The overall aim was to investigate municipal guidelines for paid dependent care which were available online, i.e. documents regarding situations where a relative is hired to care for a next-to-kin. The overall aim has been built on the following three research questions regarding how municipalities describe: 1) which situations qualify for paid dependent care, 2) how the elderly person’s needs are met in case of paid dependent care and 3) how the dependent caregivers’ rights and well-being are ensured?

There is no legal basis for demanding cash-for-care setting, and the local self-government determines whether the municipality offers this form of care. Recently, paid dependent care has been restricted and banned in several Swedish municipalities, and according to some statistics paid dependent care is allowed in 55–65 % of the Swedish municipalities. It is mostly women of foreign origin who are dependent caregivers nowadays, and feminist care research and the media lift up cash-for-care settings as a trap for women and for migrant integration.

The study included guidelines from a total of 21 municipalities, which were analyzed using qualitative content analysis according to Elo & Kyngäs (2007). The guidelines analysed were found from the websites of Sweden's 121 medium and large municipalities (more than 20 000 inhabitants). The results were processed using feminist theory (Hirdman 2012).

The results show that overall there are few guidelines available in Sweden's municipalities and that the regulations differ in the different municipalities’ guidelines. The guidelines that are available often contain general or vague descriptions. One conclusion is therefore that many municipalities ensure their own discretion and prevail through vague and general rules in their guidelines. From a feminist perspective, these different municipal policies create unfair structures and differences in conditions and terms for the elderly and their family caregivers regarding cash-for-care settings. Finally, the result shows that the few detailed descriptions prioritize elder people's rights over their caregivers'. Ensuring the paid dependent caregivers’ rights is mainly described to be done by checking and controlling them. In other words, the paid dependent caregivers are often invisible in the guidelines, are often regarded as pseudo-employees and therefore fall between the cracks in terms of their need for support (Sand 2010).

We used national surveys to study how older persons’ changing household patterns influence the gender balance of caregiving in two countries with distinct household structures and cultures, Spain and Sweden. In both countries, men and women provide care equally often for their partner in couple-only households. This has become the most common household type among older persons in Spain and prevails altogether in Sweden. This challenges the traditional dominance of young or middle-aged women as primary caregivers in Spain. In Sweden, many caregivers are old themselves. We focus attention to partners as caregivers and the consequences of changing household structures for caregiving, which may be on the way to gender equality in both countries, with implications for families and for the public services.

Usually it is women who take care of family members in the home, but with age, gender differences become less pronounced and, from 80 years onwards, there are more men caring for a family member – generally their partner – than women. Social and demographic changes are presenting new challenges for public services. In particular, in two-person households with elderly inhabitants, one of whom is dependent, it is necessary to tackle not only the needs of the dependent partner but also those of the carer partner. For this reason, carer support programmes are needed.

We linked individual-level data from the 2004 wave of the National Long-Term Care Survey with state-level data from the National Aging Program Information Systems (NAPIS) State Program Reports to predict care mix and unmet need for assistance. Our sample consisted of 2422 community-dwelling individuals aged 65 and older (69% women, 8% nonwhite) who reported at least one limitation in an instrumental or basic activity of daily living. We used the data to predict the mix of formal and informal support received, and the probability of having at least one unmet need from individual (predisposing, enabling, and need) characteristics with state-level home help coverage rates, intensity of home help services, and proportion of population aged 60+ residing in institutional settings. Consistent with past research, a majority (52.6%) of the disabled sample reported unmet need. At the individual level, enabling (availability of kin support) and need (number of basic and instrumental activity of daily living impairments, BADLs and IADLs) were most strongly associated with care mix and unmet need. State-level services were not associated with receipt of informal supports. In states providing home help services to a higher proportion of elders, women were more likely to receive formal help. In states providing more intensive services, women were less likely and individuals living alone more likely to receive formal supports. In states where a higher proportion of elders lived in nursing homes, individuals living alone were more likely to receive formal assistance, less likely overall to report unmet needs, but the oldest-old were more likely to report unmet need.

