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  • 1.
    Abramsson, Marianne
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    The housing situation of older people – Issues of investigations2017In: Book of abstracts, 2017, 51-51 p.Conference paper (Other academic)
    Abstract [en]

    The housing situation of older people has been on the Swedish political agenda for some time. An increasing ageing population implies a demand for housing in correspodence to their needs. Assisted living facilities decreased with 30 000 places between 2002 and 2016, as a result, the majority of older people age in a dwelling in the ordinary housing market. In 2008 and 2015 respectively two government investigations on older people’s housing were presented. The investigations focused on the need for housing to bridge the gap between ordinary housing and assisted living facilities and issues of affordability and social community but also the lack of accessible housing in particular geographic areas. This paper aims to investigate the origins of the two investigations and relate them to changes in the housing market affecting older people, arguing that the strong emphasis on ageing in place has shifted the responsibility of having a good place to live from general welfare to older individuals themselves.

  • 2.
    Antelius, Eleonor
    et al.
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Kiwi, Mahin
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Frankly, None of Us Know What Dementia Is: Dementia Caregiving Among Iranian Immigrants Living in Sweden2015In: Care Management Journals, ISSN 1521-0987, Vol. 16, no 2, 79-94 p.Article in journal (Refereed)
    Abstract [en]

    In quite a short amount of time, Sweden has gone from being a relatively homogeneous society to a multicultural one, with a rapid expansion of immigrants having culturally and linguistically diverse (CALD) backgrounds growing old in Sweden. This is particularly interesting in relation to studying age-related dementia diseases. Research shows that not only do CALD persons with dementia diseases tend to mix languages, have difficulties with separation of languages, or revert to speaking only their native tongue as the disease progresses, but they also show tendencies to experience that they live in the cultural environment in which they were brought up, rather than in the current Swedish one. In this article, we explore findings in relation to one such CALD group in Sweden, Iranians. The article is empirically driven and based on data gathered in 2 separate settings with specific ethnocultural profiles, offering dementia care with Middle Eastern, Arab, and/or Persian profile. Observations were carried out in combination with semistructured in-depth interviews (n = 66). By using a combination of content and ethnographic analysis, 4 main findings related to ethnocultural dementia care were elucidated. These include (a) a wider recognition of people from different CALD backgrounds possibly having different perceptions of what dementia is, (b) a possibility that such ascribed meaning of dementia has a bearing on health maintenance and health-seeking behavior as well as the inclination to use formal services or not, (c) choosing to use formal service in the forms of ethnoculturally profiled dementia care facility seems to relate to being able to “live up to ideals of Iranian culture,” and (d) “culture,” however ambiguous and hotly debated a concept it is, appears to be a relevant aspect of people's lives, an aspect that is both acquired as well as ascribed to oneself and to others. As such, we argue that culture needs to be further addressed in relation to dementia care in multicultural societies because ascribing culture boxes people in as well as out. In addition, ethnocultural contextualization of dementia care needs to be understood in relation to this because it affects the care provided.

  • 3.
    Bjalkebring, Par
    et al.
    University of Gothenburg, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. University of Oregon, OR 97403 USA.
    Dickert, Stephan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Vienna University of Econ and Business, Austria.
    Slovic, Paul
    University of Oregon, OR 97403 USA.
    Greater Emotional Gain from Giving in Older Adults: Age-Related Positivity Bias in Charitable Giving2016In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 7Article in journal (Refereed)
    Abstract [en]

    Older adults have been shown to avoid negative and prefer positive information to a higher extent than younger adults. This positivity bias influences their information processing as well as decision-making. We investigate age-related positivity bias in charitable giving in two studies. In Study 1 we examine motivational factors in monetary donations, while Study 2 focuses on the emotional effect of actual monetary donations. In Study 1, participants (n = 353, age range 20-74 years) were asked to rate their affect toward a person in need and then state how much money they would be willing to donate to help this person. In Study 2, participants (n = 108, age range 19-89) were asked to rate their affect toward a donation made a few days prior. Regression analysis was used to investigate whether or not the positivity bias influences the relationship between affect and donations. In Study 1, we found that older adults felt more sympathy and compassion and were less motivated by negative affect when compared to younger adults, who were motivated by both negative and positive affect. In Study 2, we found that the level of positive emotional reactions from monetary donations was higher in older participants compared to younger participants. We find support for an age-related positivity bias in charitable giving. This is true for motivation to make a future donation, as well as affective thinking about a previous donation. We conclude that older adults draw more positive affect from both the planning and outcome of monetary donations and hence benefit more from engaging in monetary charity than their younger counterparts.

  • 4.
    Classon, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, The Swedish Institute for Disability Research. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Fallman, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Relations between Concurrent Longitudinal Changes in Cognition, Depressive Symptoms, Self-Rated Health and Everyday Function in Normally Aging Octogenarians2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 8, e0160742- p.Article in journal (Refereed)
    Abstract [en]

    Ability to predict and prevent incipient functional decline in older adults may help prolong independence. Cognition is related to everyday function and easily administered, sensitive cognitive tests may help identify at-risk individuals. Factors like depressive symptoms and self-rated health are also associated with functional ability and may be as important as cognition. The purpose of this study was to investigate the relationship between concurrent longitudinal changes in cognition, depression, self-rated health and everyday function in a well-defined cohort of healthy 85 year olds that were followed-up at the age of 90 in the Elderly in Linkoping Screening Assessment 85 study. Regression analyses were used to determine if cognitive decline as assessed by global (the Mini-Mental State Examination) and domain specific (the Cognitive Assessment Battery, CAB) cognitive tests predicted functional decline in the context of changes in depressive symptoms and self-rated health. Results showed deterioration in most variables and as many as 83% of these community-dwelling elders experienced functional difficulties at the age of 90. Slowing-down of processing speed as assessed by the Symbol Digits Modality Test (included in the CAB) accounted for 14% of the variance in functional decline. Worsening self-rated health accounted for an additional 6%, but no other variables reached significance. These results are discussed with an eye to possible preventive interventions that may prolong independence for the steadily growing number of normally aging old-old citizens.

  • 5.
    Danielsson, Henrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Linnaeus Centre HEAD.
    Kathleen, Pichora-Fuller
    University of Toronto, Department of Psychology.
    Dupuis, Kate
    Baycrest Health Sciences, Rotman Research Institute.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Linnaeus Centre HEAD.
    Modeling the effect of early ageing and hearing loss on cognition and participation in social leisure activities2015Conference paper (Other academic)
    Abstract [en]

    There are well-known age-related declines in hearing, cognition and social participation. Furthermore, previous studies have shown that hearing loss is associated with both cognitive decline and increased risk for social isolation and that engagement in social leisure activities is related to cognitive decline. However, it is unclear how the three concepts and age relate to each other. In the current study, behavioral measures of hearing and memory were examined in relation to self-reported participation in social leisure activities. Data from two different samples were analyzed with structural equation modeling. The first consisted of 297 adults from Umeå, Sweden, who participated in the Betula longitudinal study. The second consisted of 273 older adults who volunteered for lab-based research on aging in Toronto, Canada. Structural equation modeling yielded two models with similar statistical properties for both samples. The first model suggests that age contributes to both hearing and memory performance, hearing contributes to memory performance, and memory (but not hearing) contributes to participation in social leisure activities. The second model also suggests that age contributes to hearing and memory performance and that hearing contributes to memory performance, but that age also contributes to participation in social leisure activities, which in turn contributes to memory performance. The models were confirmed in both samples, indicating robustness in the findings, especially since the samples differed on background variables such as years of education and marital status. Few participants in both samples were candidates for hearing aids, but most of those who were candidates used them. This suggests that even early stages of hearing loss can increase demands on cognitive processing that may deter participation in social leisure activities.

