together with older persons.

Keywords
Sense of Security; Nursing Homes; Regression Analysis; Health Promotion
National Category
Social Sciences
Identifiers
urn:nbn:se:hj:diva-22494 (URN)10.4236/health.2013.56A2009 (DOI)
Available from: 2013-10-31 Created: 2013-10-30 Last updated: 2017-12-06Bibliographically approved
4. How older people perceive and experience sense of security when moving into and living in a nursing home: [Hur äldre personer uppfattar och erfar trygghet i flytt till och boende i särskilt boende för äldre. En fallstudie]
Open this publication in new window or tab >>How older people perceive and experience sense of security when moving into and living in a nursing home: [Hur äldre personer uppfattar och erfar trygghet i flytt till och boende i särskilt boende för äldre. En fallstudie]
2017 (English)In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 20, no 5, p. 697-710Article in journal (Refereed) Published
Abstract [en]

Sense of security is important throughout the lifespan not at least in advanced age with increased risks of functional declines and decreased social capital. Despite this, knowledge concerning older person’s perceptions and experiences of sense of security when moving into nursing homes is scarce. This study is a longitudinal, descriptive, exploratory case study with in-depth interviews and observations of three older persons in the age of 87, 88, and 91 years in a mid-sized municipality in the south of Sweden, in order to highlight how sense of security is experienced when moving into and living in a nursing home. Data were analysed using qualitative content analysis, which resulted in one main theme and four categories. The main theme, ‘Adaptation and sense of security’, indicates older persons’ need to adapt to the new context of the nursing home, and how this relates to their sense of security. The categories – ‘Control’, ‘Struggling for understanding’, ‘Lack of influence’, and ‘Grasping’ – suggest that older persons’ sense of security is reduced when they must adjust to routines without sufficient management and understanding. When able to maintain control over daily routines, and felt as a part of the new context, they perceived a sense of security.

Abstract [sv]

Trygghet är viktigt genom hela livet, inte minst som äldre med tilltagande funktionedsättningar. Kunskap behövs gällande äldre personers uppfattning av trygghet i flytt från ordinärt till särskilt boende. Syftet med studien var att öka förståelsen av hur äldre personer med skiftande omsorgsbehov uppfattar och erfar trygghet, i flytt från ordinärt till särskilt boende. En explorativ fallstudie med intervjuer och observation av tre äldre personer i åldrarna 87, 88 och 91 år genomfördes över en tidsperiod på 3 -4 månader; före flytten till särskilt boende; 3 -5 dagar efter flytt; 2 -4 veckor efter flytt då genomförandeplanen ägde rum och slutligen efter 12 -16 veckor efter flytt. Vid varje intervjutillfälle användes samma fokusområden och följdfrågor. Kvalitativ innehållsanalys användes för att analysera datamaterialet, vilket resulterade i ett huvudtema och fyra kategorier. Huvudtemat indikerar äldre personer genom hela flyttprocessen behöver anpassa sig till den nya miljön på särskilt boende för att uppleva trygghet. Anpassning till de nya rutinerna gav visserligen struktur i vardagen och uppfattades som en säkerhet, men inte nödvändigtvis som trygghet. Då de äldre personerna kunde behålla kontrollen och kunskapen över dagliga rutiner, och kände sig som en del av den nya sammanhang uppfattas de en känsla av trygghet.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Case study, control, routines, in-depth interviews, sense of security, fallstudie, upplevelse av kontroll, rutiner, djupintervju, känsla av trygghet
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-23857 (URN)10.1080/13691457.2016.1255877 (DOI)000413972900008 ()2-s2.0-85002050769 (Scopus ID)
Available from: 2014-05-23 Created: 2014-05-23 Last updated: 2018-01-24Bibliographically approved

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