Background: Allostatic load (AL) is defined as the cumulative dysregulation of neuroendocrine, immunological, metabolic, and cardiovascular systems that increases the susceptibility to stress-related health problems. Several dementia and Alzheimer's disease (AD) risk factors have been identified, yet little is known about the role of AL and its associations with AD biomarkers (e.g., beta-amyloid (Aβ) or tau) and cognitive function among memory clinic patients. Hence, this study aims to assess the association between AL and AD biomarkers, cognitive performance, and cognitive decline after 3-years of follow-up.

Methods: Data from 188 memory clinic patients were derived from the Cortisol and Stress in AD (Co-STAR) study in Sweden. Participants underwent baseline assessments including blood tests for AL measures (including cortisol, thyroid stimulating hormone, cobalamin, homocysteine, leukocytes, glycated hemoglobin, albumin, high-density and low-density lipoprotein cholesterol, triglycerides, and creatinine), cerebrospinal fluid (CSF) sampling for AD biomarkers and neuropsychological tests including five cognitive domains. Linear regressions were conducted, adjusting for age, sex, and education.

Results: Higher AL was associated with lower CSF Aβ1-42 levels (β = −0.175, p = 0.025), reflecting higher brain levels of Aβ1-42. Stratified analyses suggested a significant association among women but not men, although the AL-sex interaction was not statistically significant. AL was not significantly associated with T-tau level (β = −0.030, p = 0.682) and P-tau level (β = 0.091, p = 0.980). There were no significant associations between AL and cognition or cognitive decline after 3 years.

Conclusion: This study showed that higher AL was associated with increased brain amyloid accumulation. This suggests that AL may play a role in AD/dementia pathophysiology. Potential sex-related differences should be assessed in further larger studies.

Background

Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old.

Methods

Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n = 863) collected in 2010/2011 were used. Mortality was analyzed until 2014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5–30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed.

Results

Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant.

Conclusions

The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to-moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.

Graphical abstract

OBJECTIVES: to examine the association between 34-year trajectories of social activity, from middle age to old age and late-life disability.

METHODS: data from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of the Oldest Old (SWEOLD) were used. LNU data from 1968, 1981, 1991 and 2000 were merged with SWEOLD data from 1992, 2002 and 2004 to create a longitudinal data set with five observation periods. Trajectories of social activities covered 1968-2002, and late-life disability was measured in 2004. The sample consisted of 729 individuals aged 33-61 at baseline (1968), who participated in at least four observation periods and who were free from mobility limitations at baseline. Four trajectories of social activity were identified and used as predictors of late-life disability.

RESULTS: reporting low/medium levels of social activity from mid-life to old age was the most common trajectory group. Persons reporting continuously low/medium or decreasing levels of social activity had higher odds ratios for late-life disability (OR = 2.33 and OR = 2.15, respectively) compared with those having continuously high levels of activity, even when adjusting for age, sex and mobility limitations, and excluding persons with baseline mobility limitations.

CONCLUSIONS: results suggest that the disability risk associated with social activities is related to recent levels of activity, but also that risk may accumulate over time, as indicated by the higher disability risk associated with the continuously low/medium level social activity trajectory.

Objectives: To investigate how trajectories of social activities, suchas spending time with family and friends, observed during a34-year period (from middle age to old age) were associated withtrajectories of mobility problems during the same time periodamong men and women.Methods: Nationally representative data from the Swedish Levelof Living Survey (LNU) and the Swedish Panel Study of the OldestOld (SWEOLD) were used. LNU data from 1968, 1981, 1991 and2000 were merged with SWEOLD data from 1992 and 2002 tocreate a longitudinal dataset with four observation periodscovering the period 1968-2002. The sample consisted of thoseaged 40-60 years at baseline who survived through the period,and participated in at least three observation periods (n=698).Trajectories of social activity were identified through clusteranalysis, and then used as predictors of mobility trajectories inmultilevel regression models.Results: Most people had a socially active life as they moved frommiddle age into old age. Five trajectories of social activity wereidentified: continuously very active, continuously active,increasing social activity, decreasing social activity, and continuouslyinactive. Upholding a very active social life was morecommon among women than men.Mobility problems increased significantly over time for bothwomen and men. Among men, decreasing activity levels overtime were associated with a faster increase in mobility problems.Among women, those who were continuously inactive or whodecreased their activity levels had higher levels of mobilityproblems, but the increase in mobility problems with age wassimilar across trajectories of social activity.Conclusions: Most men and women had high levels of socialactivity in midlife, and continued their high activity levels into latelife. Decreasing social activity was related to worse mobility inboth men and women. The nature and direction of theseassociations need to be explored further.