  • 6.
    Danielsson, Henrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Linnaeus Centre HEAD.
    Pichora-Fuller, Kathleen
    University of Toronto, Department of Psychology .
    Dupuis, Kate
    Baycrest Health Sciences, Rotman Research Institute.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Linnaeus Centre HEAD.
    Modeling the effect of early age-related hearing loss on cognition and participation in social leisure activities2015Conference paper (Other academic)
    Abstract [en]

    There are well-known age-related declines in hearing, cognition and social participation. Furthermore, previous studies have shown that hearing loss is associated with both cognitive decline and increased risk for social isolation and that engagement in social leisure activities is related to cognitive decline. However, it is unclear how the three concepts and age relate to each other. In the current study, behavioral measures of hearing and memory were examined in relation to self-reported participation in social leisure activities. Data from two different samples were analyzed with structural equation modeling. The first consisted of 297 adults from Umeå, Sweden, who participated in the Betula longitudinal study. The second consisted of 273 older adults who volunteered for lab-based research on aging in Toronto, Canada. Structural equation modeling yielded two models with similar statistical properties for both samples. The first model suggests that age contributes to both hearing and memory performance, hearing contributes to memory performance, and memory (but not hearing) contributes to participation in social leisure activities. The second model also suggests that age contributes to hearing and memory performance and that hearing contributes to memory performance, but that age also contributes to participation in social leisure activities, which in turn contributes to memory performance. The models were confirmed in both samples, indicating robustness in the findings, especially since the samples differed on background variables such as years of education and marital status. Few participants in both samples were candidates for hearing aids, but most of those who were candidates used them. This suggests that even early stages of hearing loss can increase demands on cognitive processing that may deter participation in social leisure activities.

  • 7.
    Eckerblad, Jeanette
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Symptom burden among people with chronic disease2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief.

    Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease.

    Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT.

    Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III).

    Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.

    List of papers
    1. Symptom burden in stable COPD patients with moderate or severe airflow limitation
    Open this publication in new window or tab >>Symptom burden in stable COPD patients with moderate or severe airflow limitation
    Show others...
    2014 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, no 4, 351-357 p.Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES:

    To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

    BACKGROUND:

    Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

    METHODS:

    A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

    RESULTS:

    The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

    CONCLUSIONS:

    Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keyword
    Chronic obstructive pulmonary disease; Symptom assessment; Symptom experience; Respiratory nursing
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-109384 (URN)10.1016/j.hrtlng.2014.04.004 (DOI)000338972500022 ()24856227 (PubMedID)
    Available from: 2014-08-15 Created: 2014-08-15 Last updated: 2017-12-05Bibliographically approved
    2. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
    Open this publication in new window or tab >>Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
    Show others...
    2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 1Article in journal (Refereed) Published
    Abstract [en]

    Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people greater than= 75 years, who had been hospitalized greater than= 3 times during the previous year, had greater than= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

    Place, publisher, year, edition, pages
    BioMed Central, 2015
    Keyword
    Chronic disease; Older people; Symptom assessment
    National Category
    Sociology Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-114010 (URN)10.1186/1471-2318-15-1 (DOI)000347569800001 ()25559550 (PubMedID)
    Note

    Funding Agencies|Faculty of Health sciences, Linkoping University; county council of Ostergotland; Signe and Olof Wallenius trust fund; Solstickan; Swedish Association of Geriatric Medicine; Mundipharma

    Available from: 2015-02-06 Created: 2015-02-05 Last updated: 2017-12-04
    3. To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity
    Open this publication in new window or tab >>To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity
    Show others...
    2015 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 28, no 4, 322-327 p.Article in journal (Refereed) Published
    Abstract [en]

    Context Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life. Objectives The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.

    Method A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-€“89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.

    Results The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure” and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.

    Conclusion This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.

    Place, publisher, year, edition, pages
    Elsevier, 2015
    Keyword
    Multimorbidity, Older people, Symptom burden, Content analysis
    National Category
    Nursing Gerontology, specializing in Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-122740 (URN)10.1016/j.apnr.2015.03.008 (DOI)000366148700012 ()
    Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2017-12-01Bibliographically approved
    4. Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study
    Open this publication in new window or tab >>Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study
    2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 11, 2773-2783 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim

    The aim of this study was to follow the symptom trajectory of community-dwelling older people with multimorbidity and to explore the effect on symptom burden from an ambulatory geriatric care unit, based on comprehensive geriatric assessment.

    Background

    Older community-dwelling people with multimorbidity suffer from a high symptom burden with a wide range of co-occurring symptoms often resulting to decreased health-related quality of life. There is a need to move from a single-disease model and address the complexity of older people living with multimorbidity.

    Design

    Secondary outcome data from the randomized controlled Ambulatory Geriatric Assessment Frailty Intervention Trial (AGe-FIT).

    Methods

    Symptom trajectory of 31 symptoms was assessed with the Memorial Symptom Assessment Scale. Data from 247 participants were assessments at baseline, 12 and 24 months, 2011–2013. Participants in the intervention group received care from an ambulatory geriatric care unit based on comprehensive geriatric assessment in addition to usual care.

    Results

    Symptom prevalence and symptom burden were high and stayed high over time. Pain was the symptom with the highest prevalence and burden. Over the 2-year period 68–81% of the participants reported pain. Other highly prevalent and persistent symptoms were dry mouth, lack of energy and numbness/tingling in the hands/feet, affecting 38–59% of participants. No differences were found between the intervention and control group regarding prevalence, burden or trajectory of symptoms.

    Conclusions

    Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms.

    Place, publisher, year, edition, pages
    Wiley-Blackwell Publishing Inc., 2016
    Keyword
    Registration clinicaltrials.gov identifier: NCT01446757 Keywords Symptom management, Community Care, Older people, Quality of care
    National Category
    Nursing Gerontology, specializing in Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-122741 (URN)10.1111/jan.13032 (DOI)000386079500019 ()27222059 (PubMedID)
    Note

    At the time for thesis presentation publication was in status: Manuscript

    At the time for thesis presentation publication was named: Symptom trajectory and symptom burden in older people with multimorbidity, data from the RCT AGe-FIT study

    Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2017-04-21Bibliographically approved
  • 8.
    Eckerblad, Jeanette
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Nursing Science.
    Theander, Kersti
    Faculty of Health, Science and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden.
    Ekdahl, Anne
    Geriatric Medicine, Department of Research and Education, Helsingborg Hospital, Sweden; Division of Clinical Geriatrics, Departmentof Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm,Sweden .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 11, 2773-2783 p.Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to follow the symptom trajectory of community-dwelling older people with multimorbidity and to explore the effect on symptom burden from an ambulatory geriatric care unit, based on comprehensive geriatric assessment.

    Background

    Older community-dwelling people with multimorbidity suffer from a high symptom burden with a wide range of co-occurring symptoms often resulting to decreased health-related quality of life. There is a need to move from a single-disease model and address the complexity of older people living with multimorbidity.

    Design

    Secondary outcome data from the randomized controlled Ambulatory Geriatric Assessment Frailty Intervention Trial (AGe-FIT).

    Methods

    Symptom trajectory of 31 symptoms was assessed with the Memorial Symptom Assessment Scale. Data from 247 participants were assessments at baseline, 12 and 24 months, 2011–2013. Participants in the intervention group received care from an ambulatory geriatric care unit based on comprehensive geriatric assessment in addition to usual care.

    Results

    Symptom prevalence and symptom burden were high and stayed high over time. Pain was the symptom with the highest prevalence and burden. Over the 2-year period 68–81% of the participants reported pain. Other highly prevalent and persistent symptoms were dry mouth, lack of energy and numbness/tingling in the hands/feet, affecting 38–59% of participants. No differences were found between the intervention and control group regarding prevalence, burden or trajectory of symptoms.

    Conclusions

    Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms.

