UNLABELLED: The aim of this study was to analyze the long-term effect of the two health-promoting and disease-preventive interventions, preventive home visits and senior meetings, with respect to morbidity, symptoms, self-rated health and satisfaction with health. The study was a three-armed randomized, single-blind, and controlled trial, with follow-ups at one and two years after interventions. A total of 459 persons aged 80 years or older and still living at home were included in the study. Participants were independent in ADL and without overt cognitive impairment. An intention-to-treat analysis was performed. The result shows that both interventions delayed a progression in morbidity, i.e. an increase in CIRS-G score (OR=0.44 for the PHV and OR=0.61 for senior meetings at one year and OR=0.60 for the PHV and OR=0.52 for the senior meetings at two years) and maintained satisfaction with health (OR=0.49 for PHV and OR=0.57 for senior meetings at one year and OR=0.43 for the PHV and OR=0.28 for senior meetings after two years) for up to two years. The intervention senior meetings prevented a decline in self-rated health for up to one year (OR=0.55). However, no significant differences were seen in postponing progression of symptoms in any of the interventions. This study shows that it is possible to postpone a decline in health outcomes measured as morbidity, self-rated health and satisfaction with health in very old persons at risk of frailty. Success factors might be the multi-dimensional and the multi-professional approach in both interventions.

This study aimed at examine the number of planned and acute hospital admissions during 1 year among people 65+ and its relation to municipal care, outpatient care, multimorbidity, age and sex. Four thousand nine hundred and seven individuals having one or more admissions during 2001 were studied. Data were collected from two registers and comparisons were made between those having one, two and three or more hospital stays and between those with and without municipal care and services. Linear regression was used to examine factors predicting number of acute and planned admissions. Fifteen percent of the sample had three or more hospital stays (range 3-15) accounting for 35% of all admissions. This group had significantly more contacts in outpatient care with physician (median number of contacts (md)=15), compared to those with one (md: 8), or two admissions (md: 11). Main predictors for number of admissions were number of diagnosis groups and number of contacts with physician in outpatient care. Those who are frequently admitted to hospital constitute a small group that consume a great deal of inpatient care and also tend to have frequent contacts in outpatient care. Thus interventions focusing on frequent admissions are needed, and this requires collaboration between outpatient and hospital care.

Introduction: Social participation  can have a positive  impact  on  health; however, physical challenges  can be hindrances. During a preventive  home  visit a health  professional (visitor) assesses different aspects of  physical,  mental and social health. However,  there might  be a challenge  for the  visitor  to discover  the interrelationship  between physical  factors that hinder social  participation. Therefore,  the aim  of this  study was, in  the context  of preventive  home visits, to identify  physical  factors which  can hinder  older  persons from taking  part in  social contexts.  Methods: Cross-sectional  register  data from  preventive  home  visits  to older  persons (n=1,245, ≥77 years old,  without  home care) was used. Data was collected during a period of 17 months, in  seven Swedish  municipalities. Logistic  regression  was used to analyse  the association between physical factors and the item physical problems hindering social participation. Results: The mean age was 78.8  (standard  deviation 1.8 years), and 55% were women. The physical  factors significantly  associated with  physical  problems  hindering  taking  part in  social contexts were: having urinary  incontinence (women  only),  having  pain,  impaired  endurance and using  a mobility  device.  Conclusions: This study  provides  insights  into  how to  make the best use of  the questions asked during preventive  home  visits, in  order to enable  older  persons to  take part in  social contexts. The  results recognise  the importance  of taking  into  account physical  challenges  to be able  to support  social  participation. Furthermore, considering physical challenges for social participation on both  an individual  and  a societal  level  might  reduce inequalities  among  older persons.