BACKGROUND:

Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade.

METHOD:

Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23-84 years at follow-up.

RESULTS:

Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population--and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population.

CONCLUSIONS:

Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence.

Aims: This study aimed to examine age, cohort and period trends in alcohol abstinence.

Design: Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

Setting: The samples were representative of the Swedish population.

Participants: Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

Measurements: Alcohol abstinence was determined by asking 'Do you ever drink wine, beer, or spirits?', where a 'no' response indicated abstinence.

Findings: Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.

Conclusion: Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.

Background: This study examines whether alcohol-related hospitalization predicts survey non-response, and evaluates whether this missing data result in biased estimates of the prevalence of hazardous alcohol use and abstinence.

Methods: Registry data on alcohol-related hospitalizations during the preceding ten years were linked to two representative surveys. Population data corresponding to the surveys were derived from the Stockholm County registry. The alcohol-related hospitalization rates for survey responders were compared with the population data, and corresponding rates for non-responders were based on the differences between the two estimates. The proportions with hazardous alcohol use and abstinence were calculated separately for previously hospitalized and non-hospitalized responders, and non-responders were assumed to be similar to responders in this respect.

Results: Persons with previous alcohol-related admissions were more likely currently to abstain from alcohol (RR=1.58, p<.001) or to have hazardous alcohol use (RR=2.06, p<.001). Alternatively, they were more than twice as likely to have become non-responders. Adjusting for this skewed non-response, i.e., the underrepresentation of hazardous users and abstainers among the hospitalized, made little difference to the estimated rates of hazardous use and abstinence in total. During the ten-year period 1.7% of the population were hospitalized.

Conclusions: Few people receive alcohol-related hospital care and it remains unclear whether this group’s underrepresentation in surveys is generalizable to other groups, such as hazardous users. While people with severe alcohol problems – i.e. a history of alcohol-related hospitalizations – are less likely to respond to population surveys, this particular bias is not likely to alter prevalence estimates of hazardous use.

Background: It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke.

Question: Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival?

Methods: All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type.

Results: Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients.

Conclusions: Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.

INTRODUCTION

Healthcare planning require an unambiguous and varied language to identify patient´s ability and effort needs regarding activities of daily living (ADL). The study's starting point is KASAM, the human need for coherence, comprehensibility, manageability and meaningfulness in their daily lives.

AIM

To highlight and validate ADL terminology of medical care and rehabilitation.

METHODOLOGY

The thesis is a combined, descriptive study with a deductive approach. ADL Rainbow tool was used as a template. The material was collected through questionnaires and focus group interviews. Care managers and occupational therapists were interviewed. The study also describes how a group of seniors, without relation to or experience of care or care planning, interpreted the terminology and synonyms. The interviews covered the following themes: ADL terminology, synonyms, views and categorization based on a hierarchical order.

RESULTS

Current terminology and approach could mean that the patients and their relatives could feel insecure regarding the team's planned interventions. The study results show that the medical team and patients can share and use a common language.

CONCLUSION

Language is the key to understanding the context. KASAM as a guiding-star in language, creates a value base for what has been agreed and ensures quality assures patient´s care and rehabilitation efforts.

The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients.

Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge.

The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.

AIMS: This study examines different correlates to health-related quality (HRQoL) of life after discharge in patients with stroke.