  • 9.
    Eckerblad, Jeanette
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Theander, Kersti
    Faculty of Health, Science and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden.
    Ekdahl, Anne
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Hellström, Iingrid
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences. Ersta Sköndal University College, Stockholm, Sweden.
    To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity2015In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 28, no 4, 322-327 p.Article in journal (Refereed)
    Abstract [en]

    Context Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life. Objectives The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.

    Method A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-€“89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.

    Results The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure” and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.

    Conclusion This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.

  • 10.
    Ekström, Anna
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Arts and Sciences.
    Ferm, Ulrika
    Sahlgrenska University Hospital, Sweden.
    Samuelsson, Christina
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science.
    Digital communication support and Alzheimer’s disease2017In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 16, no 6, 711-731 p.Article in journal (Refereed)
    Abstract [en]

    Communication is one of the areas where people with dementia and their caregivers experience most challenges. The purpose of this study is to contribute to the understanding of possibilities and pitfalls of using personalized communication applications installed on tablet computers to support communication for people with dementia and their conversational partners. The study is based on video recordings of a woman, 52 years old, with Alzheimer’s disease interacting with her husband in their home. The couple was recorded interacting with and without a tablet computer including a personalized communication application. The results from the present study reveal both significant possibilities and potential difficulties in introducing a digital communication device to people with dementia and their conversational partners. For the woman in the present study, the amount of interactive actions and the number of communicative actions seem to increase with the use of the communication application. The results also indicate that problems associated with dementia are foregrounded in interaction where the tablet computer is used.

  • 11.
    Ekström, Anna
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Majlesi, Ali Reza
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Samarbete och delaktighet2016In: Att leva med demens / [ed] Ingrid Hellström, Lars-Christer Hydén, Malmö: Gleerups Utbildning AB, 2016, 55-62 p.Chapter in book (Other academic)
  • 12.
    Eriksson, Iréne
    et al.
    Jönköping University.
    Aronsson, Kerstin
    Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Jönköping University.
    Hugoson, Anders
    Jönköping University.
    Jonsson, Margareta
    County Council of Jönköping.
    Wärnberg Gerdin, Elisabeth
    Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    The meaning of oral health-related quality of life for elderly persons with dementia2009In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 67, no 4, 212-221 p.Article in journal (Refereed)
    Abstract [en]

    Objective. Studies of oral health developments increasingly include self-reported assessments of how oral health affects quality of life (QoL), referred to as “oral health-related QoL”. People with dementia are often excluded in studies of oral health-related QoL and thus our aim in this study was to explore this area in elderly persons with dementia. Material and methods. Eighteen elderly individuals (aged between 78 and 94 years) with dementia of varying degrees of severity were interviewed with the aid of an interview guide; pictures and objects were used as stimulus material (triggers). The material was analyzed using grounded theory as point of departure, and a professional assessment of the oral health of the participants was used as reference. Results. Four categories were identified: the ability to chew and eat, independence, oral problems, and teeth are important. These factors are largely consistent with those that have emerged in earlier studies of the elderly, but in some cases less pronounced in persons with dementia. Conclusion. The use of triggers is a positive way to communicate oral health-related QoL among persons suffering from dementia, although the material used in this study needs further evaluation and development.

  • 13.
    Hellström, Ingrid
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Hydén, Lars-ChristerLinköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Arts and Sciences.
    Att leva med demens2016Collection (editor) (Other academic)
    Abstract [sv]

    För att personer med demenssjukdom ska kunna leva ett fullgott liv behövs mer kunskap. I grunden handlar det om att förändra föreställningar och attityder till personer som lever med en demenssjukdom så att personerna själva, deras anhöriga och personal inom hälso- och sjukvården och politiker, kan se nya möjligheter i stället för enbart förluster. I den här boken presenteras kunskap och forskning som sätter personer med demenssjukdom i centrum. Boken utgår alltså inte i första hand från vården eller anhöriga, utan från dem som lever med sjukdomen. På så sätt skapas en tankeram som ger stöd vid både utvecklingsarbete och reflektion bland människor som på olika sätt arbetar med och för personer med demenssjukdom.

    Cirka 110 000 och 170 000 svenskar har i dag en demenssjukdom. Om ett tiotal år är det betydligt fler: ökad livslängd och en större medvetenhet om demenssjukdomar gör att allt fler personer får en diagnos tidigt i förloppet. Som en konsekvens av detta kommer alltfler personer att leva med en demenssjukdom under lång tid, och ofta i hemmet. Detta innebär inte bara en utmaning för vård, omsorg och socialpolitik, utan väcker också frågor som berör såväl personer med demens, som anhöriga och andra i det sociala nätverket: Hur kan personer med demens leva och fungera i sitt hem tillsammans med eventuella familjemedlemmar? Hur kan de fungera som medborgare och delta i samhällslivet, ha makt över sitt eget vardagsliv och fatta egna beslut om sitt eget liv?

    I boken medverkar forskare från Centrum för demensforskning (CEDER) vid Linköpings universitet. Den innehåller många pedagogiska exempel och riktar sig till utbildningar inom vård, omvårdnad, socialt arbete och omsorg.

  • 14.
    Hellström, Ingrid
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Torres, Sandra
    Uppsala University, Sweden.
    The "not yet" horizon: Understandings of the future amongst couples living with dementia2016In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 15, no 6, 1562-1585 p.Article in journal (Refereed)
    Abstract [en]

    The way in which persons with dementia and their spouses regard the future could influence how they experience the disease itself. This study aims to explore how the future is understood by couples living with dementia. The analysis reveals different ways in which couples understand the future. The findings show that persons with dementia describe the here and now in ways that take the gloomy future they dread as a point of reference, and as a result of this, they operate in what we term the not yet horizon. But while they take for granted that there is a horizon that they have not yet reached, their spouses always seem to focus on the horizons that they have already crossed. The article discusses the findings in relation to ideas such as critical periods, existential coordinates and possible selves, and problematizes the implicit assumptions about the future that dementia researchers tend to operate from.

  • 15.
    Källdalen, Anette
    et al.
    Jönköping University, Sweden.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Interests among older people in relation to gender, function and health-related quality of life2013In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 76, no 2, 87-93 p.Article in journal (Refereed)
    Abstract [en]

    Abstract

    Introduction: Older people should have opportunities to be active participants in society as aspects such as lifestyle, physical and social environment and physical and mental status have influence on active ageing. The purpose was to explore the interests pursued by 85-year-old people living in ordinary housing in relation to gender, cognition, depression and health-related quality of life.

    Method: A sample of 240 participants completed a postal questionnaire including the EuroQoL health-related quality of life measurement. Additional instruments used during a subsequent home visit were the Canadian Occupational Performance Measure, Mini Mental State Examination and Geriatric Depression scale.

    Results: Women experienced poorer health than men, lived alone to a greater extent and used more mobility devices. Compared to men, women had a larger number of interests within household management, but no gender differences in the leisure area. Lower number of interests in active recreation was associated with lower cognitive function, poorer health-related quality of life and a higher risk of depressive symptoms.

    Conclusion: The main finding is that engaging in active recreation interests is associated with better cognition, less depression and higher health-related quality of life in these 85-year-old people and is therefore a concern of occupational therapists.

