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Aim: The aim of the study was to describe health, social and informal care utilization and costs for older adults with multimorbidity. The design was descriptive and retrospective.

Methods: The setting was a medium-sized town in an urban area of Sweden and included 10 health centers. Data were collected during 2011 using individual, structured interviews with the informal carers of 20 older adults with multimorbidity. Retrospectively, for a period of 18 months, data were also collected from the older adults’ patient registers and records, as data regarding the costs of their health and social care, in- and out-patient care and municipal care including home services.

Results: The primary result was that older adults with multimorbidity utilize health and social care from different principals, through different contacts. The results also provide insight into the complexity of these older adults’ daily living. Their 18-month health and social care costs varied between 12,084 and 137,187 Euros. For 12 older adults who utilized informal care, their calculated costs varied between 2,092 and 70,590 Euros.

Conclusion: The conclusion is that the increasing number of older adults with multimorbidity and their health and social care utilization and costs should be taken into account in healthcare policy and the organization of health and social care.

Background: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden. Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home. Methods: The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis. Results: Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals. Conclusions: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.

Background: The older adult population is expected to grow, presenting potential challenges for individuals and society. Maintenance of older adults' health will be an important factor for healthy aging. It will also be a challenge for health professionals who work to promote health and care equity. To promote healthy aging and equal care, an overview of older adults' self-rated health is needed. The aim of this study was to describe self rated health among older adults' living at home describe age group and gender-based health differences. Methods: A descriptive and a comparative cross-sectional study. The questionnaire study was part of a Swedish national population study. Randomly selected older adults 65-84 years living in five counties in central Sweden. The response rates were 79% and 75% for those 65-79 years and 80-84 years, respectively. Participants (n = 13922) were divided into two age groups: 65-79 years (n = 5926 male, n = 5755 female) and 80-84 years (n = 1208 male. n = 1033 female). Results: Older adults generally self -rated their health as good, especially in the age group aged 65-79 years. Females self-rated their health as poorer than males, especially among those aged 65-79 years. Gender-based health differences decreased in those aged 80-84 years. Conclusions: It is important to address these gender -based health differences; health policies and programmes are needed that promote equitable healthy aging.

Background: Home care was previously included in healthcare centers in county councils in Sweden. Today, home care is the responsibility of municipalities. Consequently, the work of district nurses from healthcare centers has changed, and they face a new mission and new challenges. The aim of this study was to explore district nurses' experiences of working in home care after the municipalization. Methods: The design was descriptive with an inductive approach. Five district nurses working in different municipalities were interviewed. Qualitative content analysis was used. Results: The district nurses experienced their work through the following themes: organization, local environment and leading the team, and defined the themes in terms of inadequacy, collaboration, control, comfort, continuity and own competence. Their work was free and pleasant with more time for the patients. At the same time they at time had difficulties to carry out their work. Recipients' condition in municipality home care experienced as better as a consequence of cross-border cooperation, compared to earlier organisation of home care. District nurses work involved a great nursing responsibility and required leadership. They experienced losses of competence as well as new competence. Conclusions: District nurses' work was at times difficult because of organisational barriers. There is need of improvements and tools for district nurses to carry out their work and to promote their competence development. The organisation is not functioning optimally in municipal home care. Cooperation between municipality, primary care and inpatient care needs improvement.

Hypertension is a common disease that affects approximately one fifth of the Swedish population. It may be caused by lifestyle issues such as stress, obesity, and physical inactivity. It is the job of public health nurses to control patients' blood pressure and provide support and counseling for necessary lifestyle changes, thus promoting health, preventing hypertension, and improving high blood pressure. The study's aim was to review and describe the knowledge contained in the literature regarding district nurses' nursing interventions for patients with hypertension. The method was a literature study of 12 scientific studies. The results indicate that public health nursing interventions for patients with hypertension provide health education in either a standardized or a person-centered way by monitoring health, providing health counseling, and supporting lifestyle changes. The conclusion is that it can be difficult to distinguish between a standardized approach and a person-centered approach when a health-promoting intervention can start by using a standardized approach and then move to a person-centered approach and vice versa.

Background: Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it. Aim: This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension. Methods: A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses' counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used. Results: Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs. Limitations: Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups. Conclusion: Nursing interventions through district nurses' counsel and support with empowerment improved patients' health. More research is needed to evaluate nursing interventions' effect on hypertension. Implications for nursing and health policy: This study highlighted that district nurses' counsel and support increased patients' health and decreased stress by focusing on empowerment.

Background: Primary care physicians have a responsibility to inform older adults about the drugs and drug treatments they are prescribed so as to increase patients' compliance. However, this need is not always met. Use of a 'study circle' exercise may help older adults to obtain and increase their knowledge in a community setting, having the opportunity to share experiences with others in similar situations. The aim of this study was to describe older adults' experiences of taking part in a study circle about aging and drugs. Methods: The study was designed to be descriptive with an inductive approach. Eleven older adults took part in focus group interviews in 2014, and the content of these interviews was analysed. Results: Participants felt the design of the study circle exercise was good; having a syllabus to follow but at the same time allowing individuals' problems to be discussed. They described the leader of the study circle to be competent, with characteristics they appreciated. Participants found the study circle material informative, and it could be used as a reference for reflection. Participants' knowledge of natural and pathological aging was increased, as was their knowledge of drugs and their formulations. Participants felt more confident; they dared to ask questions, challenged new drugs, and proactively took action by seeking care when needed. The study circle format was recommended to other older adults. Participants suggested that in future the study circle could be extended and repeated, and that they could be provided with supplementary educational materials or exercises. Conclusions: Use of a study circle about aging and drugs increased older adults' knowledge, and empowered them to ask questions and take an active part in their drug treatment. We believe that older adults have a desire to want to know more about the drugs they are prescribed, and want to be involved with their treatment, not simply passive recipients.

JOSEFSSON K. (2012) Registered nurses' health in community elderly care in Sweden. International Nursing Review59, 409415 Aim: To describe registered nurses' (RNs) ratings of their work-related health problems, sickness presence and sickness absence in community care of older people. To describe RNs' perceptions of time, competence and emotional pressure at work. To describe associations between time, knowledge and emotional pressure with RNs' perceptions of work-related health problems, sickness presence and sickness absence. Background: There is a global nursing shortage. It is a challenge to provide working conditions that enable RNs to deliver quality nursing care. Method: A descriptive design and a structured questionnaire were used. 213 RNs in 60 care homes for older people participated, with a response rate of 62%. Findings: RNs' reported work-related health problems, such as neck/back disorders, dry skin/dry mucous membranes, muscles/joints disorders, sleep disorders and headache. They had periods of fatigue/unhappiness/sadness because of their work (37%). Most of the RNs felt at times psychologically exhausted after work, with difficulties leaving their thoughts of work behind. RNs stated high sickness presence (68%) and high sickness absence (63%). They perceived high time pressure, adequate competence and emotional pressure at work. There was a weak to moderate correlation between RNs' health problems and time pressure. Discussion: We cannot afford a greater shortage of RNs in community care of older people. Politicians and employers need to develop a coordinated package of policies that provide a long-term and sustainable solution with healthy workplaces. Conclusion: It is important to prevent RNs' work-related health problems and time pressure at work.