BACKGROUND: HRQoL is an important aspect of life after suffering a stroke. Previous research has revealed several variables associated with poststroke quality of life, including age, gender, depression, fatigue, length of hospital stay, functional status and amount of social participation. However, the time span after stroke varies greatly in the different studies. Although the multiple factors that contribute to short-term postdischarge HRQoL have potential importance for discharge planning, to our knowledge, these factors have not been systematically investigated during the earlier days following discharge.

DESIGN: Cross-sectional study.

METHODS: The sample consisted of 188 consecutively included individuals (mean age 74 years, 56% men) from a stroke unit in southern Sweden. The interviews were performed two to three weeks after discharge and included use of the SF-36, the Center for Epidemiological Studies Depression Scale, the Barthel Index, the Frenchay Activities Index, performance of interests and survey of patients' perceived participation in discharge planning. Multiple linear regression analysis was conducted to identify variables associated with HRQoL.

RESULTS: Multiple regression analyses with the eight scales of SF-36 as dependent variables revealed eight models, one for each scale, which were statistically significant. Depressive symptoms were associated with lower HRQoL. Ability to perform personal and social activities, interests, younger age, education (elementary school) and shorter hospital stay were related to higher HRQoL. Patients' perceived participation in discharge planning was both positively and negatively associated with HRQoL.

CONCLUSIONS: Several variables were related to good HRQoL two to three weeks post-discharge, particularly fewer depressive symptoms, participation in social activities such as outdoor activities and performance of interests.

RELEVANCE TO CLINICAL PRACTICE: These results can be used to design needs assessment forms of discharge planning to promote adaptation and recovery after stroke.

OBJECTIVE:

To examine whether occupational complexity of working with data or people, and cognitive or social leisure activity at midlife predicted cognition in advanced old age.

METHODS:

We used 810 eligible participants from Longitudinal Study of Living Conditions of the Oldest Old, a Swedish nationally representative study of individuals aged 77+ with cognitive assessments (an abridged version of the Mini-Mental State Exam) administered in 1992 and 2002 and linked to information about their midlife occupation and leisure activities collected in 1968 and 1981. A bootstrapping technique was applied to examine the direct and interactive associations of occupational complexity and leisure activity with late-life cognition.

RESULTS:

Controlling for demographic and health-related factors from childhood, midlife, and late life, we found that greater work complexity, both with people and with data, and greater participation in cognitive or social leisure activities independently related to better late-life cognitive scores. The complexity-cognition link was moderated by leisure activity such that the cognitive benefit related to the complexity of work-especially complexity of working with people-was rendered insignificant when participation in leisure activities-especially social activities-was above average.

DISCUSSION:

Results are discussed in terms of using work complexity to compensate for lack of leisure activity as well as in terms of promoting leisure engagement to compensate for long-term cognitive disadvantage imposed by working in less challenging occupations.

Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.

Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.

Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.

Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.

Föreliggande studie har undersökt omsorgs- och vårdmönster för ett urval (N = 77) av alla 80 år och äldre som avled i Jönköpings sjukvårdsområde 1999. Information inhämtades om kommunal omsorg och om slutenvård samt genom intervjuer med anhöriga (bortfall 16 %). En fjärdedel av de avlidna bodde hemma tills de avled, men själva dödsfallet inträffade för dem vanligen inom akutvården. Majoriteten av de avlidna (74 %) vistades sista tiden i livet – i genomsnitt 4 år – i ”särskilt boende”. Av dessa avled de allra flesta också där. En liten grupp – och främst bland hemmaboende - använder många av alla slutenvårdstillfällen och än fler av alla vårddagar, men ”vårdkarusell” är inget vanligt fenomen bland de avlidna. Mer än 9 av 10 har fått kommunal omsorg och/eller sjukvård under sitt sista levnadsår. Anhöriga är i allmänhet nöjda med dessa insatser. I regel var de också nöjda med vården i anslutning till dödsfallet.

Ingress: En del saker återkommer i det allmänna medvetandet och forskas om, gång på gång. Dit hör bilden av de äldres isolering. Två emeritusprofessorer förhåller sig dock skeptiska till den hajpade Svenska Ensamheten.