  • 16.
    Lannering, Christina
    et al.
    Futurum, Sweden.
    Ernsth Bravell, Marie
    Jonköping University, Sweden.
    Midlov, Patrik
    Lund University, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Molstad, Sigvard
    Lund University, Sweden.
    Factors related to falls, weight-loss and pressure ulcers - more insight in risk assessment among nursing home residents2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, 940-950 p.Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo describe how the included items in three different scales, Downton Fall Risk Index, the short form of Mini Nutritional Assessment and the Modified Norton Scale are associated to severe outcomes as falls, weight loss and pressure ulcers. BackgroundFalls, malnutrition and pressure ulcers are common adverse events among nursing home residents and risk scoring are common preventive activities, mainly focusing on single risks. In Sweden the three scales are routinely used together with the purpose to improve the quality of prevention. DesignLongitudinal quantitative study. MethodsDescriptive analyses and Cox regression analyses. ResultsOnly 4% scored no risk for any of these serious events. Longitudinal risk scoring showed significant impaired mean scores indicating increased risks. This confirms the complexity of this populations status of general condition. There were no statistical significant differences between residents categorised at risk or not regarding events. Physical activity increased falls, but decreased pressure ulcers. For weight loss, cognitive decline and the status of general health were most important. ConclusionsRisk tendencies for falls, malnutrition and pressure ulcers are high in nursing homes, and when measure them at the same time the majority will have several of these risks. Items assessing mobility or items affecting mobility were of most importance. Care processes can always be improved and this study can add to the topic. Relevance to clinical practiceA more comprehensive view is needed and prevention can not only be based on total scores. Mobility is an important factor for falls and pressure ulcers, both as a risk factor and a protective factor. This involves a challenge for care - to keep the inmates physical active and at the same time prevent falls.

  • 17.
    Larsson Ranada, Åsa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Hagberg, Jan-Erik
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    All the things I have - handling one’s material room in old age2014In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 31, 110-118 p.Article in journal (Refereed)
    Abstract [en]

    The article explores how old people who live in their ordinary home, reason and act regarding their ‘material room’ (technical objects, such as household appliances, communication tools and things, such as furniture, personal belongings, gadgets, books, paintings, and memorabilia). The interest is in how they, as a consequence of their aging, look at acquiring new objects and phasing out older objects from the home. This is a broader approach than in most other studies of how old people relate to materiality in which attention is mostly paid either to adjustments to the physical environment or to the importance of personal possessions. In the latter cases, the focus is on downsizing processes (e.g. household disbandment or casser maison) in connection with a move to smaller accommodation or to a nursing home. The article is based on a study in which thirteen older people (median age 87), living in a Swedish town of medium size were interviewed (2012) for a third time. The questions concerned the need and desire for new objects, replacement of broken objects, sorting out the home or elsewhere, most cherished possessions, and the role of family members such as children and grandchildren. The results reveal the complexity of how one handles the material room. Most evident is the participants' reluctance to acquire new objects or even to replace broken things. Nearly all of them had considered, but few had started, a process of sorting out objects. These standpoints in combination resulted in a relatively intact material room, which was motivated by an ambition to simplify daily life or to facilitate the approaching dissolution of the home. Some objects of special value and other cherished objects materialized the connections between generations within a family. Some participants wanted to spare their children the burden of having to decide on what to do with their possessions. Others (mostly men), on the contrary, relied on their children to do the sorting out after they had died.

  • 18.
    Larsson, Åsa
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Reducing the material room in old age - The Casser maison-process of elderly people living at home2012Conference paper (Other academic)
  • 19.
    Larsson, Åsa
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    The materialized connections of objects to other generations for elderly people living at home who are reducing their material room in old age2012Conference paper (Other academic)
  • 20.
    Majlesi, Ali Reza
    et al.
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences. Department of Education, Stockholm University, Sweden.
    Ekström, Anna
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Baking together-the coordination of actions in activities involving people with dementia2016In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 38, 37-46 p.Article in journal (Refereed)
    Abstract [en]

    This study explores interaction and collaboration between people with dementia and their spouses in relation to the performance of household chores with the focus on instruction as an interactional context to engage the person with dementia in collaboration to accomplish joint activities. Dementia is generally associated with pathological changes in peoples cognitive functions such as diminishing memory functions, communicative abilities and also diminishing abilities to take initiative as well as to plan and execute tasks. Using video recordings of everyday naturally occurring activities, we analyze the sequential organization of actions (see Schegloff, 2007) oriented toward the accomplishment of a joint multi-task activity of baking. The analysis shows the specific ways of collaboration through instructional activities in which the person with dementia exhibits his competence and skills in accomplishing the given tasks through negotiating the instructions with his partner and carrying out instructed actions. Although the driving force of the collaboration seems to be a series of directive sequences only initiated by the partner throughout the baking activity, our analyses highlight how the person with dementia can actively use the material environment including collaborating partners to compensate for challenges and difficulties encountered in achieving everyday, tasks. The sequential organization of instructions and instructed actions are in this sense argued to provide an interactional environment wherein the person with dementia can make contributions to the joint activity in an efficient way. While a collaborator has been described as necessary for a person with dementia to be able to partake in activities, this study shows that people with dementia are not only guided by their collaborators in joint activities but they can also actively use their collaborators in intricate compensatory ways. (C) 2016 Elsevier Inc. All rights reserved.

  • 21.
    Manchaiah, Vinaya
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Lamar University, TX 77710 USA; Audiol India, India; Manipal University, India.
    Taylor, Brian
    Taylor Audio LLC, MN USA.
    Dockens, Ashley L.
    Lamar University, TX 77710 USA.
    Tran, Nicole R.
    Lamar University, TX 77710 USA.
    Lane, Kayla
    Lamar University, TX 77710 USA.
    Castle, Mariana
    Lamar University, TX 77710 USA.
    Grover, Vibhu
    Lamar University, TX 77710 USA.
    Applications of direct-to-consumer hearing devices for adults with hearing loss: a review2017In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, 859-871 p.Article, review/survey (Refereed)
    Abstract [en]

    Background: This systematic literature review is aimed at investigating applications of direct-to-consumer hearing devices for adults with hearing loss. This review discusses three categories of direct-to-consumer hearing devices: 1) personal sound amplification products (PSAPs), 2) direct-mail hearing aids, and 3) over-the-counter (OTC) hearing aids. Method: A literature review was conducted using EBSCOhost and included the databases CINAHL, MEDLINE, and PsycINFO. After applying prior agreed inclusion and exclusion criteria, 13 reports were included in the review. Results: Included studies fell into three domains: 1) electroacoustic characteristics, 2) consumer surveys, and 3) outcome evaluations. Electroacoustic characteristics of these devices vary significantly with some meeting the stringent acoustic criteria used for hearing aids, while others producing dangerous output levels (ie, over 120-dB sound pressure level). Low-end (or low-cost) devices were typically poor in acoustic quality and did not meet gain levels necessary for most adult and elderly hearing loss patterns (eg, presbycusis), especially in high frequencies. Despite direct-mail hearing aids and PSAPs being associated with lower satisfaction when compared to hearing aids purchased through hearing health care professionals, consumer surveys suggest that 5%-19% of people with hearing loss purchase hearing aids through direct-mail or online. Studies on outcome evaluation suggest positive outcomes of OTC devices in the elderly population. Of note, OTC outcomes appear better when a hearing health care professional supports these users. Conclusion: While some direct-to-consumer hearing devices have the capability to produce adverse effects due to production of dangerously high sound levels and internal noise, the existing literature suggests that there are potential benefits of these devices. Research of direct-to-consumer hearing devices is limited, and current published studies are of weak quality. Much effort is needed to understand the benefits and limitations of such devices on people with hearing loss.

