Purpose: In Sweden, in the wake of deinstitutionalization, in 1995 the responsibility for support regarding accommodation, employment, and an active everyday life for persons with severe mental illness (SMI) became a matter for the municipality’s social services. The overall aim of this study was to investigate whether there are differences in functioning and needs among older adults (65+) with severe mental illness (SMI) when divided into Psychosis and Non‑Psychosis groups.

Materials and methods: Data was collected from 5 surveys, and data from national registers. A group of older adults with SMI, with a history of long-term stays in mental hospitals, was identified and divided into two groups: Psychosis diagnosis (N = 222) and Non-Psychotic diagnosis (N = 253).

Results: The level of functioning was significantly lower in the Psychosis group, but at the same time, long periods of institutionalization, regardless of diagnosis category, also contributed to lower functioning scores. Diagnostic group did not explain differences in the proportion of unsatisfied needs; however, the length of institutionalization did.

Conclusions: Although there were diagnostic group differences in functioning, there were no diagnostic group differences in unmet needs, suggesting that social services were responding to individuals’ actual level of functioning. In line with the studies by Barton and by Goffman, it can be argued that the long periods of institutionalization were the most decisive factors influencing functional levels.

Purpose

To map and summarise the available knowledge regarding older adults’ experiences of team-based home rehabilitation.

Method

The Johanna Briggs Institute (JBI) guidelines for scoping reviews guided the process. Eight databases, eight organisational websites, one registry and Google Scholar were searched. Searches were limited to publications published from 2006 to 2023 in English and Scandinavian languages. Data were extracted from the eligible publications using a data extracting tool developed for this study. Extracted data were condensed and coded into categories.

Results

Seventeen publications, conducted mainly in Scandinavian countries, were included. Older adults’ experiences of team-based home rehabilitation were identified and categorised as: home as a rehabilitation context; staff′s attitudes, approach and collaboration; the intervention process, content and outcome; and impact of the older adults’ own personal conditions.

Conclusions

This scoping review provides insight into older adults’ experiences of team-based home rehabilitation. Although the majority were positive towards receiving rehabilitation in their homes there were also negative experiences that need to be further explored. An identified knowledge gap in team-based home rehabilitation research is the lack of cultural aspects. Moreover, there is a need of consensus among researchers on how to report on population, context and content in team-based home rehabilitation.

IMPLICATIONS FOR REHABILITATION 

• The home as a context for rehabilitation is experienced as meaningful and valued by older adults
• When the home becomes a workplace, older adults’ sense of at-homeness may decrease
• If rehabilitation staff use the home as an arena for partnership, with respect for personal integrity, a person-centred process can emerge
• The outdoor environment is important to consider in home rehabilitation interventions

Changes in daily function and cognition are two of the primary indicators of the aging process. However, how these twodomains decline with respect to each other remains unclear.Recent work has suggested accelerated declines in fine motorfunction in instrumental activities of daily living (IADLs) precedethe onset of dementia in older adults. However, whether earlychanges in IADLs contribute to subsequent changes in cognitionremains unclear. Random intercept cross lag panel models(RI-CLPM) allow us to examine the temporal dynamics of therelationships between two variables that change over time andtest hypotheses about direction of influence. This study appliedage-based RI-CLPM to longitudinal changes in performance ona timed fine motor IADL test (which included five subtests, e.g.,putting coins into a slot) and changes in the Mini-Mental StatusExam (MMSE). Up to 20 years of follow-up were available for1,462 participants (aged 62-88 years at baseline) from three longitudinal Swedish datasets of older adults (OCTO-Twin,GENDER, SATSA). Model comparisons indicated a unidirectional relationship when participants were in their 60s and 70s:IADL time contributed to subsequent MMSE scores, but MMSEscores did not contribute to subsequent IADL time. For participants in their 80s, the relationship was bi-directional: both variables contributed to subsequent performance on the othervariable. These data not only give insights into the temporaldynamics of decline in IADLs and cognition, but also provideproof-of-concept that tests involving motor performance, particularly when evaluated in ecologically-valid contexts, can beused for monitoring progression towards dementia.

In Sweden, older persons living with severe mental illnesses (SMI) increasingly live independently in the community with support from informal and formal carers and welfare services. A proportion of this group is older people with SMI who, due to age or disability, receive municipal eldercare services such as home care in their ordinary housing, or in residential care. The situation and needs of this group demand that eldercare staff have an understanding for the older person's situation and the tools to provide appropriate care. The aim of this present study is to explore the experiences of eldercare staff working with older people with SMI. Focus group interviews were conducted with staff from three residential care facilities and two home care teams in one mid-sized Swedish municipality. To analyse the interviews, qualitative content analysis was used. The overarching theme from the analysis was "Doing the best they can," which was unpacked in two categories: "Working with fragmentary knowledge" and "Finding the right approach." We could also see differences between the experiences of staff in residential care and in home care. The eldercare staff in our interviews faced lack of formal training, insufficient information and skills concerning mental illness and its treatment. Nevertheless, they tried to make the situation of the older people with SMI as good as possible using experiential and tacit knowledge. Our results also point to system level barriers that hinder effective care for older people with SMI.

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.

The interest of using digital technologies, robots etc in supporting old age care is growing, due to the fact that the technological possibilities are also increasing. The fact that older populations are growing while working populations are decreasing in proportion represents yet a driving force. Implementation of welfare technology for older people and persons with disabilities requires awareness of that necessary evidence and guidance may not always be available, even though it is necessary for a successful implementation of the same.

Background and Objectives: Preventive care is vital in maintaining health and supporting independence among older persons. In Sweden, a national quality register (Senior Alert) was developed in elder care to support healthcare workers working to prevent malnutrition, falls, pressure ulcers, and poor oral health. However, we predicted that challenges in providing care at home result in preventive work being least used when and where it would be most effective: early in disease processes. The current study examines the preventive care actions planned and performed for older persons with identified risks, to compare quality and equity of care in different care settings. Methods: Persons from the Swedish Screening Across the Lifespan Twin Study registered in the Senior Alert were included in the study (N = 2914). Descriptive and analytical statistical analyses regarding risk assessment and planned and performed preventive actions were conducted among those persons registered in hospitals, home health care, nursing homes, dementia care homes, or short-term nursing homes. Results: Almost 80% of the sample had identified risk in at least one of the four risk areas, with falls and malnutrition being most common. Risks differed between care settings, and having any risk was most common among older persons in short-term nursing homes. The largest difference between planned and performed actions was for older persons with home health care, and especially true for the oldest persons (>80 years old). Conclusions: Preventive care is vital as it is often easier to prevent than treat, and pressure ulcers, malnutrition, poor oral health, and falls are common among older persons. However, preventive actions were less likely to be performed in the home health care, especially for the oldest adults. Reasons for this might be related to challenges of performing care in a person’s home, lack of knowledge, and organizational challenges, but further investigation is needed.