BACKGROUND: Dance classes for people with Parkinson's Disease (PD) are offered worldwide; however, further studies are needed to explore patients' experiences of how dance affects well-being.

PURPOSE: To explore how Dance for Parkinson (Dance for PD) is experienced, and how it contributes to the well-being and health of participants in Sweden.

METHODS: This qualitative study collected data from four focus groups. Participants were asked how dance classes impacted their well-being, and their ability to perform activities of daily life. The focus groups were recorded and transcribed. Data were analysed using content analysis, meaning units were coded, and codes were coalesced into categories from which themes were abstracted.

RESULTS: Dance for PD provided a multifaceted experience related to social relationships, aesthetic context, feelings of wellbeing and the physical experience of dancing. The main theme contained four sub-themes: Connectedness, Pleasure and glamour, Well-being in mind and body and Customized movements.

CONCLUSION: The present study highlights that health and well-being are improved by Dance for PD. It is an enjoyable activity that meets the specific needs of persons living with the consequences of PD and should therefore be promoted by occupational therapists.

Tokyo is the most aged mega-city in the world, yet it has been subjected to few micro-scale evaluations of walkability in its super-aged neighborhoods. Systematic walking audits were conducted in two aging cities within western aspect of Tokyo to assess street-level walkability from older-adult housing to local destinations. A multi-method approach included administration of the Microscale Analysis of Pedestrian Streetscapes (MAPS-mini) tool augmented with GIS analyses and photography across 10 super-aged neighborhoods (40 walking routes and 102 street segments) in the cities of Musashino and Mitaka. Musashino city had measurably better conditions for walking than the adjacent municipality of Mitaka with evidence of significant intra- and inter-city environmental variations. Prevailing barriers across both cities included poor access to parks and public transit, limited seating and shelter, inconsistent pedestrian infrastructure, narrow roadways, and few traffic calming measures. Signs of neighborhood disorder were conspicuously absent suggesting that sociocultural influences may enhance walkability in the context of sparse infrastructural support. These findings have implications for age-friendly remediation of pedestrian conditions in aging mega cities.

Background: The number of older people in Sweden and globally who need health care at home is increasing. In Sweden, care is being transformed into Good and close care (Directly translated from God och nära vård), of which the patient's participation is central. Physiotherapists who work with older patients in ordinary housing need to work person-centred and support the patient with their self-care to enable participation.

Aim: The aim of the study was to describe physiotherapists 'experience of older patients' participation in their rehabilitation in their home.  

Method: Qualitative method with an inductive approach. Eight interviews were conducted with physiotherapists in municipal health care. The study was analyzed with qualitative content analysis.

Results: The results revealed three overarching categories: 1) Factors that enable participation, 2) Barriers to participation and 3) A more independent life.

Conclusion: Increased patient participation can lead to better treatment results, improved health, patients that are more independent and autonomy. Physiotherapists working in a structured person-centred and activity-oriented way, by listening to and guiding the patient and providing sufficient support for self-care, can promote patients' independence. Physiotherapists’ professional experience and clear activity goals contribute to person-centred treatment. Relatives’ attitudes, the patient’s ability and willingness to participate, lack of time, resources and the staff’s work environment in the patient’s home proved to be barriers to participation. 

Aims: This study aimed to describe the impact of the COVID-19 pandemic on lifestyle and social activities among older adults in Sweden, with a special focus on differences between the ‘younger old’ (aged 77–84) and ‘older old’ (aged 85–109).

Methods: This study is based on a nationally representative sample of older adults (aged ⩾77 years) in Sweden (SWEOLD). Data were collected between May 2021 and April 2022, when many recommendations were removed but the virus was still classified as a public health disease. We studied occurrences and differences between the two age groups in several lifestyle factors and social activities.

Results: The younger old displayed larger changes in lifestyles because of the pandemic than the older old. Most changes were found in social interactions with family.

Conclusions: Our results highlight the large heterogeneity within the Swedish population aged ⩾77 years, and that the younger old experienced a bigger lifestyle change than the older old. Previous activity levels might be important to consider in order to understand how regulations may affect the older population. Finally, our findings indicate large age differences in Internet use, which require attention to prevent digital exclusion of an already vulnerable group.