  • 22.
    Marteinsdottir, Ina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Garvin, Peter
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Psychological Resources Are Independently Associated with Markers of Inflammation in a Middle-Aged Community Sample2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 5, 611-620 p.Article in journal (Refereed)
    Abstract [en]

    Purpose To elucidate possible independent associations of psychological resources with inflammatory markers, all linked with coronary heart disease (CHD). Method In a middle-aged general population (n = 944), psychological resources (coping, self-esteem, and sense of coherence (SOC)), a global measure of quality of life (Cantrils self-anchoring ladder, also called "ladder of life"), and psychological risk factors (hopelessness, vital exhaustion, and depressive symptoms) were used in linear regression models to evaluate associations with the inflammatory markers interleukin (IL)-6, C-reactive protein (CRP), and matrix metalloproteinase (MMP)-9. Adjustments were done for age, sex, medical conditions, and cardiovascular risk factors. Results After full adjustments, self-esteem was independently associated with all three biomarkers. Ladder of life was associated with IL-6 and log-CRP; coping, vital exhaustion, and depressive symptoms with IL-6; and SOC with MMP-9 (p amp;lt; 0.05 for all associations). Conclusion Numerous significant associations of psychological resources and risk factors with IL-6, CRP, and MMP-9 were found in a community-based sample. The associations of psychological resources were mostly independent, while the psychological risk factors seemed preferentially dependent on lifestyle factors as smoking, physical activity, and body mass index (BMI). This suggests that the psychological resources (in particular self-esteem) protective effects on CHD are linked to inflammatory markers.

  • 23.
    Mok, Zaneta
    et al.
    La Trobe University, Australia.
    Müller, Nicole
    University of Louisiana at Lafayette, USA.
    Staging casual conversations for people with dementia.2014In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 13, no 6, 834-853 p.Article in journal (Refereed)
    Abstract [en]

    Social isolation is a key concern for individuals with dementia in long-term care. A possible solution is to promote social interaction between residents. A first step toward facilitating positive relationships between residents with dementia is to understand the mechanisms behind their interactions with each other, and also how their relationships with each other are built through such interactions. Drawing on casual conversations between residents in a special care unit for dementia, this paper uses systemic functional linguistics to examine how people with dementia use language to enact and construct their role-relations with each other. Results suggest people with dementia are able and willing conversationalists. However, factors such as the extent of communication breakdown and compatibility of the interlocutors may influence whether positive relations develop or not. Casual conversation is suggested to be a promising activity to encourage positive interpersonal processes between individuals with dementia in residential care.

  • 24.
    Motel-Klingebiel, Andreas
    et al.
    German Centre for Gerontology, Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany.
    von Kondratowitz, Hans-Joachim
    German Centre for Gerontology, Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany.
    Tesch-Römer, Clemens
    German Centre for Gerontology, Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany.
    Social inequality in the later life: Cross-national comparison of quality of life2004In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 1, no 1, 6-14 p.Article in journal (Refereed)
    Abstract [en]

    This paper analyses quality of life and inequality in old age in an international comparative and a life course perspective. Quality of life is seen as an outcome of unequal chances in life. We distinguish between overall and domain specific expressions of quality of life which allows us to analyse the determinants of overall quality of life and their development over the life course. The data presented come from the research project “OASIS - Old Age and Autonomy: The Role of Service Systems and Intergenerational Family Solidarity”. This data set is based on an age stratified random sample of the urban population (25–102 years) in Norway, England, Germany, Spain, and Israel (n=6,106). With advancing age, there are decreasing mean levels and increasing variation of quality of life. With age, the impact of physical health on overall quality of life increases, while the predictive power of other domains decreases. The results support the hypothesis of differentiation as well as the age-dependency hypothesis. For both these both aspects, international comparisons show similar results in different societies. These uniform age tendencies in modern European societies point to a limited importance of societal embeddedness and support the interpretation of age group differences as being life course effects.

  • 25.
    Müller, Nicole
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Mok, Zaneta
    La Trobe University, Melbourne, Australia.
    “Getting to know you”: Situated and distributed cognition in conversation with dementia2014In: Dialogue and Dementia: Cognitive and Communicative Resources for Engagement / [ed] Robert Schrauf, Nicole Müller, New York: Psychology Press, 2014, 61-86 p.Chapter in book (Other academic)
  • 26.
    Müller, Nicole
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Schrauf, Robert
    The Pennsylvania State University, PA, USA.
    Conversation as cognition: reframing cognition in dementia2014In: Dialogue and Dementia: Cognitive and Communicative Resources for Engagement / [ed] Robert Schrauf, Nicole Müller, New York: Psychology Press, 2014, 3-26 p.Chapter in book (Other academic)
  • 27.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    O'Connor, Deborah
    Centre for Research on Personhood and Dementia, University of British Columbia, Canada.
    Editorial introduction: Special issue on Citizenship and Dementia.2016In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 15, no 3, 285-288 p.Article in journal (Other academic)
  • 28.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Taghizadeh Larsson, Annika
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Support, protection and citizenship: The case of people living with dementia in Sweden2016In: Risk and resilience: global learning across the age span / [ed] Charlotte Clarke, Sarah Rhynas, Matthias Schwannauer and Julie Taylor, Edinburgh: Dunedin Academic Press, 2016, 116-129 p.Chapter in book (Other academic)
  • 29.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Taghizadeh Larsson, Annika
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    To protect and to support: How citizenship and self-determination are legally constructed and managed in practice for people living with dementia in Sweden2016In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 15, no 3, 343-357 p.Article in journal (Refereed)
    Abstract [en]

    Since living with dementia implies increasing difficulties in taking charge of rights due to cognitive as well as communicative impairments, many people with dementia are vulnerable and in need of support in order to realize full citizenship. In Sweden, all adults right to self-determination is strongly emphasized in law, regulations, and policies. Further, and in contrast to the situation in many other countries, people living with dementia cannot be declared as incompetent of making decisions concerning social care and their right to self-determination cannot legally be taken away. The article shows that in the Swedish welfare system, the focus is more on protecting the self-determination of citizens than on supporting people in making decisions and exercising citizenship. Subsequently, this causes legally constructed zones of inclusion and exclusion. This article examines and problematizes how different institutional contexts, legal constructions, norms, and practices in Sweden affect the management of issues concerning guardianship, supported decision-making and self-determination, and outline the implications for people living with dementia.

  • 30.
    Nordgren, Anders
    Linköping University, Department of Culture and Communication, Arts and Humanities. Linköping University, Faculty of Arts and Sciences.
    Emerging technologies and vulnerable people: The case of assistive technologies for persons with dementia2017Conference paper (Refereed)
    Abstract [en]

    Dementia has emerged as a problem to be tackled by various assistive technologies, for example, mobile safety alarms with GPS positioning, fall detectors and adapted internet for social contact. However, persons with dementia are vulnerable, suggesting that such technologies should be used with caution. It is a common experience among care professionals that persons with dementia often show resistiveness to care. This resistiveness is an indication of their vulnerable condition. They are sometimes not aware of what is in their best interest. In this paper I discuss how to handle resistiveness to assistive technologies among these patients. Some assistive technologies for persons with dementia can be beneficial provided that they are used with special consideration of their vulnerable condition. However, it can be a delicate task to overcome resistiveness while at the same time respecting their autonomy. I suggest how this can be done in a stepwise manner. Special attention is given to the concept of nudging. I also indicate under which circumstances some form of coercion might be justified.

  • 31.
    Pham, Tuan D
    et al.
    Aizu Research Cluster for Medical Engineering and Informatics, Center for Advanced Information Science and Technology, The University of Aizu, Aizu-Wakamatsu, Japan.
    Oyama-Higa, Mayumi
    Chaos Technology Research Lab, Shiga, Japan.
    Truong, Cong-Thang
    School of Computer Science and Engineering, The University of Aizu, Aizu-Wakamatsu, Japan.
    Okamoto, Kazushi
    School of Nursing and Health, Aichi Prefectural University, Aichi, Japan.
    Futaba, Terufumi
    Faculty of Intercultural Communication, Ryukoku University, Shiga, Japan.
    Kanemoto, Shigeru
    School of Computer Science and Engineering, The University of Aizu, Aizu-Wakamatsu, Japan.
    Sugiyama, Masahide
    School of Computer Science and Engineering, The University of Aizu, Aizu-Wakamatsu, Japan.
    Lampe, Lisa
    Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia.
    Computerized assessment of communication for cognitive stimulation for people with cognitive decline using spectral-distortion measures and phylogenetic inference2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, 1-29 p., e0118739Article in journal (Refereed)
    Abstract [en]

    Therapeutic communication and interpersonal relationships in care homes can help people to improve their mental wellbeing. Assessment of the efficacy of these dynamic and complex processes are necessary for psychosocial planning and management. This paper presents a pilot application of photoplethysmography in synchronized physiological measurements of communications between the care-giver and people with dementia. Signal-based evaluations of the therapy can be carried out using the measures of spectral distortion and the inference of phylogenetic trees. The proposed computational models can be of assistance and cost-effectiveness in caring for and monitoring people with cognitive decline.