The objectives were to investigate the prevalence and predictors for falls and dizziness among people younger and older than 80 years of age. The sample was drawn from the Swedish National study on Aging and Care (SNAC) and comprised 973 and 1273 subjects with data on the occurrence of falls and dizziness respectively at baseline. Follow-ups were made after 3- and 6-years. Data included socio-demographics, physical function, health complaints, cognition, quality of life and medications. The prevalence of falls was 16.5% in those under aged 80 and 31.7% in those 80+ years while dizziness was reported by 17.8% and 31.0% respectively. Predictors for falls in those under aged 80 were neuroleptics, dependency in personal activities of daily living (PADL), a history of falling, vision impairment and higher age, and in those 80+ years a history of falling, dependency in instrumental activities of daily living (IADL), fatigue and higher age. Factors predicting dizziness in those under aged 80 were a history of dizziness, feeling nervous and reduced grip strength and in those 80+ years a history of dizziness and of falling. Predictors for falls and dizziness differed according to age. Specific factors were identified in those under aged 80. In those 80+ years more general factors were identified implying the need for a comprehensive investigation to prevent falls. This longitudinal study also showed that falling and dizziness in many older people are persistent and therefore should be treated as chronic conditions.

There are many instruments assessing the wellbeing of staff, but far from all have been psychometrically investigated. When evaluating supportive interventions directed toward nurse assistants in residential care, valid and reliable instruments are needed in order to detect possible changes. The aim of the study was to investigate validity in terms of data quality, construct validity, convergent and divergent validity and reliability in terms of the internal consistency and stability of the Job Satisfaction Questionnaire, the Psychosocial Aspects of Job Satisfaction, the Strain in Dementia Care Scale (SDCS), and the Stress of Conscience Questionnaire (SCQ) in a residential care context. The psychometric properties of the instruments were investigated in terms of data quality, construct validity, convergent and divergent validity and reliability, including test-retest reliability, in a residential care context with a sample consisting of nurse assistants (n=114). The four instruments responded with different psychometric-related problems such as internal missing data, floor and ceiling effects, problems with construct validity and low test-retest reliability, especially when assessed on the item level. These problems were however reduced or disappeared completely when assessed for total and factor scores. From a psychometric perspective, the SDCS seemed to stand out as the best instrument. However, it should be modified in order to reduce floor effects on item level and thereby gain sensitivity. The Job Satisfaction Questionnaire seemed to have problems both with the construct validity and test-retest reliability. The final choice of instrument must, however, be made dependent on what one intends to measure.

The aim was to compare urinary symptoms and their influence on daily life among elderly (75+) women and men in a sample that previously had reported difficulties controlling urine (urine incontinence (UI)) and/or other urinary symptoms (OU). A further aim was to find underlying structures of urinary symptoms and to identify symptomsthat had an impact on seeking medical help and need of help in daily activities (dependency). In total, 771persons (352menand419women) over75 years answered a questionnaire, addressed to those (n = 1881) who in a previous population-based study had reported having symptoms of UIand/orOUusing theBristolFemaleLower UrinaryTractSymptoms(BF-LUTS) questionnaire and International Continence Society male (ICSmale) questionnaire. The groups with UI, OU, women and men reported similar symptoms of frequency, day and night, as well as influence on social life, and avoidance of places and situations due to the urinary symptoms although they differed in storage and voiding symptoms. Feeling incomplete emptying of bladder differed between the UI, OU, and mixed symptoms (MS) groups but not between genders. Of the whole sample, 43.3% had sought medical help.Factoranalysis of similarquestions inBF-LUTSandICSmalequestionnaire resulted inthe factors labeled voiding, storage, pain, frequency, and daily life. Predictors of the urinary symptoms for needing help in daily activities were frequent micturition day and night (OR 3.2) when aged was controlled for. Influence on daily life(OR2.5), storage symptoms(OR2.2), and pain symptoms(OR2.1)predicted seeking medical help. The results show that urinary symptoms are equally bothersome among men and women. There is a need to encourage elderly to seek medical help and to obtain treatment or alleviations for symptoms that give most bother and indicate dependency, such as frequent micturition day and night and difficulties to reach the toilet in time without leakage.