Introduction: Consistently with international trends, managerial reforms and incentive systems in Sweden have been introduced to achieve quality improvement and increased efficiency in welfare services. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as service transformations or innovation.

Aim: In this study we explore how organizational performance are changing within the context of a patient choice reform in primary healthcare.

Material and Methods: This qualitative study is based on 48 semi-structured interviews with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants) at five PHCCs, conducted as part of a study designed to explore financial incentives and motivation in PHC in Sweden. The PHCCs were purposively selected to ensure the inclusion of both public and private facilities. All centers had a longstanding reputation for good leadership and high quality care. 

Results: The findings show how professional fields and traits were dissolving and changing, triggering the emergence of innovative solutions in practice. Through ongoing negotiations of professional boundaries new practices unfolded and professionalism increasingly was achieved through contextual conditions. The expanding and changing of professional boundaries as shown in the study are implied to stimulate innovative processes. Thus, the main findings suggest that innovative practices developed as a relationship between contextual conditions and professionalism. E.g. nurses and physical therapists remitted patients directly to the hospital, multiprofessional teams for patient groups with joint needs handled patients that previous needed hospital care, and nurse assistants became responsible for summing patients with minor hypertension for blood pressure controls and consultations.

Conclusions: The reform seemed to act as a lever for innovation and professionalism under certain conditions. How work is organized and managed is a contextual factor that not only affects work circumstances, but also provides conditions for innovation and professionalism. Impartial to governments’ ambitions to improve their responsiveness to the needs of citizens by altering market rules, new provider models may be of little assistance in achieving the desired effect on health sector reform outcomes if suitable contextual conditions are missing.

Background: frailty shows an upward trajectory with age, and higher levels increase the risk of mortality. However, it is less known whether the shape of frailty trajectories differs by age at death or whether the rate of change in frailty is associated with mortality. Objectives: to assess population frailty trajectories by age at death and to analyse whether the current level of the frailty index (FI) i.e. the most recent measurement or the person-specific rate of change is more predictive of mortality. Methods: 3,689 individuals from three population-based cohorts with up to 15 repeated measurements of the Rockwood frailty index were analysed. The FI trajectories were assessed by stratifying the sample into four age-at-death groups: <70, 70-80, 80-90 and >90 years. Generalised survival models were used in the survival analysis. Results: the FI trajectories by age at death showed that those who died at <70 years had a steadily increasing trajectory throughout the 40 years before death, whereas those who died at the oldest ages only accrued deficits from age similar to 75 onwards. Higher level of FI was independently associated with increased risk of mortality (hazard ratio 1.68, 95% confidence interval 1.47-1.91), whereas the rate of change was no longer significant after accounting for the current FI level. The effect of the FI level did not weaken with time elapsed since the last measurement. Conclusions: Frailty trajectories differ as a function of age-at-death category. The current level of FI is a stronger marker for risk stratification than the rate of change.

Background Frailty has been identified as a risk factor for cognitive impairment and dementia. However, it is not known whether familial factors, such as genetics and shared environmental factors, underlie this association. We analyzed the association between frailty and the risk of dementia in a large twin cohort and examined the role of familial factors in the association. Methods The Rockwood frailty index (FI) based on 44 health deficits was used to assess frailty. The population-level association between FI and the risk of all-cause dementia was analyzed in 41,550 participants of the Screening Across the Lifespan Twin (SALT) study (full sample, aged 41-97 years at baseline), using Cox and competing risk models. A subsample of 10,487 SALT participants aged 65 and older who received a cognitive assessment (cognitive sample) was used in a sensitivity analysis to assess the effect of baseline cognitive level on the FI-dementia association. To analyze the influence of familial effects on the FI-dementia association, a within-pair analysis was performed. The within-pair model was also used to assess whether the risk conferred by frailty varies by age at FI assessment. Results A total of 3183 individuals were diagnosed with dementia during the 19-year follow-up. A 10% increase in FI was associated with an increased risk of dementia (hazard ratio [HR] 1.17 (95% confidence interval [CI] 1.07, 1.18)) in the full sample adjusted for age, sex, education, and tobacco use. A significant association was likewise found in the cognitive sample, with an HR of 1.13 (95% CI 1.09, 1.20), adjusted for age, sex, and cognitive level at baseline. The associations were not attenuated when adjusted for APOE e4 carrier status or considering the competing risk of death. After adjusting for familial effects, we found no evidence for statistically significant attenuation of the effect. The risk conferred by higher FI on dementia was constant after age 50 until very old age. Conclusions A higher level of frailty predicts the risk of dementia and the association appears independent of familial factors. Targeting frailty might thus contribute to preventing or delaying dementia.