  • 32.
    Pichora-Fuller, Kathleen
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. University of Toronto, Canada; Toronto Rehabil Institute, Canada; Rotman Research Institute, Canada.
    Dupuis, Kate
    University of Toronto, Canada; Toronto Rehabil Institute, Canada; Baycrest Health Science, Canada.
    Smith, Sherri L.
    Vet Affairs Medical Centre, TN USA; E Tennessee State University, TN 37614 USA.
    EFFECTS OF VOCAL EMOTION ON MEMORY IN YOUNGER AND OLDER ADULTS2016In: Experimental Aging Research, ISSN 0361-073X, E-ISSN 1096-4657, Vol. 42, no 1, 18-39 p.Article in journal (Refereed)
    Abstract [en]

    Background/Study Context: Emotional content can enhance memory for visual stimuli, and older adults often perform better if stimuli portray positive emotion. Vocal emotion can enhance the accuracy of word repetition in noise when vocal prosody portrays attention-capturing emotions such as fear and pleasant surprise. In the present study, the authors examined the effect of vocal emotion on the accuracy of repetition and recall in younger and older adults when words are presented in quiet or in a background of competing babble.Methods: Younger and older adults (M-age = 20 and 72years, respectively) participated. Lists of 100 items (carrier phrase plus target word) were presented in recall sets of increasing size. Word repetition accuracy was tested after each item and recall after each trial in each set size. In Experiment 1, one list spoken in a neutral voice and another with emotion (fear, pleasant surprise, sad, neutral) were presented in quiet (n = 24 per group). In Experiment 2, participants (n = 12 per group) were presented the emotional list in noise.Results: In quiet, word repetition accuracy was near perfect for both groups and did not vary systematically with set size for the list spoken in a neutral voice; however, for the emotional list, repetition was less accurate, especially for the older group. Recall in quiet was higher for younger than older adults; collapsed over groups, recall was higher for the neutral than for the emotional list and it decreased with increasing set size. In noise, emotion-specific effects emerged; word repetition for the older group and word recall for both groups (more for younger than older) was best for fear or pleasant surprise and worst for sad.Conclusion: In quiet, vocal emotion reduced the word repetition accuracy of the older group and recall accuracy for both groups. In noise, there were emotion-specific effects on the repetition accuracy of older adults and the recall accuracy of both groups. Both groups, but especially the younger group, performed better for items portraying fear or pleasant surprise and worse for items portraying sadness or neutral emotion. The emotion-specific effects on word repetition cascade to recall, especially in older listeners.

  • 33.
    Ryd, Charlotta
    et al.
    Karolinska Institute, Sweden.
    Nygård, Louise
    Karolinska Institute, Sweden.
    Malinowsky, Camilla
    Karolinska Institute, Sweden.
    Öhman, Annika
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kottorp, Anders
    Karolinska Institute, Sweden; Zurich University of Appl Science, Switzerland; University of Illinois, IL USA.
    Can the everyday technology use questionnaire predict overall functional level among older adults with mild cognitive impairment or mild-stage alzheimers disease? - a pilot study2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, 201-209 p.Article in journal (Refereed)
    Abstract [en]

    Introduction:The number of older adults living with mild cognitive impairment (MCI) or mild-stage Alzheimers disease (AD) is increasing and they are often expected to live in their own homes without support, despite limited ability to perform daily life activities. The Everyday Technology Use Questionnaire (ETUQ) has proven to be able to separate these groups and might also have potential to predict overall functional level (need of assistance in daily life activities) among them. Aim:To investigate whether the ETUQ can predict overall functional level among older adults with MCI or mild-stage AD. Method:Participants were older adults with a mean age of 76 years with MCI (n = 28) or mild-stage AD (n = 39). A three-step scale indicating (i) independence, (ii) need for minimal assistance or (iii) need for moderate to maximal assistance in daily life was dichotomised in two ways and used as outcome variables in two logistic regression models. Predictors in both models were perceived ability to use everyday technology (ET) and amount of relevant everyday technologies measured by the ETUQ. Ethical approval was obtained from the regional Ethical Committee. Result:Perceived ability to use ET discriminated individuals who were independent or in need of minimal support from those in need of moderate to maximal assistance (OR = 1.82, p amp;lt; 0.01, confidence interval = 95%; 1.76-2.82). The amount of relevant everyday technologies discriminated individuals who were independent from those in need of assistance at any level (OR = 1.39; p amp;lt; 0.01; confidence interval = 95%; 1.11-1.75). Conclusion:Both perceived ability to use ET and amount of relevant everyday technologies had potential to predict overall function but at different levels. The findings support the predictive validity of the ETUQ and suggest further research for the development of clinical cut-off criteria.

  • 34.
    Samefors, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Mölstad, Sigvard
    Lund University, Malmö, Sweden.
    Lannering, Christina
    Futurum, Jönköping, Sweden.
    Midlöv, Patrik
    Lund University, Malmö, Sweden.
    Tengblad, Anders
    Futurum, Jönköping, Sweden.
    Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality2014In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 170, no 5, 667-675 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality.

    DESIGN:

    The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (>65 years) in 11 nursing homes in Sweden.

    METHODS:

    We analysed the levels of 25-hydroxyvitamin D₃ (25(OH)D₃) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D₃ quartiles were calculated.

    RESULTS:

    We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D₃ >48  nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D₃ <29  nmol/l) (P<0.05); 2.03 (1.32-3.14) in Q2 (25(OH)D₃ 30-37  nmol/l) (P<0.05) and 1.6 (1.03-2.48) in Q3 (25(OH)D₃ 38-47  nmol/l) (P<0.05). The mean 25(OH)D₃ concentration was 40.2  nmol/l (S.D. 16.0) and 80% had 25(OH)D₃ below 50  nmol/l. The vitamin D levels decreased from baseline to the second and third measurements.

    CONCLUSIONS:

    Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials.

  • 35.
    Samuelsson, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ekström, Anna
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Majlesi, Ali Reza
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Plejert, Charlotta
    Linköping University, Department of Culture and Communication, Language and Culture. Linköping University, Faculty of Arts and Sciences.
    Kommunikation vid demens2016In: Att leva med demens / [ed] Ingrid Hellström & Lars-Christer Hydén, Gleerups Utbildning AB, 2016, 1, 63-70 p.Chapter in book (Other academic)
  • 36.
    Samuelsson, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hjalmarsson Österholm, Johannes
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Olaison, Anna
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Orally Positioning Older People in Assessment Meetings2015In: Educational gerontology, ISSN 0360-1277, E-ISSN 1521-0472, Vol. 41, no 11, 767-785 p.Article in journal (Refereed)
    Abstract [en]

    It has been demonstrated that persons with dementia may be positioned as less competent than participants of the same age without dementia, and that persons with dementia possibly also are positioned as less competent than other older persons without dementia. In the present study, we aim to explore this further by analysing Swedish assessment meetings, in which needs and preferences are investigated for older persons without dementia. The material consists five audio-recorded assessment meetings, where there were at least two conversational partners present (a spouse and/or a child) and where the older person applying for social services was not diagnosed with dementia. The ages of the older persons ranged from 81 to 88, while the age of the relatives ranged from 46 to 93. The results of the present study demonstrate that older persons without dementia mainly are positioned as competent. However, it may be related to the degree of frailty, since the frailest person in the present study appears to be positioned as less competent than the other participants. The present paper adds to existing knowledge on how professionals in assessment meetings contribute to the positioning of older persons as competent and capable of making decisions. The results of the present article may be useful to promote development of education and training of communication skills for care mangers in assessments in order to further ensure that older persons with and without cognitive impairments can be actively involved in the creation and interpretation of their applications for social services.

  • 37.
    Schrauf, Robert W.
    et al.
    The Pennsylvania State University, PA, USA.
    Müller, NicoleLinköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Dialogue and dementia : cognitive and communicative resources for engagement2014Collection (editor) (Other academic)
    Abstract [en]

    This volume takes the positive view that conversation between persons with dementia and their interlocutors is a privileged site for ongoing cognitive engagement. The book aims to identify and describe specific linguistic devices or strategies at the level of turn-by-turn talk that promote and extend conversation, and to explore real-world engagements that reflect these strategies.

    Final reflections tie these linguistic strategies and practices to wider issues of the "self" and "agency" in persons with dementia. Thematically, the volume fosters an integrated perspective on communication and cognition in terms of which communicative resources are recognized as cognitive resources, and communicative interaction is treated as reflecting cognitive engagement. This reflects perspectives in cognitive anthropology and cognitive science that regard human cognitive activity as distributed and culturally rooted.

    This volume is intended for academic researchers and advanced students in applied linguistics, linguistic and medical anthropology, nursing, and social gerontology; and practice professionals in speech-language pathology and geropsychology.

  • 38.
    Sehlstedt, Isac
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. University of Gothenburg, Sweden.
    Ignell, Hanna
    University of Gothenburg, Sweden.
    Backlund Wasling, Helena
    University of Gothenburg, Sweden.
    Ackerley, Rochelle
    University of Gothenburg, Sweden.
    Olausson, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Croy, Ilona
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Technical University of Dresden, Germany.
    Gentle Touch Perception Across the Lifespan2016In: Psychology and Aging, ISSN 0882-7974, E-ISSN 1939-1498, Vol. 31, no 2, 176-184 p.Article in journal (Refereed)
    Abstract [en]

    Pleasant, affective touch provides various health benefits, including stress and depression relief. There is a dichotomy between mechanoreceptive afferents that predominantly signal discriminative (myelinated A-beta) and affective (unmyelinated C-tactile) aspects of touch. It is well documented that discriminative abilities of touch decline with age. However, a thorough investigation of how the pleasant aspects of touch develop with age has not been previously attempted. Here, we investigated the relationship between age and psychophysical ratings in response to gentle stroking touch. One hundred twenty participants (60 males, 60 females) ages 13-82 years were presented with C-tactile optimal and suboptimal stroking velocities, and rated pleasantness and intensity. Moreover, to examine the specificity of age effects on touch perception, we used olfactory stimuli as a cross-sensory comparison. For all ages, we found that C-tactile optimal stimuli were rated significantly more pleasant than C-tactile suboptimal stimuli. Although, both touch and olfactory intensity ratings were negatively correlated with age, a positive correlation between pleasantness ratings of touch (but not olfactory stimuli) and age was found. We conclude that the affective, but not the discriminative, aspects of touch are enhanced with increasing age. The increase of pleasantness of all touch stimuli in late adulthood is discussed in relation to cognitive modulations.

  • 39.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Individually tailored internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Anxiety disorders share the feature of excessive fear, anxiety and related behavioural disturbances. Fear is defined as the emotional response to a real or a perceived imminent threat and anxiety is the anticipation of a future threat. The anxiety disorders covered in this thesis are panic disorder with or without agoraphobia, social phobia, post-traumatic stress disorder, generalized anxiety disorder and anxiety disorder not otherwise specified.

    Cognitive behavioural treatment protocols are typically designed to target one specific disorder and falls under the definition of disorder-specific cognitive behavioural therapy. It is however unclear if this is the most optimal approach in regards to the high comorbidity between anxiety disorders and depressive disorders. Internet-based cognitive behavioural therapy has in the past generally been disorder-specific and from above mentioned predicament two alternative treatment approaches emerged, the tailored and the transdiagnostic approach that aims to simultaneously treat both principal and comorbid disorders. Previous trials on internet-based cognitive behavioural therapy have targeted adults in general and relatively few target adolescents, young adults and older adults.

    The aims of this thesis were to further develop and test the effects of tailored internet-based cognitive behavioural therapy on the basis of age, for adolescents, young adults and older adults. Specifically by developing and testing the effects of individually tailored internet-based cognitive behavioural therapy for adolescents with anxiety and comorbid depressive symptoms and by adapting and testing the effects of individually tailored internet-based cognitive behavioural therapy for young adults and older adults with anxiety and comorbid depressive symptoms. These aims were tested in two pilot effectiveness studies (Paper I and III) and two efficacy randomised controlled trials (Paper II and IV). The results from these four trials showed significant results across all outcome measures with overall moderate to large effect sizes. The tentative conclusion based on these results is that tailoring internet-based cognitive behavioural therapy can be a feasible approach in the treatment of anxiety symptoms and comorbid depressive symptoms for adolescents, young adults and older adults. Despite the positive findings of the studies in this thesis, there is a need for more research examining the acceptability and effectiveness of internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety and depression before implementation on a larger scale.

    List of papers
    1. Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial
    Open this publication in new window or tab >>Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial
    Show others...
    2012 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 14, no 3, 32-44 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Previous studies on Internet-based treatment with minimal therapist guidance have shown promising results for several specific diagnoses. Objective: To 91) investigate the effects of a tailored, therapist-guided, Internet-based treatment for individuals with reoccurring panic attacks, and 92) to examine whether people in different age groups 918-30 years and 31-45 years) would respond differently to the treatment. Methods: We recruited 149 participants from an online list of individuals having expressed an interest in Internet treatment. Screening consisted of online questionnaires followed by a telephone interview. A total of 57 participants were included after a semistructured diagnostic interview, and they were randomly assigned to an 8-week treatment program 9n = 29) or to a control condition 9n = 28). Treatment consisted of individually prescribed cognitive behavior therapy text modules in conjunction with online therapist guidance. The control group consisted of people on a waitlist who later received treatment. Results: All dependent measures improved significantly immediately following treatment and at the 12-month follow-up. The between-group effect size on the primary outcome measure, the Panic Disorder Severity Scale, was d = 1.41 995% confidence interval 0.81-1.95) at posttreatment. The within-group effect size from pretreatment to 12-month follow-up was d = 1.66 995% confidence interval 1.14-2.35). Age group had no effect, suggesting that age did not influence the outcome. Conclusions: Tailoring an Internet-based treatment can be a feasible approach in the treatment of panic symptoms and comorbid anxiety and depressive symptoms. Younger adults benefit as much as adults over 30 years and up to 45 years of age.

    Place, publisher, year, edition, pages
    Journal of Medical Internet Research, 2012
    Keyword
    Anxiety; depression; effectiveness; Internet-based treatment; cognitive behavior therapy
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-79782 (URN)10.2196/jmir.1853 (DOI)000305797300003 ()
    Available from: 2012-08-17 Created: 2012-08-14 Last updated: 2017-12-07
    2. Individually tailored internet-based cognitive behavior therapy for adolescents with anxiety disorders: A pilot effectiveness study
    Open this publication in new window or tab >>Individually tailored internet-based cognitive behavior therapy for adolescents with anxiety disorders: A pilot effectiveness study
    Show others...
    2015 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 2, no 3, 297-302 p.Article in journal (Refereed) Published
    Abstract [en]

    This is the first study of adolescents suffering from anxiety disorder in Sweden to receive individually tailored internet-based treatment within a child and adolescent psychiatric clinic. The primary aim of this effectiveness study was to examine the effects of tailored internet-based cognitive behaviour therapy for adolescents.