Background: Illness behaviors—or affective, cognitive, and behavioral responses to symptoms of illness—predict patient outcomes, including symptom exacerbation and functional recovery, and they account for a large proportion of U.S. healthcare costs. Although priorcross-sectional work has examined illness behaviors like symptom reporting in isolation, the measurement of illness behavior using a longitudinal, multi-indicator approach has yet to be explored.

Aim: We evaluated illness behavior as a latent, developmental construct in the Swedish Adoption/Twin Study of Aging (SATSA).

Method: Participants were up to 1,886 individuals (from 1,223 twin pairs) ages 29 to 102 years (Mage baseline = 62.32 years; SD =13.69; 59% Female). Illness behavior indicators included somatic complaints, non-prescription medication use, pain-related disability and perceived illness complications. The psychomotor retardation subscale of the CES-D was used to index somatic complaints, and medication use was a simple composite of 9 dichotomous items on participants’ use of non-prescription medications, such as over-the-counter analgesics, in the previous month. Pain-related disability included a simple composite of three dichotomous items on the presence of neck,back, or shoulder pain that prevented participants from performing daily tasks or activities. Perceived illness disability was a composite of difference scores, calculated from subtracting a physician panel’s objective ratings of disability for each of 35 medical conditions (on a 3-pointscale; 1= Little or no disability; 3= Severe disability) from participants’ self-ratings of how much each of the same endorsed medical conditions interfered with their daily lives (on the same 3-point scale; 1= Not at all; 3= A lot). Positive composite scores reflected higher perceived disability relative to what was expected from the objective ratings, whereas a composite score of zero reflected “accuracy” or agreement in perceived illness complications. Confirmatory Factor Analysis (CFA) was used to evaluate invariance in the loadings of these four indicatorson a latent illness behavior factor across four questionnaire waves (1987-2004).

Findings: Confirmatory factor analyses revealed moderate factor loadings of the four indicators (standardized loadings ranged from .49 to .52, all ps < .0001). Also, practical fit indices from the nested model comparisons suggested strong factorial invariance in the loadings across time (CFI = .96; TLI = .95, RMSEA= .03, 90% CI: [.026, .035]).

Conclusion: Illness behavior as a latent, multi-indicator construct represents a promising focus for longitudinal work on behavior change and maintenance.

The prolongation of life expectancy has opened unprecedented opportunities for the growth of aggregate resources, accumulation of human capital, and the use of individual human potential. Moreover, as the measure of human responsibility for personal development throughout life increases (Blair and Schroeder 2000), the importance of education level increases, especially with regard to ensuring the continued social, economic, psychological, and emotional well-being of older adults. The focus on the association between education level and the subjective perception of well-being among older adults is motivated by the fact that this is currently the fastest growing age group in the world. Regarding Russia, the number of people past retirement age is 24% of the population now. An aging society requires fundamental changes in socioeconomic policies, especially those that focus on the needs of senior citizens. However, it is important to consider regional differences. In particular, the Tomsk region has been recognized as one of the country’s top producers of university students. In fact, the region exceeds the Russian average by more than one-and-a half. In addition, one in five citizens is in the older age group while the proportion of those aged 60 years and above is steadily increasing.

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 - the eligibility age for basic pension - compared to retiring earlier affects older adults' (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.