    11 adolescents, aged 15-19 years, were allocated to treatment after assessment. Screening consisted of online questionnaires followed by a diagnostic face-to-face interview at the clinic. Treatment consisted of individually prescribed cognitive behaviour therapy (CBT) text modules adapted for the age group. Therapist guidance was via an online platform along with telephone support and face-to-face sessions if needed.

    Statistically significant improvements were found on all dependent measures immediately following treatment for the 8 adolescents who completed treatment. The within-group effect size on the Beck Anxiety Inventory, the primary outcome measure, was d = 2.51 at post-treatment and 80 percent (4/5) adolescents no longer met DSM-IV criteria for their primary anxiety disorder as measured by the Anxiety Disorders Interview Schedule for DSM- IV: Child and Parent Versions.

    Based on the results from this pilot study the tentative conclusion might be that tailored internet delivered CBT could be useful for adolescents with anxiety disorders along with standard treatment delivered in child and adolescent psychiatric clinics.

    Keyword
    Adolescent;Anxiety disorders;Cognitive behavior therapy;Internet-based treatment
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-125381 (URN)10.1016/j.invent.2015.07.002 (DOI)
    Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2017-11-30
    3. Individually tailored internet-based cognitive behavioural therapy for young adults with anxiety disorders: A pilot effectiveness study
    Open this publication in new window or tab >>Individually tailored internet-based cognitive behavioural therapy for young adults with anxiety disorders: A pilot effectiveness study
    2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 8, 5 p.48-52 p.Article in journal (Refereed) Published
    Abstract [en]

    The mental health of young people is decreasing. It is therefore important to develop early interventions for young people with mental health problems. One previous randomized controlled trial on tailored Internet-based treatment for young adults with minimal therapist guidance has shown promising results for anxiety symptoms. The purpose of this study was to investigate the effects of tailored internet-administered CBT for young adults (16–25 years old) with anxiety, depression and possible comorbidity in regular care. Participants were recruited from a youth health care centre (n=15). Screening consisted of online questionnaires followed by a semi-structured interview. A total of 10 participants completed pre and post measurement. The treatment consisted of individually prescribed CBT text modules with online therapist guidance. All dependent measures improved significantly immediately following treatment and the within-group effect based on pre- to post measurement on the primary outcome measure, the Beck Anxiety Inventory, was d=1.50, the within-group effect on the secondary outcome measures, Montgomery Åsberg Depression Rating Scale-Self-Rated, Clinical Outcomes in Routine Evaluation and Quality of Life Inventory showed large improvement. Tailored internet-based treatment can be an approach in the treatment of anxiety symptoms and comorbid depressive symptoms in youth care.

    Place, publisher, year, edition, pages
    Amsterdam: Elsevier, 2017. 5 p.
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-136525 (URN)10.1016/j.invent.2017.03.002 (DOI)
    Available from: 2017-04-19 Created: 2017-04-19 Last updated: 2017-05-08Bibliographically approved
  • 40.
    Strindhall, Jan
    et al.
    Jonköping University, Sweden.
    Löfgren, Sture
    Ryhov County Hospital, Sweden.
    Framsth, Caroline
    Ryhov County Hospital, Sweden.
    Matussek, Andreas
    Ryhov County Hospital, Sweden; Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Bengner, Malin
    Ryhov County Hospital, Sweden.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Wikby, Anders
    Jönköping University, Sweden.
    CD4/CD8 ratio < 1 is associated with lymphocyte subsets, CMV and gender in 71-year old individuals: 5-Year follow-up of the Swedish HEXA Immune Longitudinal Study2017In: Experimental Gerontology, ISSN 0531-5565, E-ISSN 1873-6815, Vol. 95, 82-87 p.Article in journal (Refereed)
    Abstract [en]

    n/a

  • 41.
    Svedin, Carl Göran
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Warby, Marie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Kunskapsöversikt beträffande interventioner mot prostitution. : En uppdatering.2014Report (Refereed)
    Abstract [sv]

    Inom ramen för Socialstyrelsens uppdrag R30088-1 gavs Linköpings universitet uppdraget att genomföra en uppdaterad kunskapsöversikt kring interventioner mot prostitution. Mer preciserat önskades en kunskapsöversikt över vad det finns för dokumentation av vilka insatser som görs för att få sexsäljare att sluta sälja sex, och en dokumentation av vilka insatser som görs för att förebygga att personer börjar sälja sex. Vidare önskades få en översikt över vilka insatser som görs för att få sexköpare att sluta köpa sex, och vad det görs för insatser för att förhindra att personer börjar köpa sex.

  • 42.
    Veenstra, Helene
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Cumulative evidence for MS as a neural network disconnection syndrome consistent with cognitive impairment mechanisms and the confounding role of fatigue and depressionoutlook from the Fourth Nordic MS symposium2016In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 134Article, review/survey (Refereed)
    Abstract [en]

    The Fourth Nordic MS symposium served as a platform to present an overview over the rise and impact of cognitive impairment in people with MS, from early stages on, impairing their quality of life. After discussing MS and cognitive impairment symptoms, a review on the pathophysiology underlying cognitive impairment was given, followed by a talk on neuroimaging highlighting cortical reorganization in MS-affected brains. As a conclusion, therapy and treatment options were discussed. The symposium presented several cutting-edge research studies providing or testing working models that appear successful in predicting and explaining cognitive impairment in MS, such as the disconnection syndrome.

  • 43.
    Wilińska, Monika
    et al.
    Department of Behavioural Science and Social Work, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Cedersund, Elisabet
    Department of Behavioural Science and Social Work, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    "Classic ageism" or "brutal economy"?- Old age and older people in the Polish media2010In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 24, no 4, 335-343 p.Article in journal (Refereed)
    Abstract [en]

    This article explores media discourse of ageing, taking the example of Poland and relating it to a broader discussion of ageing policy. The discourse in news magazines appears both to reflect and create attitudes towards older people, which in turn has implications for ageing policy. To reveal the nature of these attitudes, we use a method of attitudinal positioning. The study analyzes articles that appeared in the four largest Polish weekly opinion news magazines, in the 2004–2007 period. Various domains in the discourse of ageing are identified, yet only the family and market domains seem to be described in exclusively positive terms: the authors discuss the implications of this for ageing policy.

  • 44.
    Österholm, Johannes H
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life.
    Hydén, Lars-Christer
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life.
    Citizenship as practice: Handling communication problems in encounters between persons with dementia and social workers2016In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 15, no 6, 1457-1473 p.Article in journal (Refereed)
    Abstract [en]

    The overall aim of the study was to investigate if and how persons with dementia were able to take part in negotiations for formal support, as cases of citizenship as practice. The transcripts used for analysis were from 11 assessment meetings conducted in Sweden, in which the formal applicant was a person with dementia. The findings suggest that the actual participation of persons with dementia in assessment meetings varies. Communication problems were found in the meetings to different degrees and were dealt with differently and with various consequences. For those persons with dementia contributing at the same levels as the other participants, there was an attempt at mutual understanding. For those making fewer contributions, the other interlocutors took over the initiative and thus affected the practice of citizenship by persons with dementia in a negative way. The practice of citizenship is situation based and varies depending on all participants. When the person with dementia is able to participate in the conversation, social workers can facilitate for them to overcome communication problems by giving them more time and signaling acceptance. If the person with dementia has great problems in participating, the other participants can find different strategies to at least involve her or him in the conversation

1 - 44 of 44
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